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Second Substitute S.B. 40

Senator Peter C. Knudson proposes the following substitute bill:


             1     
COSMETIC MEDICAL PROCEDURES

             2     
2012 GENERAL SESSION

             3     
STATE OF UTAH

             4     
Chief Sponsor: Peter C. Knudson

             5     
House Sponsor: ____________

             6     
             7      LONG TITLE
             8      General Description:
             9          This bill amends the Utah Medical Practice Act and the Utah Osteopathic Practice 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          .    exempts certain licensees from the definition of cosmetic medical procedures;    
             20          .    establishes standards for the supervision of cosmetic medical procedures;
             21          .    amends the definition of the practice of medicine; and
             22          .    amends provisions of unprofessional conduct for physicians and other licensees
             23      whose scope of practice includes cosmetic medical procedures.
             24      Money Appropriated in this Bill:
             25          None


             26      Other Special Clauses:
             27          None
             28      Utah Code Sections Affected:
             29      AMENDS:
             30          58-1-102, as renumbered and amended by Laws of Utah 1993, Chapter 297
             31          58-11a-102, as last amended by Laws of Utah 2010, Chapter 145
             32          58-11a-502, as last amended by Laws of Utah 2009, Chapter 130
             33          58-16a-102, as last amended by Laws of Utah 2004, Chapters 48 and 280
             34          58-67-102, as last amended by Laws of Utah 2011, Chapter 214
             35          58-68-102, as last amended by Laws of Utah 2011, Chapter 214
             36      ENACTS:
             37          58-1-505, Utah Code Annotated 1953
             38          58-1-506, Utah Code Annotated 1953
             39          58-67-805, Utah Code Annotated 1953
             40          58-68-805, Utah Code Annotated 1953
             41     
             42      Be it enacted by the Legislature of the state of Utah:
             43          Section 1. Section 58-1-102 is amended to read:
             44           58-1-102. Definitions.
             45          For purposes of this title:
             46          (1) "Ablative procedure" is as defined in Section 58-67-102 .
             47          (2) "Cosmetic medical procedure":
             48          (a) is as defined in Section 58-67-102 ; and
             49          (b) except for Chapter 67, Utah Medical Practice Act, and Chapter 68, Utah
             50      Osteopathic Medical Practice Act, does not apply to the scope of practice of an individual
             51      licensed under this title if the individual's scope of practice includes the authority to operate or
             52      perform surgical procedures.
             53          [(1)] (3) "Department" means the Department of Commerce.
             54          [(2)] (4) "Director" means the director of the Division of Occupational and
             55      Professional Licensing.
             56          [(3)] (5) "Division" means the Division of Occupational and Professional Licensing


             57      created in Section 58-1-103 .
             58          [(4)] (6) "Executive director" means the executive director of the Department of
             59      Commerce.
             60          [(5)] (7) "Licensee" includes any holder of a license, certificate, registration, permit,
             61      student card, or apprentice card authorized under this title.
             62          (8) (a) "Nonablative procedure" means a procedure that is expected or intended to alter
             63      living tissue, but not to excise, burn, vaporize or remove below the epidermal surface of the
             64      skin.
             65          (b) "Nonablative procedure" does not include:
             66          (i) a superficial procedure;
             67          (ii) the application of permanent make-up; or
             68          (iii) the use of infrared photo therapy and low level lasers for treatments that:
             69          (A) are not cosmetic medical procedures; and
             70          (B) are performed by a chiropractor or physical therapist for treatment of a condition
             71      that is within their scope of practice.
             72          (9) "Superficial procedure" means a procedure that is expected or intended to
             73      temporarily alter living skin tissue and may excise or remove stratum corneum but have no
             74      appreciable risk of damage to any tissue below the stratum corneum.
             75          [(6)] (10) "Unlawful conduct" has the meaning given in Subsection 58-1-501 (1).
             76          [(7)] (11) "Unprofessional conduct" has the meaning given in Subsection 58-1-501 (2).
             77          Section 2. Section 58-1-505 is enacted to read:
             78          58-1-505. Cosmetic medical procedure supervisor.
             79          (1) For purposes of this section:
             80          (a) "Cosmetic medical facility" means a physician's office or a facility that has a
             81      supervisor who performs the supervision required in Section 58-1-506 .
             82          (b) "Supervisor" means:
             83          (i) a physician with an unrestricted license under Chapter 67, Utah Medical Practice
             84      Act, or Chapter 68, Utah Osteopathic Medical Practice Act, who is acting within the scope of
             85      the practice of medicine, as defined in Section 58-67-102 ; and
             86          (ii) an advanced practice registered nurse with an unrestricted license under Chapter
             87      31b, Nurse Practice Act, who is acting within the scope of practice of advanced practice


