By Patrick O’Brien, JD, General Counsel, American Med Spa Association (AmSpa)         

A new bill has been filed in Texas that, if passed, would negatively impact many medical spas. The bill is known as House Bill 3749 (HB 3749) and would regulate the training, supervision and scope of practice of cosmetic medical treatments performed in medical spas and elective intravenous (IV) therapy offered in IV clinics. This post will review some of the major issues of this bill and its current standing in the legislative process. Members in Texas can access more analysis of the other provisions of the bill here.

Background

Many states, including Texas, have adopted rules specifically for medical spas or cosmetic medical treatments. For a number of years, Texas had a comprehensive set of rules for medical spas called Rule 193.17. This year, the Texas Medical Board adopted revised rules that govern the delegation of all types of treatments and procedures in addition to medical spa treatments. These new rules keep or strengthen many of the provisions of the old med spa rule. Under these rules, physicians, physician assistants (PAs) and nurse practitioners (NPs) can see patients, provide an initial examination (often called a “good faith exam” or “GFE”), create a patient treatment plan and delegate the treatment to others. The rules provide for specific elements in supervision, supporting protocols and training that must be met before the treatments can be performed. The Texas rules—both the current and prior versions—are among the more flexible and well-structured rules nationwide.  

The problem

HB 3749 also contains provisions for training, documentation and protocols. Where it differs the most from Texas’s current rule is in its supervision requirements. Under HB 3749, only trained physicians can see patients and supervise others. Under this bill, they must perform the initial patient exam, create the treatment order, and then delegate and supervise others who can perform the treatment. PAs and NPs would be considered “non-physicians” alongside other nurses and unlicensed medical assistants. All non-physicians would have the same training requirement and scope of practice in this area. 

This is harmful to practitioners and practices because both PAs and NPs have prescriptive authority in Texas. This means that, in most contexts, they can examine patients, diagnose them, and issues prescriptions or treatment orders. Texas medical spas rely on PAs and NPs to examine patients, create treatment plans and provide onsite medical support when the physician medical director may be at a different location or with another patient. HB 3749 will negatively impact most medical spas by arbitrarily limiting the PA and NP scope of practice in the area of cosmetic medical procedures. The possible consequences are that physicians will have to allocate more of their time to examining patients for these procedures and less time to seeing patients with more complex issues. Likewise, PAs and NPs will be forced to greatly underutilize their skillsets, placing them—along with registered nurses (RNs) and licensed practical nurses (LPNs)—at a competitive disadvantage to unlicensed medical assistants. The net effect being less licensed health care professionals working in the cosmetic medical field. Which, in turn, may possibly negatively impact patient safety. 

If you would like additional information, to read the bill or to contact the sponsors, you can find it through this link: HB 3749. You may also be interested in this article on how to speak with your representatives about med spa law. HB 3749 is in the earliest stages of the legislative process. As of the time of this article, HB 3749 has just been filed, but it has not yet been assigned to a committee for deliberation or to hold a hearing.