New Jersey Board Votes to Move Forward with New Delegation Rules
Tuesday, June 18, 2019
The New Jersey Board of Medical Examiners voted at its June 12 meeting to approve for publication new rules for the delegation of cosmetic medical procedures, including lasers, injectables and intense pulsed light (IPL). (Click here to download a PDF featuring the changes.) It is important to understand that these rules are not officially adopted yet—the board has only approved this version to be published in a future edition of the New Jersey Register. Once published in the Register, these rules will be in a period where the public can give feedback and possible revision can occur prior to official adoption. If these proposed rules are adopted in their current forms, they will provide physicians in New Jersey much more flexibility to delegate common medical spa procedures to other licensed health care professionals.
These rule changes have been something of an ongoing saga. Official changes were last offered back in 2015 but never formally adopted. Under the current rules, physicians are extremely limited in what and to whom they may delegate. As it stands, using all types of lasers and IPL are considered to be the practice of surgery, and these procedures may only be administered by physicians or podiatrists. This includes both ablative and non-ablative procedures. Injecting medications such as fillers or toxins may be delegated to properly trained and supervised physician assistants (PAs) or nurse practitioners (NPs). Only deep heating procedures using technologies such as ultraviolet (UV), ultrasound and microwave can be delegated to a wider range of health care professionals, including physical therapists, registered nurses, licensed practical nurses, chiropractors and athletic trainers, in addition to PAs and NPs.
The new version of the proposed rules provides delegation guidelines for four groups of procedures.
- “Treatment modalities” including UV, ultrasonic, microwave and other deep heating treatments;
- Lasers, IPL, infrared and radio frequency procedures for both hair removal and skin treatment;
- Injection of fillers and neuromuscular blockers; and
- Procedures affecting the epidermis, including microdermabrasion and epidermal peels.
The first group, referred to as “treatment modalities,” are still delegable to the same list of licensed health care professionals as contained in the current rules. After the physician has examined the patient and determined the appropriate treatment, the administration of the treatment can be delegated to the licensed person who has appropriate training and skill, as long as the physician provides proper supervision.
The major changes com in the second and third procedures groups. The second group, which includes lasers, and the third group, which includes injections, can be delegated to a PA or registered professional nurse. The physician will need to take a medical history, perform a physical examination and develop a treatment plan prior to performing the procedure. The physician can delegate performing the exam and taking the history to the PA or registered professional nurse as long as the physician reviews the results. When physicians delegate these procedures, they will need to provide onsite supervision for the registered nurses, but for PAs, they can provide offsite supervision as long as they are reasonably close and available to electronically communicate.
The fourth group—covering peels, microdermabrasions and other epidermal procedures—has two levels of delegation. For superficial chemical peels and microdermabrasion, the physician can delegate to appropriately trained individuals who are not required to hold a particular professional license. The procedure can be performed only after a medical history is taken, a physical exam is performed, and a treatment plan is developed. The physician can only delegate procedures that affect the subcutaneous layer or dermis to a PA. The physician can provide offsite supervision to the PA as long as he or she is in reasonable proximity and able to be contacted through electronic means.
While these rules allow for much more flexibility in the delegation of common medical spa procedures, providers cannot begin implementing them yet—they are only in the proposal stage, so for now, New Jersey medical spas are still governed by the current statues and rules. We will be monitoring these proposed rules as they work their way to formal adoption.