             88      registered nursing, as defined in Section 58-31b-102 .
             89          (2) (a) An individual authorized by this title to perform a cosmetic medical procedure
             90      shall be supervised by a supervisor when performing a medical procedure.
             91          (b) Cosmetic medical procedures may only be performed in a cosmetic medical
             92      facility.
             93          (c) A supervisor may delegate the supervisory role only to another individual who is
             94      qualified as a supervisor.
             95          Section 3. Section 58-1-506 is enacted to read:
             96          58-1-506. Supervision of cosmetic medical procedures.
             97          (1) For purposes of this section:
             98          (a) "Delegation group A" means the following who are licensed under this title, acting
             99      within their respective scope of practice, and qualified under Subsection (2)(f):
             100          (i) a physician assistant, if supervised by a physician and the procedure is included in
             101      the delegation agreement;
             102          (ii) a registered nurse;
             103          (iii) a master esthetician; and
             104          (iv) an electrologist, if evaluating for or performing laser hair removal.
             105          (b) "Delegation group B" means the following who are licensed under this title, acting
             106      within their respective scope of practice, and are qualified under Subsection (2)(f):
             107          (i) a practical nurse;
             108          (ii) an esthetician; and
             109          (iii) a medical assistant.
             110          (c) "Direct cosmetic medical procedure supervision" means the supervisor:
             111          (i) has authorized the procedure to be done on the patient by the supervisee; and
             112          (ii) is present and available for a face-to-face communication with the supervisee when
             113      and where a cosmetic medical procedure is performed.
             114          (d) "General cosmetic medical procedure supervision" means the supervisor:
             115          (i) has authorized the procedure to be done on the patient by the supervisee;
             116          (ii) is available in a timely and appropriate manner in person to evaluate and initiate
             117      care for a patient with a suspected adverse reaction or complication; and
             118          (iii) is located within 45 minutes or 45 miles of the cosmetic medical facility.


             119          (e) "Indirect cosmetic medical procedure supervision" means the supervisor:
             120          (i) has authorized the procedure to be done on the patient by the supervisee;
             121          (ii) has given written instructions to the person being supervised;
             122          (iii) is present within the cosmetic medical facility in which the person being
             123      supervised is providing services; and
             124          (iv) is available to:
             125          (A) provide immediate face-to-face communication with the person being supervised;
             126      and
             127          (B) evaluate the patient, as necessary.
             128          (f) "Hair removal review" means:
             129          (i) conducting an in-person, face-to-face interview of a patient based on the responses
             130      provided by the patient to a detailed medical history assessment that was prepared by the
             131      supervisor;
             132          (ii) evaluating for contraindications and conditions that are part of the treatment plan;
             133      and
             134          (iii) if the patient history or patient presentation deviates in any way from the treatment
             135      plan, referring the patient to the supervisor and receiving clearance from the supervisor before
             136      starting the treatment.
             137          (2) A supervisor supervising a nonablative cosmetic medical procedure for hair
             138      removal shall:
             139          (a) have an unrestricted license to practice medicine or advanced practice registered
             140      nursing in the state;
             141          (b) develop the medical treatment plan for the procedure;
             142          (c) conduct a hair removal review, or delegate the hair removal review to a member of
             143      delegation group A, of the patient prior to initiating treatment or a series of treatments;
             144          (d) personally perform the nonablative cosmetic medical procedure for hair removal, or
             145      authorize and delegate the procedure to a member of delegation group A or B;
             146          (e) during the nonablative cosmetic medical procedure for hair removal provide general
             147      cosmetic medical procedure supervision to individuals in delegation group A performing the
             148      procedure and indirect cosmetic medical procedure supervision to individuals in delegation
             149      group B performing the procedure; and


             150          (f) verify that a person to whom the supervisor delegates an evaluation under
             151      Subsection (2)(c) or delegates a procedure under Subsection (2)(d):
             152          (i) has received appropriate training regarding the medical procedures developed under
             153      Subsection (2)(b);
             154          (ii) has an unrestricted license under this title or is performing under the license of the
             155      supervising physician and surgeon; and
             156          (iii) if a practical nurse or medical assistant, has maintained competence to perform the
             157      nonablative cosmetic medical procedure for hair removal through documented training and
             158      experience of at least 80 hours, as further defined by rule, regarding:
             159          (A) the appropriate standard of care for performing nonablative cosmetic medical
             160      procedures for hair removal;
             161          (B) physiology of the skin;
             162          (C) skin typing and analysis;
             163          (D) skin conditions, disorders, and diseases;
             164          (E) pre and post procedure care;
             165          (F) infection control;
             166          (G) laser and light physics training;
             167          (H) laser technologies and applications;
             168          (I) safety and maintenance of lasers;
             169          (J) cosmetic laser hair removal procedures;
             170          (K) recognition and appropriate management of complications from a procedure; and
             171          (L) cardio-pulmonary resuscitation (CPR).
             172          (3) For a nonablative cosmetic medical procedure other than hair removal under
             173      Subsection (2):
             174          (a) a physician who has an unrestricted license to practice medicine shall:
             175          (i) develop a treatment plan for the nonablative cosmetic medical procedure; and
             176          (ii) conduct an in-person face-to-face evaluation of the patient prior to the initiation of
             177      a treatment protocol or series of treatments;
             178          (b) the supervisor supervising the procedure shall:
             179          (i) have an unrestricted license to practice medicine or advanced practice registered
             180      nursing;


             181          (ii) personally perform the nonablative cosmetic medical procedure or:
             182          (A) authorize and provide general cosmetic medical procedure supervision for the
             183      nonablative cosmetic medical procedure that is performed by:
             184          (I) a physician assistant, if supervised by a physician and the procedure is included in
             185      the delegation agreement;
             186          (II) a registered nurse;
             187          (III) a master esthetician; or
             188          (B) authorize and provide direct cosmetic medical procedure supervision for the
             189      nonablative cosmetic medical procedure that is performed by an esthetician; and
             190          (iii) verify that a person to whom the supervisor delegates a procedure under
             191      Subsection (3)(b):
             192          (A) has received appropriate training regarding the medical procedures to be
             193      performed; and
             194          (B) has an unrestricted license and is acting within their scope of practice under this
             195      title.
             196          (4) A supervisor performing or supervising a cosmetic medical procedure under
             197      Subsection (2) or (3) shall ensure that:
             198          (a) the supervisor's name is prominently posted at the cosmetic medical facility
             199      identifying the supervisor;
             200          (b) a copy of the supervisor's license is displayed on the wall of the cosmetic medical
             201      facility;
             202          (c) the patient receives written information with the name and licensing information of
             203      the supervisor who is supervising the nonablative cosmetic medical procedure and the person
             204      who is performing the nonablative cosmetic medical procedure;
             205          (d) the patient is provided with a telephone number that is answered within 24 hours
             206      for follow-up communication;
             207          (e) the cosmetic medical facility's contract with a master esthetician who performs a
             208      nonablative cosmetic medical procedure at the facility is kept on the premises of the facility;
             209      and
             210          (f) a supervisee and supervisor, who are required to have malpractice and liability
             211      insurance, have proof of insurance available for inspection at the request of a patient.


