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             1     

COSMETIC MEDICAL PROCEDURES

             2     
2012 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Peter C. Knudson

             5     
House Sponsor: Stewart Barlow

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill amends the Division of Occupational and Professional Licensing Act.
             10      Highlighted Provisions:
             11          This bill:
             12          .    defines:
             13              .    ablative procedure;
             14              .    cosmetic medical facility;
             15              .    cosmetic medical procedure;
             16              .    nonablative procedure;
             17              .    superficial procedure; and
             18              .    supervisor;
             19          .    prohibits the use of the term "medical" when advertising a facility that performs
             20      cosmetic medical procedures under certain circumstances;
             21          .    exempts certain licensees from the definition of cosmetic medical procedures;
             22          .    establishes standards for the supervision of cosmetic medical procedures;
             23          .    amends the definition of the practice of medicine; and
             24          .    amends provisions of unprofessional conduct for physicians and other licensees
             25      whose scope of practice includes cosmetic medical procedures.
             26      Money Appropriated in this Bill:
             27          None
             28      Other Special Clauses:
             29          None


             30      Utah Code Sections Affected:
             31      AMENDS:
             32          58-1-102, as renumbered and amended by Laws of Utah 1993, Chapter 297
             33          58-11a-102, as last amended by Laws of Utah 2010, Chapter 145
             34          58-11a-502, as last amended by Laws of Utah 2009, Chapter 130
             35          58-16a-102, as last amended by Laws of Utah 2004, Chapters 48 and 280
             36          58-67-102, as last amended by Laws of Utah 2011, Chapter 214
             37          58-68-102, as last amended by Laws of Utah 2011, Chapter 214
             38      ENACTS:
             39          58-1-505, Utah Code Annotated 1953
             40          58-1-506, Utah Code Annotated 1953
             41          58-1-507, Utah Code Annotated 1953
             42          58-67-805, Utah Code Annotated 1953
             43          58-68-805, Utah Code Annotated 1953
             44     
             45      Be it enacted by the Legislature of the state of Utah:
             46          Section 1. Section 58-1-102 is amended to read:
             47           58-1-102. Definitions.
             48          For purposes of this title:
             49          (1) "Ablative procedure" is as defined in Section 58-67-102 .
             50          (2) "Cosmetic medical procedure":
             51          (a) is as defined in Section 58-67-102 ; and
             52          (b) except for Chapter 67, Utah Medical Practice Act, and Chapter 68, Utah
             53      Osteopathic Medical Practice Act, does not apply to the scope of practice of an individual
             54      licensed under this title if the individual's scope of practice includes the authority to operate or
             55      perform surgical procedures.
             56          [(1)] (3) "Department" means the Department of Commerce.
             57          [(2)] (4) "Director" means the director of the Division of Occupational and


             58      Professional Licensing.
             59          [(3)] (5) "Division" means the Division of Occupational and Professional Licensing
             60      created in Section 58-1-103 .
             61          [(4)] (6) "Executive director" means the executive director of the Department of
             62      Commerce.
             63          [(5)] (7) "Licensee" includes any holder of a license, certificate, registration, permit,
             64      student card, or apprentice card authorized under this title.
             65          (8) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
             66      alter living tissue, but not intended or expected to excise, vaporize, disintegrate, or remove
             67      living tissue.
             68          (ii) Notwithstanding Subsection (8)(a)(i), nonablative procedure includes hair removal.
             69          (b) "Nonablative procedure" does not include:
             70          (i) a superficial procedure;
             71          (ii) the application of permanent make-up; or
             72          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
             73      performed by an individual licensed under this title who is acting within their scope of practice.
             74          (9) "Superficial procedure" means a procedure that is expected or intended to
             75      temporarily alter living skin tissue and may excise or remove stratum corneum but have no
             76      appreciable risk of damage to any tissue below the stratum corneum.
             77          [(6)] (10) "Unlawful conduct" has the meaning given in Subsection 58-1-501 (1).
             78          [(7)] (11) "Unprofessional conduct" has the meaning given in Subsection 58-1-501 (2).
             79          Section 2. Section 58-1-505 is enacted to read:
             80          58-1-505. Cosmetic medical procedure supervisor.
             81          (1) For purposes of this section and Section 58-1-506 :
             82          (a) "Cosmetic medical facility" means a physician's office or a facility that has a
             83      supervisor who performs the supervision required in Section 58-1-506 .
             84          (b) "Supervisor" means:
             85          (i) a physician with an unrestricted license under Chapter 67, Utah Medical Practice


             86      Act, or Chapter 68, Utah Osteopathic Medical Practice Act, who is acting within the scope of
             87      the practice of medicine, as defined in Section 58-67-102 ; and
             88          (ii) an advanced practice registered nurse with an unrestricted license under Chapter
             89      31b, Nurse Practice Act, who is acting within the scope of practice of advanced practice
             90      registered nursing, as defined in Section 58-31b-102 .
             91          (2) (a) An individual authorized by this title to perform a cosmetic medical procedure
             92      shall be supervised by a supervisor when performing a medical procedure.
             93          (b) Cosmetic medical procedures may only be performed in a cosmetic medical
             94      facility.
             95          (c) A supervisor may delegate the supervisory role only to another individual who is
             96      qualified as a supervisor.
             97          Section 3. Section 58-1-506 is enacted to read:
             98          58-1-506. Supervision of cosmetic medical procedures.
             99          (1) For purposes of this section:
             100          (a) "Delegation group A" means the following who are licensed under this title, acting
             101      within their respective scope of practice, and qualified under Subsections (2)(f)(i) and (iii):
             102          (i) a physician assistant, if acting under the supervision of a physician and the
             103      procedure is included in the delegation of services agreement as defined in Section 58-70a-102 ;
             104          (ii) a registered nurse;
             105          (iii) a master esthetician; and
             106          (iv) an electrologist, if evaluating for or performing laser hair removal.
             107          (b) "Delegation group B" means:
             108          (i) a practical nurse or an esthetician who is licensed under this title, acting within their
             109      respective scope of practice, and qualified under Subsections (2)(f)(i) and (iii); and
             110          (ii) a medical assistant who is qualified under Subsections (2)(f)(i) and (iii).
             111          (c) "Direct cosmetic medical procedure supervision" means the supervisor:
             112          (i) has authorized the procedure to be done on the patient by the supervisee; and
             113          (ii) is present and available for a face-to-face communication with the supervisee when


