89R15680 BEE-F     By: Orr H.B. No. 3749       A BILL TO BE ENTITLED   AN ACT   relating to the regulation of the practice of medicine, including   the performance of cosmetic medical procedures and the provision of   elective intravenous therapy.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle B, Title 3, Occupations Code, is   amended by adding Chapters 172 and 173 to read as follows:   CHAPTER 172. MEDICAL SPAS   SUBCHAPTER A. GENERAL PROVISIONS          Sec. 172.001.  DEFINITIONS. In this chapter:                (1)  "Cosmetic medical procedure" means a medical   procedure or medical treatment that is performed to alter or   reshape normal structures of the human body or to ablate or remove   living tissue solely to improve physical appearance. The term   includes the administration of a neuromodulator or dermal filler,   an ablative or non-ablative laser procedure, and a procedure using   an energy-emitting device.                (2)  "Medical spa" means a facility outside a   physician's primary office location where cosmetic medical   procedures are performed.                (3)  "Medical spa director" means a physician who   assumes the role of or represents that the person is the medical   director of a medical spa.          Sec. 172.002.  STATUS OF MEDICAL SPA. A medical spa is a   medical practice setting.          Sec. 172.003.  NOTICE REQUIRED IF PHYSICIAN NOT PRESENT. A   medical spa must post a notice stating that a physician is not   present at the location at any time when a physician is not present   at the medical spa.   SUBCHAPTER B. MEDICAL SPA DIRECTOR          Sec. 171.051.  MEDICAL SPA DIRECTOR REQUIRED. A cosmetic   medical procedure may not be performed at a medical spa unless the   medical spa has a medical director.          Sec. 172.052.  MEDICAL SPA DIRECTOR ELIGIBILITY. A person   may not act as a medical spa director unless the person is a   physician trained in:                (1)  the indications for and performance of cosmetic   medical procedures; and                (2)  the use of medical devices or instruments capable   of altering, causing biologic change to, or penetrating skin and   subcutaneous tissue.          Sec. 172.053.  MEDICAL SPA DIRECTOR DUTIES. A medical spa   director shall:                (1)  implement policies and procedures to:                      (A)  promote quality patient care; and                      (B)  provide for physician delegation and   supervision of the performance of cosmetic medical procedures;                (2)  provide overall supervision for cosmetic medical   procedures performed at the medical spa, whether by a physician or a   non-physician provider; and                (3)  oversee the training of physician and   non-physician providers to safely and effectively perform each   cosmetic medical procedure performed at the medical spa.   SUBCHAPTER C. PHYSICIAN PERFORMANCE, DELEGATION, OR SUPERVISION OF   COSMETIC MEDICAL PROCEDURE          Sec. 172.101.  PHYSICIAN TRAINING REQUIREMENTS REGARDING   COSMETIC MEDICAL PROCEDURE. (a) A physician may not perform a   cosmetic medical procedure or supervise the performance of a   cosmetic medical procedure by a non-physician provider unless the   physician has completed training in the indications for and   performance of the cosmetic medical procedure and is able to   perform the procedure according to the standard of care.          (b)  For purposes of Subsection (a), training provided by the   vendor or manufacturer of an injectable or medical device used to   perform a cosmetic medical procedure does not satisfy the training   requirements of that subsection.          Sec. 172.102.  PHYSICIAN DELEGATION OR SUPERVISION OF   COSMETIC MEDICAL PROCEDURES. (a) A physician's authority to   delegate the prescribing or ordering of a drug or device relating to   cosmetic medical procedures is subject to Subchapter B, Chapter   157.          (b)  A prescriptive authority agreement relating to cosmetic   medical procedures is included in the number of prescriptive   authority agreements authorized under Section 157.0512(c). The   exception provided in Section 157.0512(d) does not apply to a   prescriptive authority agreement relating to cosmetic medical   procedures.          (c)  A physician who delegates or supervises the performance   of a cosmetic medical procedure shall:                (1)  for each cosmetic medical procedure performed   under the physician's delegation and supervision:                      (A)  develop and maintain a written protocol; or                      (B)  review and approve in writing a written   protocol developed and maintained by another physician at the   medical spa;                (2)  perform an initial assessment of the patient on   whom a cosmetic medical procedure will be performed;                (3)  prepare a written treatment plan for each patient   on whom a cosmetic medical procedure will be performed, including   diagnosis, course of treatment, and specifications for any device   being used;                (4)  if a cosmetic medical procedure is being performed   by a non-physician provider:                      (A)  obtain the patient's consent to the procedure   to be performed by the non-physician provider; and                      (B)  identify the name and credentials of the   non-physician provider who will perform the procedure; and                (5)  create and maintain medical records in a manner   consistent with accepted medical practice and in compliance with   board rules.          