HB 3749, filed during the 89th Texas legislative session, seeks to enhance regulations for medical spas (medspas) following a tragic incident in 2023 where a woman died during an IV procedure at a medspa in Wortham, Texas. Named Jenifer's Law, it aims to classify medspas as medical practice settings, subjecting them to the same regulatory standards as traditional medical practices, focusing on cosmetic medical procedures and elective intravenous therapy.

Current Regulations and Proposed Changes

Currently, medspas are regulated by the Texas Department of Licensing and Regulation (TDLR) and the Texas Medical Board (TMB). Services like facials can be performed by licensed estheticians, but advanced treatments like botox require physician delegation. Recent TMB rules, effective January 9, 2025, mandate physician name postings and staff identification. HB 3749 proposes requiring a physician on site during procedures, increasing training, supervision, and transparency, potentially aligning medspas more closely with medical practice standards.

Impact on Medspa Owners

Medspa owners may face higher costs for physician presence, need to update policies for compliance, and ensure staff training meets new standards. This could affect operations, especially for smaller medspas, but aims to enhance patient safety.

Survey Note: Comprehensive Analysis of HB 3749 for Medspa Owners and Administrators

Introduction

HB 3749, introduced on March 4, 2025, by Representative Angelia Orr during the 89th Texas legislative session, represents a significant proposed change to the regulation of medical spas (medspas) in Texas. Known as Jenifer's Law, this bill is a direct response to a tragic incident in 2023 where Jenifer Cleveland died during an IV procedure at Luxe Med Spa in Wortham, Texas. The legislation aims to classify medspas as medical practice settings, subjecting them to the same regulatory standards as traditional medical practices, with a focus on enhancing patient safety for cosmetic medical procedures and elective intravenous therapy. This survey note provides a detailed examination for medspa owners and administrators, covering current regulations, proposed changes, implications, and preparation strategies.

Current Regulatory Landscape for Medspas in Texas

Medspas in Texas are currently regulated by the Texas Department of Licensing and Regulation (TDLR) and the Texas Medical Board (TMB). According to the TDLR, medspas offer esthetic and non-surgical medical treatments, such as facials, eyelash extensions, and hair removal, which can be performed by licensed estheticians or cosmetology operators (TDLR Medical Spas). More advanced services, including botox injections, fillers, body contouring, and laser treatments, must be provided under the order and delegation of a licensed physician.

Recent updates by the TMB, effective January 9, 2025, have introduced additional requirements for medspas. These include:

  • Posting the delegating physician’s name and Texas medical license number in all public areas and treatment rooms.
  • Ensuring all staff wear identification with their name and credentials.
  • Including the supervising physician’s name in all advertising materials, unless the med spa is the physician’s primary practice.
  • Documenting all delegation through written standing delegation orders, standing medical orders, protocols, or prescriptive authority agreements, signed by the delegating physician, with specific instructions, procedures, required supervision levels, and emergency plans.
  • Establishing a practitioner-patient relationship before any delegated medical procedures, either through in-person visits or telemedicine consultations.

These changes, detailed in a blog post by Hendershot Cowart P.C., aim to enhance transparency and accountability (Major Changes to Texas Medical Board Rules).

Details of HB 3749

HB 3749, as summarized on LegiScan, relates to the regulation of the practice of medicine, specifically targeting the performance of cosmetic medical procedures and the provision of elective intravenous therapy (LegiScan HB3749 Summary). News reports, such as an article from kcentv.com, indicate that the bill proposes to:

  • Classify medspas as medical practice settings, aligning their regulatory framework with traditional medical practices.
  • Require a trained physician to be on site during the performance of procedures or to perform them personally, a significant shift from current delegation practices.
  • Increase training, supervision, availability, and transparency requirements for medspas.

The kcentv.com article highlights that the bill was filed after Jenifer Cleveland's death, with Dr. Kelly Green of TX400, a nonprofit, calling it "landmark legislation" (Texas Lawmaker Files Bill). Lengea Law’s analysis further notes that this classification would subject medspas to medical board rules and healthcare regulations, potentially increasing oversight (Lengea Law Article).

Given the bill’s early stage (filed and referred to committee as of March 17, 2025), the exact text and additional provisions are not fully accessible, but these reports provide a clear indication of its intent.