             114      and where a cosmetic medical procedure is performed.
             115          (d) "General cosmetic medical procedure supervision" means the supervisor:
             116          (i) has authorized the procedure to be done on the patient by the supervisee;
             117          (ii) is available in a timely and appropriate manner in person to evaluate and initiate
             118      care for a patient with a suspected adverse reaction or complication; and
             119          (iii) is located within 60 minutes or 60 miles of the cosmetic medical facility.
             120          (e) "Indirect cosmetic medical procedure supervision" means the supervisor:
             121          (i) has authorized the procedure to be done on the patient by the supervisee;
             122          (ii) has given written instructions to the person being supervised;
             123          (iii) is present within the cosmetic medical facility in which the person being
             124      supervised is providing services; and
             125          (iv) is available to:
             126          (A) provide immediate face-to-face communication with the person being supervised;
             127      and
             128          (B) evaluate the patient, as necessary.
             129          (f) "Hair removal review" means:
             130          (i) conducting an in-person, face-to-face interview of a patient based on the responses
             131      provided by the patient to a detailed medical history assessment that was prepared by the
             132      supervisor;
             133          (ii) evaluating for contraindications and conditions that are part of the treatment plan;
             134      and
             135          (iii) if the patient history or patient presentation deviates in any way from the treatment
             136      plan, referring the patient to the supervisor and receiving clearance from the supervisor before
             137      starting the treatment.
             138          (2) A supervisor supervising a nonablative cosmetic medical procedure for hair
             139      removal shall:
             140          (a) have an unrestricted license to practice medicine or advanced practice registered
             141      nursing in the state;


             142          (b) develop the medical treatment plan for the procedure;
             143          (c) conduct a hair removal review, or delegate the hair removal review to a member of
             144      delegation group A, of the patient prior to initiating treatment or a series of treatments;
             145          (d) personally perform the nonablative cosmetic medical procedure for hair removal, or
             146      authorize and delegate the procedure to a member of delegation group A or B;
             147          (e) during the nonablative cosmetic medical procedure for hair removal provide general
             148      cosmetic medical procedure supervision to individuals in delegation group A performing the
             149      procedure, except physician assistants, who shall be supervised as provided in Chapter 70a,
             150      Physician Assistant Act, and indirect cosmetic medical procedure supervision to individuals in
             151      delegation group B performing the procedure; and
             152          (f) verify that a person to whom the supervisor delegates an evaluation under
             153      Subsection (2)(c) or delegates a procedure under Subsection (2)(d) or (3)(b)(ii):
             154          (i) has received appropriate training regarding the medical procedures developed under
             155      Subsection (2)(b);
             156          (ii) has an unrestricted license under this title or is performing under the license of the
             157      supervising physician and surgeon; and
             158          (iii) has maintained competence to perform the nonablative cosmetic medical
             159      procedure through documented education and experience of at least 80 hours, as further
             160      defined by rule, regarding:
             161          (A) the appropriate standard of care for performing nonablative cosmetic medical
             162      procedures;
             163          (B) physiology of the skin;
             164          (C) skin typing and analysis;
             165          (D) skin conditions, disorders, and diseases;
             166          (E) pre and post procedure care;
             167          (F) infection control;
             168          (G) laser and light physics training;
             169          (H) laser technologies and applications;


             170          (I) safety and maintenance of lasers;
             171          (J) cosmetic medical procedures an individual is permitted to perform under this title;
             172          (K) recognition and appropriate management of complications from a procedure; and
             173          (L) cardio-pulmonary resuscitation (CPR).
             174          (3) For a nonablative cosmetic medical procedure other than hair removal under
             175      Subsection (2):
             176          (a) (i) except as provided in Subsection (3)(a)(ii) and (iii), a physician who has an
             177      unrestricted license to practice medicine shall:
             178          (A) develop a treatment plan for the nonablative cosmetic medical procedure; and
             179          (B) conduct an in-person face-to-face evaluation of the patient prior to the initiation of
             180      a treatment protocol or series of treatments;
             181          (ii) a nurse practitioner who has an unrestricted license for advanced practice registered
             182      nursing may perform the evaluation and develop the treatment plan under Subsection (3)(a)(i)
             183      for nonablative medical procedures other than tattoo removal; or
             184          (iii) a physician assistant acting under the supervision of a physician, with the
             185      procedure included in the delegation of service agreement as defined in Section 58-70a-102 ,
             186      may perform the evaluation under Subsection (3)(a)(i)(B) for nonablative medical procedures
             187      other than tattoo removal; and
             188          (b) the supervisor supervising the procedure shall:
             189          (i) have an unrestricted license to practice medicine or advanced practice registered
             190      nursing;
             191          (ii) personally perform the nonablative cosmetic medical procedure or:
             192          (A) authorize and provide general cosmetic medical procedure supervision for the
             193      nonablative cosmetic medical procedure that is performed by a registered nurse or a master
             194      esthetician;
             195          (B) authorize and provide supervision as provided in Chapter 70a, Physician Assistant
             196      Act, for the nonablative cosmetic medical procedure that is performed by a physician assistant,
             197      if the procedure is included in the delegation of services agreement; or