Sec. 172.103.  AVAILABILITY OF MEDICAL SPA SUPERVISING   PHYSICIAN. A physician supervising the performance of a cosmetic   medical procedure at a medical spa must be immediately able to be   present on site and respond in person, if needed.   SUBCHAPTER D. NON-PHYSICIAN PROVIDER PERFORMANCE OF COSMETIC   MEDICAL PROCEDURES          Sec. 172.151.  NON-PHYSICIAN PROVIDER REQUIREMENTS FOR   COSMETIC MEDICAL PROCEDURES. (a) A non-physician provider may   perform cosmetic medical procedures only if the provider has been   properly trained, the procedure has been delegated to the provider   by a supervising physician, and the provider is acting under   physician supervision.          (b)  Training provided by a vendor or manufacturer of an   injectable or medical device used to perform a cosmetic medical   procedure does not qualify the individual to perform a cosmetic   medical procedure.          (c)  A non-physician provider shall:                (1)  wear identification that clearly indicates any   license the person holds and states that the person is not a   physician;                (2)  review and follow written protocols for each   delegated cosmetic medical procedure;                (3)  verify that the supervising physician has assessed   the patient and given written treatment instructions for each   procedure to be performed;                (4)  review with each patient the cosmetic medical   procedure to be performed;                (5)  notify the medical spa director and supervising   physician of any adverse events or complications before the patient   leaves the medical spa or, if the patient has already left the   medical spa, immediately on becoming aware of the adverse event or   complication;                (6)  communicate post-procedure instructions to each   patient;                (7)  document all relevant details of the cosmetic   medical procedure in the patient's medical record; and                (8)  satisfy any requirement of the non-physician   provider's licensing board.          (d)  A cosmetic medical procedure may not be performed at a   medical spa unless:                (1)  a physician is physically present at the medical   spa; or                (2)  at least one non-physician provider trained in   basic life support is physically present at the medical spa.   CHAPTER 173. PROVISION OF ELECTIVE INTRAVENOUS THERAPY   SUBCHAPTER A. GENERAL PROVISIONS          Sec. 173.001.  DEFINITIONS. In this chapter:                (1)  "Elective intravenous therapy" means a procedure:                      (A)  to administer fluids, nutrients,   medications, or blood directly into a patient's bloodstream through   a vein;                      (B)  that is sought by the patient to alleviate   symptoms of temporary discomfort or improve temporary wellness; and                      (C)  that is not administered in:                            (i)  a physician's office;                            (ii)  a health facility licensed under   Subtitle B, Title 4, Health and Safety Code;                            (iii)  a mental hospital licensed under   Chapter 577, Health and Safety Code; or                            (iv)  a hospital maintained or operated by   this state.                (2)  "Registered nurse" means a person licensed by the   Texas Board of Nursing to practice professional nursing.   SUBCHAPTER B. ELECTIVE INTRAVENOUS THERAPY          Sec. 173.051.  DELEGATION OF PRESCRIBING OR ORDERING   ELECTIVE INTRAVENOUS THERAPY. (a) A physician may delegate the act   of prescribing or ordering elective intravenous therapy to:                (1)  a physician assistant acting under adequate   physician supervision; or                (2)  a registered nurse acting under adequate physician   supervision.          (b)  A physician's authority to delegate the act of   prescribing or ordering elective intravenous therapy is subject to   Subchapter B, Chapter 157.          (c)  A prescriptive authority agreement relating to elective   intravenous therapy is included in the maximum number of   prescriptive authority agreements authorized under Section   157.0512(c). The exception provided in Section 157.0512(d) does   not apply to a prescriptive authority agreement relating to   elective intravenous therapy.          SECTION 2.  The changes in law made by this Act apply to the   performance of a medical act on or after the effective date of this   Act under a physician's delegation, including the act of   prescribing, ordering, or administering a controlled substance,   dangerous drug, or device, regardless of:                (1)  the manner in which the delegation is made; and                (2)  whether the delegation is made before, on, or   after the effective date of this Act.          SECTION 3.  This Act takes effect September 1, 2025.