2025 -- H 5351

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LC001015

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2025

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A N   A C T

RELATING TO HEALTH AND SAFETY -- MEDICAL AESTHETIC PRACTICES SAFETY

ACT

     Introduced By: Representatives Baginski, Bennett, and Casey

     Date Introduced: February 07, 2025

     Referred To: House Health & Human Services

     It is enacted by the General Assembly as follows:

     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

amended by adding thereto the following chapter:

CHAPTER 104

MEDICAL AESTHETIC PRACTICES SAFETY ACT

     23-104-1. Short title.

     This chapter shall be known and may be cited as the “Medical Aesthetic Practices Safety

Act”.

     23-104-2. Definitions.

     As used in this chapter, the following words and terms shall have the following meanings

unless the context clearly indicates another or different meaning or intent:

     (1) "Advanced practice registered nurse" or "APRN" as defined in § 5-34-3.

     (2) "Advanced practice registered nursing" as defined in § 5-34-3.

     (3) "Certified nurse practitioner” or “CNP” as defined in § 5-34-3.

     (4) "Cosmetic medical procedure" means any medical procedure that does not require

sedation that is performed on a person and is directed at improving the person’s appearance and

does not meaningfully promote the proper function of the body or prevent or treat illness or disease.

Cosmetic medical procedures may include, but are not limited to, cosmetic surgery, microneedling,

hair transplants, cosmetic injections such as soft tissue fillers and neurotoxins, dermaplaning,

dermastamping, dermarolling, dermabrasion that removes cells beyond the stratum corneum,

chemical peels using modification solutions that exceed thirty percent (30%) concentration with a

pH value of lower than 3.0, laser hair removal, laser skin resurfacing, laser treatment of veins,

platelet-rich plasma, platelet-rich fibrin, sclerotherapy, other laser procedures, intense pulsed light,

intravenous therapy, radiofrequency, and vitamin infusion.

     (i) Subject to the provisions in § 23-104-2(e), the performance of cosmetic medical services

shall be performed by a qualified licensed physician, PA, or APRN or by a qualified non-physician,

non-PA, or non-APRN only if the services have been delegated by a physician, PA, or APRN who

is responsible for supervision of the services performed.

     (6) "Department" means the Rhode Island department of health.

     (7) "Medical aesthetics practice" means an establishment in which cosmetic medical

procedures are performed. A medical aesthetics practice may operate as a licensed healthcare

facility pursuant to the provisions of chapter 17 of title 23, an organized, ambulatory-care facility

owned and operated by professional services corporation pursuant to the provisions of chapter 5.1

of title 7, a practitioner’s office or group of practitioner’s offices (whether owned and/or operated

by a hospital or an affiliate of a hospital or an individual practitioner, alone or as a member of a

partnership, professional service corporation, organization, or association). Nothing in this chapter

shall affect or modify the definition of “healthcare facility” in § 23-17-2.

     (8) "Physician" means a person with a license to practice medicine as defined in § 5-37-1.

     (9) "Physician assistant" or "PA" means a person who is qualified to provide medical

services in collaboration with physicians as defined in § 5-54-2.

     (11) “Registered nurse” or “RN” means a person licensed to practice nursing in the state

as defined in § 5-34-3.

     (12) "Supervision" means an arrangement when a qualified supervising physician,

physician assistant, or APRN is either:

     (i) On site at the treatment location, though not necessarily in the same room (i.e., direct

supervision); or

     (ii) Is off site, but immediately available if needed, either in person or by

telecommunication (i.e., indirect supervision).

     23-104-3. Protection of patients in a medical aesthetics practice.

     (a) Each medical aesthetics practice shall be owned by, employ, and/or contract for the

services of:

     (1) A licensed physician;

     (2) A licensed physician assistant; or

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     (3) A licensed advanced practice registered nurse. Each such physician, physician assistant

or advanced practice registered nurse shall be actively practicing in the state; and have received

education or training from an institution of higher education or professional organization to perform

cosmetic medical procedures and have experience performing such procedures. Any cosmetic

medical procedure performed at a medical aesthetics practice shall be performed in accordance

with the provisions of this chapter, and, subject to the provisions in subsection (e) of this section,

shall only be performed by such physician, physician assistant, advanced practice registered nurse,

or delegated to and performed by a qualified non-physician, non-PA or non-APRN under the

supervision of a physician, physician assistant, or advanced practice registered nurse.

     (b) A physician, PA or APRN who performs cosmetic medical procedures or supervises

such procedures delegated to and performed by a non-physician, non-PA or non-APRN shall be

trained in the indications for and performance of the cosmetic medical procedure.

