# Texas MedSpa Business Facts

## Executive Summary
Texas is one of the most strictly regulated states for operating a MedSpa. The state relies heavily on strict Corporate Practice of Medicine doctrines forcing laypersons into MSO structures. More importantly, Texas Medical Board Rule 193.17 dictates rigid, non-negotiable steps regarding the initial examination and delegation formatting required before an RN or Esthetician can touch a patient with a laser or needle.

**Difficulty Rating:** Hard

## 1. Ownership Rules & CPOM
- **The Core Rule:** Texas strictly enforces the Corporate Practice of Medicine (CPOM). Non-physicians are prohibited from owning a medical practice, employing physicians to practice medicine, or sharing in the direct profits of clinical care.
- **Corporate Structures:** A clinic offering medical aesthetic services must legally operate as a Professional Association (PA) or a Professional Limited Liability Company (PLLC) owned exclusively by a Texas-licensed physician.
- **The MSO Model:** Entrepreneurs, marketers, and RNs who wish to build a MedSpa business must utilize the Management Services Organization (MSO) model. The non-physician owns an LLC that leases operations to and contracts with the physician-owned PLLC via a formal Management Services Agreement (MSA).
- **Fee-Splitting:** The MSO cannot be paid a direct percentage of the medical clinic’s revenue. Management fees must be established at a fair market value (FMV) transparent rate.

## 2. Everyday Clinical Operations & TMB Rule 193.17
The Texas Medical Board (TMB) regulates nonsurgical medical cosmetic procedures (lasers, IPL, Botox, dermal fillers) explicitly under **Rule 193.17**.
- **The Exam Requirement:** Firing a laser or injecting a filler is practicing medicine. Before a delegate (like an RN or an MA) performs a procedure, the delegating physician (or mid-level PA/NP acting under agreement) MUST physically evaluate the patient (or do so via compliant telemedicine).
- **Written Orders:** The evaluating provider must then issue a specific written order for the procedure prior to the RN or esthetician executing it.
- **Ongoing Supervision:** The facility must have maintained written protocols. The Medical Director must supervise the quality of care, which requires periodically reviewing a sample of patient charts.

## 3. Key Challenges & Common Pitfalls
- **Skipping the Initial Exam:** The most frequent trap in Texas is an RN "clearing" and injecting a new patient without the physician or a PA/NP having examined them and written an order first. This violates TMB Rule 193.17 and can result in license suspension.
- **Esthetician Injections:** Allowing a basic esthetician to inject dermal fillers.
- **Breach Ignorance (250+ Rule):** Scaling MSOs failing to realize that under Texas law, a CRM data breach affecting just 250 Texans mandates immediate disclosure to the Texas Attorney General, triggering expensive state audits.
- **Improper MSO Structure:** Drafting an MSA where the non-physician effectively hires and fires the clinical staff or dictates medical supply brands.

## 4. Timeline & Costs
- **Legal Setup:** Proper MSO agreements, professional entity formation, and drafting clinical protocols tightly aligned to Rule 193.17 take time. Expect 3 to 6 months to establish the complete legal framework.
- **Costs:** Legal setup fees for establishing the MSO, PA structure, and outlining precise delegation protocols typically range from $12,000 to $20,000.