             212          (5) Failure to comply with the provisions of this section is unprofessional conduct.
             213          Section 4. Section 58-11a-102 is amended to read:
             214           58-11a-102. Definitions.
             215          As used in this chapter:
             216          (1) "Approved barber or cosmetologist/barber apprenticeship" means an apprenticeship
             217      that meets the requirements of Subsection 58-11a-306 (1) for barbers or Subsection
             218      58-11a-306 (2) for cosmetologist/barbers and the requirements established by rule by the
             219      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             220      Administrative Rulemaking Act.
             221          (2) "Approved esthetician apprenticeship" means an apprenticeship that meets the
             222      requirements of Subsection 58-11a-306 (3) and the requirements established by rule by the
             223      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             224      Administrative Rulemaking Act.
             225          (3) "Approved master esthetician apprenticeship" means an apprenticeship that meets
             226      the requirements of Subsection 58-11a-306 (4) and the requirements established by rule by the
             227      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             228      Administrative Rulemaking Act.
             229          (4) "Approved nail technician apprenticeship" means an apprenticeship that meets the
             230      requirements of Subsection 58-11a-306 (5) and the requirements established by rule by the
             231      division in collaboration with the board in accordance with Title 63G, Chapter 3, Utah
             232      Administrative Rulemaking Act.
             233          (5) "Barber" means a person who is licensed under this chapter to engage in the
             234      practice of barbering.
             235          (6) "Barber instructor" means a barber who is licensed under this chapter to teach
             236      barbering at a licensed barber school or in an apprenticeship program as defined in Section
             237      58-11a-306 .
             238          (7) "Board" means the Barber, Cosmetology/Barbering, Esthetics, Electrology, and
             239      Nail Technology Licensing Board created in Section 58-11a-201 .
             240          (8) "Cosmetic laser procedure" means only a nonablative procedure as defined in
             241      Section 58-67-102 .
             242          (9) "Cosmetic supervisor" means a supervisor as defined in Section 58-1-505 .


             243          [(8)] (10) "Cosmetologist/barber" means a person who is licensed under this chapter to
             244      engage in the practice of cosmetology/barbering.
             245          [(9)] (11) "Cosmetologist/barber instructor" means a cosmetologist/barber who is
             246      licensed under this chapter to teach cosmetology/barbering at a licensed cosmetology/barber
             247      school, licensed barber school, licensed nail technology school, or in an apprenticeship
             248      program as defined in Subsection 58-11a-306 (2).
             249          [(10)] (12) "Direct supervision" means that the supervisor of an apprentice or the
             250      instructor of a student is immediately available for consultation, advice, instruction, and
             251      evaluation.
             252          [(11)] (13) "Electrologist" means a person who is licensed under this chapter to engage
             253      in the practice of electrology.
             254          [(12)] (14) "Electrologist instructor" means an electrologist who is licensed under this
             255      chapter to teach electrology at a licensed electrology school.
             256          [(13)] (15) "Esthetician" means a person who is licensed under this chapter to engage
             257      in the practice of esthetics.
             258          [(14)] (16) "Esthetician instructor" means a master esthetician who is licensed under
             259      this chapter to teach the practice of esthetics and the practice of master-level esthetics at a
             260      licensed esthetics school, a licensed cosmetology/barber school, or in an apprenticeship
             261      program as defined in Subsection 58-11a-306 (3).
             262          [(15)] (17) "Fund" means the Barber, Cosmetologist/Barber, Esthetician, Electrologist,
             263      and Nail Technician Education and Enforcement Fund created in Section 58-11a-103 .
             264          [(16)] (18) "Licensed barber or cosmetology/barber school" means a barber or
             265      cosmetology/barber school licensed under this chapter.
             266          [(17)] (19) "Licensed electrology school" means an electrology school licensed under
             267      this chapter.
             268          [(18)] (20) "Licensed esthetics school" means an esthetics school licensed under this
             269      chapter.
             270          [(19)] (21) "Licensed nail technology school" means a nail technology school licensed
             271      under this chapter.
             272          [(20)] (22) "Master esthetician" means an individual who is licensed under this chapter
             273      to engage in the practice of master-level esthetics.


