89R16079 BEE-F
By: Kolkhorst S.B. No. 2695
A BILL TO BE ENTITLED
AN ACT
relating to education programs to enable certain students and
advanced practice registered nurses to practice medicine in certain
rural counties and physician delegation of certain medical acts to
advanced practice registered nurses and physician assistants.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1. SHORT TITLE
SECTION 1.001. This Act may be cited as the Texas Critically
Underserved Relief and Enhancement Act (Texas Cure Act).
ARTICLE 2. RURAL ADMISSION MEDICAL PROGRAM (RAMP)
SECTION 2.001. Chapter 51, Education Code, is amended by
adding Subchapter X to read as follows:
SUBCHAPTER X. RURAL ADMISSION MEDICAL PROGRAM
Sec. 51.851. DEFINITIONS. In this subchapter:
(1) "Council" means the Rural Admission Medical
Program Council established under Section 51.853.
(2) "General academic teaching institution" and
"private or independent institution of higher education" have the
meanings assigned to those terms by Section 61.003.
(3) "Participating medical school" has the meaning
assigned by Section 51.821.
(4) "Participating student" means an eligible
undergraduate student who is admitted to the program and who
maintains eligibility for continued participation in the program.
(5) "Program" means the Rural Admission Medical
Program established under this subchapter.
Sec. 51.852. RURAL ADMISSION MEDICAL PROGRAM. The Rural
Admission Medical Program is a program administered by the Rural
Admission Medical Program Council to:
(1) provide services to support and encourage highly
qualified students from counties in this state with populations of
less than 25,000 who are pursuing a medical education;
(2) award undergraduate and graduate scholarships and
summer stipends to those students; and
(3) guarantee the admission of those students to at
least one participating medical school, subject to the conditions
under Section 51.827 and under other provisions of this subchapter.
Sec. 51.853. COMPOSITION OF COUNCIL. (a) The
participating medical schools shall jointly establish the Rural
Admission Medical Program Council consisting of one faculty member
employed by and representing each of the participating medical
schools.
(b) The council shall select one of its members to serve as
council chair for a term of two years.
Sec. 51.854. COUNCIL DUTIES. (a) The council shall:
(1) recruit eligible undergraduate students for
admission to the program;
(2) establish an application process for admitting
eligible undergraduate students to the program;
(3) evaluate applications for admission to the program
according to the procedures the council establishes for selecting
participating students;
(4) monitor the implementation of the program;
(5) assist in developing services to support and
encourage the pursuit of a medical education by participating
students and, as applicable, nontraditional students described by
Section 51.861;
(6) establish a process for participating students to:
(A) be matched to an internship program as
described by Subsection (b);
(B) be matched to any required undergraduate
mentoring program as described by Subsection (c);
(C) apply for admission to participating medical
schools;
(D) be matched to a participating medical school
as described by Subsection (d); and
(E) enroll in that school;
(7) award to participating students undergraduate
scholarships and summer stipends, including a summer stipend for a
student who is required to participate in an internship program in
the summer immediately following the student's senior year;
(8) award graduate scholarships to participating
students and, as applicable, nontraditional students described by
Section 51.861;
(9) enter into an agreement with each student admitted
to the program, each participating medical school, and each general
academic teaching institution or private or independent
institution of higher education as required by this subchapter; and
(10) take any other action necessary to implement the
program.
(b) The council shall match each participating student with
appropriate internship programs offered by participating medical
schools during the summers immediately following the student's
sophomore and junior years.
(c) The council shall match each participating student with
any appropriate undergraduate mentoring program required of the
student by the council.
(d) During a participating student's senior year, the
council shall match the student with an appropriate participating
medical school as necessary to fill the percentage of enrollment
capacity set aside by each medical school under the program.
Sec. 51.855. ELIGIBILITY FOR ADMISSION TO PROGRAM. (a) To
be eligible for admission to the program, an undergraduate student
must:
(1) have enrolled at a general academic teaching
institution or a private or independent institution of higher
education not later than the first fall semester following the
student's graduation from high school;
(2) be a resident of this state for purposes of tuition
under Subchapter B, Chapter 54;
(3) successfully complete at least 15 semester credit
hours during the fall semester of the student's freshman year at the
general academic teaching institution or the private or independent
institution of higher education;
(4) apply for admission to the program not later than a
date, as designated by the council, that occurs at the beginning of
the spring semester of the student's freshman year at the general
academic teaching institution or the private or independent
institution of higher education; and
(5) meet criteria established by the council
regarding:
(A) minimum high school and undergraduate grade
point averages;
(B) location in a county in this state with a
population of less than 25,000; and
(C) any other matter the council considers
appropriate.
(b) For purposes of Subsection (a)(2), a student is not a
Texas resident as described by that subdivision solely because the
student is eligible to pay tuition at the resident tuition rate.
Sec. 51.856. ELIGIBILITY TO CONTINUE PARTICIPATION IN
PROGRAM. (a) To be eligible to continue participation in the rural
program, an undergraduate student who is admitted to the program
must:
(1) meet criteria established by the council
regarding:
(A) courses taken and the minimum grade point
average for those courses during enrollment at the general academic
teaching institution or the private or independent institution of
higher education;
(B) progress in those courses;
(C) achievement of an acceptable score on the
Medical College Admission Test or any equivalent examination taken
as a precondition for enrollment in or admission to a participating
medical school; and
(D) any other matter the council considers
appropriate;
(2) participate in:
(A) internship programs described by Section
51.854(b) in:
(i) the summers immediately following the
student's freshman, sophomore, and junior years; and
(ii) if required, the summer immediately
following the student's senior year; and
(B) any undergraduate or graduate mentoring
program required by the council; and
(3) exhibit intelligence, integrity, and personal and
emotional characteristics that are considered necessary for the
student to become an effective physician.
