Posted By Madilyn Moeller, Tuesday, June 3, 2025
Texas House Bill 3749, dubbed “Jenifer’s Law,” has passed in both the Texas House of Representatives and the Senate, was sent to the governor May 30th and now awaits his signature.
Originally, the bill proposed substantial changes to how medical spas operate in the state of Texas, including requiring onsite physician supervision and limiting the roles of physician assistants and nurse practitioners. These changes could have made Texas one of the most restrictive states for aesthetic medicine. However, the bill was revised. Its substitute removes all references to medical spas and cosmetic procedures and focuses on the concern at the heart of this legislation: the safe practice of elective IV therapy.
What follows is a recap of the Texas med spa and IV therapy bill that would have impacted advanced practitioners and med spa operations, and how industry advocates spoke up for patient safety while preserving the roles of qualified medical professionals in lawfully operating aesthetic practices.
The legislative momentum behind HB 3749 was driven by a heartbreaking event that shook the medical spa community. In the summer of 2023, mother and beloved radio personality Jenifer Cleveland visited a med spa in Wortham, Texas, where an unlicensed, unsupervised provider administered IV therapy treatment containing TPN electrolytes. Cleveland suffered a cardiac event and tragically passed away.
The treatment was administered by the spa’s owner, who held no medical or healthcare license. No licensed medical professionals were present at the time.
According to a suspension order issued by the Texas Medical Board, the med spa’s physician medical director was based more than 100 miles away and had only visited the practice three times. The board found that the physician had failed to establish protocols, implement standard operating procedures or maintain a signed medical director agreement. Critically, he had not established a physician-patient relationship with Cleveland, nor had he provided adequate supervision or oversight. The medical board temporarily suspended his medical license and continues to restrict him from supervising or delegating to others.
This tragedy underscores the critical importance of proper medical oversight, delegation and compliance in aesthetic practices. It also served as a powerful catalyst for legislative reform.
Medical spas in Texas are regulated by a well-structured set of rules from the state medical board, which classifies non-surgical medical cosmetic procedures as the practice of medicine and defines medical spas as medical clinics subject to the same oversight and protocols as physician offices. The rules, which were recently streamlined in January, lay out specific elements for delegation and supervision, including signed written protocols and appropriate training that must be met before performing treatment.
Delegation. Physicians can use their discretion to delegate cosmetic procedures to non-physician providers if the physician was trained in the procedure, the delegate was appropriately trained and a written protocol was in place, following an initial patient exam and treatment order by a physician, PA or NP.
Practitioner-patient relationship. The initial patient exam, or good faith exam, is step one in establishing a practitioner-patient relationship. A physician, PA or APRN must conduct an initial exam, create a treatment plan and maintain medical records, and disclose the identity and credentials of the person performing treatment.
Supervision and emergency preparedness. At least one person with basic life support training must be on site at all times. The supervising physician, PA, or APRN must be on site or immediately available for emergency consultation and the physician must be capable of conducting an emergency appointment if necessary.
Written protocols. A physician must develop written orders or must review and approve any existing orders. The orders include the delegating physician’s identity, patient screening criteria, treatment guidelines and emergency procedures.
Notice and identification. In each public area and treatment room, medical spas have to post the delegating physician’(s) name and medical license number and a mandatory complaint notice explaining how to file a complaint with the board. All staff performing delegated acts must wear name tags with their name and credentials.
On March 4, 2025, Representative Angelia Orr filed Texas House Bill 3749. When first introduced, HB 3749 proposed sweeping changes that alarmed many in the medical aesthetics community. Under the original language, this bill:
Only physicians could perform the good faith exam and supervise cosmetic medical procedures. Only physicians could establish the patient relationship, perform the initial patient assessment, diagnose, create the treatment order, and delegate and supervise others who can perform the treatment. While NPs and PAs have prescriptive authority in Texas and can assess, diagnose, prescribe, and treat conditions, provided they are working under a physician with a written agreement and protocols in place, HB 3749 would restrict those duties only to physicians. Advanced practitioners would have the same scope as all other non-physician providers (RNs, LVNs/LPNs, unlicensed medical assistants), solely for cosmetic medical procedures.
A physician must be on site or immediately able to be present on site. HB3749 requires supervising physicians to be on site or immediately physically available to supervise treatments. Treatments also cannot be performed unless a physician is physically present at the medical spa or at least one non-physician provider trained in basic life support is physically present at the medical spa. PA and NP prescriptive authority authorizes them to supervise treatment and provide onsite medical support, which they routinely provide in other private healthcare settings. An onsite physician is not required in any other area of medicine and is a requirement that would force many med spas to close.
