A Guide to Med Spa Regulations by State

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With millions of cosmetic procedures being done each year, there’s no wonder that the medical spa industry is a fast-growing sector in the United States. If you want to offer med spa services or own a clinic, you need to follow the guidelines that regulate aesthetic procedures in your state.

So what do you need to know about the state-by-state regulations for med spas? Each state has a medical board that oversees and provides guidelines on how every aesthetic practice should conduct its business. It’s important to review these regulations before starting your own med spa to avoid any penalties or medical malpractice. In this article, we’ve summarized some of the essential rules and regulations for each state.

Basics of a Medical Spa

Nowadays, there are plenty of establishments that offer beauty treatments but not all of them can be considered a med spa. Unlike traditional spas which have dominated the industry for decades, a med spa offers a combination of aesthetic and medical services that are administered and supervised by a professional doctor or board-certified plastic surgeon.

Similar to a day spa, all procedures in an aesthetic medical practice are performed in a relaxing and comfortable environment. The only difference is that these services are more advanced and use medical-grade tools, specialized equipment, and injections which are typically prescribed and thus require physician supervision.

In most states, med spas are owned by a licensed physician who is trained and has an extensive background in aesthetic medicine. However, some states aren’t strict and can allow a physician assistant or nurse practitioner to own their medical spa. In these cases, they’d need to register their business with the medical board or hire their own physicians.

Common Services Provided in a Med Spa

Medical spas can offer a wide range of cosmetic treatments and non-surgical procedures that aim to improve the appearance of the skin. Some of the typical medical spa treatments that you can provide are:

• Injectables like Botox and dermal filler procedures for wrinkles and fine lines
• Laser hair removal
• Laser treatment for tattoo removal and skin resurfacing
• Hair restoration
• Hormone replacement services
• Microneedling and microdermabrasion procedures
• Medical weight loss management
• IV therapies
• Body contouring and non-invasive fat reduction treatments
• Chemical peels
• Medical-grade facials
• Platelet-rich plasma therapies

Owning and Performing Med Spa Services: What You Need To Know By State

Opening a med spa facility involves a lot of processes and you’ll need legal advice to ensure that you are meeting the requirements needed for the business. One of the first steps you need to take is to review your state’s rules and regulations on running medical spa practices. Here’s a guide to help you understand the standard and protocols for medspas in each state:

Alabama

Alabama follows the corporate practice of medicine doctrine which means that only state-licensed physicians have the right to own a medical spa. There’s no exemption to that rule and even hiring a medical director will not be considered a workaround to that regulation.

The state’s medical board also considers all Botox treatments, dermal fillers, and laser procedures as medical treatment. This means that only certified physicians can do the treatment or they should at least be present to supervise the procedure. It’s possible to delegate non-ablative lasers to a nurse practitioner, while ablative treatments should only be done by the doctor. They also require all staff members who use lasers to register with the board.

Alaska

Under Alaska’s law, non-physicians can have their own medical spa provided that they employ a medical director and other licensed doctors to perform the services. They can also have a share in the profits as long as they are considered an owner of the practice.

The state does not require specialized training or background to perform most treatments like Botox and soft tissue fillers, and it can be done by a physician assistant or nurse practitioner. However, for laser treatments, a licensed physician must delegate and supervise the procedure before they can administer it. There’s also no limit as to how many PAs a licensed physician can supervise.

Arizona

In Arizona, state-licensed professionals, physician group practice, and even non-physicians can open a medical spa. They don’t strictly follow the corporate practice of medicine doctrine which means physicians can be employed with other non-physician-owned businesses to provide cosmetic and medical treatments.

When it comes to compensation, the state allows all PAs, NPs, and RNs to be paid a reasonable salary for their duties. However, in accordance with the anti-kickback law, they may not accept any commission in exchange for a referral to provide their services.

California

According to California’s regulations, a medical spa must be owned by a state-licensed physician or practice group and they should hold at least 51% of the clinic’s shares. The remaining 49% may be held by other professional entities such as licensed registered nurses, physician assistants, physical therapists, and medical corporations.

The state also requires that all staff members, including PAs, NPs, and RNs, should be licensed and actively practicing. They should also have obtained higher education or specialized training related to the cosmetic procedures that they offer.

Colorado

In Colorado, there’s no specific license that distinguishes a med spa practice from health care or medical facilities. The practice of medical aesthetics is recognized to be the same as medicine so they can operate without needing a special license. However, the law clearly states that only a licensed medical doctor or physician can form a med spa practice.

