Utah Makes Med Spa Recommendations to Lawmakers
By Patrick O’Brien, JD, American Med Spa Association (AmSpa)
Recently the Utah Office of Professional License Review (OPLR) conducted a presentation identifying issues and making recommendations on medical spa regulations. The presentation is available as a PDF. These recommendations include changes to scope of practice, supervision, and training. Before we review what was in the presentation, it is important to keep in mind that these are just recommendations at this time. The OPLR is a policy analysis group that supports law makers providing research and recommendations. They do not have any regulatory authority, and Utah practices can continue under the existing rules they are using now. But these recommendations may be influential for future changes in Utah and may influence other states as well.
Utah, unlike many other states, already has laws on who may perform cosmetic medical procedures and what supervision is required. These were originally passed in 2012 under a bill known as SB 40. Since that time, minor changes have been made but the basic structure remains. Utah’s rules divide providers into two groups, with Group “A” being able to perform most non-ablative treatments and Group “B” being more limited in scope and generally requiring closer on-site supervision. Supervision can be provided by physicians or advanced practice registered nurses (APRN). And these supervising practitioners must conduct an in-person evaluation and develop a treatment plan before delegating the treatment to another.
The OPLR presentation addressed issues related to the expansion of services offered in medical spas, concerns over lack of medical director oversight, unclear rules on scope of practice, and patient safety from compounded medications. The presentation also addressed uncertainties in who may perform minor surgical procedures and minor cosmetic procedures. These serve as the foundation for the OPLR’s other recommendations. In this presentation “minor surgical procedures” are those that only require local or topical anesthesia or minimal sedation and have lower risk and do not require post operative hospitalization. Physician assistants (PA) and APRNs can perform minor surgical procedures but may only assist with surgical procedures.
Minor cosmetic procedures are defined as a subset of minor surgical procedures and are characterized as being performed to enhance or alter appearance only requiring none or topical anesthesia and does not excise or implant tissue or alter below the subcutaneous layer. This category of procedures can be delegated to registered nurses (RN), licensed practical nurses (LPN), and master estheticians under the supervision of a physician, PA, or APRN. Under these recommendations, unlicensed medical assistants would be unable to perform these procedures.
The presentation goes on to define a medical spa as a facility that offers 1) minor cosmetic medical procedures, 2) cosmetic injections, and 3) wellness injections. Cosmetic injections include neuromodulators like botulinum toxin and dermal fillers like hyaluronic acid. Wellness injections are a broader category that include fluids, nutrients, hormones, peptides, medications, blood or blood derivatives that are sought by the patient to improve temporary wellness or symptoms of discomfort. The supervision and delegation framework presented by the OPLR is significantly simplified from Utah’s current rules. Under the recommendation, all three categories of treatments require a physician, PA, or APRN to perform a patient evaluation and create an induvial treatment plan before delegating the treatment to others. Cosmetic and wellness injections can only be delegated to RNs. For cosmetic injections, the supervisor may be off-site and located within 60 minutes or 60 miles of the RN’s practice site, (“general supervision”). However, the RN must be under on-site supervision when performing wellness injections. Minor cosmetic procedures can be delegated to RNs, LPNs, and master estheticians. RNs and master estheticians can be under general supervision, but LPNs require the supervisor to be present and available for face-to-face communication when the procedure is performed.
This OPLR presentation mirrors some of the trends we have seen in other states. Over time the concept of what a “medical spa” is has expanded, with many offering a wider variety of treatments and procedures. Many states are finding that their rules that addressed only injectables and laser treatments from 10-15 years ago have become inadequate. Many states also appear to be moving away from complex and detailed rules covering who can do what specific treatment and instead are embracing more general rules with broad delegation and supervision concepts. These are not only easier to understand and follow but can more easily adapt to new and emerging treatments and procedures.
I want to reiterate that these recommendations are not official and Utah rules have not changed. Whether or not these OPLR recommendations are implemented remains to be seen. But they do give us insight into what Utah legislators are seeing and how future legislation and rules may be directed. Utah practices do not need to make any changes based on this presentation, but they may want to review their practices for compliance with current laws. Utah providers will also want to keep an eye on new bills that get introduced or rules proposed that may seek to implement these recommendations.
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