     (c) The supervising physician, PA or APRN shall:

     (1) Perform an initial assessment of the patient.

     (2) Prepare a written treatment plan for each patient, which plan shall include, as

applicable, diagnoses, course of treatment, and specifications for any device being used.

     (3) Obtain patient consent and, if the cosmetic medical procedure(s) are being performed

by a non-physician, non-PA or non-APRN and document, in the patient’s medical record, the

credentials and names of the non-physician, non-PA or non-APRN who will be performing the

cosmetic medical procedure.

     (4) Create and maintain medical records in a manner consistent with applicable laws and

regulations and accepted medical practice.

     (d) Subject to the provisions of subsection (e) of this section, qualified non-physicians,

non-PAs and non-APRNs shall only perform cosmetic medical procedures:

     (1) For which they have the requisite experience, certificates as applicable, and a minimum

of twenty (20) hours of training; and

     (2) Which have been delegated to them by a supervising physician, supervising PA or

supervising APRN.

     (e) Nothing in this chapter shall be construed to prohibit:

     (1) A registered nurse from engaging in the practice of professional nursing as set forth in

chapter 34 of title 5 including, but not limited to, providing cosmetic injections such as soft tissue

fillers and neurotoxins, intravenous fluids, vitamin injections, laser hair removal, intense pulsed

light, laser skin resurfacing, microneedling, laser vein removal, scelerotherapy, and radiofrequency

when such services are delegated by a physician, PA, or APRN and supervised by a physician, PA

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or APRN pursuant to this chapter;

     (2) A licensed esthetician from engaging in the practice of esthetics as set forth in chapter

10 of title 5 including, but not limited to, chemical peels using modification solutions that do not

exceed thirty percent (30%) concentration with a pH value of lower than 3.0, radio frequency,

intense pulsed light, and microneedling. Supervision and delegation as defined in this section are

not required for a licensed esthetician to practice esthetics;

     (3) A licensed dentist from engaging in the practice of dentistry as set forth in chapter 31.1

of title 5 including, but not limited to, cosmetic injections such as soft tissue fillers and neurotoxins.

Supervision and delegation defined in this section are not required for a licensed dentist to practice

dentistry;

     (4) A licensed electrologist from engaging in the practice of electrology as set forth in

chapter 32 of title 5 including, but not limited to, laser hair removal. Supervision and delegation

defined in this section are not required for a licensed electrologist to practice electrology in

accordance with the requirements of § 5-32-21; or

     (5) A licensed tattoo artist from engaging in the practice of tattoo artistry as set forth in

chapter 1 of this title including, but not limited to, inkless stretch mark revision, permanent makeup

artistry, microblading, and saline tattoo removal. Supervision and delegation as defined in this

section are not required for a licensed tattoo artist to practice tattoo artistry.

     (f) Subject to subsection (e) of this section, at all times in the performance of their duties

relative to cosmetic procedures, all providers shall:

     (1) Review and follow written protocols for each delegated cosmetic medical procedure;

     (2) Verify that the supervising physician, supervising PA or supervising APRN, as

applicable, has assessed the patient and given written treatment instructions for each procedure

performed;

     (3) Review the cosmetic medical procedure with each patient;

     (4) Notify the supervising physician, supervising PA or supervising APRN, as applicable,

before the patient leaves or as they become aware, of any adverse events or complications, and

follow up with the patient post-procedure, as appropriate;

     (5) Document all relevant details of the performed cosmetic medical procedure in the

patient’s medical record; and

     (6) As applicable, satisfy any requirements imposed upon them by their licensing boards.

     23-104-4. Rules and regulations.

     The department shall, by January 1, 2026, promulgate rules and regulations necessary and

not inconsistent with law to implement the purpose and intent of this chapter.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY -- MEDICAL AESTHETIC PRACTICES SAFETY

ACT

***

     This act would mandate that all cosmetic medical procedures be performed by a physician,

physician assistant, advanced practice registered nurse, or delegated to a qualified non-physician,

non-PA or non-APRN under the supervision of a physician, physician assistant, or advanced

practice registered nurse trained in the performance of the cosmetic medical procedure.

Specifically, the act would require the supervising physician, PA or APRN to perform an initial

patient assessment, prepare a detailed written treatment plan, and obtain patient consent. The act

would not apply to a registered nurse engaging in the practice of professional nursing, a licensed

esthetician engaging in the practice of esthetics, a licensed dentist engaging in the practice of

dentistry, a licensed electrologist engaging in the practice of electrology, or a licensed tattoo artist

engaging in the practice of tattoo artistry.

     This act would take effect upon passage.

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