As the medical spa industry rapidly expands, states are increasing regulatory oversight to ensure patient safety and compliance with medical standards. Texas is the latest state to propose legislation targeting med spas, signaling greater scrutiny and reinforcing the need for med spas and investors to stay up to date on evolving regulations.
On March 4, 2025, Rep. Angelia Orr introduced House Bill 3749 to the Texas Legislature, proposing regulatory changes that will impact med spa operators within the state. The proposed legislation seeks to formally classify med spas, which HB 3749 defines as a “facility outside a physician’s primary office location where cosmetic medical procedures are performed,” as medical practice settings. It also sets forth certain physician supervision and patient safety requirements that med spas must begin complying with by Sept. 1, 2025.
Key Provisions of HB 3749:
- Mandatory Medical Director: Every med spa that performs “cosmetic medical procedures,” broadly defined under HB 3749, must appoint a licensed physician with specific training in cosmetic medical procedures as its medical director. It will be illegal to perform cosmetic medical procedures at a med spa if there is no medical director. As proposed, HB 3749 only permits physicians to serve in this role who are trained in: (1) the indications for and performance of cosmetic medical procedures; and (2) the use of medical devices that are capable of altering, changing or penetrating the skin.
- Physician Oversight: If HB 3749 passes in its current state, physicians serving as medical directors or who otherwise delegate or supervise the performance of cosmetic medical procedures will be required to, among other things, conduct initial patient assessments and develop written treatment plans before delegating such procedures to nonphysician providers, such as nurse practitioners.
- Availability of Supervising Physicians: A physician supervising the performance of a cosmetic medical procedure must be able to immediately be onsite and respond in person if needed. If a physician is not onsite, cosmetic medical procedures may not be performed unless at least one nonphysician provider trained in basic life support is physically present. Further, the med spa must post a notice specifically stating that a physician is not present at the office any time a physician is absent.
- Nonphysician Provider Restrictions: Nonphysician providers, such as physician assistants, nurse practitioners, registered nurses and other licensed individuals, may perform cosmetic medical procedures only under the delegation and supervision of a qualified physician. Such nonphysician providers must have completed appropriate training to perform these procedures safely and effectively under the scope of their license, but HB 3749 does not state what this training must include. The physician delegating or supervising a cosmetic medical procedure to a nonphysician provider must obtain a patient’s express consent to the procedure being performed by a nonphysician provider and certain specifics regarding the nonphysician provider must be kept in the patient’s medical record. HB 3749 also imposes other identification, notification and review obligations on such providers.
- Training Requirements: Both physicians and nonphysician providers must complete specific training in cosmetic medical procedures to ensure compliance with the standard of care. Training provided by vendors or manufacturers of injectables or medical devices does not satisfy this requirement.
Considerations for Med Spas
If enacted, HB 3749 may introduce additional compliance costs for med spas, depending on how a med spa has historically been operating. While trade associations have raised concerns about the increased burden on physicians to conduct more patient examinations, many med spa procedures already require physician involvement and oversight or must occur at a physician office. As a result, the impact of these changes may be less disruptive than expected. However, this bill reflects Texas’s growing focus on med spa regulation and creates the potential for additional scrutiny.
As of March 24, 2025, HB 3749 has been filed and is under consideration in the Texas Legislature. McGuireWoods continues to closely monitor the progress of this bill.
