Texas 2025 - 89th Regular

Texas Senate Bill SB2695 Compare Versions

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1	1	89R16079 BEE-F
2	2	By: Kolkhorst S.B. No. 2695
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to education programs to enable certain students and
10	10	advanced practice registered nurses to practice medicine in certain
11	11	rural counties and physician delegation of certain medical acts to
12	12	advanced practice registered nurses and physician assistants.
13	13	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	14	ARTICLE 1. SHORT TITLE
15	15	SECTION 1.001. This Act may be cited as the Texas Critically
16	16	Underserved Relief and Enhancement Act (Texas Cure Act).
17	17	ARTICLE 2. RURAL ADMISSION MEDICAL PROGRAM (RAMP)
18	18	SECTION 2.001. Chapter 51, Education Code, is amended by
19	19	adding Subchapter X to read as follows:
20	20	SUBCHAPTER X. RURAL ADMISSION MEDICAL PROGRAM
21	21	Sec. 51.851. DEFINITIONS. In this subchapter:
22	22	(1) "Council" means the Rural Admission Medical
23	23	Program Council established under Section 51.853.
24	24	(2) "General academic teaching institution" and
25	25	"private or independent institution of higher education" have the
26	26	meanings assigned to those terms by Section 61.003.
27	27	(3) "Participating medical school" has the meaning
28	28	assigned by Section 51.821.
29	29	(4) "Participating student" means an eligible
30	30	undergraduate student who is admitted to the program and who
31	31	maintains eligibility for continued participation in the program.
32	32	(5) "Program" means the Rural Admission Medical
33	33	Program established under this subchapter.
34	34	Sec. 51.852. RURAL ADMISSION MEDICAL PROGRAM. The Rural
35	35	Admission Medical Program is a program administered by the Rural
36	36	Admission Medical Program Council to:
37	37	(1) provide services to support and encourage highly
38	38	qualified students from counties in this state with populations of
39	39	less than 25,000 who are pursuing a medical education;
40	40	(2) award undergraduate and graduate scholarships and
41	41	summer stipends to those students; and
42	42	(3) guarantee the admission of those students to at
43	43	least one participating medical school, subject to the conditions
44	44	under Section 51.827 and under other provisions of this subchapter.
45	45	Sec. 51.853. COMPOSITION OF COUNCIL. (a) The
46	46	participating medical schools shall jointly establish the Rural
47	47	Admission Medical Program Council consisting of one faculty member
48	48	employed by and representing each of the participating medical
49	49	schools.
50	50	(b) The council shall select one of its members to serve as
51	51	council chair for a term of two years.
52	52	Sec. 51.854. COUNCIL DUTIES. (a) The council shall:
53	53	(1) recruit eligible undergraduate students for
54	54	admission to the program;
55	55	(2) establish an application process for admitting
56	56	eligible undergraduate students to the program;
57	57	(3) evaluate applications for admission to the program
58	58	according to the procedures the council establishes for selecting
59	59	participating students;
60	60	(4) monitor the implementation of the program;
61	61	(5) assist in developing services to support and
62	62	encourage the pursuit of a medical education by participating
63	63	students and, as applicable, nontraditional students described by
64	64	Section 51.861;
65	65	(6) establish a process for participating students to:
66	66	(A) be matched to an internship program as
67	67	described by Subsection (b);
68	68	(B) be matched to any required undergraduate
69	69	mentoring program as described by Subsection (c);
70	70	(C) apply for admission to participating medical
71	71	schools;
72	72	(D) be matched to a participating medical school
73	73	as described by Subsection (d); and
74	74	(E) enroll in that school;
75	75	(7) award to participating students undergraduate
76	76	scholarships and summer stipends, including a summer stipend for a
77	77	student who is required to participate in an internship program in
78	78	the summer immediately following the student's senior year;
79	79	(8) award graduate scholarships to participating
80	80	students and, as applicable, nontraditional students described by
81	81	Section 51.861;
82	82	(9) enter into an agreement with each student admitted
83	83	to the program, each participating medical school, and each general
84	84	academic teaching institution or private or independent
85	85	institution of higher education as required by this subchapter; and
86	86	(10) take any other action necessary to implement the
87	87	program.
