Texas Medical Spas Should Closely Follow HB3749

New Legislation Could Restructure Texas Medical Spas: HB3749 Explained

Texas medical spas may soon face significant regulatory changes under House Bill 3749, recently filed in the Texas Legislature. Unlike earlier administrative updates that focused on marketing disclosures and statute reorganization, HB3749 proposes more far-reaching changes that would impact day-to-day clinical operations, including the roles and supervision of nurse practitioners, physician assistants, and registered nurses.

This article aims to clarify key provisions of the bill, address common misconceptions, and help medical spa owners, providers, and industry stakeholders understand how these changes could affect their practices.

Today, April 8, 2025, the Texas House Public Health Committee held a scheduled hearing but did not discuss HB3749, HB3890, or HB3889. No hearing has been scheduled to discuss HB3749. Follow the blog and our LinkedIn to stay up to date on the latest news.

What is HB3749?

HB3749 is a bill co-sponsored by Texas House Representatives Angelia Orr (District 13), Dr. Tom Oliverson (District 130), and Dr. Suleman Lalani (District 76). The bill’s summary statement reads: Relating to the regulation of the practice of medicine, including the performance of cosmetic medical procedures and the provision of elective intravenous therapy.

Where is the bill in the legislative pipeline?

On March 26, 2025, the House referred HB3749 to the Public Health Committee. As of today, the committee has not taken any action on the bill.

What does the bill say?

Medical Director Requirements

The bill clarifies that all medical spas must appoint a physician medical director. If the medical director is not on site at any time the medical spa must state so in a posted notice.  The medical director must be trained in cosmetic medical procedures and the use of medical devices. For clarification, the bill states that training by vendors or manufacturers is insufficient.

The responsibilities of the medical director are further enumerated to include the implementation of policies and procedures, providing supervision of all procedures performed at the medical spa, and oversee the training of providers to perform medical cosmetic procedures at the spa.

The medical director must be immediately able to be present on-site and respond in person if needed. “Immediately available” is vague, but the requirement implies that the physician must be within physical proximity of the spa and be able to drop what they’re doing and respond in person without delay. This is stricter than “readily available” which might include virtual supervision.

Initial Assessment Requirement or Good Faith Exam (GFE)

Any medical cosmetic procedure, even if delegated and supervised by the physician, must begin with an initial assessment performed by the physician. This requirement creates a two-tiered system and raises some legal questions on unequal treatment. This physician-only initial assessment requirement has no clear statutory precedent in Texas or other states with comparable medical spa regulations. In most clinical settings, including urgent care and telemedicine, nurse practitioners and physician assistants perform initial evaluations under physician supervision without issue.

Life-Saving Training Requirement

A medical cosmetic procedure may not be performed at a medical spa unless a physician is physically present at the medical spa or at least one non-physician provider trained in basic life support is physically present at the medical spa.

Intravenous Hydration Procedure

A physician may only delegate intravenous hydration procedures to a physician assistant or registered nurse. Nurse practitioners are notably absent from the text of HB3749. This omission is likely intentional and reflects the distinct way Texas law treats nurse practitioners compared to physician assistants and registered nurses. In Texas, nurse practitioners, also known as Advanced Practice Registered Nurses (APRNs), hold prescriptive authority through a written prescriptive authority agreement with a supervising physician, as outlined in Texas

Occupations Code Chapter 157.

There are other clarifications within the bill’s text about the policies and procedures required for medical spas. But, undoubtedly, the change which is sparking the most controversy is the initial assessment requirement. This requirement appears punitive in that it is stricter on medical spas than any other medical setting which employs PAs and APRNs.

Patient safety is critical in the medical spa industry. However, recent enforcement efforts have struggled to target true bad actors, leading instead to broad legislative proposals like HB3749. Rather than addressing specific safety concerns, the bill risks imposing overly punitive measures on compliant providers without offering clear, data-driven improvements to patient outcomes. There’s no evidence that spas properly supervised by PAs or APRNs result in worse safety for patients or more adverse outcomes.

What happens next?

HB3749 introduces significant changes that, if passed, would impact how medical spas operate in Texas, particularly in areas of physician oversight, delegation, and provider roles. Stakeholders should monitor the bill’s progress through the legislative process and consider how these changes could affect their current practices. As the bill moves forward, opportunities may arise to provide feedback or submit testimony through the appropriate legislative channels.

Note from the Author: Julia Cantu Hendrick

I will be closely monitoring the Texas House Public Health Committee’s hearing schedule and sharing updates on my LinkedIn and through the Marti Law Group blog.

If you would like to engage in the legislative process regarding HB3749, here are the steps you can take:

Before a Hearing is Scheduled

Contact Committee Members

Call, email, or visit members of the House Public Health Committee to share your comments or concerns.

If a Public Hearing is Scheduled

Attend the Hearing

You may attend the hearing in person at the Texas Capitol to observe or provide oral testimony.

Submit Public Comments Online

Use the Texas House Public Comment Portal to submit written comments.

Email Written Testimony to the Committee Clerk

Submit a PDF letter or testimony by email. Include the following in your submission:

• Your full name

• Your profession

• Your city of residence

• A clear statement of support or opposition

Clerk Contact:

Scott Crownover

House Committee on Public Health

Phone: (512) 463-0806

At Any Time:

Engage with Your House Representative

Reach out to your own representative to share your position on the bill. Find your representative here.