Implications for Medspa Owners and Administrators

The proposed changes under HB 3749 will have several implications for medspa owners and administrators:

  1. Classification as Medical Practice Settings:
    • Medspas will need to comply with all regulations applicable to medical practices, such as maintaining medical records in compliance with HIPAA and state laws, adhering to infection control and sanitation standards, and following prescribing and dispensing regulations for medications. This alignment is detailed in TMB resources (TMB Laws Main Page).
  2. Physician Presence Requirement:
    • The requirement for a trained physician to be on site during procedures or to perform them personally could significantly impact operations. Currently, many medspas operate with physicians providing oversight remotely, but this change may necessitate hiring or contracting with a physician to be physically present, potentially increasing operational costs. This is a notable shift, as highlighted in the kcentv.com article, and could affect smaller medspas more acutely.
  3. Increased Training Requirements:
    • Staff may need additional training to meet the new standards, particularly in areas related to medical procedures and patient care. This could involve investing in continuing education for estheticians, nurses, and other staff, ensuring they are equipped to handle the increased scrutiny.
  4. Transparency Requirements:
    • Medspas must ensure compliance with transparency measures, such as displaying the delegating physician’s name and license number, ensuring staff wear identification badges, and including the supervising physician’s name in advertising. These requirements, already part of the TMB’s January 2025 rules, may be reinforced or expanded under HB 3749.

Operational and Financial Considerations

The increased regulatory burden could lead to higher operational costs, particularly for ensuring physician presence and staff training. Medspa owners may need to adjust pricing structures to cover these costs, which could impact competitiveness, especially for smaller practices. Additionally, the need for a physician on site could limit operating hours or require restructuring of service offerings to align with physician availability.

Steps to Prepare for Compliance

To navigate these potential changes, medspa owners and administrators should take the following steps:

  1. Stay Informed:
    • Monitor the progress of HB 3749 through legislative tracking platforms like LegiScan (LegiScan HB3749) and updates from the Texas Legislature. The bill, as of March 17, 2025, is in the early stages, with expected committee hearings and potential amendments.
  2. Assess Current Compliance:
    • Evaluate current operations against both existing TMB rules and the proposed changes under HB 3749. Identify areas such as delegation documentation, physician presence, and staff training that may need enhancement.
  3. Engage with Legal and Regulatory Experts:
    • Consult with attorneys specializing in healthcare law, such as Hendershot Cowart P.C. (Health Medical Law), to understand the implications and ensure compliance. Legal firms can provide tailored advice on structuring operations to meet new standards.
  4. Update Policies and Procedures:
    • Develop or revise policies to reflect the new requirements, such as creating detailed delegation orders, establishing patient relationship protocols, and ensuring transparency measures are in place. This aligns with the TMB’s Chapter 169 requirements (Texas Administrative Code Chapter 169).
  5. Train Staff:
    • Invest in training programs to ensure all staff are aware of and compliant with new regulations. This could include workshops on medical procedures, patient safety, and regulatory compliance, potentially through resources from the American Med Spa Association (AmSpa Texas Summary).
  6. Prepare for Increased Costs:
    • Budget for potential increases in expenses, such as hiring additional staff or contracting with physicians for on-site presence. Consider financial planning to mitigate impacts on profitability.
  7. Communicate with Patients and Stakeholders:
    • Keep patients, employees, and other stakeholders informed about any changes in operations or services due to the new regulations. Transparency in communication can help maintain trust and manage expectations.

Timelines and Deadlines

The 89th Texas legislative session, during which HB 3749 was filed, runs from January 14, 2025, to June 2, 2025. As of March 17, 2025, the bill is in the early stages, referred to committee, with hearings and testimony expected. If passed, the bill will likely have a specified effective date, potentially immediate or deferred to a later date, such as the start of the following year. Medspa owners should monitor legislative updates to prepare for implementation within the next few months.

Resources and Support

Medspa owners and administrators can leverage the following resources for guidance:

  • Texas Medical Board (TMB): Offers regulations and guidance for medical practices, including practice acts and recent rule changes (TMB Practice Acts).
  • Texas Department of Licensing and Regulation (TDLR): Regulates cosmetology and related fields, with specific information on medspas (TDLR Medical Spas).
  • Legal Firms: Such as Hendershot Cowart P.C., providing expertise on healthcare law and compliance (Health Medical Law).
  • Industry Associations: The American Med Spa Association offers legal updates and resources for members, including state-specific summaries (AmSpa Texas Summary).

Conclusion

HB 3749 represents a pivotal moment for the medspa industry in Texas, aiming to enhance patient safety through increased regulation. Medspa owners and administrators must proactively engage with these proposed changes, ensuring compliance with current and future standards. By staying informed, updating policies, and seeking expert support, they can navigate the evolving regulatory landscape and maintain high standards of care.

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