Supervision Requirements for Aesthetic Treatments

In Texas, med spas offering aesthetic treatments must adhere to specific supervision requirements to ensure compliance with state regulations and maintain patient safety. The Texas Medical Board (TMB) oversees these regulations, which have recently undergone restructuring. Here, we outline the supervision requirements for aesthetic treatments in Texas as well as the recent proposed legislative changes.

Supervision Requirements:

Delegating Physician Responsibilities: Non-surgical medical cosmetic procedures are considered the practice of medicine and must be properly delegated and supervised by a licensed physician. The physician must ensure that individuals performing these procedures have appropriate training and that there are signed written protocols in place. Before delegation, a physician, physician assistant (PA), or advanced practice registered nurse (APRN) must establish a practitioner-patient relationship, create and maintain medical records, disclose the credentials of the individual performing the procedure, and ensure that at least one person with basic life support training is on-site. Supervision requires the physician, PA, or APRN to be on-site or immediately available for emergency consultation.

Standing Orders and Written Protocols: The delegating physician must develop or approve written standing delegation orders and written protocols that include the description of the procedure identity, criteria for patient screening, details for administration, descriptions of appropriate care, and procedures for handling complications or emergencies.

Notice and Identification: Facilities must publicly display the names of delegating physicians and mandatory complaint notifications. Additionally, all individuals performing delegated medical acts must wear name tags that identify their name and license or credential.

Proposed Legislative Changes:

As of March 2025, Texas House Bill 3749 (HB 3749) has been introduced, proposing stricter regulations for med spas, which include the following.

Physician Oversight: Physicians serving as medical directors or supervising cosmetic medical procedures would be required to conduct initial patient assessments and develop written treatment plans before delegating procedures to non-physician providers, such as nurse practitioners (NPs) and PAs.

Availability of Supervising Physicians: Supervising physicians must be immediately available on-site during procedures or ensure that at least one trained non-physician provider is present if they are off-site. Med spas would need to post notices indicating the absence of a physician when applicable.

Non-Physician Provider Restrictions: NPs and PAs could perform cosmetic medical procedures only under the delegation and supervision of a qualified physician, with required training and patient consent documented.

Training Requirements: Both physicians and non-physician providers must complete specific training in cosmetic medical procedures, excluding vendor or manufacturer-provided training.

Conclusion on Supervision Requirements for Aesthetic Treatments

To be clear, the proposed rules are not law yet. But, med spa operators and practitioners in Texas should ensure compliance with current standards for supervision and stay informed about the proposed changes and assess their compliance protocols, staffing, training, and transparency measures to align with regulations.