             274          [(21)] (23) "Nail technician" means an individual who is licensed under this chapter to
             275      engage in the practice of nail technology.
             276          [(22)] (24) "Nail technician instructor" means a nail technician licensed under this
             277      chapter to teach the practice of nail technology in a licensed nail technology school, a licensed
             278      cosmetology/barber school, or in an apprenticeship program as defined in Subsection
             279      58-11a-306 (5).
             280          [(23)] (25) "Practice of barbering" means:
             281          (a) cutting, clipping, or trimming the hair of the head of any person by the use of
             282      scissors, shears, clippers, or other appliances;
             283          (b) draping, shampooing, scalp treatments, basic wet styling, and blow drying; and
             284          (c) removing hair from the face or neck of a person by the use of shaving equipment.
             285          [(24)] (26) "Practice of barbering instruction" means instructing barbering in a licensed
             286      barber school, licensed cosmetology/barber school, or in an apprenticeship program as defined
             287      in Subsection 58-11a-306 (1).
             288          [(25)] (27) "Practice of basic esthetics" means any one of the following skin care
             289      procedures done on the head, face, neck, arms, hands, legs, feet, eyebrows, or eyelashes for
             290      cosmetic purposes and not for the treatment of medical, physical, or mental ailments:
             291          (a) cleansing, stimulating, manipulating, exercising, applying oils, antiseptics, clays, or
             292      masks, manual extraction, including a comodone extractor, depilatories, waxes, tweezing, the
             293      application of eyelash extensions, natural nail manicures or pedicures, or callous removal by
             294      buffing or filing;
             295          (b) limited chemical exfoliation as defined by rule;
             296          (c) removing superfluous hair by means other than electrolysis, except that an
             297      individual is not required to be licensed as an esthetician to engage in the practice of threading;
             298          (d) other esthetic preparations or procedures with the use of the hands, a
             299      high-frequency or galvanic electrical apparatus, or a heat lamp for cosmetic purposes and not
             300      for the treatment of medical, physical, or mental ailments; or
             301          (e) cosmetic laser procedures under [direct] the supervision of a [licensed health care
             302      practitioner as defined by rule,] cosmetic supervisor limited to the following:
             303          (i) superfluous hair removal;
             304          (ii) anti-aging resurfacing enhancements;


             305          (iii) photo rejuvenation; or
             306          (iv) tattoo removal.
             307          [(26)] (28) (a) "Practice of cosmetology/barbering" means:
             308          (i) styling, arranging, dressing, curling, waving, permanent waving, cleansing,
             309      singeing, bleaching, dyeing, tinting, coloring, or similarly treating the hair of the head of a
             310      person;
             311          (ii) cutting, clipping, or trimming the hair by the use of scissors, shears, clippers, or
             312      other appliances;
             313          (iii) arching eyebrows, or tinting eyebrows or eyelashes, applying eyelash extensions,
             314      or any combination of these procedures;
             315          (iv) removing hair from the face, neck, shoulders, arms, back, torso, feet, bikini line,
             316      or legs of a person by the use of depilatories, waxing, or shaving equipment;
             317          (v) cutting, curling, styling, fitting, measuring, or forming caps for wigs or hairpieces
             318      or both on the human head; or
             319          (vi) practicing hair weaving or hair fusing or servicing previously medically implanted
             320      hair.
             321          (b) The term "practice of cosmetology/barbering" includes:
             322          (i) the practice of basic esthetics; and
             323          (ii) the practice of nail technology.
             324          (c) An individual is not required to be licensed as a cosmetologist/barber to engage in
             325      the practice of threading.
             326          [(27)] (29) "Practice of cosmetology/barbering instruction" means instructing
             327      cosmetology/barbering as defined in Subsection [(26)] (28) in a licensed cosmetology/barber
             328      school or in an apprenticeship program as defined in Subsection 58-11a-306 (2).
             329          [(28)] (30) "Practice of electrology" means:
             330          (a) the removal of superfluous hair from the body of a person by the use of electricity,
             331      waxing, shaving, or tweezing; or
             332          (b) cosmetic laser procedures under the [general] supervision of a [licensed health care
             333      practitioner as defined by rule,] cosmetic supervisor limited to superfluous hair removal.
             334          [(29)] (31) "Practice of electrology instruction" means instructing electrology in a
             335      licensed electrology school.


             336          [(30)] (32) "Practice of esthetics instruction" means instructing esthetics in a licensed
             337      esthetics school, a licensed cosmetology/barber school, or instructing master-level esthetics in a
             338      licensed esthetics school or in an apprenticeship program as defined in Subsections
             339      58-11a-306 (2), (3), and (4).
             340          [(31)] (33) (a) "Practice of master-level esthetics" means:
             341          (i) any of the following when done for cosmetic purposes on the head, face, neck,
             342      torso, abdomen, back, arms, hands, legs, feet, eyebrows, or eyelashes and not for the treatment
             343      of medical, physical, or mental ailments:
             344          (A) body wraps as defined by rule;
             345          (B) hydrotherapy as defined by rule;
             346          (C) chemical exfoliation as defined by rule;
             347          (D) advanced pedicures as defined by rule;
             348          (E) sanding, including microdermabrasion;
             349          (F) advanced extraction;
             350          (G) other esthetic preparations or procedures with the use of:
             351          (I) the hands; or
             352          (II) a mechanical or electrical apparatus which is approved for use by division rule for
             353      beautifying or similar work performed on the body for cosmetic purposes and not for the
             354      treatment of a medical, physical, or mental ailment; or
             355          (H) cosmetic laser procedures under the [general] supervision of a [licensed health care
             356      practitioner as defined by rule,] cosmetic supervisor with a physician's evaluation before the
             357      procedure, as needed, unless specifically required under Section 58-1-506 , and limited to the
             358      following:
             359          (I) superfluous hair removal;
             360          (II) anti-aging resurfacing enhancements;
             361          (III) photo rejuvenation; or
             362          (IV) tattoo removal with a physician's evaluation before the tattoo removal procedure;
             363      and
             364          (ii) lymphatic massage by manual or other means as defined by rule.
             365          (b) Notwithstanding the provisions of Subsection [(31)] (33)(a), a master-level
             366      esthetician may perform procedures listed in Subsection [(31)] (33)(a)(i) for noncosmetic


