Update (June 18, 2:00 pm CDT): We have added new information to this piece, originally posted June 10. There will be a forthcoming meeting of the JCARR on June 28 to review the rules discussed.

By Patrick O'Brien, JD, Legal Coordinator, American Med Spa Association

At its June 9 meeting, the State Medical Board of Ohio proposed a new version of administrative rules that define a physician's ability and requirements when delegating laser and light-based procedures. The board has been in the process of attempting to adopt changes regarding light-based and laser procedures for several years, and these represent the most current development of the rules. They are available to read at the Register of Ohio. The rules are currently going to be reviewed at the June 28 meeting of the Joint Committee on Agency Rule Review (JCARR). Also, please note that these are medical board rules and govern how physicians may delegate—they do not apply to the nurse practitioner scope of practice.

The proposed rules would make a number of changes to how light-based procedures are performed in Ohio. The changes address ablative and non-ablative dermatologic procedures. Ablative procedures are treatments that are expected or intended to excise, burn or vaporize the skin below the dermo-epidermal junction, whereas non-ablative procedures are not expected or intended to excise, burn or vaporize the epidermal surface of the skin.

Under the proposed rules, physicians would be unable to delegate any ablative light-based procedures at all. For non-ablative dermatologic procedures, they would only be able to delegate them to physician assistants (PAs), registered nurses (RNs) and licensed practical nurses (LPNs). Any laser or light device used must be approved by the U.S. Food and Drug Administration for the specific procedure. The physician must personally evaluate the patient both prior to the procedure and following the initial treatment. While PAs would be supervised according to their written supervision agreements, the physician must provide onsite supervision for RNs and LPNs. Additionally, they would be limited to supervising only two such persons at a time. The PA, RN or LPN must obtain at least eight hours of education of specific laser topics, and they must also observe the procedure 15 times and perform it under direct supervision 20 times.

For laser hair removal (LHR), the delegation rules and training requirements are similar to other non-ablative procedures, with the addition of special rules for cosmetic therapists. The physician can delegate the procedure to PAs, RNs, LPNs and cosmetic therapists. Cosmetic therapists are no longer licensed in Ohio, but are persons who have completed a 750-hour approved LHR training program and examination. Again, the physician must personally evaluate the patient prior to treatment and again afterward to assess the effectiveness. The training requirements of least eight hours of education of specific laser topics, and they must also observe the procedure 15 times and perform it under direct supervision 20 times.

However, there is a grandfather clause that allows practitioners who have been performing LHR under appropriate delegation for two years before this rule is adopted to have their physician certify that they are trained and competent already. Additionally, cosmetic therapists may complete this requirement as part of their training course. The supervision must still be on site for RNs and LPNs. Cosmetic therapists may work under offsite supervision, provided they have completed a board-approved training course of 50 hours, with 30 of those being clinical training, and they have previously worked under onsite supervision for a sufficient length of time to satisfy the physician that they can be overseen off site.

These proposed rules are currently awaiting a hearing at the June 28 meeting of JCARR. Comments and information can be submitted for committee review prior to the meeting; you can obtain an agenda and information about the meeting here.