In Texas, nurse practitioners, beauticians, and other non-doctors cannot own a medical spa, also known as a medi-spa or medical spa. However, a non-doctor can participate in the day-to-day operations of a medical spa through a Management Services Organization (MSO). Equally important, medical practices can only be owned by physicians, with the only exceptions being podiatrists, chiropractors, optometrists and sometimes physician assistants. According to the Occupations Code, Section 1602.251 (c), a cosmetologist is only authorized to perform cosmetology services in a center authorized by TDLR as a cosmetology establishment.
Therefore, if a person performs acts under a beautician license in a place of business, then that company must have a license for a cosmetology salon or specialty salon from TDLR. A person must obtain a cosmetology license before performing a service regulated by the cosmetology statute, including facials, masks, general skin care, etc. See Occupations Code, Section 1602,003 for a specific list of exemptions set out in the cosmetology statute. Many entrepreneurs and non-medical health professionals see an opportunity on the property of a medical spa, but they are uncertain how to proceed.
The fact is that in most US states, services provided by medical spas are considered medical. According to the legal doctrine known as “corporate practice of medicine”, only doctors or corporations owned by doctors can own medical facilities. In addition, only physicians or physician-owned corporations may charge patients' fees for the provision of medical services. If someone with a beautician license works in a doctor's office, the doctor's office must have a beauty salon license.
Failure to operate in accordance with the law could result in significant liabilities for all parties involved, including substantial fines, loss of medical license and penalties related to practicing medicine without a license. To benefit from these liability protections, it is essential that the MSO and medical practice are properly trained and that the MSA be carefully drafted. According to the Occupations Code, Section 1602.003, if a cosmetology service is within the scope of practice of a nursing license, then nurses are not required to have a cosmetology license. The bottom line is that in many states a “medical director” must be the owner of the medical spa, not simply an employee or contractor.
The sobering reality of the Botox arrest is this: Orange monkeys are not reserved only for MedSpas who do not comply with the rules that mutilate or kill a patient. While that definition is technically accurate, it hides the point that because medical spas offer medical services they are considered medical practices in Texas and must comply with the rules and regulations that apply to traditional doctor's offices. Recently AMSpa has received many emails and calls telling us that they have been informed that in Texas people without licenses can own medical spas and simply hire a medical director. Management fees cannot be percentages of medical office bills; instead fixed fee structures are ideal; however it can be difficult to assess the value of management services when office success is difficult to predict.
In addition to providing aesthetic cosmetic treatments common in many spa settings, medical spas provide services that cross into the practice of medicine. We also wanted to take this time to review the rules governing delegation of non-surgical medical cosmetic procedures in Texas. To clarify: if you are a nurse (or any other non-doctor) you cannot open your own medical spa; you must have an associated doctor with your medical spa. For example tanning and permanent makeup are regulated services by the Texas Department of State Health Services and medical laws are regulated by the Texas Medical Board.
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