             367      purposes if done under the supervision of a licensed health care practitioner acting within the
             368      scope of the licensed health care practitioner's license as defined by rule.
             369          (c) The term "practice of master-level esthetics" includes the practice of esthetics, but
             370      an individual is not required to be licensed as an esthetician or master-level esthetician to
             371      engage in the practice of threading.
             372          [(32)] (34) "Practice of nail technology" means to trim, cut, clean, manicure, shape,
             373      massage, or enhance the appearance of the hands, feet, and nails of an individual by the use of
             374      hands, mechanical, or electrical preparation, antiseptic, lotions, or creams, including the
             375      application and removal of sculptured or artificial nails.
             376          [(33)] (35) "Practice of nail technology instruction" means instructing nail technology
             377      in a licensed nail technician school, licensed cosmetology/barber school, or in an
             378      apprenticeship program as defined in Subsection 58-11a-306 (5).
             379          [(34)] (36) "Recognized barber school" means a barber school located in a state other
             380      than Utah, whose students, upon graduation, are recognized as having completed the
             381      educational requirements for licensure in that state.
             382          [(35)] (37) "Recognized cosmetology/barber school" means a cosmetology/barber
             383      school located in a state other than Utah, whose students, upon graduation, are recognized as
             384      having completed the educational requirements for licensure in that state.
             385          [(36)] (38) "Recognized electrology school" means an electrology school located in a
             386      state other than Utah, whose students, upon graduation, are recognized as having completed the
             387      educational requirements for licensure in that state.
             388          [(37)] (39) "Recognized esthetics school" means an esthetics school located in a state
             389      other than Utah, whose students, upon graduation, are recognized as having completed the
             390      educational requirements for licensure in that state.
             391          [(38)] (40) "Recognized nail technology school" means a nail technology school
             392      located in a state other than Utah, whose students, upon graduation, are recognized as having
             393      completed the educational requirements for licensure in that state.
             394          [(39)] (41) "Salon" means a place, shop, or establishment in which
             395      cosmetology/barbering, esthetics, electrology, or nail technology is practiced.
             396          [(40)] (42) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-11a-502 .
             397          [(41)] (43) "Unprofessional conduct" is as defined in Sections 58-1-501 and


             398      58-11a-501 and as may be further defined by rule by the division in collaboration with the
             399      board in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act.
             400          Section 5. Section 58-11a-502 is amended to read:
             401           58-11a-502. Unlawful conduct.
             402          Unlawful conduct includes:
             403          (1) practicing or engaging in, or attempting to practice or engage in activity for which a
             404      license is required under this chapter unless:
             405          (a) the person holds the appropriate license under this chapter; or
             406          (b) an exemption in Section 58-1-307 or 58-11a-304 applies;
             407          (2) knowingly employing any other person to engage in or practice or attempt to
             408      engage in or practice any occupation or profession licensed under this chapter if the employee
             409      is not licensed to do so under this chapter or exempt from licensure;
             410          (3) touching, or applying an instrument or device to the following areas of a client's
             411      body:
             412          (a) the genitals or the anus, except in cases where the patron states to a licensee that the
             413      patron requests a hair removal procedure and signs a written consent form, which must also
             414      include the witnessed signature of a legal guardian if the patron is a minor, authorizing the
             415      licensee to perform a hair removal procedure; or
             416          (b) the breast of a female patron, except in cases in which the female patron states to a
             417      licensee that the patron requests breast skin procedures and signs a written consent form, which
             418      must also include the witnessed signature of a parent or legal guardian if the patron is a minor,
             419      authorizing the licensee to perform breast skin procedures; [and]
             420          (4) using or possessing as a nail technician a solution composed of at least 10% methyl
             421      methacrylete on a client[.]; or
             422          (5) performing an ablative procedure as defined in Section 58-67-102 .
             423          Section 6. Section 58-16a-102 is amended to read:
             424           58-16a-102. Definitions.
             425          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             426          (1) "Board" means the Optometrist Licensing Board created in Section 58-16a-201 .
             427          (2) "Contact lens" means any lens that:
             428          (a) has a spherical, cylindrical, or prismatic power or curvature;


             429          (b) is made pursuant to a current prescription; or
             430          (c) is intended to be worn on the surface of the eye.
             431          (3) (a) "Contact lens prescription" means a written or verbal order for contact lenses
             432      that includes:
             433          (i) the commencement date of the prescription;
             434          (ii) the base curve, power, diameter, material or brand name, and expiration date;
             435          (iii) for a written order, the signature of the prescribing optometrist or physician; and
             436          (iv) for a verbal order, a record maintained by the recipient of:
             437          (A) the name of the prescribing optometrist or physician; and
             438          (B) the date when the prescription was issued or ordered.
             439          (b) A prescription may include:
             440          (i) a limit on the quantity of lenses that may be ordered under the prescription if
             441      required for medical reasons documented in the patient's files; and
             442          (ii) the expiration date of the prescription, which shall be two years from the
             443      commencement date, unless documented medical reasons require otherwise.
             444          (c) When a provider prescribes a private label contact lens for a patient the prescription
             445      shall include:
             446          (i) the name of the manufacturer;
             447          (ii) the trade name of the private label brand; and
             448          (iii) if applicable, the trade name of the equivalent national brand.
             449          (4) "Contact lens prescription verification" means a written request from a person who
             450      sells or provides contact lenses that:
             451          (a) is sent to the prescribing optometrist or physician; and
             452          (b) seeks the confirmation of the accuracy of a patient's prescription.
             453          (5) "Eye and its adnexa" means the human eye and all structures situated within the
             454      orbit, including the conjunctiva, lids, lashes, and lacrimal system.
             455          (6) "Fitting of a contact lens" means:
             456          (a) the using of a keratometer to measure the human eye;
             457          (b) utilizing refractive data provided by a licensed optometrist or ophthalmologist; and
             458          (c) trial fitting of contact lenses, which includes a period of time for evaluation for fit
             459      and performance, to determine a tentative contact lens prescription for a patient if the patient:


