Texas Medical Board Proposes Changes to Rule 193.17

December 6, 2019

In mid-October, the Texas Medical Board (“TMB”) voted to officially propose a set of changes to Texas Administrative Code Rule §193.17—the rule that provides guidance of the delegation of nonsurgical medical cosmetic procedures. However, the TMB chose not to publicly disclose the version it approved for publication at the meeting. Instead, the TMB waited for their publication in Texas Register to release them. The November 8 issue of Texas Register contains the TMB’s proposed rule changes (starting on page 6669).

In addition to a few major changes, these proposed rules make a number of minor adjustments in terminology and structure, such as removing the use of the term “midlevel” and relocating key terms under a “definitions” section. The proposed version maintains the status quo on supervision and to whom the physician may delegate. It still permits physicians to delegate to both licensed and unlicensed people, provided they are “qualified and properly trained.” Similarly, the proposed rules still require that supervision be provided by an advanced practice registered nurse (“APRN”) or physician assistant (“PA”) who is onsite or by a physician who may be offsite. Additionally where the current rule requires that the physician be available for emergency consultation, the proposed rule would require the physician’s “immediate availability…for consultation.” In practice this may be very similar to the current requirement. However, the proposed language does clarify that supervision does not require direct observation, and would require the physician to secure an alternate supervising physician if they are unable to provide the required supervision.

The proposal’s significant addition to the current rules is a requirement that the physician notify the TMB of their intent to delegate and supervise medical spa-type procedures. This notification would be made on a board-supplied form and would include:

  • Information on the business’s owner, location, and phone number;
  • A list of all PAs, APRNs, and qualified persons who will be performing procedures; and
  • The name and license information of the supervising physician.

This document would need to be updated within 30 days of changes, additions, or terminations. The proposed rules go on to state that all physicians who delegate and supervise procedures are responsible for ensuring compliance with all applicable rules and laws, and violations are grounds for discipline.

It is important to remember that this initial Texas Register publication is only proposing the changes; they are not yet official or final. For 30 days following the initial publication, members of the public can submit comments and feedback. At the end of the 30 days, the TMB, at a public hearing, will vote on whether to formally adopt the changes as they are currently written or to make modifications as a result of public comments. A subsequent publication in the Texas Register would be needed to formally adopt the changes.

If you have any questions on Texas medical delegation requirements or would like to know more about medical delegation and supervision generally, please schedule a consult at info@byrdadatto.com.

ByrdAdatto attorney Patrick O'Brien

Patrick O’Brien

Patrick O'Brien focuses on state and federal health care laws and regulations, and legislative developments primarily for the aesthetic industry.