88	88	(b) The council shall match each participating student with
89	89	appropriate internship programs offered by participating medical
90	90	schools during the summers immediately following the student's
91	91	sophomore and junior years.
92	92	(c) The council shall match each participating student with
93	93	any appropriate undergraduate mentoring program required of the
94	94	student by the council.
95	95	(d) During a participating student's senior year, the
96	96	council shall match the student with an appropriate participating
97	97	medical school as necessary to fill the percentage of enrollment
98	98	capacity set aside by each medical school under the program.
99	99	Sec. 51.855. ELIGIBILITY FOR ADMISSION TO PROGRAM. (a) To
100	100	be eligible for admission to the program, an undergraduate student
101	101	must:
102	102	(1) have enrolled at a general academic teaching
103	103	institution or a private or independent institution of higher
104	104	education not later than the first fall semester following the
105	105	student's graduation from high school;
106	106	(2) be a resident of this state for purposes of tuition
107	107	under Subchapter B, Chapter 54;
108	108	(3) successfully complete at least 15 semester credit
109	109	hours during the fall semester of the student's freshman year at the
110	110	general academic teaching institution or the private or independent
111	111	institution of higher education;
112	112	(4) apply for admission to the program not later than a
113	113	date, as designated by the council, that occurs at the beginning of
114	114	the spring semester of the student's freshman year at the general
115	115	academic teaching institution or the private or independent
116	116	institution of higher education; and
117	117	(5) meet criteria established by the council
118	118	regarding:
119	119	(A) minimum high school and undergraduate grade
120	120	point averages;
121	121	(B) location in a county in this state with a
122	122	population of less than 25,000; and
123	123	(C) any other matter the council considers
124	124	appropriate.
125	125	(b) For purposes of Subsection (a)(2), a student is not a
126	126	Texas resident as described by that subdivision solely because the
127	127	student is eligible to pay tuition at the resident tuition rate.
128	128	Sec. 51.856. ELIGIBILITY TO CONTINUE PARTICIPATION IN
129	129	PROGRAM. (a) To be eligible to continue participation in the rural
130	130	program, an undergraduate student who is admitted to the program
131	131	must:
132	132	(1) meet criteria established by the council
133	133	regarding:
134	134	(A) courses taken and the minimum grade point
135	135	average for those courses during enrollment at the general academic
136	136	teaching institution or the private or independent institution of
137	137	higher education;
138	138	(B) progress in those courses;
139	139	(C) achievement of an acceptable score on the
140	140	Medical College Admission Test or any equivalent examination taken
141	141	as a precondition for enrollment in or admission to a participating
142	142	medical school; and
143	143	(D) any other matter the council considers
144	144	appropriate;
145	145	(2) participate in:
146	146	(A) internship programs described by Section
147	147	51.854(b) in:
148	148	(i) the summers immediately following the
149	149	student's freshman, sophomore, and junior years; and
150	150	(ii) if required, the summer immediately
151	151	following the student's senior year; and
152	152	(B) any undergraduate or graduate mentoring
153	153	program required by the council; and
154	154	(3) exhibit intelligence, integrity, and personal and
155	155	emotional characteristics that are considered necessary for the
156	156	student to become an effective physician.
157	157	(b) If an undergraduate student who is admitted to the
158	158	program fails to meet the requirements of Subsection (a) without
159	159	good cause as determined by the council, the council may terminate
160	160	that student's participation in the program at the end of the
161	161	semester during which the student failed to meet the requirements
162	162	of that subsection. A student's participation in the program is
163	163	automatically terminated if the student fails to meet the
164	164	requirements of Subsection (a) for two consecutive semesters
165	165	without good cause.
166	166	Sec. 51.857. COUNCIL AGREEMENT WITH STUDENT ADMITTED TO
167	167	PROGRAM. (a) A student admitted to the program must enter into an
168	168	agreement with the council under which the student agrees to:
169	169	(1) maintain eligibility for continued participation
170	170	in the program; and
171	171	(2) repay any scholarship or stipend received under
172	172	the program if the student enrolls in a public or private medical
173	173	school in another state, other than temporary enrollment occurring
174	174	as a result of an exchange program.