Connecticut

The state doesn’t restrict anyone from owning a med spa so even non-physicians can open their practice. However, they should employ a licensed physician, registered nurse, or physician assistant to perform the services. The PAs, RNs, and NPs can also have a share in the profits generated through their medical services or take commissions. Any cosmetic medical procedure in the state of Connecticut is also subject to 6.35% sales and use tax.

Delaware

In Delaware, both physicians and non-physicians can own a medical spa practice and offer aesthetic services. In terms of cosmetic procedures, you may need advanced training in order to administer the treatment. For example, you’ll need to first complete 300 hours of training and acquire the electrologist license in Delaware before performing hair removal.

Florida

While anyone can own a med spa in Florida, the law states that non-physicians can’t receive compensation or profits gained from the use of equipment or services performed by the professional doctor. You may create contracts that will permit the non-physicians to have a share in the practice’s revenues.

Georgia

The regulations state that only physicians can own a medical spa but any facility can still provide cosmetic services such as laser and IPL hair removal provided that they have the equipment. If you’re offering light-based procedures, you need to acquire a laser license and have at least 3 certifications from specialized training courses. For PAs performing cosmetic procedures, they should be supervised by at least one licensed physician. The law also states that an LP should supervise no more than 4 physician assistants at a time.

Hawaii

Any individual with a state license in Hawaii and even non-physicians can own a med spa practice. Under the state’s law, all laser and light procedures, dermal fillers, Botox, collagen injections, spray and airbrush tanning, and microneedling are considered medical treatments.

Typically, PAs, NPs, and RNs do not require special training to perform the procedures as long as they have physician supervision. However, for electrologists, they need to register 600 hours from an accredited electrology school, complete 800 hours of apprenticeship over 6 months, or have 700 hours combined of schooling and practice.

Idaho

Almost all med spas in Idaho are owned by licensed physicians since they are the only ones allowed by the state to open a practice. They also do not allow the employment of physicians in businesses or corporations owned by non-physicians. The services that are considered a medical treatment in Idaho are injectables, microneedling, CoolSculpting, microdermabrasion, and non-superficial ultrasound or radiofrequency therapy.

Illinois

While the state provides the right to own a medical spa to licensed physicians, it also allows NPs to open their practice provided that they have finished training and obtained proper certification. All unlicensed individuals and non-medical doctors may not have share in the ownership and profits generated by the med spa. In terms of sales tax, the state requires a tax of at least 1% on prescription and nonprescription medicines, including Botox injections.

Indiana

According to state regulations, any licensed medical practitioner, healthcare professional, and physician can own and operate a medical spa in Indiana. Individuals who aren’t trained, qualified, or experienced in the practice of medicine can’t run a med spa or contract a medical director. Medical spas should also be registered and authorized by the Indiana Medical Board and Department of State.

Iowa

Medical spascosmetic procedures

Any doctor or medical professional can perform cosmetic treatments but specifically for lasers and electrolysis, it requires that the individual has finished a 425-hour training course in electrology. They should also do 8 hours of continuing education each year to keep their license active.

Kansas

The state of Kansas only allows licensed physicians or a physician group practice to form and operate a medical spa. However, under the special provision of KSA 65-28a13, PAs may also own up to 49% of the practice while there are no restrictions on how much percentage of a business can be owned by NPs. If a practice is found to be violating this regulation, there may be civil penalties of up to $1000 per day.

Kentucky

Under Kentucky law, only licensed physicians, physician group practice, and advanced practice nurses may own a medspa. If you’re a non-physician, you can enter certain contracts or follow the MSO (medical services organization) model prepared by your legal adviser in order to share the profits of the practice.

Some procedures such as Botox injectables are taxed at 6% in the state. Kentucky law also provides that treatments like laser hair removal should be done by a physician who has undergone formal training and completed at least 30 treatments with supervision.

Louisiana

Medical spaselectrolysis services

Maine

Maine lawnon

Maryland

Following the Maryland Board of Physicians, only licensed physicians, physician group practices, and certified nurse practitioners may be able to own a medical spa. The state also establishes that only the physicians can evaluate, prescribe treatment, provide informed consent, and perform the procedure.

Other members of the staff such as PAs, RNs, and NPs may also conduct the treatment provided that they finish the required training from higher education and they are supervised by physicians.

Massachusetts

Under Massachusetts law, non-physicians can also operate a med spa practice as long as they apply for a clinic license from the state’s Department of Public Health. The state clearly defines that all light- and heat-based treatments, injectables, chemical peels, scrubs, and microdermabrasion are medical procedures.

