Operating a business that offers esthetic services to the public is a complicated endeavor with numerous legal and practical considerations. These include restrictions on who can own a business, the legal options for structuring the business, limitations on who can perform particular services, and the level of supervision required.
You are strongly encouraged to consult with experienced attorney to help guide you through this process. The Washington State Department of Health and Washington State Department of Licensing are not providing legal advice but are merely offering information to anyone considering opening a med spa or a business offering esthetic services to the public.
Esthetic services include a variety of cosmetic or dermatologic treatments, including laser hair removal, chemical peels, microdermabrasion, body contouring, injectables, and intravenous hydration. These treatments can be provided in a variety of settings, including medical clinics, med spas, wellness clinics, mobile clinics, and remotely via telehealth.
A business offering esthetic services to the public may employ a variety of licensed people to provide those services. It is critical to understand the varying legal scopes of practice of each licensed person providing those services. Allowing a person to exceed their legal scope of practice could result in disciplinary action against the medical director, the supervisor, and the individual performing a task they are not licensed to perform.
A list of some of the applicable laws are listed below, along with resources that you may find helpful. Please understand that this is not a comprehensive list of the applicable laws. Again, an attorney can help you navigate the vast array of legal requirements involved in operating a business.
The legal requirements and guidance are divided into the following categories
- General Information on Starting a Business in Washington
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If you qualify to own a business providing health care services to the public, here are some resources available to you.
The Governor’s office for Regulatory Innovation and Assistance website provides guidance on Washington state’s regulations for businesses. Governor’s Office for Regulatory Innovation & Assistance.
Washington State Department of Revenue website provides information on types of businesses, ownership structure, and taxes. It also provides general guidance for small businesses and an application for a business license. Open a business | Washington Department of Revenue.
Having an ownership interest in a business the provides esthetic services raises many legal issues to consider when setting up such a business, including prohibitions against fee-splitting, rebating, the corporate practice of medicine, and aiding or abetting the unlicensed practice of a profession, just to name a few. An attorney can help you determine whether the law permits you to have an ownership interest in the business and how your business should be structured, whether as a corporation, a limited liability company, a partnership, a sole proprietorship, or other legal entity.
- Information on Obtaining a License, Certificate, or Registration
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For information on obtaining a health care license, permit or certificate, see the Department of Health webpage.
For more information on obtaining a license as an esthetician or master esthetician, see the Department of Licensing webpage.
- Guidance for the Provision of Medication
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The Washington Pharmacy Quality Assurance Commission (Pharmacy Commission) regulates the practice of pharmacy and the distribution, and manufacturing of pharmaceuticals within and into Washington. The Pharmacy Commission regulates the delivery of pharmaceuticals within and into Washington for those that hold a credential with the commission. The Pharmacy Commission does regulate prescription labeling standards for both dispensing practitioners and those licensed by the commission. See WAC 246-945-015 and WAC 246-945-016.
Anyone who administers medication to another person, for example in a med spa, must have legal authority to do so. Since an IV hydration bag is a medication, a medication order is required prior to initiating IV hydration therapy. The Pharmacy Commission has a webpage listing the professions that can administer and prescribe medication in Washington.
The Pharmacy Commission has a webpage listing the state and federal laws relating to administering and prescribing medication.
For licensees of the Pharmacy Commission, they must comply with the United States Pharmacopeia (USP) when compounding medications. See RCW 18.64.270 and WAC 246-945-100.
Laws applicable to specific health care professionals
- Allopathic Physicians (MDs), Osteopathic Physicians (DOs) and Physician Assistants (PAs)
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The Washington Medical Commission (WMC) regulates allopathic physicians (MDs) and physician assistants (PAs). The Washington Board of Osteopathic Medicine and Surgery (BOMS) regulates osteopathic physicians (DOs).
A specific law permits a physician assistant (PA) to own a healthcare clinic. RCW 18.71A.120(8). The WMC issued a guidance document providing recommendations to PAs who own clinics (PDF).