175	175	(b) At the time the student enters into an agreement under
176	176	this section, the council shall provide the student with
177	177	information regarding:
178	178	(1) available program benefits, including
179	179	undergraduate and graduate scholarships and summer stipends; and
180	180	(2) repayment of scholarship and stipend benefits
181	181	received under the program.
182	182	Sec. 51.858. COUNCIL AGREEMENT WITH PARTICIPATING MEDICAL
183	183	SCHOOL. (a) Each participating medical school must enter into an
184	184	agreement with the council under which the medical school agrees
185	185	to:
186	186	(1) select a faculty member employed by the medical
187	187	school to serve on the council;
188	188	(2) commit faculty and administrative resources to the
189	189	program;
190	190	(3) set aside for participating students or, if
191	191	necessary, nontraditional students described by Section 51.861 at
192	192	least 10 percent of the medical school's enrollment capacity for
193	193	each entering class, except as provided by Subsection (b);
194	194	(4) admit participating students who are matched to
195	195	the medical school under the program;
196	196	(5) provide internship programs for participating
197	197	students who have been matched to or are required to participate in
198	198	those programs as described by Section 51.854(b) and coordinate the
199	199	administration of those programs with general academic teaching
200	200	institutions or private or independent institutions of higher
201	201	education as necessary;
202	202	(6) provide for participating students any mentoring
203	203	programs required by the council at the undergraduate level and
204	204	coordinate the administration of those programs with general
205	205	academic teaching institutions or private or independent
206	206	institutions of higher education as necessary; and
207	207	(7) provide support services, including
208	208	postbaccalaureate mentoring programs required by the council, to
209	209	participating students and, as applicable, nontraditional students
210	210	described by Section 51.861 who enroll in the medical school.
211	211	(b) The Baylor College of Medicine must agree under
212	212	Subsection (a) to set aside under Subsection (a)(3) not less than 10
213	213	percent of its enrollment capacity set aside for students who are
214	214	entitled to pay tuition at the rate provided by Chapter 54 for
215	215	resident students.
216	216	Sec. 51.859. COUNCIL AGREEMENT WITH GENERAL ACADEMIC
217	217	TEACHING INSTITUTION. Each general academic teaching institution
218	218	must enter into an agreement with the council under which the
219	219	institution agrees to:
220	220	(1) provide academic counseling to a participating
221	221	student enrolled at that institution;
222	222	(2) as soon as practicable after entering into the
223	223	agreement, implement or expand appropriate degree programs as
224	224	necessary to provide participating students with sufficient
225	225	preparation for enrollment in participating medical schools; and
226	226	(3) select a faculty director or an academic or health
227	227	professions advisor to assist in implementing the program at the
228	228	institution and in implementing or expanding the institution's
229	229	degree programs as necessary under Subdivision (2).
230	230	Sec. 51.860. COUNCIL AGREEMENT WITH PRIVATE OR INDEPENDENT
231	231	INSTITUTION OF HIGHER EDUCATION. Each private or independent
232	232	institution of higher education must enter into an agreement with
233	233	the council under which the institution agrees to:
234	234	(1) provide academic counseling to a participating
235	235	student enrolled at the institution;
236	236	(2) as soon as practicable after entering into the
237	237	agreement, implement or expand appropriate degree programs as
238	238	necessary to provide participating students with sufficient
239	239	preparation for enrollment in participating medical schools;
240	240	(3) select a faculty director or an academic or health
241	241	professions advisor to assist in implementing the program at the
242	242	institution and in implementing or expanding the institution's
243	243	degree programs as necessary under Subdivision (2); and
244	244	(4) provide, in addition to any other scholarship
245	245	money awarded to the student, a scholarship to a participating
246	246	student in an amount equal to the amount awarded a participating
247	247	student attending a general academic teaching institution, except
248	248	that the amount of a scholarship award may not exceed the amount of
249	249	tuition and fees that the student is charged.
