6 Things to Know About Certified Medical Assistants Under South Carolina Law

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In 2022, the South Carolina General Assembly enacted Act No. 171, which made several changes to the landscape surrounding delegation of medical tasks to unlicensed medical personnel and medical assistants. The new law defined a “certified medical assistant” (CMA) as a person who is a graduate of an accredited post-secondary medical assisting education program, and who has obtained and maintains certification.

The purpose of Act 171 was to expand the role of CMAs in assisting other health care providers, and to allow APRNs and PAs to more fully utilize CMAs in their practices. Act 171 originally provided for a two-year “grace period” to allow time for individuals working as CMAs to achieve the certification required by the law. Since that law was passed in 2022, there have been several changes and clarifications to the law surrounding CMAs and their delegation and supervision.

Here are 6 things to know about CMAs under South Carolina Law:

1. Under South Carolina law, a physician, a physician assistant (PA) if authorized to do so in his or her scope of practice guidelines, or an advanced practice registered nurse (APRN) if authorized to do so in his or her practice agreement, may delegate tasks to a Certified Medical Assistant (CMA).
2. In the closing days of the 2024 legislative session, the General Assembly passed Act 209 which made several key changes to Act 171 to make it more workable, as it had become apparent that many individuals would not be able to achieve certification by the end of the grace period on July 15, 2024, and for other reasons including the lack of flexibility in achieving certification under the requirements of the original law. Act 209 allowed two additional years for individuals who wish to become CMAs and work in that expanded role to achieve certification. An individual employed in that role now has until July 15, 2026 to meet the requirements of the law.
3. Act 209 also expanded the educational options prior to becoming certified, which include, among other things, a medical assisting program provided by a branch of the US military, a Career and Technical Health Sciences Program approved by the SC Department of Education, or a training program delivered in whole or in part by a health care employer that aligns with a nationally accredited certification exam.
4. The delegation of tasks to a CMA must be pursuant to certain requirements set forth by South Carolina law. Those requirements include:
   • Direct delegation by the physician, PA, or APRN to the CMA;
   • “Close proximity” of the physician, PA, or APRN so as to be immediately available to CMA when the task is performed;
   • Determination by the physician, PA, or APRN whether the task is within the training and competency of the CMA and will not pose a significant risk to the patient if improperly performed; and
   • The wearing of an appropriate badge by the CMA identifying the CMA’s status clearly visible to patients at all times.
5. While there is no defined list of tasks that may be delegated to a CMA, the law sets forth a list of tasks that may not be delegated to a CMA by an APRN or PA (this prohibition does not apply to physicians), including tasks like administering controlled or intravenous medications, using certain lasers, placing sutures, and triaging patients.
6. South Carolina law now defines the term “unlicensed assistive personnel” (UAP) and provides for the nursing tasks that could be delegated to them. UAPs are individuals working in various health care settings who do not function as CMAs and who do not intend to become certified. Nursing tasks may be delegated to UAP under the supervision of a physician or PA. Those tasks include, but are not limited to:
   • Meeting patients’ needs for personal hygiene;
   • Meeting patients’ needs relating to nutrition;
   • Meeting patients’ needs relating to ambulation;
   • Meeting patients’ needs relating to elimination;
   • Taking vital signs;
   • Maintaining asepsis;
   • Collecting specimens (urine, stool, sputum);
   • Point of care testing and screening tests;
   • Recording information;
   • Performing nonclinical tasks via telemedicine; and
   • Observing, recording or reporting any of the above tasks.