Alert: New Texas Rules Affecting Medical Spas and IV Hydration Clinics

January 30, 2025

On January 9, 2025, the Texas Medical Board (“TMB”) enacted significant rule changes, including changes specifically affecting medical spas, IV hydration clinics, and practitioners of alternative medicine. These updates aim to enhance transparency, clarify delegation and supervision protocols, and streamline regulations for complementary and alternative medicine practices.

Enhanced Transparency for Medical Spas and IV Hydration Clinics

Under new Rule 169.28 and amendments to Rule 164.3, the TMB introduced stricter transparency requirements. Medical spas and IV hydration clinics are now mandated to:

  • Advertising Disclosure: Include the supervising physician’s name in all advertising materials, unless it pertains to the physician’s primary practice.

  • Display Information Prominently: Post the delegating physician’s name and Texas medical license number in all public areas and treatment rooms.

  • Staff Identification: Ensure all staff members wear identification badges displaying their name and credentials.

These measures are designed to provide patients with clear information about the medical professionals responsible for their care.

Clarified Delegation and Supervision Protocols

The TMB consolidated delegation-related rules under Chapter 169 of the Texas Administrative Code (“TAC”), providing clearer guidelines for physician delegation:

  • Documentation Requirements: All delegation must be documented through written standing delegation orders, standing medical orders, protocols, or prescriptive authority agreements.

  • Content of Delegation Documents: These documents must be signed by the delegating physician and include specific instructions, required supervision levels, and plans for addressing patient emergencies.

  • Emergency Consultation Availability: A physician, physician assistant (“PA”), or advanced practice registered nurse (“APRN”) can now serve as the point of contact for emergency consultations in the event of an adverse outcome. However, the delegating physician must still be available to conduct an emergency consultation if necessary.

Physician Qualifications

The TMB rules expressly require physicians to be trained in or familiar with the delegated medical act and able to perform it in accordance with the standard of care. This rule, previously applicable to medical spas, now confirms specifically that it extends to all delegated medical acts, notably impacting IV hydration clinics. This rule follows the trend set by Alabama on providing guidance for proper treatment of IV therapy.

Streamlined Regulations for Alternative Medicine

The TMB significantly streamlined its rules for complementary and alternative medicine. Under Chapter 171 of the TAC, alternative medicine is defined as methods of diagnosis, treatment, or interventions that are not considered as conventional treatment or medicine and may or may not be regulated by the Food and Drug Administration (“FDA”). Conventional medicine is defined as methods of diagnosis, treatment, or interventions are generally considered routine treatments and medicine by the majority of licensed physicians. Examples of what is commonly considered alternative medicine are homeopathy, naturopathy, herbal remedies, acupuncture, massage, magnet therapy, and other holistic or non-traditional therapies. Complementary medicine is the use of a combination of conventional medicine and some form of alternative medicine. 

The updated rules aim to provide clearer guidelines for physicians offering complementary medicine and alternative medicine treatments, including the requirement for informed consent. Health care providers should note that the TMB will be issuing a standardized disclosure and consent form that must be used by practices offering these services. This form is intended to ensure patients are fully informed about the nature of alternative treatments, including potential risks and the lack of conventional medical validation in some cases.

Action Steps for Health Care Providers

To comply with these new regulations, health care providers should:

  1. Review and Update Policies: Ensure that all operational policies reflect the new transparency and delegation requirements.

  2. Implement Required Signage and Identification: Display the necessary physician information and ensure staff wear appropriate identification.

  3. Update Delegation Documentation: Prepare and sign updated delegation documents that meet the new standards.

  4. Prepare for Alternative Medicine Consent Forms: Stay alert for the forthcoming standardized disclosure and consent form and integrate it into practice protocols upon release.

Final Thoughts

At is core the baseline requirement to establish practitioner-patient relationship by conducting a good faith exam must be still conducted by a physician, PA, or APRN. These practitioners should be trained in or familiar with the delegated medical act and able to perform it in accordance with the standard of care. These comprehensive changes reflect the TMB’s effort to modernize health care regulations in Texas while maintaining patient safety standards. With the TMB’s updated rules now in effect, medical spas, IV hydration clinics, and alternative medicine providers must take proactive steps to ensure compliance. Failure to meet the new transparency, delegation, and supervision standards could lead to disciplinary action.

ByrdAdatto Can Help You Understand Changing TMB Rules

At ByrdAdatto, we will continue to monitor regulatory changes and provide updates on new TMB rules. Our legal team can assist with questions you may have about TMB law. If you need guidance on how these new rules affect your practice, contact ByrdAdatto.

ByrdAdatto founding partner Michael Byrd

Michael S. Byrd

As the son of a doctor and entrepreneur, ByrdAdatto attorney Michael S. Byrd has a personal connection to both business and medicine.