Massachusetts House advances bill authorizing medical assistants to administer vaccines

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BOSTON — In an effort to make immunizations more readily available and ease burdens on staff at busy health centers, the House this month advanced a bill authorizing medical assistants to give vaccines to patients.

Medical assistants perform medical and administrative tasks in clinical settings, including drawing blood, administering medication, conducting lab tests and changing dressings. They are trained to administer immunizations but state law doesn't specifically authorize them to do so, according to Rep. Jeffrey Sanchez, House chair of the Joint Committee on Health Care Financing and a sponsor of the bill.

"This simple provision will allow primary care providers, particularly those practicing in community health centers, to more easily meet the demand for immunizations and free up these providers to see more patients and focus on more complex clinical care," Sanchez, a Jamaica Plain Democrat, said in written testimony.

The bill authorizes primary care providers to delegate the administration of immunizations to certified and trained medical assistants, under the "direct supervision" of the provider. The provider would not need to be in the room when immunizations are administered, but must be at the facility and "immediately available to furnish assistance and direction."

The move to authorize medical assistants to give vaccines is supported by the Massachusetts Medical Society, which called promoting immunizations "a vital component" of the state's public health. In testimony submitted to the Joint Committee on Public Health for a November hearing, the society described the legislation as a thoughtful response to higher demand for vaccines and a way to increase flexibility in immunization delivery.

The medical society recommended amendments that would require an assistant to be trained in administering vaccines, and that would expand the language beyond primary care providers to include all physicians.

"For example, a pulmonologist, caring for a patient with chronic pulmonary disease, would want to ensure that their patient receives the flu vaccine and would provide that care during the course of a visit," the society said in its testimony.

Released by the Health Care Financing Committee on Dec. 14, the immunization bill (H 3895) was taken up in the House three days later and given initial approval. A second affirmative vote would send the bill to the Senate.

Both the American Association of Medical Assistants and its local chapter, the Massachusetts Society of Medical Assistants, agree with bill's requirement that a delegating physician be on the premises and available when an assistant is giving an immunization, said Donald Balasa, the association's chief executive officer and legal counsel.

The medical assistants group has a "general position" that assistants who are delegated to administer injections should first complete an accredited post-secondary academic program "that verifies that each student has demonstrated sufficient knowledge and competence" to safely give the shots, Balasa said.

Under the terms of the bill, any medical assistant giving an immunization would need to be a graduate of an accredited, post-secondary medical assisting education program or a program approved by the commissioner of public health.

In addition to the training, Balasa said medical assistants giving immunizations should be required to have a current credential that requires them to prove knowledge through continuing education or retesting.

"Requiring graduating, but not requiring passing an accredited medical assisting credentialing examination and periodic recertification does not adequately protect patients, the delegating physicians, and the medical assistants themselves," he said in an email.

Balasa suggested that some sort of "transitional provision" — potentially a gradual phase-in or grandfather clause — could be adopted "if there are a significant number of medical assistants currently being delegated the administration of immunizations who do not meet educational or credentialing requirements."


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