Most IV therapy clinics and medical spas misunderstand what Texas HB 3749 (Jenifer’s Law) actually requires. Jenifer’s law:
- Does NOT ban menu-based IV therapy
- Does NOT require medical directors on-site
- Does NOT prohibit EMTs and paramedics from administering IVs.
Here’s what the law actually says – and what it means for your business.
What Is Jenifer’s Law and Why Was It Passed?
On September 1, 2025, Texas House Bill 3749 – known as Jenifer’s Law – went into effect, marking the most significant change to IV therapy regulation in over a decade.
The law is named for Jenifer Cleveland, who died in July 2023 after receiving an IV infusion at a medical spa in Wortham, Texas. The Texas Medical Board’s investigation revealed concerning practices that prompted legislative action:
- The medical director was based 100 miles away from the facility
- The clinic had no established protocols for IV therapy administration
- Treatment was administered by an unlicensed individual
- There was an absence of adequate physician supervision
Representative Angelia Orr introduced HB 3749 on March 4, 2025, in response to Jenifer Cleveland’s death. The bill passed with overwhelming bipartisan support: 117-2 in the Texas House and 31-0 in the Texas Senate.
However, the final enacted version of Jenifer’s Law differs dramatically from early drafts – creating confusion about what the law actually requires.
The Three Biggest Myths About Jenifer’s Law
Industry confusion stems from how significantly HB 3749 evolved during the legislative process. Early versions would have imposed strict restrictions on IV therapy clinics. The final law is far more limited in scope.
Here are the three most common – and costly – myths about Jenifer’s Law:
Myth #1: “Jenifer’s Law Bans EMTs and Paramedics from Starting IVs”
Jenifer’s Law does NOT prohibit paramedics and EMTs from administering IV therapy.
What the law actually says: Section 172.051(b) states that “a physician may delegate the act of administering elective intravenous therapy to:
- A physician assistant acting under adequate physician supervision
- An advanced practice registered nurse acting under adequate physician supervision
- A registered nurse acting under adequate physician supervision”
The keyword is “may” – not “may only”.The law confirms physician authority to delegate to these specific licensed professionals but does not create an exclusive list.
This language does not override – and, in fact, specifically preserves – existing delegation of a physician’s prescriptive authority under Chapter 157 of the Texas Occupations Code, which provides broad authority for physicians to delegate medical acts to “any person” who has appropriate training and is capable of performing the delegated act safely, regardless of licensure status.
Jenifer’s Law does not create an exclusive list or prohibit delegation of IV therapy to other qualified personnel. With that said, Jenifer’s law grants permission to physicians to delegate the administration of elective intravenous therapy under certain conditions. If those conditions are not met, the physician cannot delegate the administration of elective intravenous therapy.
This means that if the physician delegates the procedure to a paramedic, the medical practice will need to document medical necessity to comply with the conditions set forth under Section 157.002 of the Texas Occupations Code.
If you employ paramedics or EMTs, you can continue doing so if you maintain:
- Proper delegation orders from your supervising physician
- Documented training and competency assessments
- Adequate physician supervision protocols
- Clear scope of practice documentation
Myth #2: “Medical Directors Must Be Physically On-Site Under Jenifer’s Law”
Jenifer’s Law does NOT require medical directors to be physically present at IV therapy locations.
This misconception causes the most panic among clinic owners operating with remote medical director arrangements. Many believe they must now hire on-site physicians or restructure their entire business model.
This is incorrect.
Early versions of HB 3749 included language that would have required supervising physicians for medical spas to be “immediately available on-site and able to respond in person.”
This provision was completely removed before the bill passed.
The tragic circumstances of Jenifer Cleveland’s death – where the medical director was 100 miles away – understandably raised concerns about remote supervision. However, the final enacted law addresses supervision through existing Texas Medical Board regulations rather than mandating physical presence.