             460          (i) has not worn contact lenses before; or
             461          (ii) has changed to a different type or base curve.
             462          (7) "Laser surgery" means surgery in which human tissue is cut, burned, or vaporized
             463      by means of laser or ionizing radiation.
             464          (8) "Ophthalmic lens" means any lens used to treat the eye and that:
             465          (a) has a spherical, cylindrical, or prismatic power;
             466          (b) is made pursuant to an unexpired prescription; and
             467          (c) is intended to be used in eyeglasses or spectacles.
             468          (9) "Optometric assistant" means an unlicensed individual:
             469          (a) working under the direct and immediate supervision of a licensed optometrist; and
             470          (b) engaged in specific tasks assigned by the licensed optometrist in accordance with
             471      the standards and ethics of the profession.
             472          (10) "Optometrist" or "optometric physician" means an individual licensed under this
             473      chapter.
             474          (11) "Optometry" and "practice of optometry" mean any one or any combination of the
             475      following practices:
             476          (a) examination of the human eye and its adnexa to detect and diagnose defects or
             477      abnormal conditions;
             478          (b) determination or modification of the accommodative or refractive state of the
             479      human eye or its range or power of vision by administration and prescription of pharmaceutical
             480      agents or the use of diagnostic instruments;
             481          (c) prescription, ordering, administration, or adaptation of ophthalmic lenses, contact
             482      lenses, ophthalmic devices, pharmaceutical agents, laboratory tests, or ocular exercises to
             483      diagnose and treat diseases, defects, or other abnormal conditions of the human eye and its
             484      adnexa;
             485          (d) display of any advertisement, circular, sign, or device offering to:
             486          (i) examine the eyes;
             487          (ii) fit glasses or contact lenses; or
             488          (iii) adjust frames;
             489          (e) removal of a foreign body from the eye or its adnexa, that is not deeper than the
             490      anterior 1/2 of the cornea;


             491          (f) consultation regarding the eye and its adnexa with other appropriate health care
             492      providers, including referral to other appropriate health care providers; and
             493          (g) a person, not licensed as an optometrist, directing a licensee under this chapter to
             494      withhold or alter the eye care services the licensee has ordered.
             495          (12) "Pharmaceutical agent" means any diagnostic or therapeutic drug or combination
             496      of drugs that has the property of assisting in the diagnosis, prevention, treatment, or mitigation
             497      of abnormal conditions or symptoms of the eye and its adnexa.
             498          (13) "Physician" has the same meaning as defined in [Subsection 58-67-102 (7)]
             499      Sections 58-67-102 and 58-68-102 .
             500          (14) "Prescription drug" has the same definition as in Section 58-17b-102 .
             501          (15) "Unexpired" means a prescription that was issued:
             502          (a) not more than two years prior to presentation of the prescription for an ophthalmic
             503      lens; or
             504          (b) in accordance with Subsection (3) for a contact lens.
             505          Section 7. Section 58-67-102 is amended to read:
             506           58-67-102. Definitions.
             507          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             508          (1) "Ablative procedure" means a procedure that is expected to excise, burn, vaporize
             509      or remove a portion or all of the epidermis, including the use of carbon dioxide lasers and
             510      erbium:YAG lasers.
             511          [(1)] (2) "ACGME" means the Accreditation Council for Graduate Medical Education
             512      of the American Medical Association.
             513          [(2)] (3) "Administrative penalty" means a monetary fine or citation imposed by the
             514      division for acts or omissions determined to constitute unprofessional or unlawful conduct, in
             515      accordance with a fine schedule established by the division in collaboration with the board, as a
             516      result of an adjudicative proceeding conducted in accordance with Title 63G, Chapter 4,
             517      Administrative Procedures Act.
             518          [(3)] (4) "Board" means the Physicians Licensing Board created in Section 58-67-201 .
             519          (5) "Cosmetic medical device" means tissue altering energy based devices that have the
             520      potential for altering living tissue, such as American National Standards Institute designated
             521      Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic


