Several bills have been filed in the Texas state legislature in this 2025-2026 legislative session that would put severe restrictions on the ability of mid-level and non-core medical professionals to operate in medical aesthetics. Read on for more information and to find out how you can get involved.
The following bills recently filed in Texas have the potential to drastically reshape the medical aesthetic landscape in the state. They include provisions restricting PAs and NPs, and making it more difficult for non-core physicians to operate med spa practices.
Read more from AmSpa Founder and CEO Alex Thiersch, JD, on these three bills and how they could affect the medical spa industry.
**Update May 28, 2025** the revised version of HB 3749 passed the House on May 15th and the Senate on May 27th. It will now head to the Governor's desk for signing into law. As a reminder, HB 3749 was amended and now only addresses elective IV therapy.
**Updated May 2, 2025**
As of HB 3749's public hearing on April 28, 2025, the bill has been significantly revised. References to "cosmetic medical treatments" and "medical spas" have been removed, making the bill solely focused on elective IV therapy. As well, delegation requirements have specifically been included to reflect existing Texas law, allowing physicians to delegate diagnosis and prescription to nurse practitioners and physician assistants who are trained and operating under a prescriptive authority agreement.
The new bill text does specify that the actual IV treatment in an IV therapy center must be administered by an RN or above.
Download the full text of the revised bill*.
*Note that as of May 6, 2025 the website for the Texas state legislature still carries the original text of HB 3749. AmSpa received this revised text directly from the office of the bill's sponsor, Texas state representative Angelia Orr and this was the text that was voted on and approved by the Committee on Public Health.
Read a letter from AmSpa founder Alex Thiersch, JD, on his experience on site in Austin for the bill's public hearing, and how the industry can continue to move forward.
Previous information and resources (prior to to 4/28/25 public hearing.)
AmSpa recorded a webinar on March 11 delving into the specifics of HB 3749 and how it could affect medical spa practices if it passes.
Read a letter from AmSpa founder Alex Thiersch, JD to the bill's chief sponsor, Rep Angelia Orr.
Click here to view the webinar.
Click here to read a recap of the webinar.
**Update May 16, 2025** HB 3889 and 3890 were defeated this session. Since the Public Health Committee did not hold a public hearing and the bills failed to move out of committee before the May 15, 2025, deadline for second reading in the House, they are effectively dead for this session.
Texas House Bill 3889 amends current law , restricting the ability of a PA or NP to diagnose and create treatment plans for new patients. Under this bill, PAs or NPs can only take these actions with patients that already have a physician-patient relationship with their supervising physician, meaning that PAs and NPs in Texas would no longer be able to perform the initial patient assessment (Good Faith Exam.) This bill is not specific to medical aesthetic practices, and would amend this for all PAs and NPs in the state of Texas.
**Update May 16, 2025** HB 3889 and 3890 were defeated this session. Since the Public Health Committee did not hold a public hearing and the bills failed to move out of committee before the May 15, 2025, deadline for second reading in the House, they are effectively dead for this session.
Texas House Bill 3890 restricts the abilities of physicians to supervise NPs and PAs outside of the practice of their residency or primary practice. This would limit the available pool of supervising physicians in Texas, and make it much more difficult for non-core physicians to open medical aesthetic practices.
JD, Founder and CEO, AmSpa
"We have to rally around each other and do the things we know we can do. Whether it's consistent minimum standards or credentialing. We've got to do that because this bill is an example of what...
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NP, VP of Operations, Vitalyc Med Spa
"Any other type of specialty, primary care, specialty medicine, an APRN or PA has the ability to write a treatment plan, to diagnose, to create and prescribe medications and treatment plans. So it's a little alarming...
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It is important to organize and educate legislators together as a medical aesthetic community. AmSpa believes that patient safety is of the utmost importance, and regulation and legal compliance are an integral part of that. However, HB 3749 as written does not make patients safer, and instead reduces the ability of licensed, trained, safe medical practitioners to take part in patient care.