Specialized training is required for electrologists and they should complete an 1100-hour course in an accredited program and earn continuing education credit every 2 years. Aestheticians should also have 30 hours of IPL device training to be allowed to perform laser hair removal.

Michigan

Michigan isn’t particularly strict as to who can own medspas but in cases of non-physicians, it is recommended that they should be set up as a professional services organization or PLLC. They should also not interfere with any medical decisions or physician-patient relationships.

The state also allows PAs, RNs, and NPs to take commissions for certain treatments but they shouldn’t take any in cases of referrals. Most cosmetic procedures can be done by any practitioner without requiring specialized background. However, the law requires electrologists to obtain a license by finishing a 400-hour training course and passing an exam.

Minnesota

State-licensed physicians and nurse practitioners have the right to own a medspa and set up a PLLC in Minnesota. In terms of the medical equipment, there’s no need to get a license to own them except for lasers which require that they should be bought only by a physician. The state also allows any practitioner to perform the treatments and doesn’t require any specialized background as long as they are properly trained and supervised by a physician.

Mississippi

Under Mississippi law, non-physicians can also operate a medspa but for practices that are set up as a PLLC, only state-licensed individuals can be shareholders. The state is also not restrictive in terms of the requirements needed to perform procedures. As long as they have been delegated or supervised by a licensed physician, any PA, RN, NP, or electrologist can provide the specific treatment.

Missouri

In Missouri, only individuals who have active licenses in the state or a physician group practice can start a medspa. Those performing specific procedures such as electrolysis should have an electrologist license. Additionally, any cosmetologist hired by the practice is required to finish 1500 hours of study and an esthetician should complete at least 750 hours.

Montana

Under Montana law, anyone except for non-physicians can start and operate a med spa practice. The state also doesn’t have any strict rules regarding the requirements to perform the treatments as long as the physician has the skill, extensive training, and experience to practice medical aesthetics. However, the law provides that any establishment that violates the corporate practice of medicine may be subject to penalties and possible imprisonment.

Nebraska

Nebraska regulates that all med spas should only be owned by a licensed physician in the state. According to their law, any doctor can perform Botox and soft tissue fillers without any specialized training. For laser procedures, a PA, NP, or RN can also get the job done as long as they are delegated by the physician in a practice agreement. For other services like CoolSculpting or microneedling, a state-licensed physician, PA, or ARNP may perform the treatment.

Nevada

While only licensed professionals can run and own a part of a medspa in Nevada, non-physicians can still have a share in the profits provided there’s a clear contract that permits them to be included in the revenues. Under NRS 454 and 629.086, the state only allows Botox and filler injections to be done by licensed physicians, PAs, properly trained dentists, RNs, ARNPs, and podiatric physicians. There are no specific regulations regarding laser hair removal procedures.

New Hampshire

Anyone can open an aesthetic practice in New Hampshire but there are regulations regarding who can perform certain procedures. For example, only PAs and physicians who are licensed by the state medical board can administer laser treatments. PAs, RNs, and NPs can also provide Botox and facial fillers as long it is in practice agreement with the physician.

New Jersey

Under New Jersey laws, any procedure that affects the body’s living tissue is considered a medical treatment. This can include services like lasers, microdermabrasion, chemical peels, and injectables. The state clearly provides that aestheticians aren’t allowed to perform these procedures and should only be administered by licensed physicians with special training from higher education.

New Mexico

In New Mexico, non-physicians may also organize corporations and provide medical services as long as they employ licensed professionals and a medical director. The medical director’s name should be clearly shown on all advertising posts by the medical spa on social media and discounts on Groupons. While there’s no required training for most practitioners, electrologists are required to finish a 600-hour instruction course before they can perform treatments.

New York

New York provides the right to own a medspa to any licensed physician, physician group practice, and nurse practitioner who has the required certification and training. However, it’s a must that all individuals performing the procedures should have an active state license and have completed training from a higher education institution. ARPNs may practice independently provided that they meet the requirements of the state’s laws.

North Carolina

According to state regulations, businesses that provide medical services should only be owned by licensed individuals. This can include medical doctors, nurse practitioners, physician assistants, certified clinical specialists, and nurse anesthetists. For laser procedures, the attending practitioner should carry a special license and have finished a 600-hour training in electrology from the State of North Carolina.

North Dakota

Under North Dakota law, non-physicians can’t own or have a share in the profits of a medical spa. Most cosmetic procedures like Botox, dermal fillers, and lasers should also only be done by a licensed physician. There are exemptions for injectables where a PA, NP, and RN can perform the treatment under physician supervision.