             198          (C) authorize and provide direct cosmetic medical procedure supervision for the
             199      nonablative cosmetic medical procedure that is performed by an esthetician; and
             200          (iii) verify that a person to whom the supervisor delegates a procedure under
             201      Subsection (3)(b):
             202          (A) has received appropriate training regarding the medical procedures to be
             203      performed;
             204          (B) has an unrestricted license and is acting within their scope of practice under this
             205      title; and
             206          (C) is qualified under Subsection (2)(f)(iii).
             207          (4) A supervisor performing or supervising a cosmetic medical procedure under
             208      Subsection (2) or (3) shall ensure that:
             209          (a) the supervisor's name is prominently posted at the cosmetic medical facility
             210      identifying the supervisor;
             211          (b) a copy of the supervisor's license is displayed on the wall of the cosmetic medical
             212      facility;
             213          (c) the patient receives written information with the name and licensing information of
             214      the supervisor who is supervising the nonablative cosmetic medical procedure and the person
             215      who is performing the nonablative cosmetic medical procedure;
             216          (d) the patient is provided with a telephone number that is answered within 24 hours
             217      for follow-up communication; and
             218          (e) the cosmetic medical facility's contract with a master esthetician who performs a
             219      nonablative cosmetic medical procedure at the facility is kept on the premises of the facility.
             220          (5) Failure to comply with the provisions of this section is unprofessional conduct.
             221          (6) A chiropractic physician licensed under Chapter 73, Chiropractic Physician Practice
             222      Act is not subject to the supervision requirements in this section for a nonablative cosmetic
             223      medical procedure for hair removal if the chiropractic physician is acting within the scope of
             224      practice of a chiropractic physician and with training specific to nonablative hair removal.
             225          Section 4. Section 58-1-507 is enacted to read:


             226          58-1-507. Cosmetic medical procedure -- Truth in advertising.
             227          Beginning July 1, 2013, a facility that performs a cosmetic medical procedure as
             228      defined in Section 58-67-102 may not advertise or hold itself out to the public as a "medical
             229      spa", "medical facility", or "medical clinic" unless the facility has an individual on the premises
             230      while a cosmetic medical procedure is performed who is licensed under:
             231          (1) Chapter 31b, Nurse Practices Act, as an advanced practice registered nurse,
             232      practicing as a nurse practitioner;
             233          (2) Chapter 67, Utah Medical Practice Act; or
             234          (3) Chapter 68, Utah Osteopathic Medical Practice Act.
             235          Section 5. Section 58-11a-102 is amended to read:
             236           58-11a-102. Definitions.
             237          As used in this chapter:
             238          (1) "Approved barber or cosmetologist/barber apprenticeship" means an apprenticeship
             239      that meets the requirements of Subsection 58-11a-306 (1) for barbers or Subsection
             240      58-11a-306 (2) for cosmetologist/barbers and the requirements established by rule by the
             241      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             242      Administrative Rulemaking Act.
             243          (2) "Approved esthetician apprenticeship" means an apprenticeship that meets the
             244      requirements of Subsection 58-11a-306 (3) and the requirements established by rule by the
             245      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             246      Administrative Rulemaking Act.
             247          (3) "Approved master esthetician apprenticeship" means an apprenticeship that meets
             248      the requirements of Subsection 58-11a-306 (4) and the requirements established by rule by the
             249      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             250      Administrative Rulemaking Act.
             251          (4) "Approved nail technician apprenticeship" means an apprenticeship that meets the
             252      requirements of Subsection 58-11a-306 (5) and the requirements established by rule by the
             253      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah


             254      Administrative Rulemaking Act.
             255          (5) "Barber" means a person who is licensed under this chapter to engage in the
             256      practice of barbering.
             257          (6) "Barber instructor" means a barber who is licensed under this chapter to teach
             258      barbering at a licensed barber school or in an apprenticeship program as defined in Section
             259      58-11a-306 .
             260          (7) "Board" means the Barber, Cosmetology/Barbering, Esthetics, Electrology, and
             261      Nail Technology Licensing Board created in Section 58-11a-201 .
             262          (8) "Cosmetic laser procedure" includes a nonablative procedure as defined in Section
             263      58-67-102 .
             264          (9) "Cosmetic supervisor" means a supervisor as defined in Section 58-1-505 .
             265          [(8)] (10) "Cosmetologist/barber" means a person who is licensed under this chapter to
             266      engage in the practice of cosmetology/barbering.
             267          [(9)] (11) "Cosmetologist/barber instructor" means a cosmetologist/barber who is
             268      licensed under this chapter to teach cosmetology/barbering at a licensed cosmetology/barber
             269      school, licensed barber school, licensed nail technology school, or in an apprenticeship
             270      program as defined in Subsection 58-11a-306 (2).
             271          [(10)] (12) "Direct supervision" means that the supervisor of an apprentice or the
             272      instructor of a student is immediately available for consultation, advice, instruction, and
             273      evaluation.
             274          [(11)] (13) "Electrologist" means a person who is licensed under this chapter to engage
             275      in the practice of electrology.
             276          [(12)] (14) "Electrologist instructor" means an electrologist who is licensed under this
             277      chapter to teach electrology at a licensed electrology school.
             278          [(13)] (15) "Esthetician" means a person who is licensed under this chapter to engage
             279      in the practice of esthetics.
             280          [(14)] (16) "Esthetician instructor" means a master esthetician who is licensed under
             281      this chapter to teach the practice of esthetics and the practice of master-level esthetics at a


