The Texas Medical Board (TMB) has enacted sweeping changes to its rules, effective January 9, 2025, significantly impacting medical spas, IV hydration clinics, and various healthcare facilities across the state. These regulatory updates introduce new compliance obligations, enhance transparency requirements, and reinforce the importance of physician supervision. Understanding these changes is critical for healthcare providers to avoid penalties and maintain compliance with TMB regulations.
Latest Texas Medical Board Regulations in 2025
1. Non-Surgical Medical Cosmetic Procedures Now Clearly Defined as Medical Practice.
Under §169.25 of the Texas Administrative Code, non-surgical medical cosmetic procedures are now explicitly recognized as the practice of medicine. These procedures must be properly delegated and supervised, ensuring that only trained professionals perform them under appropriate oversight.
2. General Standards for Delegating Tasks.
The new §169.26 replaces section (d) of the previous Rule §193.17, covering the general standards for physician delegation. Physicians must ensure that any personnel to whom they delegate tasks have appropriate training and a signed, written protocol is in place. Additionally, physicians themselves must be trained in any procedure they delegate. Before delegation, a physician, physician assistant (PA), or advanced practice registered nurse (APRN) must:
- Establish a practitioner-patient relationship;
- Create and maintain medical records for the patient;
- Disclose who will be performing the delegated act and their credentials;
- Ensure that at least one individual with basic life support training is present on-site; and
- Be available on-site or immediately for emergency consultation, and be able to conduct an emergency appointment if necessary.
3. Delegating Physician’s Responsibilities for Written Orders.
Under §169.27, physicians delegating medical procedures must use written orders that align with the former “written protocols” required under §193.17. These orders must:
- Be developed, reviewed, and approved by the delegating physician;
- Identify the delegating physician;
- Establish criteria for screening patients; and
- Describe appropriate care and procedures for handling injuries, complications, or emergencies.
4. Enhanced Notice and Identification Requirements.
Transparency remains a priority with the adoption of §169.28, which mirrors a provision of §193.17. Facilities must prominently display the names of delegating physicians and the mandatory complaint notification required by §177.2 in public areas and treatment rooms. Additionally, all personnel performing delegated medical acts must wear name tags identifying their name, license, or credentials.
5. Updates to Complementary and Alternative Medicine Regulations.
For practices offering complementary and alternative medicine services, the TMB will soon require the use of a standardized disclosure and consent form. This measure aims to improve patient understanding and ensure providers adhere to proper documentation practices.
6. Ketamine Treatment Oversight.
The TMB maintains its strict stance on ketamine treatments, regulating its use under office-based anesthesia rules. However, the Board has announced plans to review regulations related to low-dose ketamine for emerging therapeutic uses following the current Texas legislative session.
7. Changes to Medication Dispensing Limitations.
Physicians are no longer restricted to dispensing medications in amounts that only meet a patient’s immediate needs (72 hours). However, despite the removal of the previous TMB rule, Chapter 158 of the Texas Occupations Code still prohibits physicians from dispensing medications beyond a patient’s immediate needs, with limited exceptions.
Will Your Practice Need to Make Changes?
These regulatory changes bring both challenges and opportunities for healthcare providers. While the new rules are simpler and easier to understand, your practice may still need to make adjustments. If your current policies complied with Rule §193.17, they likely align with Rule §169, requiring only minor updates. However, if any of these changes seem unfamiliar, a more substantial review may be necessary.
This is an excellent time to reassess your policies and procedures to ensure compliance and improve clarity. Navigating the complexities of compliance can be daunting, but failure to do so could put your license and practice at risk. At Nichols Weitzner Thomas LLP, we specialize in helping healthcare professionals adapt to regulatory changes, mitigate risk, and ensure full compliance with TMB rules.