Both the WMC and BOMS have developed rules applicable to services commonly provided in med spas. These rules, set forth below, apply to the use of lasers or similar devices, the injection of substances for cosmetic purposes, and the use of prescription devices.
The rules governing the use of lasers and similar devices set standards for an MD, DO, or PA using such a device for the treatment of the skin. The rules also describe the circumstances under which an MD or DO can delegate procedures to other licensed professionals and the level of supervision required.
- WAC 246-919-605 Laser rule for MDs
- WAC 246-853-630 Laser rule for DOs
- WAC 246-918-125 Laser rule for PAs
The WMC and BOMS also created rules governing nonsurgical medical cosmetic procedures performed by an MD, DO, or PA. These rules cover the injection of substances for cosmetic purposes and the use of prescription devices that are not lasers. The rules also describe the circumstances under which an MD or DO can delegate procedures to other licensed professionals and the level of supervision required.
- WAC 246-919-606 Nonsurgical medical cosmetic procedures rule for MDs
- WAC 246-853-640 Nonsurgical medical cosmetics procedure rule for DOs
- WAC 246-918-126 Nonsurgical medical cosmetic procedures rule for PAs
An MD, DO, or PA considering serving as a medical director for a medical spa or wellness clinic should be familiar with the responsibilities that come with this role. The WMC has issued a guidance document on this topic (PDF). Please be aware that a medical director is responsible for ensuring that each person in the facility practices within their legal scope.
The WMC has also issued a guidance document on medical professionalism for MDs and PAs PDF).
An MD, DO, and PA should be familiar with the statutes, rules, and policies governing their respective professions:
- Nurse Practitioners (ARNPs), Registered Nurses (RNs), and Licensed Practical Nurses (LPNs)
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The Washington State Board of Nursing (WABON) regulates advance registered nurse practitioners, registered nurses, and licensed practical nurses.
WABON has a webpage devoted to providing support for practicing nurses.
The website includes a scope of practice decision tree.
The website also provides advisory opinions, interpretive statements, and guidance documents regarding the practice of professional nursing in the state of Washington.
The following advisory opinions and guidance documents may apply to nurses working in medical spas.
- Estheticians, Master Estheticians, and Cosmetologists
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The Washington State Department of Licensing (DOL) regulates estheticians, master estheticians, and cosmetologists. For information on the scope of practice of these licensees, please see the DOL webpage for professional licensing. The webpage provides information on the scope of practice of estheticians, master estheticians, and cosmetologists, as well as information on its technical assistance program.
Estheticians, master estheticians, and cosmetologists typically practice without supervision. However, if an esthetician uses a device that the FDA has designated as a prescription device, such as a laser or light-based device on a person’s skin, the esthetician may use the device only under the supervision of an MD or DO.
The DOL issued a statement on the use of lasers and other prescription devices. This statement describes the scope of practice for esthetics and master esthetics and explains how an esthetician and master esthetician can use lasers in compliance with Department of Health rules.
An esthetician, master esthetician or cosmetologist should be familiar with the statutes, rules, and policies governing their respective professions:
- Dentists: DDS and DMDs
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Dentists may provide cosmetic or other dental services to patients. A dentist providing such services must ensure that they are competent to provide those services, that they provide appropriate supervision to ancillary personnel, and that all personnel perform duties within their legal scope of practice.
The Washington State Dental Quality Assurance Commission regulates the practice of dentistry. The Commission’s website provides information on the applicable statutes and rules, including the scope of practice and supervision and delegation requirements. Washington State Dental Quality Assurance Commission.
A dentist should be familiar with the statutes and rules regulating the profession:
- Naturopathic Physicians: NDs
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Licensed naturopathic physicians may provide cosmetic or other services so long as the services are within the legal scope of practice of a naturopathic physician.
The Washington State Board of Naturopathy regulates the practice of naturopathy. The Board’s website provides information on the applicable statutes and rules regulating the practice of naturopathy, including a guideline on naturopathic physicians performing dry needling (PDF).
A naturopath should be familiar with the statutes and rules regulating the profession: