On January 9, 2025, the Texas Medical Board (TMB) implemented comprehensive changes to its rules, marking a significant shift in how medical spas, IV hydration clinics, and other healthcare facilities operate in Texas.
Here's what healthcare providers need to know about these important updates.
Medical Spas and IV Hydration: New Transparency Requirements
The TMB has introduced stricter transparency requirements for medical spas and IV hydration clinics. Under the new Rule 169.28 and Rule 164.3, these facilities must:
- Post the delegating physician's name and Texas medical license number in all public areas and treatment rooms
- Ensure all staff members wear identification displaying their name and credentials
- Include the supervising physician's name in all advertising materials (unless it's the physician's primary practice)
Changes to Delegation and Supervision
The TMB has consolidated all delegation-related rules under Chapter 169 of the Texas Administrative Code, bringing clarity to physician delegation requirements:
- All delegation must now be documented through written standing delegation orders, standing medical orders, protocols, or prescriptive authority agreements
- These documents must be signed by the delegating physician and include specific instructions and procedures, required supervision levels, and plans for addressing patient emergencies.
- Unlike the previous rules under 193.17, a physician, physician assistant (PA), or advanced practice registered nurse (APRN) can now serve the role of “being available for emergency consultation in the event of an adverse outcome.” However, the physician must still be available to conduct an emergency consultation.
Additionally, a physician must be trained or familiar with and able to perform the delegated medical act in accordance with the standard of care. This rule was previously in place under 193.17 for medical spas and is now in place for all delegated medical acts—a notable change for IV hydration clinics.
Practitioner-Patient Relationship Requirements
The new rules emphasize the importance of establishing a practitioner-patient relationship before any delegated medical procedures. The TMB has clarified that this relationship can be established either through:
- In-person visits
- Telemedicine consultations
Alternative Medicine Updates
The TMB has significantly streamlined its rules for complementary and alternative medicine. Healthcare providers should note that the Board will be issuing a standardized disclosure and consent form that must be used by practices offering these services.
Ketamine Treatment Regulations
The TMB has maintained its current stance on ketamine treatments, continuing to regulate it under office-based anesthesia rules.
However, providers should be aware that:
- Current rules only apply to ketamine's use as an anesthetic
- The Board has announced plans to review regulations for emerging therapeutic uses of low-dose ketamine in the coming year
Limits on Dispensing Medications Removed
TMB has removed the limitation on physicians dispensing medications from their offices in amounts that exceed the patient’s immediate needs (72 hours). However, physicians should not see the deletion of the TMB rule as a sign that the prohibition has been lifted.
Chapter 158 of the Texas Occupations Code still prohibits physicians from supplying drugs beyond a patient’s immediate needs (with limited exceptions).
Looking Ahead
These comprehensive changes reflect TMB’s effort to modernize healthcare regulations in Texas while maintaining patient safety standards.
Healthcare providers should:
- Review and update their policies and procedures to ensure compliance with the new rules
- Implement required signage and identification measures
- Update their delegation documentation to meet new requirements
- Watch for forthcoming guidance on alternative medicine consent forms
Consult with legal counsel to ensure full compliance with these new regulations, particularly in areas where additional guidance may be forthcoming.
Talk to our team today to help ensure your healthcare business complies with these new TMB rules.
