Massachusetts Medical Spa Task Force Report

Massachusetts has just delivered it's Medical Spa Task Force Report: Download it here as a PDF.

MA has launched a multi-party task force to recommend legal and oversight requirements for medial spas, skin clinics, laser clinics and for IPL and laser treatments.


In recent years a new type of business enterprise has emerged, one that mixes traditional salon
treatments, like hair and nail care, with medical procedures like Botox B injections and laser skin  treatments. These so-called "medical spas" have proven popular with an aging population of baby
boomers and others seeking an expanded menu of services to enhance beauty, "restore" youth and improve self-esteem.

The International Spa Association reports that the number of medical spas in the United States grew
from 472 to 976 between 2004 and 2007, a 105% increase in just three years. No figures specific to
Massachusetts are available, but there is no reason to think that the growth of medical spas here is any
different from the growth nationally.

Medical spas combine many different licensed professions under one roof. This presents regulators
with the distinct challenge to create a regulatory structure that respects consumer demand and the free
market, but still holds p;blic safety as paramo;nt. How can the ~immonwealthe nsure that patients
receive treatment of whatever form only by professionals who are properly trained and licensed?
In the spring of 2006, Senator Joan Menard introduced legislation to create a task force to study this
issue. The bill, which was enacted as Chapter 81 of the Acts of 2006, provided for a Task Force
composed of representatives of the separate Boards of Registration in Cosmetology, Electrology,
Nursing and Medicine, as well as dermatologists, plastic surgeons, nurses and consumers.

The Task Force first met in November 2006, and began its work by conceptualizing the issue as a matter of determining three factors:

  • What procedures are at issue?
  • Who may perform these procedures, and under what conditions and supervision?
  • Where may these procedures appropriately be performed?

The Task Force heard from representatives of the spa industry and device manufacturers and received
overviews of the current regulatory environment from the various Commonwealth Boards of Registration. The Task Force also reviewed information from national organizations involved in the
industry and articles from the medical literature and surveyed what other states have done in this area.
At the conclusion of this fact-finding process, the Task Force set about addressing the three guiding
questions above.

A list of procedures, both traditional salon treatments and medical procedures, was developed, and the
Task Force adopted a three-tiered system of classification based on risk to the patient. Level I
procedures were defined as those strictly cosmetic in nature, such as hair and nail care. Procedures that
met the definition of the practice of medicine or nursing and that must be performed by a licensed
physician, or a nurse in collaboration with a physician, were classified as Level 111. Those procedures that are of an intermediate nature -laser hair removal, for example - are classified as Level 11, and the ; Task Force recommends a level of training for licensed professionals performing such procedures and defines the appropriate supervision for each. As a general matter, most Level I1 procedures would require a registered nurse or advanced practice nurse to perform them, although electrologists could
perform laser hair removal, for example. Recognizing that new procedures and devices used in medical
spas are being developed almost monthly, the Task Force also recommends creating a standing
advisory committee to periodically review new technologies and procedures and determine how they 4
should be classified and what level of training and supervision should be required for those licensed
professionals performing them.

Having thus determined the "what" and the "who," the Task Force next considered the "where,"
meaning what type of facility is appropriate for medical spa procedures and how those facilities should
be regulated. Ultimately the Task Force concluded that medical spa facilities should be licensed by the
Department of Public Health (DPH) in a manner similar to the way DPH licenses medical clinics.

nonmedicalOther facility-based issues were addressed, including segregation of medical procedures from procedures, ownership models and requirements, employment of clinical directors and the sale
of goods.

The recomme'ndations of the Task Force include draft legislation that defines various terms developed
by the Task Force to describe medical spa regulation. It includes authorization and direction to DPH to
license medical spas for renewable terms of two years, similar to clinic and nursing home licensure
already performed by the Department. The legislation also sets forth requirements and restrictions for
medical spa ownership, staffing and inspection.

Much of the detail for medical spa licensure and operations would be further defined by regulations to
be promulgated by DPH. The legislation includes authorization to the DPH Commissioner to issue
such regulations, and the Task Force report includes guidance for the Commissioner regarding what
the Task Force would expect the regulations to contain.

The Task Force also recommends creation of a new Board of Registration of Aestheticians, and
charging that Board with the responsibility of regulating the prof;tssion. Currently aestheticians are
licensed by the Board of Registration in Cosmetology, but during its deliberations the Task Force
concluded that the skin care practiced by aestheticiis was sufficiently distinct from the hair and nail
care performed by cosmetologists as to warrant a licensing board specific to aestheticians and their

Other recommendations include changes to Board of Registration in Medicine policies to no longer
classify laser hair removal as the practice of medicine, and to eliminate a ban on the sale of goods from
physicians' off~ces.

The Task Force hopes this report and its recommendations will serve as a model, not just for the
Commonwealth, but for other states, to establish a comprehensive, coherent and regulatory structure
for medical spas.

One final note: the Task Force agreed early on that its recommendations would be a matter of
consensus among the members, each of whom represent different professions, regulatory boards and
points of view. Throughout its deliberations, a remarkable unity of purpose, commitment to patient
safety and thoughtful - not overbearing - regulation was the common goal. The Task Force was, !<>
O however, unable to reach consensus on two issues: creating a new Board of Registration in Aesthetics
and a new Advanced Aesthetician license (see Recommendations 6 & 7). The Board of Registration in Cosmetology, which currently licenses and regulates aestheticians and their practice opposes creating a
new licensing board, believing it to be unnecessary, duplicative and potentially harmful. While the
Cosmetology Board has indicated support for an advanced aesthetician license in the past, it has not
yet voted to create one, and the Board's Task Force members opposed the education and training $7
requirements recommended in this report. A majority of the Task Force and most, if not all, of the
dozens of licensed aestheticians who regularly attended Task Force meetings, respectfully disagree.
The Board of Registration in Cosmetology intends to file separate comments on these matters with the
legislative committees designated by Chapter 81 to receive this report.