Click here to find your state representative and make your voice heard.
Download this form letter for messaging to oppose this bill.
Stay tuned as AmSpa releases more new and resources in the coming weeks.
“There’s a lot of education needed in legislatures to understand what we do and how safe we actually are. And AmSpa is willing to take that on and we hope you are too because the industry is only as strong as its people.” - Cathy Christensen, President and CSO, AmSpa
Texas House Bill 3749, dubbed "Jenifer's Law," was drafted in reaction to the tragic death of Jenifer Cleveland during an IV treatment in July of 2023. Rather than regulate IV treatments or unlicensed providers, however, the bill restricts licensed NPs and PAs, drastically curtailing what they are able to do in a medical spa practice.
The bill seeks to regulate med spa practices "including the performance of cosmetic medical procedures and the provision of elective intravenous therapy" and defines cosmetic medicine as including "the administration of a neuromodulator or dermal filler, an ablative or non-ablative laser procedure, and a procedure using an energy-emitting device."
It further states that only physicians may administer the initial patient assessment (Good Faith Exam), diagnose and create treatment plans, taking these duties away from licensed PAs and NPs. Additionally, with this bill only physicians would be able to supervise RNs and other providers performing medical aesthetic treatments and requires supervising physicians to be on-site or immediately available.
"If this bill were to pass, for cosmetic medicine the PA or NP wouldn't be able to examine patients or prescribe those procedures. They'd still have their regular scope in primary care and other things like that, but for med spa type procedures this would be a physician-only proposition." -Patrick O'Brien, JD, General Counsel, AmSpa
On March 4, 2025, Representative Angelia Orr filed HB 3749 in the Texas Legislature. Dubbed “Jenifer’s Law” by some in the press, it was purportedly filed in response to the tragic death of Jenifer Cleveland following an intravenous (IV) infusion treatment administered by an unlicensed person at Luxe Medical Spa in Wortham, Texas, July 10, 2023.
While most of the bill generally mirrors current Texas law for medical spas and IV therapy clinics, there are multiple new provisions that, if passed, would drastically and detrimentally change the current landscape in Texas.
First, HB 3749 excludes nurse practitioners (NPs) and physician assistants (PAs) from performing patient assessments, writing treatment plans and orders, and providing supervision functions (good faith exams and general supervision) at medical spas. These duties would only be able to be performed by a physician. Under Texas’s current rules, and the rules of virtually every other state, the patient assessment, treatment, order, and supervision functions in a medical spa can be provided by NPs and PAs, along with physicians. HB 3749 removes that function entirely, effectively giving both NPs and PAs the same scope of practice and authority as registered nurses (RNs) in medical spas. It is important to note that, in all other settings, NPs and PAs retain their status as highly trained prescribing practitioners.
Second, HB 3749 states that every medical spa must have a physician, again excluding NPs and PAs, “immediately available … to be present” at the facility, if needed. In order for a physician to be “immediately available” to be on-site, the physician would need to be physically on-site and present at the location every day. Because of this provision, every Texas medical spa would require an on-site physician at all times, a requirement that is not in place in other areas of medicine in Texas or other states.
Finally, HB 3749 also provides basic rules for elective IV therapy. This section is much less restrictive and contains none of the assessment and physical presence requirements of the medical spa bill, despite Jenifer Cleveland’s tragic death occurring due to IV therapy performed without supervision by an unlicensed person. It also allows the physician to delegate the act of prescribing or ordering an elective IV to an RN using a prescriptive authority agreement, something not allowed in other areas of healthcare.
Taking the above provisions into consideration, this passage of this bill would not make medical spas safer. It does not address the very real issues that caused Ms. Cleveland’s unfortunate death in July of 2023: unlicensed and undertrained providers, lack of supervision, and the blatant disregard of Texas’ extensive existing medical spa regulations.
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