Rhode Island DOH Guidelines Present Roadblocks to Medical Spas and IV Therapy

Rhode Island Guidelines Impact Scope of Practice at Medical Spas

In July 2024, the Rhode Island Department of Health released new guidelines for medical spas and IV therapy businesses in response to a “proliferation” of such businesses in the state. The guidelines, authored with support of several physician groups, present significant new roadblocks for medspa and IV therapy clinics with respect to scope of practice and delegation.  

This is just one recent example of a state tightening regulations as medical spas and IV therapy businesses become more common. And, like in other states (notably Texas), it has been met with some backlash from current medical spa owners and providers. In this case, legislators have proposed a bill to walk back portions of the guidelines. 

What do medical spa or IV therapy clinic owners in Rhode Island need to know? We break it down in this article. 

Standing Orders, Scope of Practice, and Standard of Care 

The Rhode Island Department of Health (“RIDOH”) specified that “the use of standard orders for an individualized assessment, diagnosis and treatment of patients is considered unprofessional conduct and can result in disciplinary action on one’s license.” 

The practical effect of this guidance is that medspas and IV Therapy businesses cannot rely on a physician’s standing orders to circumvent individualized physical assessments. Furthermore the RIDOH called out IV therapy clinics specifically, saying the administration of intravenous hydration therapy is considered the practice of medicine. Accordingly, the procedure requires individual patient evaluation, diagnosis, and implementation of a treatment plan by an authorized provider. This can only be done by physicians, physician assistants, and CNPs in family practice or adult gerontology. 

The practical effect of this is that in Rhode Island, RNs may not diagnose, prescribe, compound, or treat a patient with IV hydration therapy. The assessments themselves should ideally be conducted in person, but the guidelines do leave room for telemedicine when appropriate. The assessment should be “thorough,” not a general patient health questionnaire, and should be documented in a written medical record with an assessment (diagnosis) and plan for treatment. 

The RIDOH also called out treatment menus, a common practice at IV therapy clinics, noting that they are not permissible under this guidance. Offering patients IV “cocktails” from menus essentially gives the patient the ability to diagnose and implement a treatment plan for themselves, which is of course impermissible under Rhode Island law. 

Compounding 

According to the new guidelines, RNs are practicing outside of their scope of practice if they are diagnosing, compounding, and/or treating a patient with IV hydration therapy. Additionally, the RIDOH noted that the “regular storage, preparation, and compounding of drugs by anyone other than a licensed physician, pharmacist, or pharmacy is prohibited unless licensed by RIDOH in these professions.” 

Businesses that choose to compound must have a physician on-site to supervise compounding or have a licensed pharmacy on-site to prepare the compounds with the supervision of a pharmacist.

Mobile and Ambulatory Ownership and Licensure 

Medical spas who provide mobile care, or care in a place that is not the business’s brick and mortar establishment, require a Home Nursing Care Provider license (HNCP) regardless of their professional license. 

Additionally, medical spas that perform care in a van, trailer, or other mobile method will require an organized ambulatory care facility license (OACF). 

Management companies that work with a professional service corporation (PSC) that is otherwise exempt from needing an ambulatory care facility license, who have “significant influence and no active involvement of the PSC members” are required to have an organized ambulatory care facility license. Members of PSCs who attempt to “lease” the PSC to circumvent the ambulatory care license requirement “may have adverse action taken against their professional license.” 

New Bill Responds to Strict Guidelines

In response to the guidelines, Rhode Island Representatives Baginski, Bennet, and Casey co-sponsored House Bill No. 5351, “Medical Aesthetic Practices Safety Act.” Their bill provides some safety guidelines, but largely attempts to walk back RIDOH’s guidelines. 

Among other things, the bill, if passed would mandate the following requirements:

Initial Assessment 

A supervising physician, PA, or APRN should perform an initial patient assessment, prepare a detailed written treatment plan, and obtain patient consent prior to the performance of “cosmetic medical procedures” (defined below).

RN Scope of Practice

Cosmetic medical procedures are defined in the bill as included, but not limited to, cosmetic surgery, microneedling, hair transplants, cosmetic injections like fillers and neurotoxins, dermaplaning, derma stamping, dermabrasion, certain high-concentration chemical peels, laser hair removal, laser skin resurfacing, laser vein treatment, platelet-rich plasma, platelet-rich fibrin, sclerotherapy, IV therapy, radiofrequency, and vitamin infusions. 

The bill states that these cosmetic procedures may be performed by a qualified licensed physician, PA, APRN, or non-APRN including an RN, if the services have been delegated by a physician, PA, or APRN. The delegating professional must be qualified and on-site or immediately available by phone.

Esthetician Scope of Practice 

A licensed esthetician should be able to administer chemical peels that do not exceed 30% concentration of modification solutions, and with a pH value of lower than 3.0. (This concentration and pH is less than what the bill states an RN should be able to administer with proper supervision. It proposes estheticians can also administer radiofrequency, intense pulsed light, and microneedling. All of these, the Bill states, should not require supervision and delegation.

Dentist Scope of Practice 

A licensed dentist should be permitted to administer cosmetic injections (including fillers and neurotoxins) without supervision and delegation.

Next steps for business owners

As of March 31, 2025, House Bill No. 5351 has been recommended to be held for further study. In the meantime, it is best for medical spa and IV therapy business owners to comply with the RIDOH’s guidance. Failure to do so could impact your professional licensure. Have questions? Reach out to our team for guidance to ensure your practice is in compliance with the RIDOH guidelines.