At its June 9 board 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. These rules are not currently available on the board’s website; however, there is a version of these rules from May 27, 2020, that may be similar, based on comments made at the meeting. We have contacted the board for the current version of this rule and will update this article once we are able to review it. Please note that the information below is based off of the May 27 proposed rule and the board meeting discussion from June 9; 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 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. During the treatment, the physician must provide onsite supervision, and they may only supervise 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 also must observe the procedure 15 times and perform it under direct supervision 20 times.
For laser hair removal (LHR), the delegation rules remain, 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. Again, the physician must personally evaluate the patient prior to treatment and again after to assess the effectiveness. The training requirements of least eight hours of education of specific laser topics, and they also must observe the procedure 15 times and perform it under direct supervision 20 times.
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. The supervision must still be on site for PAs, RNs and LPNs; however, 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.
It is important to note that these are newly proposed and are not yet officially adopted, and the final version of the rules is not yet available to the public.