250	250	Sec. 51.861. NONTRADITIONAL STUDENTS. (a) If for any
251	251	reason a participating medical school does not fill the percentage
252	252	of enrollment capacity set aside for participating students under
253	253	the program, the medical school shall fill the remaining openings
254	254	with economically disadvantaged students who:
255	255	(1) are 25 years of age or older;
256	256	(2) have been admitted to the medical school
257	257	independently of the program;
258	258	(3) are referred by the medical school to the council
259	259	and admitted to the program by the council; and
260	260	(4) are entitled to pay tuition at the rate provided by
261	261	Chapter 54 for resident students.
262	262	(b) A nontraditional student admitted to the program under
263	263	this section is subject only to the program benefits and
264	264	requirements applicable to a participating student after
265	265	enrollment in a participating medical school. The nontraditional
266	266	student shall sign an agreement to that effect.
267	267	Sec. 51.862. FUNDING. (a) The council may accept a gift,
268	268	grant, devise, or bequest of money, securities, service, or
269	269	property to carry out any purpose of this subchapter, including
270	270	funds raised or services provided by a volunteer or volunteer group
271	271	to promote the work of the council.
272	272	(b) The legislature may appropriate money for the purposes
273	273	of this subchapter.
274	274	Sec. 51.863. REPORT. (a) The council shall deliver a
275	275	report on the program to the governor, the lieutenant governor, and
276	276	the speaker of the house of representatives not later than December
277	277	31 of each even-numbered year.
278	278	(b) The report must contain detailed information regarding:
279	279	(1) any problems the council identifies in
280	280	implementing the rural program, with recommended solutions for
281	281	those problems;
282	282	(2) the expenditure of any money received under this
283	283	subchapter, including legislative appropriations; and
284	284	(3) the number of students who are admitted to the
285	285	program and who are enrolled in each year of a baccalaureate,
286	286	graduate, or professional degree program offered by a general
287	287	academic teaching institution, a private or independent
288	288	institution of higher education, or a participating medical school,
289	289	as applicable.
290	290	ARTICLE 3. MEDICALLY EXTENDED GEOGRAPHIC ACCESS (MEGA) ADVANCED
291	291	PRACTICE REGISTERED NURSE TO PHYSICIAN PATHWAY PROGRAM
292	292	SECTION 3.001. Chapter 301, Occupations Code, is amended by
293	293	adding Subchapter O to read as follows:
294	294	SUBCHAPTER O. MEGA ADVANCED PRACTICE REGISTERED NURSE TO PHYSICIAN
295	295	PATHWAY PROGRAM
296	296	Sec. 301.701. DEFINITIONS. In this subchapter:
297	297	(1) "Coordinating board" means the Texas Higher
298	298	Education Coordinating Board.
299	299	(2) "Program" means the Medically Extended Geographic
300	300	Access (MEGA) Advanced Practice Registered Nurse to Physician
301	301	Pathway program established under this subchapter.
302	302	Sec. 301.702. PROGRAM ESTABLISHMENT AND GENERAL
303	303	ELIGIBILITY. The Medically Extended Geographic Access (MEGA)
304	304	Advanced Practice Registered Nurse to Physician Pathway program is
305	305	established under this subchapter. The coordinating board shall
306	306	accept into the program an individual licensed in this state as an
307	307	advanced practice registered nurse who:
308	308	(1) applies to the coordinating board in the manner
309	309	the board prescribes;
310	310	(2) is physically located in and actively engaged in
311	311	practice as an advanced practice registered nurse in a county with a
312	312	population of less than 25,000;
313	313	(3) has practiced as an advanced practice registered
314	314	nurse for at least seven years in primary care in this state under
315	315	physician delegation and supervision in a county with a population
316	316	of less than 25,000;
317	317	(4) signs an agreement attesting that, if the
318	318	individual participates in the program and ultimately obtains a
319	319	license to practice medicine in this state after completing medical
320	320	school in this state, the individual will return to practice in a
321	321	primary care specialty for at least five of the first eight years
322	322	after obtaining the license in a county with a population of less
323	323	than 25,000;
324	324	(5) meets other criteria as required by coordinating
325	325	board rule; and
326	326	(6) is not otherwise ineligible to participate in the
327	327	program under Section 301.703.