Ohio

According to the State Medical Board of Ohio, they no longer prohibit the corporate practice of medicine doctrine and thus Ohio-licensed physicians can be employed by any business or corporation to provide medical treatments. Still, non-medical doctors can’t acquire profits from the spa. The law also states that injectables can be given by PAs, RNs, and NPs, while laser hair removal should be performed by a practitioner with at least 50 hours of training.

Oklahoma

In Oklahoma, anyone can own a medical spa but a licensed physician is the only one allowed to perform the medical services. The state defines what constitutes medical treatments in a medspa and it includes cosmetic injections, laser procedures, chemical peels, abrasion, and cold and heat therapy. Med spas can also hire cosmetologists to provide facials and non-medical services provided that they have an active license in the state.

Oregon

In Oregon law, only licensed physicians, physician group practice, or nurse practitioners can start a medspa. However, under the provision of Or. Rev. Stat. §58.375, non-physicians may also be part of the corporation as a minor shareholder. There’s no specialized background required for performing injectables but an individual must have 600 hours training in electrology and pass the exam from Oregon Health licensing agency to become an electrologist.

Pennsylvania

Under Pennsylvania regulations, a medspa is recognized as a medical practice which means that only licensed physicians can form a business. The state also requires that all individuals performing procedures should have training from a higher education institution and have an active license. The Pennsylvania State Board of Cosmetology also provides that an aesthetician can’t administer lasers even with a supervising physician.

Rhode Island

In Rhode Island, both licensed and non-physicians can become a medical spa owner however, the latter should contract a professional to perform the services. There are some treatments that require special training and certification such as lasers and electrolysis. To become a state-licensed electrologist, individuals should complete a 650-hour instruction course and practice for at least 9 months.

South Carolina

Pursuant to the South Carolina Medical Board, there are no strict restrictions regarding licenses or regulations of corporations and employment of medical directors for a practice. However, licensees should ensure that all non-licensed personnel are properly trained and informed on how to perform delegated tasks and should provide documentation to the Board.

A licensed physician can perform procedures that are within the scope of their education and training. They can attend specialized training courses and have continuing education to demonstrate competency in the treatment. They can also supervise no more than 3 non-physicians in the practice.

South Dakota

The medical spa law in South Dakota doesn’t allow non-physicians to start their own practice nor can they employ a medical director to provide medical care. If a business is found violating the corporate practice of medicine in the state, there may be penalties, fines, and possible suspension of license. Most procedures can be done by a PA, NP, and RN with physician supervision.

Tennessee

Under Tennessee Code Title 46, Ch. 101, Part 6 Section 48-101-610, the right to own and form a medical spa or corporation belongs only to licensed physicians and healthcare professionals including optometrists, podiatrists, and doctors of chiropractic. There are corresponding penalties if a non-physician is practicing in a med spa. The state law also mentions that electrologists should have completed a 600-hour training course in electrology.

Texas

The Texas Medical Board prohibits anyone who is not a physician from forming a medical spa. However, an esthetician or licensed laser technician can own a med spa provided that they only performed laser hair removal services. All laser hair removal devices also require a physician’s order or prescription and must be registered following the §289.302 Registration and Radiation Safety Requirements for Use of Laser Hair Removal devices.

Utah

The Utah state law clearly defines medical treatments as any procedure involving Botox, light and heat devices, collagen injections, and dermal fillers. Any doctor can provide cosmetic injectables without advanced training required. However, for hair removal, a practitioner must show certification to the Utah Division of Occupational and Professional licensing that they have completed a 600-hour training and passed the theory and practical skills exams.

Vermont

Anyone can form and own a medical spa practice in Vermont, however, not any practitioner can perform certain cosmetic treatments. A special license is required for some procedures such as laser and electrolysis hair removal. Electrologists can use laser devices as long as they obtain a special endorsement by finishing a comprehensive LHR course approved by the Director.

The training course should not be fewer than 60 hours and should cover the necessary laser safety topics, principles of LHR, safe operation of devices, and indications and contraindications. They should also have at least 24 hours of hands-on practice and supervised training on actual patients.

Virginia

Under Virginia law, owners of medical spas may be licensed professionals or non-physicians. Any doctor or practitioner can perform cosmetic injectables, however RNs and medical assistants can’t provide such procedures even with a supervising physician. Additionally, under the Virginia HB 2119, only licensed physicians, PAs, or properly trained PAs with supervision can perform laser treatments.

