HB 3749

relating to the regulation of the practice of medicine, including
the performance of cosmetic medical procedures and the provision of
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:
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
(2)  "Medical spa" means a facility outside a
physician's primary office location where cosmetic medical
(3)  "Medical spa director" means a physician who
assumes the role of or represents that the person is the medical
Sec. 172.002.  STATUS OF MEDICAL SPA.  A medical spa is a
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
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
(1)  the indications for and performance of cosmetic
(2)  the use of medical devices or instruments capable
of altering, causing biologic change to, or penetrating skin and
Sec. 172.053.  MEDICAL SPA DIRECTOR DUTIES.  A medical spa
(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
(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
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
(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
(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
(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
(4)  if a cosmetic medical procedure is being performed
(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
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
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
(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
(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
(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
(4)  review with each patient the cosmetic medical
(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
(6)  communicate post-procedure instructions to each
(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
(d)  A cosmetic medical procedure may not be performed at a
(1)  a physician is physically present at the medical
(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
(B)  that is sought by the patient to alleviate
symptoms of temporary discomfort or improve temporary wellness; and
(C)  that is not administered in:
(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
(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
(2)  a registered nurse acting under adequate physician
(b)  A physician's authority to delegate the act of
prescribing or ordering elective intravenous therapy is subject to
(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
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.