328	328	Sec. 301.703. INELIGIBILITY OF CERTAIN PROCEDURES AND TYPES
329	329	OF PRACTICE. An individual may not participate in the program if
330	330	the individual:
331	331	(1) has been convicted of or placed on deferred
332	332	adjudication community supervision or deferred disposition for any
333	333	offense;
334	334	(2) has ever held a license authorizing the practice
335	335	of nursing and been subject to discipline by a licensing agency in
336	336	any state or a federal or foreign jurisdiction, excluding any
337	337	action related to nonpayment of fees related to a license;
338	338	(3) has had a controlled substance license suspended
339	339	or revoked by a state or the United States Drug Enforcement
340	340	Administration;
341	341	(4) is under active investigation by a licensing
342	342	agency or law enforcement authority in any state or a federal or
343	343	foreign jurisdiction; or
344	344	(5) has a practice that is exclusively conducted
345	345	virtually.
346	346	Sec. 301.704. ELIGIBILITY FOR MEDICAL SCHOOL ADMISSION AND
347	347	ADVANCED COURSEWORK. (a) An individual who participates in the
348	348	program is eligible to apply for admission to a medical school in
349	349	this state as a third-year medical student if the individual:
350	350	(1) satisfies the requirements described by Section
351	351	301.702; and
352	352	(2) successfully completes step one of the United
353	353	States Medical Licensing Examination.
354	354	(b) This subchapter does not require a medical school in
355	355	this state to accept an applicant who participates in the program.
356	356	A medical school applicant who participates in the program must
357	357	complete the medical school's application and selection process in
358	358	addition to satisfying the criteria described by Subsection (a).
359	359	Sec. 301.705. ELIGIBILITY FOR MEDICAL LICENSING
360	360	EXAMINATION. An individual who participates in the program is
361	361	eligible to take step one of the United States Medical Licensing
362	362	Examination if the individual:
363	363	(1) has practiced as an advanced practice registered
364	364	nurse for at least seven years in primary care under physician
365	365	delegation and supervision in a county with a population of less
366	366	than 25,000; and
367	367	(2) meets all other requirements established by board
368	368	rule for continued participation in the program.
369	369	Sec. 301.706. ELIGIBILITY FOR MEDICAL SCHOOL LOAN
370	370	REPAYMENT. (a) An individual who participates in the program is
371	371	eligible for loan repayment to cover the full cost of the final two
372	372	years of medical school if the individual:
373	373	(1) was admitted to medical school after applying
374	374	under Section 301.704;
375	375	(2) graduates from medical school;
376	376	(3) graduates from residency from an accredited
377	377	residency training program in this state in a primary care
378	378	specialty;
379	379	(4) applies to the coordinating board for medical
380	380	school loan repayment assistance under Subchapter J, Chapter 61,
381	381	Education Code; and
382	382	(5) fulfills the individual's commitment under Section
383	383	301.702 to practice in a primary care specialty for at least five of
384	384	the first eight years after the individual becomes licensed in a
385	385	county in this state with a population of less than 25,000.
386	386	(b) In administering loan repayment under Subsection (a),
387	387	the coordinating board may disburse payments monthly or according
388	388	to any other schedule to allow physicians to participate in
389	389	existing federal student loan repayment plans.
390	390	ARTICLE 4. PROVISIONS APPLICABLE TO CERTAIN DELEGATION AGREEMENTS
391	391	SECTION 4.001. Subchapter A, Chapter 157, Occupations Code,
392	392	is amended by adding Section 157.008 to read as follows:
393	393	Sec. 157.008. FEE FOR DELEGATION AGREEMENT. (a) A
394	394	physician may not charge more than a reasonable fee to an advanced
395	395	practice registered nurse or physician assistant to enter into a
396	396	delegation agreement, including a prescriptive authority
397	397	agreement.
