The first quarter of 2025 has seen a significant wave of legislative activity that could have profound impacts on the day-to-day of medical spas, estheticians, and licensed medical aesthetic practitioners. Several states introduced bills aimed at adjusting the scope of practice for advanced practitioners, such as nurse practitioners (NPs) and physician assistants (PAs), while others focused on licensing and supervision requirements for medical spas and estheticians. 

Medical aesthetics is a relatively young field, and as it continues to grow, it’s essential for legislation to ensure patient safety, uphold high professional standards, and create a well-regulated environment. Below is a summary of recent legislative developments and what they could mean for the future of medical spa practices.

January

In January, states were focused on introducing bills that would allow advanced practitioners—such as advanced practice registered nurses (APRNs) and physician assistants (PAs)—more independence to practice to the level of their education and skill, once they met certain requirements. This continues a trend seen over the last several years, with many states giving more freedom and autonomy to PAs and APRNs, ranging from reduced oversight requirements all the way to full practice authority. 

South Carolina: APRN and PA independence

South Carolina House bill 3580 would allow APRNs who complete 2,000 hours of clinical experience and possess malpractice insurance coverage to apply to the board of nursing for full practice authority. Once approved for full practice authority, an APRN would be able to perform specified tasks without a practice agreement, in line with those described in National Council State Boards of Nursing Model Practice Act, national scope of practice and standards for advanced practice nursing as published by the national nursing organizations for advanced practice nursing and recognized by the board for advanced practice registered nurses.

Latest status: 1/14/2025: H 3580 was referred to Committee on Medical, Military, Public and Municipal Affairs.

South Carolina HB 3579 and S 44 would allow PAs to become independent once certain requirements are met. Instead of working under written scope of practice guidelines with a physician, a PA who completes 2,000 hours of postgraduate clinical experience would practice in the same specialty pursuant to an “attestation statement” that attests that the PA has the needed education, training and skills to provide the medical services. 

Latest status: 1/14/2025: H 3579 was referred to Committee on Medical, Military, Public and Municipal Affairs

Texas: APRN independence

Texas House Bill 1756 would allow APRNs to prescribe without the need for a prescriptive authority agreement with a physician. The bill requires the nursing board to adopt rules and policies to authorize APRNS to prescribe Schedule II, III, IV, and V controlled substances as well as dangerous and non-prescription drugs. This process could require additional and specialized training.

Latest status: 3/14/2025: HB 1756 was referred to Public Health Committee.

Indiana: APRN independence

Indiana HB 1116 and SB 383 would allow an APRN the independence to practice and prescribe within their licensed scope of practice and board of nursing rules, without a written agreement or oversight with a physician. 

Latest status: 1/8/2025: HB 1116 was referred to Committee on Public Health. 1/13/2025: SB 383 was referred to Committee on Health and Provider Services.

Missouri: APRN independence

Missouri SB 144 would allow an APRN (excepting CRNAs) who completes 2,000 hours of documented practice to practice without the need for a formal collaborative practice agreement with a physician.

Latest status: 2/25/2025: Hearing Conducted S Emerging Issues and Professional Registration Committee.

February

In February, legislation focused on expanding the scope of practice for APRNs and PAs or by otherwise making adjustments to collaboration and supervision. Other proposed legislation addressed issues such as the supervision of PAs, scope of practice for estheticians and dentists.

Oklahoma: APRN and PA independence

Under Oklahoma HB 2298 and SB 569, APRNs would no longer need a supervising physician once they met certain requirements. These bills are similar in their requirements, allowing independent prescriptive authority once an APRN completes 6,240 hours or three years of supervised practice and maintains malpractice insurance of $1 million per occurrence and $3 million in aggregate. 

Latest status: 02/04/2025: HB 2298 referred to Committee on Public Health | SB 569 referred to Committee on Health and Human Services.

Oklahoma Senate Bill 809 would allow PAs to qualify for independent practice once they file and report to the board that they have completed 6,240 hours of clinical experience under physician supervision. When practicing independently, a PA would be able to prescribe Schedule III to V substances.