             282      licensed esthetics school, a licensed cosmetology/barber school, or in an apprenticeship
             283      program as defined in Subsection 58-11a-306 (3).
             284          [(15)] (17) "Fund" means the Barber, Cosmetologist/Barber, Esthetician, Electrologist,
             285      and Nail Technician Education and Enforcement Fund created in Section 58-11a-103 .
             286          [(16)] (18) "Licensed barber or cosmetology/barber school" means a barber or
             287      cosmetology/barber school licensed under this chapter.
             288          [(17)] (19) "Licensed electrology school" means an electrology school licensed under
             289      this chapter.
             290          [(18)] (20) "Licensed esthetics school" means an esthetics school licensed under this
             291      chapter.
             292          [(19)] (21) "Licensed nail technology school" means a nail technology school licensed
             293      under this chapter.
             294          [(20)] (22) "Master esthetician" means an individual who is licensed under this chapter
             295      to engage in the practice of master-level esthetics.
             296          [(21)] (23) "Nail technician" means an individual who is licensed under this chapter to
             297      engage in the practice of nail technology.
             298          [(22)] (24) "Nail technician instructor" means a nail technician licensed under this
             299      chapter to teach the practice of nail technology in a licensed nail technology school, a licensed
             300      cosmetology/barber school, or in an apprenticeship program as defined in Subsection
             301      58-11a-306 (5).
             302          [(23)] (25) "Practice of barbering" means:
             303          (a) cutting, clipping, or trimming the hair of the head of any person by the use of
             304      scissors, shears, clippers, or other appliances;
             305          (b) draping, shampooing, scalp treatments, basic wet styling, and blow drying; and
             306          (c) removing hair from the face or neck of a person by the use of shaving equipment.
             307          [(24)] (26) "Practice of barbering instruction" means instructing barbering in a licensed
             308      barber school, licensed cosmetology/barber school, or in an apprenticeship program as defined
             309      in Subsection 58-11a-306 (1).


             310          [(25)] (27) "Practice of basic esthetics" means any one of the following skin care
             311      procedures done on the head, face, neck, arms, hands, legs, feet, eyebrows, or eyelashes for
             312      cosmetic purposes and not for the treatment of medical, physical, or mental ailments:
             313          (a) cleansing, stimulating, manipulating, exercising, applying oils, antiseptics, clays, or
             314      masks, manual extraction, including a comodone extractor, depilatories, waxes, tweezing, the
             315      application of eyelash extensions, natural nail manicures or pedicures, or callous removal by
             316      buffing or filing;
             317          (b) limited chemical exfoliation as defined by rule;
             318          (c) removing superfluous hair by means other than electrolysis, except that an
             319      individual is not required to be licensed as an esthetician to engage in the practice of threading;
             320          (d) other esthetic preparations or procedures with the use of the hands, a
             321      high-frequency or galvanic electrical apparatus, or a heat lamp for cosmetic purposes and not
             322      for the treatment of medical, physical, or mental ailments; or
             323          (e) except as provided in Subsection (27)(e)(i), cosmetic laser procedures under
             324      [direct] the direct cosmetic medical procedure supervision of a [licensed health care
             325      practitioner as defined by rule,] cosmetic supervisor limited to the following:
             326          (i) superfluous hair removal which shall be under indirect supervision;
             327          (ii) anti-aging resurfacing enhancements;
             328          (iii) photo rejuvenation; or
             329          (iv) tattoo removal.
             330          [(26)] (28) (a) "Practice of cosmetology/barbering" means:
             331          (i) styling, arranging, dressing, curling, waving, permanent waving, cleansing,
             332      singeing, bleaching, dyeing, tinting, coloring, or similarly treating the hair of the head of a
             333      person;
             334          (ii) cutting, clipping, or trimming the hair by the use of scissors, shears, clippers, or
             335      other appliances;
             336          (iii) arching eyebrows, or tinting eyebrows or eyelashes, applying eyelash extensions,
             337      or any combination of these procedures;


             338          (iv) removing hair from the face, neck, shoulders, arms, back, torso, feet, bikini line, or
             339      legs of a person by the use of depilatories, waxing, or shaving equipment;
             340          (v) cutting, curling, styling, fitting, measuring, or forming caps for wigs or hairpieces
             341      or both on the human head; or
             342          (vi) practicing hair weaving or hair fusing or servicing previously medically implanted
             343      hair.
             344          (b) The term "practice of cosmetology/barbering" includes:
             345          (i) the practice of basic esthetics; and
             346          (ii) the practice of nail technology.
             347          (c) An individual is not required to be licensed as a cosmetologist/barber to engage in
             348      the practice of threading.
             349          [(27)] (29) "Practice of cosmetology/barbering instruction" means instructing
             350      cosmetology/barbering as defined in Subsection [(26)] (28) in a licensed cosmetology/barber
             351      school or in an apprenticeship program as defined in Subsection 58-11a-306 (2).
             352          [(28)] (30) "Practice of electrology" means:
             353          (a) the removal of superfluous hair from the body of a person by the use of electricity,
             354      waxing, shaving, or tweezing; or
             355          (b) cosmetic laser procedures under the [general] supervision of a [licensed health care
             356      practitioner as defined by rule,] cosmetic supervisor limited to superfluous hair removal.
             357          [(29)] (31) "Practice of electrology instruction" means instructing electrology in a
             358      licensed electrology school.
             359          [(30)] (32) "Practice of esthetics instruction" means instructing esthetics in a licensed
             360      esthetics school, a licensed cosmetology/barber school, or instructing master-level esthetics in a
             361      licensed esthetics school or in an apprenticeship program as defined in Subsections
             362      58-11a-306 (2), (3), and (4).
             363          [(31)] (33) (a) "Practice of master-level esthetics" means:
             364          (i) any of the following when done for cosmetic purposes on the head, face, neck,
             365      torso, abdomen, back, arms, hands, legs, feet, eyebrows, or eyelashes and not for the treatment