             522      devices.
             523          (6) "Cosmetic medical procedure":
             524          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
             525      procedures; and
             526          (b) does not include a treatment of the ocular globe such as refractive surgery.
             527          [(4)] (7) "Diagnose" means:
             528          (a) to examine in any manner another person, parts of a person's body, substances,
             529      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             530      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             531      condition;
             532          (b) to attempt to conduct an examination or determination described under Subsection
             533      [(4)] (7)(a);
             534          (c) to hold oneself out as making or to represent that one is making an examination or
             535      determination as described in Subsection [(4)] (7)(a); or
             536          (d) to make an examination or determination as described in Subsection [(4)] (7)(a)
             537      upon or from information supplied directly or indirectly by another person, whether or not in
             538      the presence of the person making or attempting the diagnosis or examination.
             539          [(5)] (8) "LCME" means the Liaison Committee on Medical Education of the
             540      American Medical Association.
             541          [(6)] (9) "Medical assistant" means an unlicensed individual working under the direct
             542      and immediate supervision of a licensed physician and surgeon and engaged in specific tasks
             543      assigned by the licensed physician and surgeon in accordance with the standards and ethics of
             544      the profession.
             545          (10) "Nonablative procedure" means a procedure that is expected or intended to alter
             546      living tissue, but not excise, burn, vaporize or remove below the epidermal surface of the skin
             547      and does not include a superficial procedure as defined in Section 58-1-102 , or the application
             548      of permanent make-up.
             549          [(7)] (11) "Physician" means both physicians and surgeons licensed under Section
             550      58-67-301 , Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under
             551      Section 58-68-301 , Utah Osteopathic Medical Practice Act.
             552          [(8)] (12) (a) "Practice of medicine" means:


             553          [(a)] (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
             554      disease, ailment, injury, infirmity, deformity, pain or other condition, physical or mental, real
             555      or imaginary, including to perform cosmetic medical procedures, or to attempt to do so, by any
             556      means or instrumentality, and by an individual in Utah or outside the state upon or for any
             557      human within the state[, except that conduct described in this Subsection (8)(a) that is
             558      performed by a person legally and in accordance with a license issued under another chapter of
             559      this title does not constitute the practice of medicine];
             560          [(b)] (ii) when a person not licensed as a physician directs a licensee under this chapter
             561      to withhold or alter the health care services that the licensee has ordered[, but practice of
             562      medicine does not include any conduct under Subsection 58-67-501 (2)];
             563          [(c)] (iii) to maintain an office or place of business for the purpose of doing any of the
             564      acts described in Subsection [(8)] (12)(a) whether or not for compensation; or
             565          [(d)] (iv) to use, in the conduct of any occupation or profession pertaining to the
             566      diagnosis or treatment of human diseases or conditions in any printed material, stationery,
             567      letterhead, envelopes, signs, or advertisements, the designation "doctor," "doctor of medicine,"
             568      "physician," "surgeon," "physician and surgeon," "Dr.," "M.D.," or any combination of these
             569      designations in any manner which might cause a reasonable person to believe the individual
             570      using the designation is a licensed physician and surgeon, and if the party using the designation
             571      is not a licensed physician and surgeon, the designation must additionally contain the
             572      description of the branch of the healing arts for which the person has a license, provided that an
             573      individual who has received an earned degree of doctor of medicine degree but is not a licensed
             574      physician and surgeon in Utah may use the designation "M.D." if it is followed by "Not
             575      Licensed" or "Not Licensed in Utah" in the same size and style of lettering.
             576          (b) The practice of medicine does not include:
             577          (i) except for an ablative medical procedure as provided in Subsection (12)(b)(ii), the
             578      conduct described in Subsection (12)(a)(i) that is performed in accordance with a license issued
             579      under another chapter of this title;
             580          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
             581      performing the ablative cosmetic medical procedure includes the authority to operate or
             582      perform a surgical procedure; or
             583          (iii) conduct under Subsection 58-67-501 (2).


             584          [(9)] (13) "Prescription device" means an instrument, apparatus, implement, machine,
             585      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             586      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             587      and dispensed by or through a person or entity licensed under this chapter or exempt from
             588      licensure under this chapter.
             589          [(10)] (14) "Prescription drug" means a drug that is required by federal or state law or
             590      rule to be dispensed only by prescription or is restricted to administration only by practitioners.
             591          [(11)] (15) "SPEX" means the Special Purpose Examination of the Federation of State
             592      Medical Boards.
             593          [(12)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-67-501 .
             594          [(13)] (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and
             595      58-67-502 , and as may be further defined by division rule.
             596          Section 8. Section 58-67-805 is enacted to read:
             597          58-67-805. Supervision of cosmetic medical procedures.
             598          A physician may not delegate the performance of an ablative cosmetic medical
             599      procedure to an individual who is not licensed under this chapter or Chapter 68, Utah
             600      Osteopathic Medical Practice Act.
             601          Section 9. Section 58-68-102 is amended to read:
             602           58-68-102. Definitions.
             603          In addition to the definitions in Section 58-1-102 , as used in this chapter:
             604          (1) "Ablative procedure" means a procedure that is expected to excise, burn, vaporize
             605      or remove a portion or all of the epidermis, including the use of carbon dioxide lasers and
             606      erbium:YAG lasers.
             607          [(1)] (2) "ACGME" means the Accreditation Council for Graduate Medical Education
             608      of the American Medical Association.
             609          [(2)] (3) "Administrative penalty" means a monetary fine imposed by the division for
             610      acts or omissions determined to constitute unprofessional or unlawful conduct, as a result of an
             611      adjudicative proceeding conducted in accordance with Title 63G, Chapter 4, Administrative
             612      Procedures Act.
             613          [(3)] (4) "AOA" means the American Osteopathic Association.
             614          [(4)] (5) "Board" means the Osteopathic Physician and Surgeon's Licensing Board