398	398	(b) The board by rule shall adopt criteria for consideration
399	399	in determining whether a fee is reasonable for purposes of
400	400	Subsection (a), including:
401	401	(1) the types of medical acts delegated and supervised
402	402	under the agreement;
403	403	(2) the time required of the physician to provide
404	404	adequate supervision of medical acts under the agreement; and
405	405	(3) the liability risks associated with the delegation
406	406	and supervision of medical acts under the agreement.
407	407	SECTION 4.002. Section 157.0512, Occupations Code, is
408	408	amended by amending Subsections (c), (d), and (f) and adding
409	409	Subsections (c-1) and (f-1) to read as follows:
410	410	(c) Except as provided by Subsection (c-1) and subject to
411	411	Subsection (d), the combined number of advanced practice registered
412	412	nurses and physician assistants with whom a physician may enter
413	413	into a prescriptive authority agreement may not exceed seven
414	414	advanced practice registered nurses and physician assistants or the
415	415	full-time equivalent of seven advanced practice registered nurses
416	416	and physician assistants.
417	417	(c-1) Notwithstanding Subsection (c) and subject to
418	418	Subsection (d), if a physician delegates and supervises the
419	419	exercise of prescriptive authority exclusively in a county with a
420	420	population of less than 25,000, the combined number of advanced
421	421	practice registered nurses and physician assistants with whom the
422	422	physician may enter into a prescriptive authority agreement may not
423	423	exceed:
424	424	(1) a total of nine advanced practice registered
425	425	nurses and physician assistants; or
426	426	(2) the full-time equivalent of a total of nine
427	427	advanced practice registered nurses and physician assistants.
428	428	(d) Subsections [Subsection] (c) and (c-1) do [does] not
429	429	apply to a prescriptive authority agreement if the prescriptive
430	430	authority is being exercised in:
431	431	(1) a practice serving a medically underserved
432	432	population; or
433	433	(2) a facility-based practice in a hospital under
434	434	Section 157.054.
435	435	(f) The periodic meetings described by Subsection (e)(9)(B)
436	436	must:
437	437	(1) include:
438	438	(A) the sharing of information relating to
439	439	patient treatment and care, needed changes in patient care plans,
440	440	and issues relating to referrals; and
441	441	(B) discussion of patient care improvement;
442	442	(2) be documented; and
443	443	(3) except as provided by Subsection (f-1), take place
444	444	at least once a month in a manner determined by the physician and
445	445	the advanced practice registered nurse or physician assistant.
446	446	(f-1) Notwithstanding Subsection (f)(3), if a physician
447	447	delegates and supervises the exercise of prescriptive authority
448	448	exclusively in a county with a population of less than 25,000, the
449	449	periodic meetings described by Subsection (e)(9)(B) must take place
450	450	at least quarterly in a manner determined by the physician.
451	451	SECTION 4.003. Subchapter B, Chapter 157, Occupations Code,
452	452	is amended by adding Section 157.061 to read as follows:
453	453	Sec. 157.061. ADDITIONAL LOAN REPAYMENT ASSISTANCE FOR
454	454	CERTAIN PHYSICIANS WHO DELEGATE AND SUPERVISE. (a) A physician may
455	455	apply to the Texas Higher Education Coordinating Board for an
456	456	additional $45,000 in medical school loan repayment assistance
457	457	under Subchapter J, Chapter 61, Education Code, if the physician
458	458	delegates and supervises the exercise of prescriptive authority
459	459	exclusively in a county with a population of less than 25,000 under
460	460	a prescriptive authority agreement that satisfies the requirements
461	461	of this subchapter.
462	462	(b) In administering the loan repayment assistance under
463	463	this section, the Texas Higher Education Coordinating Board may
464	464	disburse payments monthly or according to any other schedule to
465	465	allow physicians to participate in existing federal student loan
466	466	repayment plans.
467	467	ARTICLE 5. TRANSITION AND EFFECTIVE DATE
468	468	SECTION 5.001. Not later than February 1, 2026, the Texas
469	469	Higher Education Coordinating Board and the Texas Medical Board
470	470	shall adopt rules necessary to implement the changes in law made by
471	471	this Act.
472	472	SECTION 5.002. This Act takes effect September 1, 2025.