Bill Name: Senate Bill 249 (SB 249)

Primary Sponsors: Senators Roberta Lange, Scott Hammond and Pat Spearman

Status: 3/09/2023 Referred to Committee on Commerce and Labor

AmSpa’s Take: The original advanced esthetician bill went through several revisions before passage; we have a recent article here about an issue in its implementation. This bill makes changes to many of these areas and attempts to resolve some of these issues. However, as discussed below there are better ways to solve the issues.

Outlook: This bill is in the first steps of the process but, based on the sponsors’ past records, it has a much higher likelihood of passage.

Analysis: In 2021, Nevada adopted a new law known as SB 291 that created an Advanced Esthetics license. Persons with this new license had a greatly expanded scope of practice over a regular aesthetician. In addition to practicing traditional, aesthetics, the advanced esthetician (AE) could now perform a number of other services, including non-ablative aesthetic medical procedures. The bill went through several amendments before passage, and a few issues have appeared in its implementation; we recently covered one of these issues in an article here. To briefly recap, the Nevada State Board of Cosmetology had interpreted SB 291 to mean that RNs and others working in dermatologist offices, medical spas, and plastic surgeon offices would need to get an AE license to continue to perform medical treatments that now fall into the definition of “non-ablative esthetic medical procedures.” Also, by defining several services as AE services, aestheticians and cosmetologists could no longer perform them. It appears that SB 249 attempts to remedy many of these issues while making a number of other changes. This article will focus primarily on how SB 249 would affect registered nurses (RNs) and AEs.

SB 249 begins by adding a new section to the Nurse Practice Act that would allow RNs to perform “non-ablative esthetic medical procedures.” This section mirrors the supervision for AE’s and uses the definitions contained in the cosmetology law. It specifically prohibits RNs from performing “ablative esthetic medical procedures” as defined in the cosmetology statute. It is unclear how this would interact with the RN’s current scope of practice, but it appears that it would restrict it. RNs are currently able to perform a number of medical treatments, including providing cosmetic injections of toxins and fillers.

SB 249 goes on to amend the scope of practice of AEs. It adds “medium-depth chemical peels” as a new treatment; “medium,” in this, case means the “removal of skin from the epidermis and papillary dermis layers.” It also removes some treatments—such as exfoliation, microdermabrasion, dermaplaning, extraction and hydrotherapy—for the AE scope of practice. However, exfoliation of the stratum corneum, extraction and hydrotherapy get added to the aesthetician and cosmetologist scopes of practice. So, the AE would still be permitted to perform these in addition to aestheticians and cosmetologists being able to perform them again.

SB 249 would then amend the definition of “non-ablative esthetic medical procedure,” to require that the Board of Cosmetology adopt a regulation on what procedures are included. This section would mean that only treatments which the board adopts by administrative rule would be included in the “non-ablative esthetic” definition. This is supplemented by a later section empowering the board to identify such procedures and identify appropriate devices to use in them.

As discussed in our prior article, there has been some confusion about who and what practices are exempt from needing an AE license. We believe that the intent of the original AE law was to create the new AE license with its expanded scope of practice and favorable supervision requirements. Unfortunately, the law has been interpreted to also restrict the current scope of practice of other licenses. This includes RNs, nurse practitioners and physicians all operating in their normal practices as they relate to dermatology, medical aesthetics and plastic surgery. It appears that the inclusion of the RN section at the start of SB 249 is an attempt to solve part of this issue. Unfortunately, it still actually ends up restricting the practice of RNs and, confusingly, makes their practice in part dependent on the Board of Cosmetology and portions of the cosmetology practice act. 

If you would like additional information, to read the language of the bill or to contact the sponsors, you can find the information you need through this link. The members of the Senate Commerce and Labor Committee, where SB 249 currently is, are listed here.