             615      created in Section 58-68-201 .
             616          (6) "Cosmetic medical device" means tissue altering energy based devices that have the
             617      potential for altering living tissue, such as American National Standards Institute designated
             618      Class IIIb and Class IV lasers, intense pulsed light, radio frequency devices, and lipolytic
             619      devices.
             620          (7) "Cosmetic medical procedure":
             621          (a) includes the use of cosmetic medical devices to perform ablative or nonablative
             622      procedures; and
             623          (b) does not include a treatment of the ocular globe such as refractive surgery.
             624          [(5)] (8) "Diagnose" means:
             625          (a) to examine in any manner another person, parts of a person's body, substances,
             626      fluids, or materials excreted, taken, or removed from a person's body, or produced by a person's
             627      body, to determine the source, nature, kind, or extent of a disease or other physical or mental
             628      condition;
             629          (b) to attempt to conduct an examination or determination described under Subsection
             630      [(5)] (8)(a);
             631          (c) to hold oneself out as making or to represent that one is making an examination or
             632      determination as described in Subsection [(5)] (8)(a); or
             633          (d) to make an examination or determination as described in Subsection [(5)] (8)(a)
             634      upon or from information supplied directly or indirectly by another person, whether or not in
             635      the presence of the person making or attempting the diagnosis or examination.
             636          [(6)] (9) "Medical assistant" means an unlicensed individual working under the direct
             637      and immediate supervision of a licensed osteopathic physician and surgeon and engaged in
             638      specific tasks assigned by the licensed osteopathic physician and surgeon in accordance with
             639      the standards and ethics of the profession.
             640          (10) "Nonablative procedure" means a procedure that is expected or intended to alter
             641      living tissue, but not excise, burn, vaporize or remove the epidermal surface of the skin and
             642      does not include a superficial procedure as defined in Section 58-1-102 or the application of
             643      permanent make-up.
             644          [(7)] (11) "Physician" means both physicians and surgeons licensed under Section
             645      58-67-301 , Utah Medical Practice Act, and osteopathic physicians and surgeons licensed under


             646      Section 58-68-301 , Utah Osteopathic Medical Practice Act.
             647          [(8)] (12) (a) "Practice of osteopathic medicine" means:
             648          [(a)] (i) to diagnose, treat, correct, administer anesthesia, or prescribe for any human
             649      disease, ailment, injury, infirmity, deformity, pain, or other condition, physical or mental, real
             650      or imaginary, or to attempt to do so, by any means or instrumentality, which in whole or in part
             651      is based upon emphasis of the importance of the musculoskeletal system and manipulative
             652      therapy in the maintenance and restoration of health, by an individual in Utah or outside of the
             653      state upon or for any human within the state[, except that conduct described in this Subsection
             654      (8)(a) that is performed by a person legally and in accordance with a license issued under
             655      another chapter of this title does not constitute the practice of medicine];
             656          [(b)] (ii) when a person not licensed as a physician directs a licensee under this chapter
             657      to withhold or alter the health care services that the licensee has ordered[, but practice of
             658      medicine does not include any conduct under Subsection 58-68-501 (2)];
             659          [(c)] (iii) to maintain an office or place of business for the purpose of doing any of the
             660      acts described in Subsection [(8)] (12)(a) whether or not for compensation; or
             661          [(d)] (iv) to use, in the conduct of any occupation or profession pertaining to the
             662      diagnosis or treatment of human diseases or conditions, in any printed material, stationery,
             663      letterhead, envelopes, signs, or advertisements, the designation "doctor," "doctor of osteopathic
             664      medicine," "osteopathic physician," "osteopathic surgeon," "osteopathic physician and
             665      surgeon," "Dr.," "D.O.," or any combination of these designations in any manner which might
             666      cause a reasonable person to believe the individual using the designation is a licensed
             667      osteopathic physician, and if the party using the designation is not a licensed osteopathic
             668      physician, the designation must additionally contain the description of the branch of the healing
             669      arts for which the person has a license, provided that an individual who has received an earned
             670      degree of doctor of osteopathic medicine but is not a licensed osteopathic physician and
             671      surgeon in Utah may use the designation "D.O." if it is followed by "Not Licensed" or "Not
             672      Licensed in Utah" in the same size and style of lettering.
             673          (b) The practice of osteopathic medicine does not include:
             674          (i) except for an ablative medical procedure as provided in Subsection (12)(b)(ii), the
             675      conduct described in Subsection (12)(a)(i) that is performed in accordance with a license issued
             676      under another chapter of this title;


             677          (ii) an ablative cosmetic medical procedure if the scope of practice for the person
             678      performing the ablative cosmetic medical procedure includes the authority to operate or
             679      perform a surgical procedure; or
             680          (iii) conduct under Subsection 58-68-501 (2).
             681          [(9)] (13) "Prescription device" means an instrument, apparatus, implement, machine,
             682      contrivance, implant, in vitro reagent, or other similar or related article, and any component
             683      part or accessory, which is required under federal or state law to be prescribed by a practitioner
             684      and dispensed by or through a person or entity licensed under this chapter or exempt from
             685      licensure under this chapter.
             686          [(10)] (14) "Prescription drug" means a drug that is required by federal or state law or
             687      rule to be dispensed only by prescription or is restricted to administration only by practitioners.
             688          [(11)] (15) "SPEX" means the Special Purpose Examination of the Federation of State
             689      Medical Boards.
             690          [(12)] (16) "Unlawful conduct" is as defined in Sections 58-1-501 and 58-68-501 .
             691          [(13)] (17) "Unprofessional conduct" is as defined in Sections 58-1-501 and 58-68-502
             692      and as may be further defined by division rule.
             693          Section 10. Section 58-68-805 is enacted to read:
             694          58-68-805. Supervision of cosmetic medical procedures.
             695          An osteopathic physician and surgeon may not delegate the performance of an ablative
             696      cosmetic medical procedure to an individual who is not licensed under this chapter or Chapter
             697      67, Utah Medical Practice Act.


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