Bill Name: House Bill 5877 (HB 5877)

Primary Sponsor: Representative Jacquelyn Baginski & Stephen Casey

Status: 3/15/2023 Committee recommended measure be held for further study

AmSpa’s Take: The requirements for onsite supervision and the creation of a medical spa facility license are more restrictive and complicated than what is found in most other states. This bill leaves the final setting of licensing rules to the department of health, so there is no indication of how easy compliance will be.

Outlook: This bill is in the first steps of the process and, based on the sponsor’s past records and party, it has a higher likelihood of passing. However, similar medical spa bills from the same sponsor ultimately failed to pass in 2021 and 2022, although the 2022 bill made it far in the process.

Analysis: Currently, Rhode Island medical spas are regulated in the same way as other medical offices or physician’s practices. There isn’t a separate set of regulations that apply only for medical spa facilities. The newly introduced House Bill 5877 (HB 5877), if passed, would create training, licensing and supervision requirements for medical spas. Rep. Baginski has introduced similar legislation in the last two legislative sessions.

As introduced, HB 5877 defines medical spas as establishments that perform “cosmetic medical procedures.” Cosmetic medical procedures are broadly defined to include any procedure directed at improving appearance which does not meaningfully promote function or treat a disease. The definition goes on to list a number of procedures which are included, such as hair transplants, cosmetic injections, dermabrasion beyond the stratum corneum, laser treatments, and use of class II devices for deep tissue alteration. Under this bill, cosmetic medical procedures can only be provided by qualified licensed or certified persons under the onsite supervision of a physician, physician assistant (PA) or advanced practice registered nurse (APRN). Do note that any ablative laser or energy procedures may only be performed by a physician.

Every medical spa would have a medical director who is a physician or APRN and is:

1. Trained in the cosmetic medical procedures;
2. Responsible for implementing policies and procedures;
3. Responsible for delegation and supervision of the procedures provided;
4. Responsible for oversight of procedures performed by others; and
5. Responsible for ensuring that all personal are appropriately trained.

HB 5877 requires that medical directors receive training in the various cosmetic medical procedures the medical spa performs. While it does not explicitly list how long or how much training is needed, it does say that manufacturer or vendor-provided training is insufficient if it is the only source of training.

A supervising physician or APRN must perform an initial patient assessment, create a written treatment plan for each patient, obtain patient consent and create medical records for the patients. Somewhat confusingly, the bill includes a definition of supervision which has both direct onsite and indirect off-site elements, even though onsite appears to be the only accepted method.

Similarly, when non-physicians or non-APRNs perform cosmetic medical procedures, they must, at all times, review the protocols, verify that the patient has been assessed by a physician or APRN, review the procedure with the patient, notify the supervising person and medical director of any adverse events or complications, document all details in the medical records, and satisfy any requirements of their licensing board.

The biggest potential change required under HB 5877 is the adoption of rules by the Rhode Island Department of Health (DoH). The bill gives the DoH until July 1, 2024, to adopt regulations to implement this law and to provide for the licensing of medical spas as “health care facilities.”

While mandating onsite supervision in all cases is more restrictive than in most other states, the parts left unanswered will determine how burdensome this bill’s changes would be on medical spas. The biggest unknown is how complex and costly licensing would be. Few states impose facility licensing requirements on medical spas but, often, health care facilities can be expensive and time-consuming to get licensed. If this bill advances in the legislature, it would be good if these areas are better addressed or simplified, as in other states.

We will be monitoring this bill as it works its way through the legislature. If you would like additional information, to read the bill, or to contact the sponsors you can find it through this link.