Latest status: 2/10/2025: SB 809 referred to Senate Health and Human Services.

Texas: Dentist neuromodulator injections

Texas SB 1117 would allow dentists to provide cosmetic botulinum toxin injections after completing an approved training course, as determined by the Texas State Board of Dental Examiners.

Latest status: 2/24/2025: SB 1117 referred to Business & Commerce Committee.

North Dakota: Advanced estheticians license

North Dakota House Bill 1126 would create an advanced esthetician license with an expanded scope to include a number of cosmetic procedures that are currently restricted to the practice of medicine and nursing. Training, experience, certification and course completion would be required before being able to perform advanced chemical peels; use microneedling pens, rollers or devices; or use non-ablative devices. The bill would also allow regular estheticians to perform microdermabrasion, dermaplaning and high frequency treatments, as well as cosmetic chemical peels of certain concentrations.

Latest status: 3/3/2025: HB 1126 Senate Workforce Development Committee Hearing 02:00.

Illinois: PA optimal practice

Under Illinois House Bill 2468, a PA who completed 2,000 hours of postgraduate clinical experience and 250 hours of continuing education would no longer need a written collaboration agreement to practice. They would practice under “optimal practice,” which allows them to independently prescribe Schedule II-V controlled substances. PAs would still be prohibited from owning medical corporations or PLLCs.

Latest status: 3/21/2025: HB 2468 Rule 19(a) / Re-referred to Rules Committee.

South Dakota: PA independence

South Dakota bills would allow PAs to qualify for independence once they meet certain requirements. Once a nationally certified PA files an attestation with the board that they have completed 2,080 hours of clinical experience in collaboration, they may practice without a collaboration agreement.

Latest status: 3/12/2025: HB 1071 Delivered to the Governor | 2/7/2025: SB 102: Senate Health and Human Services defers hearing to 41st legislative day.

Kentucky: PA collaboration

Under Kentucky SB 88, PAs would practice under a written collaborative agreement with a physician, instead of practicing under physician supervision agreement. Level of collaboration would be determined at the practice level, and includes a description of the PA’s scope of practice and outlines the communication and collaboration procedures between the PA and physician.

Latest status: 2/6/2025: SB 88 referred to Senate Licensing & Occupations Committee.

New Mexico – PA supervision

New Mexico House Bill 267 would allow PAs to complete their required three years of supervised practice under the supervision of other PAs before working in collaboration with a physician. Supervising PAs would need to have more than three years of clinical practice and be approved to supervise by the medical board, which can adopt rules and criteria for this process.

Latest status: 2/4/2025: HB 267 referred to House Health & Human Services Committee.

March

March brought the reintroduction of laser hair removal regulation for New York med spas and suggested licensing requirements in Rhode Island. Texas introduced legislation that, if passed, would bring the most dramatic change of any brought forth this quarter.

New York – Laser hair removal and master estheticians

A 1916 would create a license for a “laser hair removal technician” and for “LHR facilities,” and would require the adoption of rules and standards for the licensure and practice of LHR technicians and for the LHR facilities where they practice.

Latest status: 1/14/2025: A 1916 referred to House Committee on Economic Development | 3/7/2025: S 6231 referred to Senate Committee on Consumer Protection.

New York assembly bill A 3084 would expand the scope of practice of cosmetologists and estheticians to include microneedling with FDA-approved devices that use needles no longer than 0.3 mm, after completing an OSHA blood-borne pathogen training and a board-approved 40-hour course.

Latest status: 3/14/2025: A 3084 referred to Assembly Committee on Economic Development.

Rhode Island – Medical spas

Rhode Island House Bill 5351 would create training, licensing and supervision requirements for medical spas. Similar legislation has been introduced in the last three legislative sessions.

Latest status: 2/25/2025: HB 5351 referred to House Health & Human Services Committee, which recommends measure be held for further study.