Allows physicians to delegate the prescribing and ordering of an elective IV to an RN. HB3749 would grant physicians the ability to delegate the act of prescribing or ordering elective intravenous therapy to a PA or an RN acting under adequate physician supervision. This is unusual, as prescribing IV treatments is beyond the RN scope of practice in any other health care setting. The elective IV provisions also lack the safety and supervision requirements proposed for med spas, with no requirements for patient assessment, immediate supervision or onsite trained life support.
Overall, the section addressing elective IV therapy mostly restated current legislation; the brunt of the change was regarding cosmetic medicine, where the original language limited NPs and PAs from practicing at the level of their training and licensure and placed burdensome requirements on physicians that would have them perform duties that are typically delegated across all other medical fields.
For more extensive coverage of the major changes proposed in HB 3749, visit the Webinar Recap: Texas HB 3749 Restricts NPs and PAs in Medical Spas.
AmSpa played a pivotal role in reshaping HB 3749 into a more balanced and enforceable law. From the moment the bill was filed, AmSpa launched a coordinated advocacy campaign that included:
On March 14, AmSpa released a position statement.
As originally written, HB 3749 would have made medical spas less safe by removing trained and licensed professionals from critical roles in patient assessment and supervision. The bill failed to address the actual causes of the tragic incident: unsupervised, unlicensed or undertrained providers administering medical treatments, and noncompliance with existing regulations. Texas already has robust medical spa regulations, the position argued, and if these were properly enforced, they could have prevented the tragedy.
AmSpa advocated for:
AmSpa remains committed to educating lawmakers and the public about the medical aesthetics industry and to promoting safe, ethical, and compliant practices. Read the full position statement.
In a detailed letter to Representative Angelia Orr, AmSpa’s CEO Alex Thiersch, JD, explained why AmSpa could not support HB 3749in its current form. While acknowledging the bill’s intent to improve safety, he argued that it failed to address the real problem: unlicensed, unsupervised providers operating outside the law.
Texas already has one of the most comprehensive regulatory frameworks for medical spas in the country. If existing laws—particularly Rule 169—had been properly enforced, the tragic death of Jenifer Cleveland could likely have been prevented. Instead of strengthening enforcement, HB 3749 removes critical safeguards by restricting the roles of nurse practitioners (NPs) and physician assistants (PAs), who are currently authorized to assess, diagnose, and supervise under physician oversight.
The bill’s requirement that a physician be “immediately available” on-site at all times is not only unnecessary—it’s out of step with how healthcare operates across other specialties. This provision would force many compliant med spas to close, reducing access to safe care and increasing the likelihood of unlicensed treatments.
In contrast, the bill’s provisions for IV therapy are notably less stringent. There is no requirement for patient assessment, on-site supervision, or basic life support training. The bill even grants registered nurses the authority to prescribe IV treatments, something not permitted in any other healthcare setting.
AmSpa emphasized that the real threat to patient safety comes from bad actors who already ignore the law. HB 3749, as written, would punish ethical providers while allowing illegal operations to continue unchecked. Instead, AmSpa urges lawmakers to focus on enforcing existing regulations and welcomes the opportunity to collaborate on practical, well-informed legislation that truly protects patients.
Read the Letter from AmSpa Founder on Texas Med Spa Bill Restricting NPs and PAs.
AmSpa played a pivotal role in reshaping HB 3749 through coordinated advocacy, regional mobilization and direct engagement with lawmakers. From the outset, AmSpa voiced strong concerns about the original bill, which lent to its transformation from a bill that would have devastated the medical spa industry into one that more narrowly addresses elective IV therapy.
At the April 28, 2025, House Public Health Committee hearing, AmSpa CEO Alex Thiersch, JD, testified on the legal and regulatory framework of the industry, while Dr. S. Alexis Gordon, MD, FACS, Chair of AmSpa’s Texas State Chapter, addressed the clinical elements of IV therapy. Their testimony helped educate legislators, many of whom were unfamiliar with the basics of medical spa operations, on the difference between licensed, compliant practices and the unregulated, illegal clinics that pose real risks to patient safety.
The hearing was both emotional and eye-opening. Brian Cleveland, husband of the late Jenifer Cleveland, gave powerful testimony about the loss of his wife.
Thiersch, in a reflection, urged the industry to take responsibility for self-regulation and to put patient safety and professional medical care first. There is a continuing need for industry education and advocacy on a national scale, to drive informed legislation and accountability.