             366      of medical, physical, or mental ailments:
             367          (A) body wraps as defined by rule;
             368          (B) hydrotherapy as defined by rule;
             369          (C) chemical exfoliation as defined by rule;
             370          (D) advanced pedicures as defined by rule;
             371          (E) sanding, including microdermabrasion;
             372          (F) advanced extraction;
             373          (G) other esthetic preparations or procedures with the use of:
             374          (I) the hands; or
             375          (II) a mechanical or electrical apparatus which is approved for use by division rule for
             376      beautifying or similar work performed on the body for cosmetic purposes and not for the
             377      treatment of a medical, physical, or mental ailment; or
             378          (H) cosmetic laser procedures under the [general] supervision of a [licensed health care
             379      practitioner as defined by rule,] cosmetic supervisor with a physician's evaluation before the
             380      procedure, as needed, unless specifically required under Section 58-1-506 , and limited to the
             381      following:
             382          (I) superfluous hair removal;
             383          (II) anti-aging resurfacing enhancements;
             384          (III) photo rejuvenation; or
             385          (IV) tattoo removal with a physician's evaluation before the tattoo removal procedure;
             386      and
             387          (ii) lymphatic massage by manual or other means as defined by rule.
             388          (b) Notwithstanding the provisions of Subsection [(31)] (33)(a), a master-level
             389      esthetician may perform procedures listed in Subsection [(31)] (33)(a)(i)(H) [for noncosmetic
             390      purposes] if done under the supervision of a [licensed health care practitioner] cosmetic
             391      supervisor acting within the scope of the [licensed health care practitioner's] cosmetic
             392      supervisor license [as defined by rule].
             393          (c) The term "practice of master-level esthetics" includes the practice of esthetics, but


             394      an individual is not required to be licensed as an esthetician or master-level esthetician to
             395      engage in the practice of threading.
             396          [(32)] (34) "Practice of nail technology" means to trim, cut, clean, manicure, shape,
             397      massage, or enhance the appearance of the hands, feet, and nails of an individual by the use of
             398      hands, mechanical, or electrical preparation, antiseptic, lotions, or creams, including the
             399      application and removal of sculptured or artificial nails.
             400          [(33)] (35) "Practice of nail technology instruction" means instructing nail technology
             401      in a licensed nail technician school, licensed cosmetology/barber school, or in an
             402      apprenticeship program as defined in Subsection 58-11a-306 (5).
             403          [(34)] (36) "Recognized barber school" means a barber school located in a state other
             404      than Utah, whose students, upon graduation, are recognized as having completed the
             405      educational requirements for licensure in that state.
             406          [(35)] (37) "Recognized cosmetology/barber school" means a cosmetology/barber
             407      school located in a state other than Utah, whose students, upon graduation, are recognized as
             408      having completed the educational requirements for licensure in that state.
             409          [(36)] (38) "Recognized electrology school" means an electrology school located in a
             410      state other than Utah, whose students, upon graduation, are recognized as having completed the
             411      educational requirements for licensure in that state.
             412          [(37)] (39) "Recognized esthetics school" means an esthetics school located in a state
             413      other than Utah, whose students, upon graduation, are recognized as having completed the
             414      educational requirements for licensure in that state.
             415          [(38)] (40) "Recognized nail technology school" means a nail technology school
             416      located in a state other than Utah, whose students, upon graduation, are recognized as having
             417      completed the educational requirements for licensure in that state.
             418          [(39)] (41) "Salon" means a place, shop, or establishment in which
             419      cosmetology/barbering, esthetics, electrology, or nail technology is practiced.
             420          [(40)] (42) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-11a-502 .
             421          [(41)] (43) "Unprofessional conduct" is as defined in Sections 58-1-501 and


             422      58-11a-501 and as may be further defined by rule by the division in collaboration with the
             423      board in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
             424          Section 6. Section 58-11a-502 is amended to read:
             425           58-11a-502. Unlawful conduct.
             426          Unlawful conduct includes:
             427          (1) practicing or engaging in, or attempting to practice or engage in activity for which a
             428      license is required under this chapter unless:
             429          (a) the person holds the appropriate license under this chapter; or
             430          (b) an exemption in Section 58-1-307 or 58-11a-304 applies;
             431          (2) knowingly employing any other person to engage in or practice or attempt to
             432      engage in or practice any occupation or profession licensed under this chapter if the employee
             433      is not licensed to do so under this chapter or exempt from licensure;
             434          (3) touching, or applying an instrument or device to the following areas of a client's
             435      body:
             436          (a) the genitals or the anus, except in cases where the patron states to a licensee that the
             437      patron requests a hair removal procedure and signs a written consent form, which must also
             438      include the witnessed signature of a legal guardian if the patron is a minor, authorizing the
             439      licensee to perform a hair removal procedure; or
             440          (b) the breast of a female patron, except in cases in which the female patron states to a
             441      licensee that the patron requests breast skin procedures and signs a written consent form, which
             442      must also include the witnessed signature of a parent or legal guardian if the patron is a minor,
             443      authorizing the licensee to perform breast skin procedures; [and]
             444          (4) using or possessing as a nail technician a solution composed of at least 10% methyl
             445      methacrylete on a client[.]; or
             446          (5) performing an ablative procedure as defined in Section 58-67-102 .
             447          Section 7. Section 58-16a-102 is amended to read:
             448           58-16a-102. Definitions.
             449          In addition to the definitions in Section 58-1-102 , as used in this chapter:


             450          (1) "Board" means the Optometrist Licensing Board created in Section 58-16a-201 .
             451          (2) "Contact lens" means any lens that:
             452          (a) has a spherical, cylindrical, or prismatic power or curvature;
             453          (b) is made pursuant to a current prescription; or
             454          (c) is intended to be worn on the surface of the eye.
             455          (3) (a) "Contact lens prescription" means a written or verbal order for contact lenses
             456      that includes:
             457          (i) the commencement date of the prescription;
             458          (ii) the base curve, power, diameter, material or brand name, and expiration date;
             459          (iii) for a written order, the signature of the prescribing optometrist or physician; and
             460          (iv) for a verbal order, a record maintained by the recipient of:
             461          (A) the name of the prescribing optometrist or physician; and
             462          (B) the date when the prescription was issued or ordered.
             463          (b) A prescription may include:
             464          (i) a limit on the quantity of lenses that may be ordered under the prescription if
             465      required for medical reasons documented in the patient's files; and
             466          (ii) the expiration date of the prescription, which shall be two years from the
             467      commencement date, unless documented medical reasons require otherwise.
             468          (c) When a provider prescribes a private label contact lens for a patient the prescription
             469      shall include:
             470          (i) the name of the manufacturer;
             471          (ii) the trade name of the private label brand; and
             472          (iii) if applicable, the trade name of the equivalent national brand.
             473          (4) "Contact lens prescription verification" means a written request from a person who
             474      sells or provides contact lenses that:
             475          (a) is sent to the prescribing optometrist or physician; and
             476          (b) seeks the confirmation of the accuracy of a patient's prescription.
             477          (5) "Eye and its adnexa" means the human eye and all structures situated within the


