Texas House Bill 3749 (HB 3749), known as "Jenifer's Law," has undergone dramatic revisions since its introduction. What began as a bill that could have shuttered many IV hydration clinics has transformed into legislation that may actually reduce regulatory restrictions on the industry.
The bill passed both the House and Senate by large margins and currently awaits Governor Greg Abbott's signature. Given the near-unanimous legislative support, passage appears virtually certain.
The bill would take effect September 1, 2025, giving clinics approximately three months to prepare for compliance.
Why "Jenifer's Law"?
The bill was prompted by the death of Jenifer Cleveland in July 2023 after receiving an IV infusion at a Wortham, Texas medical spa. An investigation by the Texas Medical Board revealed concerning practices: an absent medical director based 100 miles away, lack of protocols, and treatment administered by an unlicensed individual.
This incident prompted Rep. Angelia Orr to introduce HB 3749 to the Texas legislature on March 4, 2025.
The Evolution of HB 3749: What Was Originally Proposed
The original version of HB 3749 would have imposed sweeping new requirements that threatened many IV hydration clinic business models:
- Classifying medical spas as medical settings
- Requiring posted notices when physicians are not present
- Mandating medical directors for all facilities performing cosmetic procedures
- Establishing standards of eligibility for medical directors and providing minimum duties for medical directors
- Prohibiting a physician from delegating the performance of cosmetic medical procedures, unless the physician has completed sufficient training to personally perform the procedure and to understand when the procedure is appropriate
- Requiring physicians to perform initial assessments and written treatment plans, before the physician is permitted to delegate the performance of the procedure
- Most concerning: Requiring supervising physicians to be immediately available on-site and able to respond in person
- Increasing training standards for individuals that are permitted to perform cosmetic procedures, by establishing that drug and device manufacturer training as insufficient under the proposed law
Current Texas Medical Board regulations only require physicians to be available for emergency consultation – not necessarily in person. The proposed "in-person" requirement would have likely resulted in the closure of many locations operating with remote medical directors.
What Actually Passed: A Complete Reversal
To the relief of many in the industry, the final version of HB 3749 is vastly different from its original design. Each of the concerning requirements outlined above has been struck from the bill. In a stark comparison to its original design, the final version of Jenifer's Law may actually lessen regulatory restrictions currently imposed on IV therapy clinics.
The most significant change in the final bill is its characterization of IV therapy as "elective" rather than medically necessary treatment.
This shift has profound implications:
Current Law: The Medical Necessity Standard
Under current Texas Medical Board disciplinary rules, physicians may be disciplined for ordering medically unnecessary drugs. Establishing medical necessity requires:
- Patient examination
- Appropriate diagnostic tests
- Formulation of a diagnosis
- Establishment of a treatment plan that will effectively treat the patient's condition
The New Paradigm: Safety Over Necessity
By characterizing IV therapy as "elective," HB 3749 suggests that IV therapy providers may no longer be required to document medical necessity. Instead, the focus shifts to safety:
- Providers may be able to offer prescription drugs selected by patients from a menu
- The key requirement becomes ensuring the selected treatment is safe by clearing contra-indications
- Determining safety may be limited to physical examination and a review of the patient’s medical history
- No diagnosis or proof that the treatment will address a specific medical condition may be required
This is a fundamental shift from treating conditions to providing wellness services based on patient preference.
Delegation Authority Remains Unchanged
Contrary to some news reports, the bill does not mandate that physicians may only delegate IV administration to physician assistants, advanced practice registered nurses, or registered nurses. The bill states that physicians "may" delegate to these professionals, but this doesn't change existing delegation authority under Chapter 157 of the Texas Occupations Code.
Under current law, physicians may already delegate medical procedures to any person with appropriate training, regardless of licensure status.
The Return of "Menu Medicine"?
This development is particularly interesting given the Texas Medical Board's October 2023 statement by TMB President Dr. Sherif Zaafran, who wrote that "medical treatments must be provided pursuant to medical standards, and not based on the patient choosing a treatment from a menu..."
If medical necessity is no longer required under the law, it follows that menu-based IV therapy services may be permitted. IV therapy providers may again market a menu of various vitamin cocktails from which patients can choose their own therapy.
If HB 3749 is signed into law, it will be interesting to see how the Texas Medical Board addresses this law with existing medical standards relating to medical necessity.
What IV Hydration Clinic and Medical Spa Owners Should Do Now
With the bill's passage appearing imminent and a September 1, 2025, effective date, now is the time to prepare for this new regulatory landscape – one that may be more favorable than many anticipated.
Consider these action steps today:
- Review your intake processes: Shift focus from medical necessity to safety screening
- Update consent forms: Reflect the elective nature of treatments
- Revisit your service menu: Consider expanded offerings under the new framework
- Document safety protocols: Ensure robust contraindication screening procedures
- Monitor TMB guidance: Watch for how the medical board interprets these changes. Hendershot Cowart will share any guidance as it becomes available through our blog and social media.
What could have been devastating legislation for the IV hydration industry has instead become a potential opportunity. The shift from medical necessity to elective therapy may open new business models and reduce documentation burdens. However, this dramatic change will require careful navigation as the Texas Medical Board determines how to apply these new standards.
Questions about compliance with HB 3749 and current Texas Medical Board rules? Call (713) 783-3110 or contact us online to schedule a one-hour consultation with a healthcare attorney today.