The Texas Medical Board has published proposed regulations that will fundamentally reshape how ketamine therapy clinics operate in Texas. Published in the January 2, 2026, Texas Register, these new rules under Chapter 173, Subchapter B establish comprehensive requirements for Psychotropic Ketamine Therapy (PKT) that many current operators will find challenging – and some may find impossible – to meet.
The proposed PKT regulations represent the Board's effort to establish clear standards that prioritize patient safety while allowing legitimate therapeutic use of ketamine for appropriate psychiatric indications.
If you own or operate a ketamine clinic in Texas, or if you're considering starting one, these proposed rules demand your immediate attention.
1. Mandatory Physician Presence Throughout Ketamine Treatment
The proposed rule requires that "the delegating physician must be immediately available onsite for in-person consultation and emergency management throughout the PKT administration."
This isn't a suggestion. This is a hard requirement that eliminates the business model many ketamine clinics currently use – where a physician provides initial authorization but isn't physically present during infusions.
What this means in practice:
- A physician must be physically present in the facility during every ketamine infusion
- The physician must be immediately available onsite for consultation and emergency intervention
- Remote oversight via telemedicine or periodic check-ins will not satisfy this requirement
- Advanced practice registered nurses (APRNs), physician assistants (PAs), and registered nurses (RNs) can administer the therapy, but only with a physician immediately available onsite
The Texas Medical Board is making clear thatketamine administration for psychiatric indications requires immediate physician availability for patient safety.
Many ketamine clinics operate with nurse practitioners or physician assistants providing treatment while physicians remain off-site or available only by phone. This business model – often chosen to reduce overhead costs – will no longer be compliant under the proposed regulations.
2. Required Training in Mental Health or Ketamine-Specific Education
The proposed rule establishes new qualification requirements for physicians ordering PKT. Specifically, physicians must have successfully completed either:
- Training in mental health treatment, or
- A course on the use of ketamine for psychiatric conditions
What qualifies as "training in mental health treatment"?
The proposed rule doesn't specify, creating uncertainty for physicians without psychiatric credentials. Will a family medicine physician's rotation in psychiatry during residency suffice? Does "training" require board certification in psychiatry? Must the training be recent?
These questions will likely be clarified through Board guidance or enforcement precedent, but physicians should assume the Board will expect documented, formal training – not merely general medical education that touched on psychiatric topics.
What about the ketamine course option?
This alternative pathway appears designed for physicians without mental health credentials who want to offer ketamine therapy. However, the rule doesn't specify:
- Course length or content requirements
- Whether the course must be Board-approved or accredited
- How recently the course must have been completed
- Whether continuing education is required
Until the Board provides additional guidance, physicians should seek comprehensive ketamine-specific courses from recognized medical education providers and maintain documentation of completion.
3. PKT Limited to Diagnosed Psychiatric Indications
The proposed rule restricts ketamine administration to psychiatric indications that have been properly documented and diagnosed by a physician, such as:
- PTSD (Post-Traumatic Stress Disorder)
- Treatment-resistant depression
- Suicidal ideation
This represents a substantial narrowing of practice scope for many ketamine clinics. If your clinic currently treats undiagnosed or self-diagnosed mental health symptoms, migraines, or chronic pain, those treatments would no longer be permissible under Texas law.
Physicians will need clear diagnostic protocols and thorough documentation demonstrating that patients have a psychiatric condition supporting PKT.
Registration Requirements and Ketamine Clinic Oversight
The proposed rule establishes mandatory registration for all PKT clinics, with limited exceptions for hospitals, medical schools, government facilities, and Board-certified health organizations.
Registration requirements include:
- Board-approved application and attestation that the requirements, standards, and equipment comply with all applicable laws and board rules
- Two-year registration period
- Renewal at least 60 days before expiration
- Immediate cessation of operations if registration expires
Ongoing compliance obligations:
- Adverse event reporting log maintained for at least three years
- Documentation of any airway intervention, EMS transport, hospitalization, or death
- Subject to audits, inspections, and investigations similar to pain management clinics
Patient Safety and Monitoring Standards
The proposed rule establishes detailed patient monitoring requirements that exceed what many current ketamine clinics provide:
During administration:
- Continuous monitoring of blood pressure, pulse, respiration, O2 saturation, cardiovascular status, and responsiveness
- Pulse oximetry, incremental blood pressure checks, and end-tidal CO2 monitoring required
- Immediate access to supplemental oxygen, bag-valve mask, and AED or defibrillator
Post-administration:
- Minimum 30-minute observation period
- At least two blood pressure readings, 10 minutes apart
- Full cognitive assessment including Aldrete score
Informed consent requirements:
- Discussion of known PKT risks
- Disclosure of identity and licensure credentials of the administering clinician
- "Time out" period immediately before beginning administration
These standards reflect the Board's emphasis on patient safety and recognition that ketamine administration, even at low doses for psychiatric indications, carries meaningful medical risks requiring appropriate monitoring and emergency preparedness.
What Happens Next?
The proposed rules are open for public comment. Healthcare providers, clinic operators, and other stakeholders can submit comments online or via email to the Texas Medical Board. A public hearing will be scheduled at a later date.
After considering public comments, the Board will determine whether to adopt the rules as proposed, adopt them with modifications, or decline to adopt them. Given the Board's clear intent to regulate this area more strictly, some version of these rules is likely to become effective.
Clinics should assume they have six to 12 months to achieve full compliance, though the actual timeline may vary.
New TMB Rules: What Ketamine Clinic Owners Can Do Now to Prepare
If you operate a ketamine clinic or are considering starting one, don't wait until these rules become effective to address compliance. The time to act is now, while you can still restructure operations, obtain necessary training, and implement required systems before mandatory compliance deadlines.
Consider these immediate action items:
1. Assess your current operational structure
- Is a physician physically present during all ketamine infusions?
- If not, can you restructure operations to ensure continuous onsite physician availability?
- What are the cost implications of required physician presence?
2. Verify physician qualifications
- Do your ordering physicians have mental health training or ketamine-specific education?
- Can you document their qualifications?
- Do any physicians need to complete additional training before the rule becomes effective?
3. Review your patient base
- What percentage of your patients are being treated for diagnosed psychiatric disorders?
- How many patients are receiving ketamine for non-diagnosed or non-qualifying conditions or symptoms?
- What diagnostic documentation exists to support treatment of approved conditions?
4. Evaluate compliance gaps
- Do you have all the required monitoring equipment?
- Are your adverse event logs complete and properly maintained?
- Do your informed consent procedures meet the proposed standards?
- Are your discharge protocols adequate?
Get Expert Guidance Now
The proposed ketamine therapy regulations present complex compliance challenges that require careful legal and operational planning. Mistakes in interpreting or implementing these requirements could result in:
- Loss of clinic registration
- Texas Medical Board investigation
- Disciplinary action against physician licenses
- Liability for patient care delivered outside regulatory compliance
- Forced closure of non-compliant operations
At Hendershot Cowart P.C., we help Texas healthcare providers navigate complex regulatory requirements and structure compliant clinical operations. Our healthcare attorneys can review your current ketamine clinic structure, identify compliance gaps, and develop strategies to meet the proposed requirements – or help you explore alternative practice models.
Call us today at (713) 783-3110 to schedule a consultation and ensure your ketamine practice is positioned for success under Texas's evolving regulatory landscape.