             478      orbit, including the conjunctiva, lids, lashes, and lacrimal system.
             479          (6) "Fitting of a contact lens" means:
             480          (a) the using of a keratometer to measure the human eye;
             481          (b) utilizing refractive data provided by a licensed optometrist or ophthalmologist; and
             482          (c) trial fitting of contact lenses, which includes a period of time for evaluation for fit
             483      and performance, to determine a tentative contact lens prescription for a patient if the patient:
             484          (i) has not worn contact lenses before; or
             485          (ii) has changed to a different type or base curve.
             486          (7) "Laser surgery" means surgery in which human tissue is cut, burned, or vaporized
             487      by means of laser or ionizing radiation.
             488          (8) "Ophthalmic lens" means any lens used to treat the eye and that:
             489          (a) has a spherical, cylindrical, or prismatic power;
             490          (b) is made pursuant to an unexpired prescription; and
             491          (c) is intended to be used in eyeglasses or spectacles.
             492          (9) "Optometric assistant" means an unlicensed individual:
             493          (a) working under the direct and immediate supervision of a licensed optometrist; and
             494          (b) engaged in specific tasks assigned by the licensed optometrist in accordance with
             495      the standards and ethics of the profession.
             496          (10) "Optometrist" or "optometric physician" means an individual licensed under this
             497      chapter.
             498          (11) "Optometry" and "practice of optometry" mean any one or any combination of the
             499      following practices:
             500          (a) examination of the human eye and its adnexa to detect and diagnose defects or
             501      abnormal conditions;
             502          (b) determination or modification of the accommodative or refractive state of the
             503      human eye or its range or power of vision by administration and prescription of pharmaceutical
             504      agents or the use of diagnostic instruments;
             505          (c) prescription, ordering, administration, or adaptation of ophthalmic lenses, contact


             506      lenses, ophthalmic devices, pharmaceutical agents, laboratory tests, or ocular exercises to
             507      diagnose and treat diseases, defects, or other abnormal conditions of the human eye and its
             508      adnexa;
             509          (d) display of any advertisement, circular, sign, or device offering to:
             510          (i) examine the eyes;
             511          (ii) fit glasses or contact lenses; or
             512          (iii) adjust frames;
             513          (e) removal of a foreign body from the eye or its adnexa, that is not deeper than the
             514      anterior 1/2 of the cornea;
             515          (f) consultation regarding the eye and its adnexa with other appropriate health care
             516      providers, including referral to other appropriate health care providers; and
             517          (g) a person, not licensed as an optometrist, directing a licensee under this chapter to
             518      withhold or alter the eye care services the licensee has ordered.
             519          (12) "Pharmaceutical agent" means any diagnostic or therapeutic drug or combination
             520      of drugs that has the property of assisting in the diagnosis, prevention, treatment, or mitigation
             521      of abnormal conditions or symptoms of the eye and its adnexa.
             522          (13) "Physician" has the same meaning as defined in [Subsection 58-67-102 (7)]
             523      Sections 58-67-102 and 58-68-102 .
             524          (14) "Prescription drug" has the same definition as in Section 58-17b-102 .
             525          (15) "Unexpired" means a prescription that was issued:
             526          (a) not more than two years prior to presentation of the prescription for an ophthalmic
             527      lens; or
             528          (b) in accordance with Subsection (3) for a contact lens.
             529          Section 8. Section 58-67-102 is amended to read:
             530           58-67-102. Definitions.
             531          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             532          (1) "Ablative procedure" means a procedure that is expected to excise, vaporize,
             533      disintegrate, or remove living tissue, including the use of carbon dioxide lasers and


             534      erbium:YAG lasers, and excluding hair removal.
             535          [(1)] (2) "ACGME" means the Accreditation Council for Graduate Medical Education
             536      of the American Medical Association.
             537          [(2)] (3) "Administrative penalty" means a monetary fine or citation imposed by the
             538      division for acts or omissions determined to constitute unprofessional or unlawful conduct, in
             539      accordance with a fine schedule established by the division in collaboration with the board, as a
             540      result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
             541      Administrative Procedures Act.
             542          [(3)] (4) "Board" means the Physicians Licensing Board created in Section 58-67-201 .
             543          (5) (a) "Cosmetic medical device" means tissue altering energy based devices that have
             544      the potential for altering living tissue and that are used to perform ablative or nonablative
             545      procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
             546      Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices, and
             547      excludes ANSI designated Class IIIa and lower powered devices.
             548          (b) Notwithstanding Subsection (5)(a), if an ANSI designated Class IIIa and lower
             549      powered device is being used to perform an ablative procedure, the device is included in the
             550      definition of cosmetic medical device under Subsection (5)(a).
             551          (6) "Cosmetic medical procedure":
             552          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
             553      procedures; and
             554          (b) does not include a treatment of the ocular globe such as refractive surgery.
             555          [(4)] (7) "Diagnose" means:
             556          (a) to examine in any manner another person, parts of a person's body, substances,
             557      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             558      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             559      condition;
             560          (b) to attempt to conduct an examination or determination described under Subsection
             561      [(4)] (7)(a);


