California Med Spa Compliance: The 2025–2026 Regulatory Survival Guide

If you operate a medical spa in California, you are operating in the most heavily regulated aesthetic market in the country. The days of the "Wild West"—where anyone with an Instagram account and a syringe could open a shop—are rapidly coming to a close.

Between 2025 and 2026, California is rolling out a series of legislative updates that will fundamentally change how Med Spas are owned, managed, and staffed. From the crackdown on Private Equity interference (SB 351) to the long-awaited independence of Nurse Practitioners (AB 890), the rules of the game have changed.

This guide breaks down the critical compliance news you need to know to keep your license—and your business—safe.

1. The "Private Equity" Crackdown: SB 351

Effective Date: January 1, 2026

This is arguably the most significant piece of legislation for the industry in a decade. For years, the "Corporate Practice of Medicine" (CPOM) prohibition was a guideline that many Management Services Organizations (MSOs) danced around. SB 351 codifies these restrictions into strict law.

If your Med Spa is backed by private investors, a hedge fund, or a non-physician-owned MSO, you must audit your contracts immediately.

What Changes?

• Clinical Autonomy is Sacrosanct: The law explicitly forbids lay entities (MSOs, investors) from interfering with any clinical decision. This includes:
  • Which devices or products to buy (e.g., "You must use this cheaper filler").
  • Staffing levels (e.g., "You can't hire another RN").
  • Patient scheduling (e.g., "You must see 4 patients per hour").
• The Death of the Provider Non-Compete: SB 351 renders non-compete clauses void for healthcare providers in these structures. You cannot contractually prevent a doctor or nurse from leaving your spa and working for a competitor (or opening their own) if your structure violates these new CPOM standards.
• No "Gag Orders": You cannot include non-disparagement clauses that prevent providers from speaking out about patient safety or quality of care issues.

The Bottom Line: If your MSO agreement gives a non-physician "ultimate authority" over budget or operations that impact patient care, it may be illegal as of Jan 1, 2026.

2. The Rise of the Independent NP: AB 890

Key Milestone: January 1, 2026

We have been hearing about AB 890 for years, but 2026 is the year it truly matters.

Under this law, Nurse Practitioners (NPs) are split into two categories: "103 NPs" (who work in group settings) and "104 NPs" (who can practice independently). The law required a 3-year "transition to practice" period. Since the clock started in 2023, January 2026 is the earliest an NP can apply for "104" status.

What This Means for Med Spas:

• Independent Ownership: Once certified as a "104 NP," a Nurse Practitioner can legally own a nursing corporation and operate a Med Spa without a Medical Director or physician collaborator, provided they stay within their scope of training.
• The "Medical Director" Shift: We may see a mass exodus of NPs leaving physician-owned spas to open their own solo practices, increasing competition.
• Verification is Key: Do not assume an NP is independent just because it is 2026. They must formally apply and receive the "104" designation from the Board of Registered Nursing (BRN). Until they hold that specific license, they still require physician supervision.

3. Selling Your Spa? The "90-Day Notice" Rule (AB 1415)

Effective Date: January 1, 2026

The California legislature is increasing scrutiny on healthcare consolidation. Under AB 1415, if you plan to sell your medical practice (or if an MSO plans to acquire it), you may be required to report the transaction to the Office of Health Care Affordability (OHCA) at least 90 days before closing.

• Who this affects: This primarily targets large transactions involving Private Equity or large MSO chains, but the definitions are broad.
• The Risk: If you fail to report, the transaction could be blocked or subject to significant fines. This adds a 3-month "cooling off" period to deal flow, meaning you cannot rush a sale at the end of the year.

4. Immediate Updates for 2025

While the big laws hit in 2026, there are immediate changes you need to address right now.

The Toxic-Free Cosmetics Act (Jan 2025)

California has banned 24 toxic ingredients from all cosmetic products sold in the state.

• Action Item: Audit your retail shelves. If you sell private-label skincare or niche brands, ensure they do not contain banned substances like Formaldehyde, Mercury, or long-chain PFAS ("forever chemicals").

CURES Fee Increase (July 1, 2025)

The fee for the Controlled Substance Utilization Review and Evaluation System (CURES) will increase.

• Action Item: Ensure all your prescribing providers (MDs, PAs, NPs) have updated their CURES registration. The Medical Board is cracking down on providers who prescribe controlled substances (like benzos for anxiety during laser treatments) without checking CURES first.

5. The "Evergreen" Traps: Enforcement Priorities

The Medical Board of California (MBC) and the Board of Registered Nursing (BRN) have signaled continued aggressive enforcement in two specific areas:

The "Good Faith Exam" (GFE)

This remains the #1 citation for Med Spas.

• The Rule: A physician, NP, or PA must examine the patient before the first treatment.
• The Trap: RNs cannot perform the GFE. If an RN injects a patient who has not been cleared by a mid-level or physician, you are aiding and abetting the unlicensed practice of medicine.
• Telehealth: You can use telehealth for the GFE, but it must be synchronous (live video), not just a questionnaire.

Influencer Marketing & Fee-Splitting

You cannot pay an influencer a "commission" or "percentage" of the patients they bring in.

• The Law: California Business & Professions Code § 650 strictly prohibits "fee-splitting" or paying for referrals.
• The Fix: Pay influencers a flat fee for their content creation or posting (e.g., "$500 per Reel"), regardless of how many bookings it generates. Never use a "commission link" for medical services.

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