Utah – Master Estheticians

Utah SB 330 would expand the master esthetician license allowing them to perform a number of cosmetic procedures on their own,  including microdermabrasion, dermaplaning and cosmetic medical devices to perform laser hair removal, body contouring, anti-aging resurfacing enhancements and photo rejuvenation. A person would need to complete a 1,200-hour course in a board-licensed or recognized school or complete 1,200 hours under a master esthetics apprenticeship. 

Latest status: 03/27/2025: SB 330 Governor Signed in Lieutenant Governor's office for filing.

Texas – Medical spas/iv clinics, PA/APRN prescribing and supervision, estheticians

In early March, the Texas legislature introduced three bills that would dramatically affect how medical aesthetic practices operate in the state. 

Texas currently has well-defined supervision and delegation rules for medical spas, which were recently streamlined by the Texas Medical Board to improve clarity and compliance. However, proposed bills, such as HB 3749, HB 3889, and HB 3890, suggest a more restrictive environment that may hinder the ability of qualified practitioners to offer services safely and effectively.

The first bill, HB 3749 would create training, licensing and supervision requirements specifically for medical spas and IV therapy clinics. Importantly, it would allow only physicians to perform the initial assessment, diagnose and create treatment plans for cosmetic medical procedures, taking these duties away from the established roles of licensed PAs and NPs. 

PAs and APRNs in Texas work pursuant to a prescriptive authority agreement with a physician who oversees their practice, and these advanced practitioners are currently allowed to see new patients and prescribe appropriate medications for them as authorized by that agreement. House Bill 3889 would limit PAs and APRNs to prescribing only after the physician has seen and examined the patient, establishing a physician-patient relationship. This is not specific to cosmetic medicine. HB 3889 would make Texas one of the most restrictive states for PA and APRN prescribing.

Thirdly, HB 3890 would limit physicians from supervising PAs and APRNs in specialties outside of the area of practice of their residency or primary practice. A physician could only supervise an advanced practitioner in a specialty practice area after the physician accrues five years of experience in that specialty. This would limit the pool of available supervising physicians for PAs and APRNs in aesthetic medicine and would make it more difficult for physicians who are just out of residency or transitioning into aesthetics to employ PAs or APRNs.

Visit the Texas Med Spa Legislation Action Center for further insights into these bills and how Texas med spas can respond.

Latest status: 3/26/2025: HB 3749, HB 3889, HB3890 referred to House Committee on Public Health.

A second set of proposed legislation would affect estheticians. SB 378 would clearly prohibit estheticians from performing medical procedures or using devices on their own unless they are separately licensed or authorized to perform them. Estheticians and barbers would be prohibited from making an incision into the dermis layer of the skin, including for the purpose of injecting a medical device or substance (such as injectable filler or neuromodulator), and would be prohibited from using a prescription medical device. If they could prove that they are licensed or otherwise authorized by law to perform the treatment, they could perform a prohibited treatment as part of a barbering or cosmetology service.

Senate Bill 2696 would create an advanced cosmetic procedure license that would allow an esthetician to perform some treatments that damage the dermis, use medical devices, or inject prescription substances for cosmetic purposes, after completing an approved training course and an examination. Unusually, this license would allow licensees to perform treatments under written protocols with a physician but without onsite supervision of a consulting physician.

Latest status: 3/13/2025: SB 2696 filed. | 3/31/2025: SB 378 Passed Senate and Received in House. 

Keep up with med spa laws in your state

It is essential for all stakeholders in medical aesthetics to stay informed and engaged with legislative developments. If you are uncertain about how these bills could affect your med spa or need legal guidance on compliance, AmSpa and its legal partners at the leading national aesthetic health care law firm ByrdAdatto are here to support you. Together, we can help shape the future of our industry while safeguarding the health and trust of our patients.

Visit AmSpa's Legal Updates page to track the status of proposed legislation in your state and region. There you can find additional analysis and details from Patrick O'Brien, JD, General Counsel, American Med Spa Association.

AmSpa State Chapters are rolling out across the country to connect medical spa owners at the local level and help influence change. Speak with chapter leadership at Medical Spa Show on Saturday, April 12 to learn more about organizing efforts and how you can get involved to shape what the medical spa industry looks like in your state.