By Patrick O'Brien, JD, legal coordinator, American Med Spa Association

As we covered previously, the Texas Medical Board (TMB) voted to officially propose a set of changes to Texas Administrative Code Rule §193.17—the rule that provides guidance of the delegation of nonsurgical medical cosmetic procedures. The TMB proposed some changes at a stakeholder meeting in early October (covered here) but did not publicly disclose the final version it approved for publication; it instead intended the publication in Texas Register to serve as the changes' public debut. The wait is over—this week's issue of Texas Register contains the TMB's proposed rule changes (starting on page 6669).

These proposed changes are broadly similar to the initial version discussed at the stakeholder meeting in early October. However, this approved version makes significantly more minor adjustments than the original proposal would have. The prior version would have made significant changes to who can perform procedures and what supervision is needed; the proposed version maintains the current rule and permits physicians to delegate to both licensed and unlicensed people, provided they are "qualified and properly trained." Similarly, the proposed rules still require that supervision be provided by an advanced practice registered nurse (APRN) or physician assistant (PA) who is onsite or by a physician who may be offsite. The current rule requires that the physician be available for emergency consultation, whereas the proposed rule would require the physician's "immediate availability... for consultation." The proposed language does clarify that supervision does not require direct observation.

This new proposal also makes a significant addition to the current rules by adding a requirement that the physician notify the board of their intent to delegate and supervise medical spa-type procedures. This notification would be made on a board-supplied form and would include:

• Information on the business's owner, location and phone number;
• A list of all PAs, APRNs and qualified persons who will be performing procedures; and
• The name and license information of the supervising physician.

This document would need to be updated within 30 days of changes, additions or terminations. Additionally, the physician would need to secure an alternate supervising physician if they are unable to provide supervision. The proposed rules go on to state that all physicians who delegate and supervise procedures are responsible for ensuring compliance with all applicable rules and laws, and violations are grounds for discipline.

It is important to remember that these are only proposed changes—they are not yet official or final. We are currently in a 30-day window during which members of the public can submit comments and feedback. At the end of the 30 days, the TMB, at a public hearing, will vote on whether to formally adopt the changes as they are currently written or to make modifications as a result of public comments. If you would like to submit feedback to the TMB, it can be sent to the attention of Rita Chapin at:

P.O. Box 2018
Austin, Texas 78768-2018

It also can be emailed to rules.development@tmb.state.tx.us.

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