Introduction
After a highly publicized death linked to an IV infusion at a Texas spa in 2023, state lawmakers moved to bring clearer rules and stronger oversight to IV services offered outside traditional medical settings. The result is House Bill 3749—formally “Jenifer’s Law”—signed by Governor Greg Abbott on June 20, 2025, and effective September 1, 2025. The law sets statewide standards for who may order and administer elective IV therapy in non-facility locations such as wellness spas, mobile IV services, and in-home settings. It also tightens how physician oversight must work when care is delegated. Here’s what the law says, why it matters, and how it will change everyday practice for patients and providers.
What the Law Covers: “Elective IV Therapy” Outside Traditional Settings
Jenifer’s Law creates a new chapter in the Texas Occupations Code devoted to “elective intravenous therapy.” The law defines this as IV treatment sought by a patient to relieve temporary discomfort or improve short-term wellness—think hydration drips, vitamin infusions, and similar services. The rules apply when the IV is provided outside of a physician’s office, a licensed health facility, a licensed mental hospital, or a state-operated hospital. In other words, the law targets non-facility locations that have fueled the growth of wellness-focused IV services.
Key Takeaway: If an IV service is offered at a spa, pop-up, mobile unit, hotel, workplace, or a client’s home, it is likely covered by the new rules.
Who Can Prescribe or Order Elective IV Therapy
Under the law, a physician is the center of care. Each elective IV session must be prescribed or ordered by a physician licensed in Texas, or delegated by a Texas physician to one of only two types of clinicians:
- Physician assistants (PAs)
- Advanced practice registered nurses (APRNs)
That delegation must occur under “adequate physician supervision” and via a prescriptive authority agreement between the physician and the PA or APRN.
Who Can Administer Elective IV Therapy
The law also narrows who may physically start and run the IV. A physician may delegate the act of administering elective IV therapy only to:
- PAs
- APRNs
- Registered nurses (RNs)
Again, this must happen under adequate physician supervision.
What “Adequate Physician Supervision” Means in Practice
The statute uses the term “adequate physician supervision” without a highly technical definition. In practical terms, existing Texas standards and commentary make clear that:
- Supervision must match the training and experience of the PA, APRN, or RN.
- Physicians are expected to provide ongoing oversight, ensure protocols and emergency procedures are in place, and review care.
- The supervising physician does not have to be physically present at all times, but must be continuously responsible for appropriate oversight.
Prescriptive Authority Agreements: Limits and Requirements
When a PA or APRN is delegated authority to prescribe or order elective IV therapy, a written prescriptive authority agreement with the physician is required. These agreements are a cornerstone of the new framework:
- They must spell out practice locations, which drugs or devices may be used, how to consult and refer, how to handle emergencies, and how the team communicates.
- They should include quality checks like chart reviews and periodic meetings.
- They must be reviewed, signed, and dated annually by all parties.
- They count toward the physician’s cap on prescriptive authority agreements—Texas generally limits a physician to seven PA/APRN agreements (combined or full-time equivalent). Importantly, the usual exception that sometimes allows exceeding that cap does not apply to elective IV therapy.
- Agreements must be registered with the Texas Medical Board before the delegated clinician begins work.
What This Means for Medical Spas, IV Clinics, and Mobile Providers
The most immediate changes are operational:
- Unlicensed staff may not start or administer IV drips in non-facility settings.
- New patients need an order or prescription from a physician or a delegated PA/APRN working under a registered prescriptive authority agreement.
- A supervising physician must be actively overseeing the care, with protocols for screening, emergencies, and communication.
- Physicians are limited by the seven-agreement cap for PAs and APRNs engaged in elective IV therapy, which may affect staffing and growth plans.
- Documentation should emphasize safety screening (medical history, contraindications, vital signs as appropriate) and demonstrate physician oversight.
Providers should prepare by:
- Auditing staffing models to ensure only PAs, APRNs, or RNs administer IVs.
- Updating intake, consent, and emergency procedures to reflect the elective nature of services and safety-focused screening.
- Reviewing and registering prescriptive authority agreements, including updating them to specify drugs, protocols, and quality measures.
- Training teams on escalation and emergency response, including when to call 911.
- Monitoring guidance from the Texas Medical Board, which may clarify expectations around supervision and documentation.
Does the Law Loosen or Tighten the Industry?
There are two lenses on the law’s impact:
- Tightening: The statute clearly limits who may order and administer elective IV therapy in non-facility settings and ties those actions to physician oversight and formal prescriptive agreements. That will prevent the unlicensed practice scenarios that contributed to the 2023 tragedy and will raise the bar on staffing, documentation, and supervision.
- Potential flexibility: By explicitly framing these services as “elective,” some see a shift in emphasis from proving medical necessity to ensuring safety. In that view, the focus becomes careful screening for contraindications and clear consent rather than diagnosing and treating a specific medical condition. Some industry observers speculate this could support menu-style offerings, provided they are safe for the individual patient.
For now, providers should treat the law as a safety and oversight mandate and await any medical board guidance on how “elective” intersects with existing standards of care.
What Patients Can Expect
For consumers, the experience should feel more medical and more consistent:
- You should be asked about your medical history, allergies, medications, and any conditions that could make IV therapy risky.
- A physician will have ordered the therapy, either directly or through a PA/APRN working under a formal agreement.
- A licensed clinician (PA, APRN, or RN) will start and manage your IV.
- The site should have clear protocols and be prepared to respond to complications.
Bottom Line
Jenifer’s Law brings overdue clarity and safety standards to a fast-growing corner of wellness care. It ensures a physician is accountable for ordering elective IV therapy and supervising care, restricts who can administer IVs in non-facility settings to licensed clinicians, and requires formal, board-registered agreements when PAs and APRNs are involved in prescribing. Clinics will need to tighten protocols, adjust staffing, and document oversight. Patients should see better screening and more professionalized care.