             562          (c) to hold oneself out as making or to represent that one is making an examination or
             563      determination as described in Subsection [(4)] (7)(a); or
             564          (d) to make an examination or determination as described in Subsection [(4)] (7)(a)
             565      upon or from information supplied directly or indirectly by another person, whether or not in
             566      the presence of the person making or attempting the diagnosis or examination.
             567          [(5)] (8) "LCME" means the Liaison Committee on Medical Education of the
             568      American Medical Association.
             569          [(6)] (9) "Medical assistant" means an unlicensed individual working under the direct
             570      and immediate supervision of a licensed physician and surgeon and engaged in specific tasks
             571      assigned by the licensed physician and surgeon in accordance with the standards and ethics of
             572      the profession.
             573          (10) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
             574      alter living tissue, but is not intended or expected to excise, vaporize, disintegrate, or remove
             575      living tissue.
             576          (ii) Notwithstanding Subsection (10)(a)(i), nonablative procedure includes hair
             577      removal.
             578          (b) "Nonablative procedure" does not include:
             579          (i) a superficial procedure as defined in Section 58-1-102 ;
             580          (ii) the application of permanent make-up; or
             581          (iii) the use of photo therapy and lasers for neuromusculoskeletal treatments that are
             582      performed by an individual licensed under this title who is acting within their scope of practice.
             583          [(7)] (11) "Physician" means both physicians and surgeons licensed under Section
             584      58-67-301 , Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
             585      Section 58-68-301 , Utah Osteopathic Medical Practice Act.
             586          [(8)] (12) (a) "Practice of medicine" means:
             587          [(a)] (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
             588      disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
             589      or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any


             590      means or instrumentality, and by an individual in Utah or outside the state upon or for any
             591      human within the state[, except that conduct described in this Subsection (8)(a) that is
             592      performed by a person legally and in accordance with a license issued under another chapter of
             593      this title does not constitute the practice of medicine];
             594          [(b)] (ii) when a person not licensed as a physician directs a licensee under this chapter
             595      to withhold or alter the health care services that the licensee has ordered[, but practice of
             596      medicine does not include any conduct under Subsection 58-67-501 (2)];
             597          [(c)] (iii) to maintain an office or place of business for the purpose of doing any of the
             598      acts described in Subsection [(8)] (12)(a) whether or not for compensation; or
             599          [(d)] (iv) to use, in the conduct of any occupation or profession pertaining to the
             600      diagnosis or treatment of human diseases or conditions in any printed material, stationery,
             601      letterhead, envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
             602      "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
             603      designations in any manner which might cause a reasonable person to believe the individual
             604      using the designation is a licensed physician and surgeon, and if the party using the designation
             605      is not a licensed physician and surgeon, the designation must additionally contain the
             606      description of the branch of the healing arts for which the person has a license, provided that an
             607      individual who has received an earned degree of doctor of medicine degree but is not a licensed
             608      physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
             609      Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
             610          (b) The practice of medicine does not include:
             611          (i) except for an ablative medical procedure as provided in Subsection (12)(b)(ii), the
             612      conduct described in Subsection (12)(a)(i) that is performed in accordance with a license issued
             613      under another chapter of this title;
             614          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
             615      performing the ablative cosmetic medical procedure includes the authority to operate or
             616      perform a surgical procedure; or
             617          (iii) conduct under Subsection 58-67-501 (2).


             618          [(9)] (13) "Prescription device" means an instrument, apparatus, implement, machine,
             619      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             620      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             621      and dispensed by or through a person or entity licensed under this chapter or exempt from
             622      licensure under this chapter.
             623          [(10)] (14) "Prescription drug" means a drug that is required by federal or state law or
             624      rule to be dispensed only by prescription or is restricted to administration only by practitioners.
             625          [(11)] (15) "SPEX" means the Special Purpose Examination of the Federation of State
             626      Medical Boards.
             627          [(12)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-67-501 .
             628          [(13)] (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and
             629      58-67-502 , and as may be further defined by division rule.
             630          Section 9. Section 58-67-805 is enacted to read:
             631          58-67-805. Supervision of cosmetic medical procedures.
             632          (1) Except as provided in Subsection (2), a physician may not delegate the performance
             633      of an ablative cosmetic medical procedure to an individual who is not licensed under this
             634      chapter or Chapter 68, Utah Osteopathic Medical Practice Act.
             635          (2) A physician may delegate to an advanced practice registered nurse with an
             636      unrestricted license under Chapter 31b, Nurse Practice Act, the performance of an erbium full
             637      ablation resurfacing procedure or a CO2 fractionated resurfacing procedure, if the physician:
             638          (a) prescribes that specific procedure for the patient who is to receive the procedure;
             639          (b) ensures that the advanced practice registered nurse performs the procedure under
             640      the indirect supervision of the physician; and
             641          (c) verifies that the advanced practice registered nurse is qualified to perform the
             642      procedure by having received at least 50 hours of training specific to the procedure to be
             643      performed and the laser to be used.
             644          Section 10. Section 58-68-102 is amended to read:
             645           58-68-102. Definitions.


             646          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             647          (1) "Ablative procedure" means a procedure that is expected to excise, vaporize,
             648      disintegrate, or remove living tissue, including the use of carbon dioxide lasers and
             649      erbium:YAG lasers, and excluding hair removal.
             650          [(1)] (2) "ACGME" means the Accreditation Council for Graduate Medical Education
             651      of the American Medical Association.
             652          [(2)] (3) "Administrative penalty" means a monetary fine imposed by the division for
             653      acts or omissions determined to constitute unprofessional or unlawful conduct, as a result of an
             654      adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
             655      Procedures Act.
             656          [(3)] (4) "AOA" means the American Osteopathic Association.
             657          [(4)] (5) "Board" means the Osteopathic Physician and Surgeon's Licensing Board
             658      created in Section 58-68-201 .
             659          (6) (a) "Cosmetic medical device" means tissue altering energy based devices that have
             660      the potential for altering living tissue and that are used to perform ablative or nonablative
             661      procedures, such as American National Standards Institute (ANSI) designated Class IIIb and
             662      Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic devices and
             663      excludes ANSI designated Class IIIa and lower powered devices.
             664          (b) Notwithstanding Subsection (6)(a), if an ANSI designated Class IIIa and lower
             665      powered device is being used to perform an ablative procedure, the device is included in the
             666      definition of cosmetic medical device under Subsection (6)(a).
             667          (7) "Cosmetic medical procedure":
             668          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
             669      procedures; and
             670          (b) does not include a treatment of the ocular globe such as refractive surgery.
             671          [(5)] (8) "Diagnose" means:
             672          (a) to examine in any manner another person, parts of a person's body, substances,
             673      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's


             674      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             675      condition;
             676          (b) to attempt to conduct an examination or determination described under Subsection
             677      [(5)] (8)(a);
             678          (c) to hold oneself out as making or to represent that one is making an examination or
             679      determination as described in Subsection [(5)] (8)(a); or
             680          (d) to make an examination or determination as described in Subsection [(5)] (8)(a)
             681      upon or from information supplied directly or indirectly by another person, whether or not in
             682      the presence of the person making or attempting the diagnosis or examination.
             683          [(6)] (9) "Medical assistant" means an unlicensed individual working under the direct
             684      and immediate supervision of a licensed osteopathic physician and surgeon and engaged in
             685      specific tasks assigned by the licensed osteopathic physician and surgeon in accordance with
             686      the standards and ethics of the profession.
             687          (10) (a) (i) "Nonablative procedure" means a procedure that is expected or intended to
             688      alter living tissue, but is not expected or intended to excise, vaporize, disintegrate, or remove
             689      living tissue.
             690          (ii) Notwithstanding Subsection (10)(a)(i), nonablative procedure includes hair
             691      removal.
             692          (b) "Nonablative procedure" does not include:
             693          (i) a superficial procedure as defined in Section 58-1-102 ;
             694          (ii) the application of permanent make-up; or
             695          (iii) the use of photo therapy lasers for neuromusculoskeletal treatments that are
             696      preformed by an individual licensed under this title who is acting within their scope of practice.
             697          [(7)] (11) "Physician" means both physicians and surgeons licensed under Section
             698      58-67-301 , Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
             699      Section 58-68-301 , Utah Osteopathic Medical Practice Act.
             700          [(8)] (12) (a) "Practice of osteopathic medicine" means:
             701          [(a)] (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human


             702      disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
             703      or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
             704      is based upon emphasis of the importance of the musculoskeletal system and manipulative
             705      therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
             706      state upon or for any human within the state[, except that conduct described in this Subsection
             707      (8)(a) that is performed by a person legally and in accordance with a license issued under
             708      another chapter of this title does not constitute the practice of medicine];
             709          [(b)] (ii) when a person not licensed as a physician directs a licensee under this chapter
             710      to withhold or alter the health care services that the licensee has ordered[, but practice of
             711      medicine does not include any conduct under Subsection 58-68-501 (2)];
             712          [(c)] (iii) to maintain an office or place of business for the purpose of doing any of the
             713      acts described in Subsection [(8)] (12)(a) whether or not for compensation; or
             714          [(d)] (iv) to use, in the conduct of any occupation or profession pertaining to the
             715      diagnosis or treatment of human diseases or conditions, in any printed material, stationery,
             716      letterhead, envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic
             717      medicine," "osteopathic physician," "osteopathic surgeon," "osteopathic physician and
             718      surgeon," "Dr.," "D.O.," or any combination of these designations in any manner which might
             719      cause a reasonable person to believe the individual using the designation is a licensed
             720      osteopathic physician, and if the party using the designation is not a licensed osteopathic
             721      physician, the designation must additionally contain the description of the branch of the healing
             722      arts for which the person has a license, provided that an individual who has received an earned
             723      degree of doctor of osteopathic medicine but is not a licensed osteopathic physician and
             724      surgeon in Utah may use the designation "D.O." if it is followed by "Not Licensed" or "Not
             725      Licensed in Utah" in the same size and style of lettering.
             726          (b) The practice of osteopathic medicine does not include:
             727          (i) except for an ablative medical procedure as provided in Subsection (12)(b)(ii), the
             728      conduct described in Subsection (12)(a)(i) that is performed in accordance with a license issued
             729      under another chapter of this title;


             730          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
             731      performing the ablative cosmetic medical procedure includes the authority to operate or
             732      perform a surgical procedure; or
             733          (iii) conduct under Subsection 58-68-501 (2).
             734          [(9)] (13) "Prescription device" means an instrument, apparatus, implement, machine,
             735      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             736      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             737      and dispensed by or through a person or entity licensed under this chapter or exempt from
             738      licensure under this chapter.
             739          [(10)] (14) "Prescription drug" means a drug that is required by federal or state law or
             740      rule to be dispensed only by prescription or is restricted to administration only by practitioners.
             741          [(11)] (15) "SPEX" means the Special Purpose Examination of the Federation of State
             742      Medical Boards.
             743          [(12)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-68-501 .
             744          [(13)] (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-68-502
             745      and as may be further defined by division rule.
             746          Section 11. Section 58-68-805 is enacted to read:
             747          58-68-805. Supervision of cosmetic medical procedures.
             748          (1) Except as provided in Subsection (2), an osteopathic physician and surgeon may
             749      not delegate the performance of an ablative cosmetic medical procedure to an individual who is
             750      not licensed under this chapter or Chapter 67, Utah Medical Practice Act.
             751          (2) A physician may delegate to an advanced practice registered nurse with an
             752      unrestricted license under Chapter 31b, Nurse Practice Act, the performance of an erbium full
             753      ablation resurfacing procedure or a CO2 fractionated resurfacing procedure, if the physician:
             754          (a) prescribes that specific procedure for the patient who is to receive the procedure;
             755          (b) ensures that the advanced practice registered nurse performs the procedure under
             756      the indirect supervision of the physician; and
             757          (c) verifies that the advanced practice registered nurse is qualified to perform the


             758      procedure by having received at least 50 hours of training specific to the procedure to be
             759      performed and the laser to be used.


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