Texas Medical Board regulations require that either a physician, physician assistant, or advanced practice registered nurse be immediately available for emergency consultation in the event of an adverse outcome and, if necessary, be able to conduct an emergency appointment with the patient.
These regulations do not specify whether availability must be in person.
This means that remote medical director arrangements remain fully compliant under Jenifer’s Law.
The key is ensuring your medical director is genuinely engaged in supervising your practice – and not a “100-miles-away” arrangement with no protocols, as in the case that prompted this legislation.
Myth #3: “Jenifer’s Law Prohibits Menu-Based IV Therapy”
Jenifer’s Law’s reclassification of IV therapy as “elective” may actually enable menu-based services that were previously prohibited.
This is perhaps the most surprising – and misunderstood – aspect of the new law.
Before Jenifer’s Law, Texas Medical Board disciplinary rules prohibited physicians from providing medically unnecessary drugs or services to patients.
This standard of medical necessity required:
- Patient examination
- Appropriate diagnostic testing
- Diagnosis based on examination and test results
- Treatment plan individually tailored to a patient's needs
This framework effectively banned “menu medicine“ – where patients choose their own treatments from a menu, regardless of medical necessity.
The Texas Medical Board made this explicit in its October 2023 bulletin, stating: “medical treatments must be provided pursuant to medical standards, and not based on the patient choosing a treatment from a menu.”
Jenifer’s Law fundamentally reclassifies IV therapy from medically necessary treatment to “elective” procedures.
Section 172.001(2) of Jenifer’s Law defines “elective intravenous therapy” as procedures:
- “sought by the patient”
- “to alleviate symptoms of temporary discomfort or improve temporary wellness”
This patient-centered language shifts IV therapy from a physician-determined medical necessity to an elective procedure chosen by the patient regardless of medical necessity.
This means that, under Jenifer’s Law’s elective framework, IV therapy providers may be able to:
- Offer wellness IV treatments selected by patients from a menu
- Provide “vitamin drips” and hydration cocktails as patient-chosen services
- Market IV therapy for wellness and temporary symptom relief
However, the phrase “elective intravenous therapy” is defined in a manner that excludes IV therapy procedures that are performed a physician’s office, hospitals, nursing facilities, ASCs, and certain other licensed healthcare facilities. Does this mean that physician offices cannot offer elective intravenous therapy? The law is unclear, and one of several regulatory gray areas I explore below.
That said, critical safety requirements still apply in any setting:
- Physical examination and medical history review required
- Contraindication screening mandatory
- Proper physician delegation and supervision are required
- Documentation of a medical order for the IV bag and the infused drugs
The Regulatory Gray Area
Regulatory questions remain:
- What constitutes a physician’s office? Due to the corporate practice of medicine doctrine prohibiting lay ownership of medical practices, many medical spas are physician-owned. Does the term “physician’s office” refer to a physical location or business ownership structure? Could a physician’s office include a patient’s home when services are rendered by a physician-owned medical practice? Or is elective therapy reserved for nurse-practitioner-owned businesses?
- Why is medical necessity required in physician offices and licensed healthcare facilities, but not outside of a physician’s office? The Texas Medical Board Rules do not require a physician to provide onsite supervision of IV infusion services; therefore, the difference in requirements cannot be related to physician supervision.
- And finally, what constitutes “adequate physician supervision” for elective procedures?
The TMB has not yet issued clarifying guidance on how to reconcile these positions
Best practice: Monitor for Texas Medical Board guidance before implementing pure menu-based models. And, of course, we will share any clarification published by the TMB on our website and via social media.
What Jenifer’s Law Actually Requires: The Real Compliance Checklist
Now that we’ve debunked the myths, here’s what Jenifer’s Law actually requires:
For Prescribing or Ordering Elective IV Therapy
Only PAs and APRNs can prescribe or order elective IV therapy under physician delegation.
This is more restrictive than general delegation rules (which allow delegation to “any person”) but only applies to the prescribing/ordering function.
For Administering Elective IV Therapy
PAs, APRNs, and RNs are specifically authorized to administer elective IV therapy under physician delegation.