Washington

In Washington, licensed physicians and nurse practitioners have the authority to own a medical spa. The state law also requires practitioners providing laser treatments to have advanced training and certification. It specifically provides that an electrologist should have a general license and completed a 750-hour instruction course and rendered an additional 450 hours for a master license.

West Virginia

Under W. Va. Code §303-14, only state-licensed physicians or physician group practice can start a med spa in West Virginia. The right to perform procedures is given to any licensed doctor with an appropriate background in aesthetic medicine but the law doesn’t require any advanced training. Electrologists aren’t necessarily licensed in the state but they need to pass the American Electrology Association certification in order to be employed and practice.

Wisconsin

Under Wisconsin law, non-physicians are restricted from starting their own medical spa and they can’t have a share in the profits of the practice. Common procedures such as Botox and cosmetic fillers can be performed by any doctor or PAs and NPs. However, a license is typically required to be able to provide electrolysis or use lasers for hair removal. Practitioners can receive their electrologist state license upon completing a 450-hour instruction course.

Wyoming

Under Wyoming law, medical spa practices can be owned by licensed professionals, physician group practice, and non-physicians. The state doesn’t restrict the corporate practice of medicine so doctors can be employed to provide medical care and cosmetic services in non-physician owned businesses. Most procedures can be performed by any licensed physician and practitioner without needing specialized background or training.

Other Things You Need To Know About Med Spa Regulations

Aside from the laws provided by state, the American Med Spa Association (AmSpa) has also released additional guidelines that will help any physician or non-physician owned corporation in the practice of medical aesthetics. Here are some of the other essential things that guide aesthetic medical practices:

1) Requirements for Medical Directors

A medical director is a licensed physician that leads a healthcare or med spa facility and supervises procedures and has the power to delegate treatments to any practitioner. According to AmSpa, a medical director should have the following qualifications:

• Has received proper education, training, experience and demonstrates competence to administer and supervise every medical treatment
• Has the ability to oversee all procedures performed at the med spa
• Must make sure that the med spa’s practitioners are thoroughly trained and qualified to do the services
• Help ensure that the practice is equipped with all the necessary equipment and medical tools
• Must be able to create written protocols for each aesthetic treatment
  

2) Consultation, Diagnosis, and Treatment Plan

Before any cosmetic procedure, an initial examination of the patient is required and should be done by a licensed physician. During the consultation, the doctor will review the client’s medical history and perform a physical assessment of the intended treatment areas.

After examination, the physician will develop a diagnosis and provide a treatment plan provided that the patient has been cleared to be a good candidate for the procedure. The plan will specify the recommended course and timeframe of treatment, as well as instructions on the specific procedure.

Unless stated otherwise by the state laws, the physician may not delegate the examination, diagnosis, and development of a treatment plan to RNs, licensed vocational nurses, nurse practitioners, or medical assistants.

3) Supervision and Delegation

In a medical practice setting, physicians also have the power to assign a patient care task to properly trained and qualified practitioners. This is what is called delegation or the formal process where the doctor transfers the authority to provide treatment to another person. The physician still must make sure that the treatment complies with the standards of medical care.

On the other hand, physicians or any advanced licensee should also practice supervision or monitor the delegated personnel during their procedure. There are two main kinds of supervision:

• General or indirect: The supervising physician is offsite, but is able to provide assistance and monitor the treatment via telecommunication.
• Direct: The supervising physician observes the procedure on site but they’re not necessarily accompanying the practitioner in the same room.

4) OSHA Regulations

Med spaspatient safety

5) HIPAA Law

Med spas should also abide by the rules and regulations provided by the Health Insurance Portability and Accountability Act of 1996. This law is designed to provide patient privacy and helps regulate any electronic transmission or sharing of health information.

For example, the HIPAA regulation must specifically be followed in the use of patient photos on social media. All photographs must be shared after obtaining written permission from the patient and the clinic must protect their client’s identity.

Start Your Med Spa With Quality Tools and Supplies From FACE Med Store

Knowing your state’s regulations is a crucial step in establishing a med spa practice. It’s important to read up on the medical spa laws that govern your area so you won’t encounter any problems or violations in the future.

When you’re finally setting up your business, you can find a trustworthy partner for your supplies in FACE Med Store. We provide a wide range of high-quality medical tools and products to help you with treatments. We also offer educational modules and aesthetic training courses to improve your skill set as a physician or practitioner. Contact us today to know more about products or inquire about how we can help you start your med spa.

All content in this blog is for informational purposes only. It is not medical or legal advice. Please consult with lawyer or a medical professional.

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