“We must take this opportunity to determine for ourselves what kind of industry we want moving forward,” Thiersch wrote. “We have the ability to fix this, but only if we move forward together as one industry.”
Read Thiersch's reflection and coverage of the revised bill: Texas Med Spa Bill Is Scrapped, Re-written As an IV Therapy Bill: HB 3749 Passes Out of Committee.
As of HB 3749's public hearing on April 28, 2025, the bill has been significantly revised. The bill that has passed in both chambers of the Texas legislature is a substitute from the Committee on Public Health.
References to "cosmetic medical treatments" and "medical spas" were removed, making the bill solely focused on elective IV therapy. There are no longer any restrictions on NPs and PAs performing good faith exams. The revision also added delegation requirements that reflect existing Texas law. As well, delegation requirements have specifically been included to reflect existing Texas law, allowing physicians to delegate diagnosis and prescription to nurse practitioners and physician assistants who are trained and operating under a prescriptive authority agreement.
Elective intravenous therapy is defined as a medical treatment. It is a procedure to administer fluids, nutrients, medications or blood into a patient’s vein to alleviate symptoms of temporary discomfort or improve temporary wellness. This applies to treatment that is not administered in a physician’s office, licensed health facility, mental hospital or state-operated hospital.
A physician can delegate prescribing or ordering to PAs and APRNs. Consistent with their prescriptive authority agreements, a physician may delegate the act of prescribing or ordering elective intravenous therapy to a PA or APRN acting under adequate physician supervision.
IV therapy can be administered by an RN or above. HB 3749 allows a physician to delegate the act of administering elective IV therapy to a PA, APRN or RN acting under adequate physician supervision. Licensed vocational nurses (LVNs), paramedics and medical assistants are excluded from this list. A clinic must have at least a trained RN to offer elective IV treatments.
This requirement is stricter than other areas of medicine in Texas. Current law gives physicians the discretion to delegate treatment to any properly trained person who they believe has the educational preparation, knowledge, competency and skill to safely perform the procedure under appropriate supervision, following a good faith exam and an order from a physician, PA, or NP who provides appropriate supervision.
If signed into law, HB 3749 would hold elective IV therapy to a higher standard beginning September 1, 2025.
The elective IV therapy bill was not the only legislation proposed this session that would have impacted medical spas and aesthetic practitioners. For a full lineup of 2025 med spa legal updates, please visit AmSpa's Legal Updates page, which includes legal analyses for AmSpa Plus Members in each state.
HB 3889 would have limited PAs and NPs to prescribing medications only for patients with an existing physician-patient relationship. It would have prohibited advanced practitioners from performing good faith exams.
Importantly, this was not specific to cosmetic medicine. This would have made Texas one of the most restrictive states for advanced practice providers.
Status: Died in Committee
HB 3890 would only allow physicians to supervise advanced practitioners (NPs, PAs) in a specialty area where they had at least five years of experience. This would have drastically reduced the pool of eligible supervising physicians, limiting access to care and making it harder for new or non-core providers to enter the med spa space. Core physicians in aesthetics are plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and dermatologists.
Status: Died in Committee
SB 2696 proposed the creation of a state-issued “cosmetic injector certificate” for individuals performing cosmetic injections. Applicants would have been required to complete an approved training program, pass a competency exam and demonstrate at least two years of supervised experience.
Status: Died in Committee
SB 378 aimed to prohibit cosmetologists and barbers SB 378 from performing injections or using medical devices that penetrate the dermis. It sought to clearly separate medical procedures from non-medical aesthetic services and was in line with existing Texas legislation.
Status: Vetoed by Governor
Texas House Bill 3749 united the medical aesthetic community to speak up for the common interests of med spa owners, practitioners and patients. The advocacy efforts led by AmSpa and other stakeholders played a critical role in shaping a law that addresses real risks in the wake of a tragedy. By narrowing the bill’s focus to IV therapy and removing restrictive language targeting medical spas and advanced practitioners, lawmakers struck a more balanced approach that prioritizes patient safety without undermining the roles of qualified professionals.
As the bill awaits the governor’s signature, medical professionals and clinic operators should take this opportunity to review their protocols, ensure compliance with the new standards, and continue advocating for thoughtful, evidence-based regulation that protects patients and supports ethical providers.
AmSpa remains committed to educating the public about how safe med spas operate and advocating for ethical, compliant and patient-centered care in the medical aesthetics industry. Speak with the leaders in your State Chapter to learn how med spas in your community are growing together in support of safe, successful practices.
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