However, physicians retain broader delegation authority under Texas Occupations Code Section 157.001 for appropriately trained personnel (including paramedics, EMTs, LVNs under RN supervision, etc.).
Section 157.002 further permits a physician delegate to any qualified and properly trained person acting under the physician’s supervision the act of administering or providing dangerous drugs in the physician’s office when those drugs are used or required to meet the immediate needs of the physician’s patients.
Adequate Physician Supervision Required
All delegation must occur “under adequate physician supervision” – the existing standard, not a new requirement.
Prescriptive Authority Agreement Limits
Prescriptive authority agreements for elective IV therapy count toward the maximum number of prescriptive authority agreements a physician may have. This is a new restriction.
This primarily affects physicians who delegate prescriptive authority to multiple APRNs or PAs.
Lessons from Jenifer Cleveland’s Death
The circumstances that prompted Jenifer’s Law should guide your compliance approach:
Don’t: Hire a medical director who is merely a name on paper
Do: Ensure genuine physician engagement and oversight
Don’t: Operate without established protocols
Do: Develop comprehensive safety and emergency procedures
Don’t: Allow unlicensed individuals to perform procedures beyond their scope
Do: Verify credentials and provide proper training
Don’t: Treat medical director supervision as a formality
Do: Build meaningful physician oversight into your operations
At Hendershot Cowart, we balance legal compliance with business realities. When you have questions about Jenifer’s Law compliance or regulatory changes, get answers from experienced healthcare attorneys who know your business. Contact us today.
FAQ: Texas Jenifer’s Law (HB 3749) for IV Therapy and Med Spas
What is Jenifer’s Law in Texas?
Jenifer’s Law is the name for Texas House Bill 3749, which took effect September 1, 2025. The law is named for Jenifer Cleveland, who died in July 2023 after receiving IV therapy at a Wortham, Texas medical spa where an unlicensed individual administered treatment under an absent medical director 100 miles away. The law reclassifies IV hydration therapy as “elective” treatment and clarifies physician delegation requirements.
Who can start IVs in Texas under Jenifer’s Law?
Under Jenifer’s Law, physicians may delegate IV administration to physician assistants, advanced practice registered nurses, and registered nurses under adequate supervision. However, Texas Occupations Code Section 157.001 – which Jenifer’s Law explicitly preserves – continues to allow physicians to delegate to any appropriately trained person, including paramedics and EMTs, with proper supervision.
Can medical assistants start IVs in Texas after Jenifer’s Law?
Jenifer’s Law does not specifically address medical assistants. Texas law allows physicians to delegate medical acts to appropriately trained personnel, including medical assistants, under proper supervision. The key requirements are written delegation orders, documented training and competency, and adequate physician oversight.
Does Jenifer’s Law require medical directors to be on-site at med spas?
No. Early versions of HB 3749 included on-site presence requirements, but these were removed before the bill passed. Remote medical director arrangements remain compliant under Jenifer’s Law as long as the physician provides adequate supervision, established protocols, and is available for emergency consultations.
Can IV hydration clinics offer menu-based services under Jenifer’s Law?
Jenifer’s Law’s “elective” classification suggests menu-based models may be permissible, as the law defines elective IV therapy as procedures “sought by the patient.” However, this conflicts with previous TMB guidance against “menu medicine.” Clinics should monitor for official TMB clarification before implementing menu-based models.
When did Jenifer’s Law take effect?
Jenifer’s Law (HB 3749) took effect on September 1, 2025.
Schedule Your Jenifer’s Law Compliance Consultation
Hendershot Cowart P.C.’s healthcare attorneys tracked HB 3749 from introduction through enactment and can help you interpret both the legal requirements and the practical business implications. We routinely help medical spas and IV therapy clinics navigate compliance with Jenifer’s Law and other state and federal regulations throughout Texas.
Call (713) 783-3110 or contact us online to schedule your consultation.