Bill Name: House Bill 3749 (HB 3749) 

Primary Sponsor: Rep. Angelia Orr, Rep. Tom Oliverson, Rep. Suleman Lalani

Status: 3/26/2025 Referred to  House Committee on Public Health      

AmSpa’s Take: This bill is somewhat unusual since Texas already has well-defined rules for delegating and supervising cosmetic medical procedures and IVs. This bill would be much more restrictive than current rules allow and would make Texas one of the most restrictive states in this area.

Analysis: Currently, Texas medical spas are regulated under the same rules as other medical offices or physician’s practices. Recently, the medical board adopted revised rules governing the delegation of treatments and procedures to non-physicians. The newly introduced House Bill 3749 (HB 3749), if passed, would create training, licensing and supervision requirements specifically for medical spas and IV therapy clinics. 

As introduced, HB 3749 defines “medical spas” as establishments that perform “cosmetic medical procedures” and are outside a physician’s primary office location. Cosmetic medical procedures are broadly defined to include any procedures that alter or reshape normal structures of the human body or that ablate or remove living tissue solely to improve physical appearance. The definition goes on to list a number of procedures that are included, such as neuromodulator or dermal filler injections, ablative or non-ablative laser procedures and energy-emitting devices. Under this bill, medical spas are medical practice settings and must post a notice whenever a physician is not physically present on site. All medical spas must have a “medical director” who is a physician trained in all the cosmetic medical procedures, devices and substances used by the medical spa. Medical directors are responsible for overseeing all the procedures performed at the spa and for promoting quality patient care. This involves both providing supervision of the procedures and overseeing the training of all who perform them.

HB 3749 also discusses physicians other than the medical director. These physicians would also need to be appropriately trained and would be responsible for performing an initial patient assessment, preparing a written treatment plan, and reviewing and approving written protocols. If the treatment is to be performed by a non-physician, the physician would need to supervise by being immediately able to be present on site and respond in person, if needed.

The physician would be able to delegate the procedures to non-physicians. These non-physicians also must: 

1. Be properly trained; 
2. Wear an ID badge; 
3. Review the treatment protocols; 
4. Ensure that the patient has been assessed by a physician; 
5. Review the proposed treatment with the patient; 
6. Provide post-treatment instructions; 
7. Document the medical record; and 
8. Meet any other requirements of their licensing board. 

Non-physicians must either have a physician or at least one person trained in basic life support physically on site.

HB 3749 also provides rules for elective intravenous therapy. These are IVs that are not administered in a physician’s office or licensed facility. This section allows the physician to delegate the act of prescribing or ordering an elective IV to a physician assistant (PA) or a registered nurse (RN) using a prescriptive authority agreement.   

This bill is very unusual. HB 3749 is much more restrictive than the current rules. Under the current rules, the patient assessment, treatment order and supervision functions can also be provided by nurse practitioners (NPs) and PAs. However, HB 3749 gives both NPs and PAs the same scope of practice and authority as unlicensed persons, whereas in all other settings, even regarding cosmetic medical procedures, they are highly trained prescribing practitioners. The IV section is unusual in that it delegates the prescribing of IVs to PAs, which is something they can already do. It also completely ignores NPs, who also have prescriptive authority and can currently provide IVs. Texas currently has well-defined supervision and delegation rules for medical spas. If adopted, HB 3749 would make Texas one of the most restrictive states for medical spas.

We will be monitoring this bill as it works its way through the session. If you would like additional information, to read the bill or to contact the sponsors, you can find it through this link: HB 3749.