(b) If an undergraduate student who is admitted to the
program fails to meet the requirements of Subsection (a) without
good cause as determined by the council, the council may terminate
that student's participation in the program at the end of the
semester during which the student failed to meet the requirements
of that subsection. A student's participation in the program is
automatically terminated if the student fails to meet the
requirements of Subsection (a) for two consecutive semesters
without good cause.
Sec. 51.857. COUNCIL AGREEMENT WITH STUDENT ADMITTED TO
PROGRAM. (a) A student admitted to the program must enter into an
agreement with the council under which the student agrees to:
(1) maintain eligibility for continued participation
in the program; and
(2) repay any scholarship or stipend received under
the program if the student enrolls in a public or private medical
school in another state, other than temporary enrollment occurring
as a result of an exchange program.
(b) At the time the student enters into an agreement under
this section, the council shall provide the student with
information regarding:
(1) available program benefits, including
undergraduate and graduate scholarships and summer stipends; and
(2) repayment of scholarship and stipend benefits
received under the program.
Sec. 51.858. COUNCIL AGREEMENT WITH PARTICIPATING MEDICAL
SCHOOL. (a) Each participating medical school must enter into an
agreement with the council under which the medical school agrees
to:
(1) select a faculty member employed by the medical
school to serve on the council;
(2) commit faculty and administrative resources to the
program;
(3) set aside for participating students or, if
necessary, nontraditional students described by Section 51.861 at
least 10 percent of the medical school's enrollment capacity for
each entering class, except as provided by Subsection (b);
(4) admit participating students who are matched to
the medical school under the program;
(5) provide internship programs for participating
students who have been matched to or are required to participate in
those programs as described by Section 51.854(b) and coordinate the
administration of those programs with general academic teaching
institutions or private or independent institutions of higher
education as necessary;
(6) provide for participating students any mentoring
programs required by the council at the undergraduate level and
coordinate the administration of those programs with general
academic teaching institutions or private or independent
institutions of higher education as necessary; and
(7) provide support services, including
postbaccalaureate mentoring programs required by the council, to
participating students and, as applicable, nontraditional students
described by Section 51.861 who enroll in the medical school.
(b) The Baylor College of Medicine must agree under
Subsection (a) to set aside under Subsection (a)(3) not less than 10
percent of its enrollment capacity set aside for students who are
entitled to pay tuition at the rate provided by Chapter 54 for
resident students.
Sec. 51.859. COUNCIL AGREEMENT WITH GENERAL ACADEMIC
TEACHING INSTITUTION. Each general academic teaching institution
must enter into an agreement with the council under which the
institution agrees to:
(1) provide academic counseling to a participating
student enrolled at that institution;
(2) as soon as practicable after entering into the
agreement, implement or expand appropriate degree programs as
necessary to provide participating students with sufficient
preparation for enrollment in participating medical schools; and
(3) select a faculty director or an academic or health
professions advisor to assist in implementing the program at the
institution and in implementing or expanding the institution's
degree programs as necessary under Subdivision (2).
Sec. 51.860. COUNCIL AGREEMENT WITH PRIVATE OR INDEPENDENT
INSTITUTION OF HIGHER EDUCATION. Each private or independent
institution of higher education must enter into an agreement with
the council under which the institution agrees to:
(1) provide academic counseling to a participating
student enrolled at the institution;
(2) as soon as practicable after entering into the
agreement, implement or expand appropriate degree programs as
necessary to provide participating students with sufficient
preparation for enrollment in participating medical schools;
(3) select a faculty director or an academic or health
professions advisor to assist in implementing the program at the
institution and in implementing or expanding the institution's
degree programs as necessary under Subdivision (2); and
(4) provide, in addition to any other scholarship
money awarded to the student, a scholarship to a participating
student in an amount equal to the amount awarded a participating
student attending a general academic teaching institution, except
that the amount of a scholarship award may not exceed the amount of
tuition and fees that the student is charged.
Sec. 51.861. NONTRADITIONAL STUDENTS. (a) If for any
reason a participating medical school does not fill the percentage
of enrollment capacity set aside for participating students under
the program, the medical school shall fill the remaining openings
with economically disadvantaged students who:
(1) are 25 years of age or older;
(2) have been admitted to the medical school
independently of the program;
(3) are referred by the medical school to the council
and admitted to the program by the council; and
(4) are entitled to pay tuition at the rate provided by
Chapter 54 for resident students.
(b) A nontraditional student admitted to the program under
this section is subject only to the program benefits and
requirements applicable to a participating student after
enrollment in a participating medical school. The nontraditional
student shall sign an agreement to that effect.
Sec. 51.862. FUNDING. (a) The council may accept a gift,
grant, devise, or bequest of money, securities, service, or
property to carry out any purpose of this subchapter, including
funds raised or services provided by a volunteer or volunteer group
to promote the work of the council.
(b) The legislature may appropriate money for the purposes
of this subchapter.
Sec. 51.863. REPORT. (a) The council shall deliver a
report on the program to the governor, the lieutenant governor, and
the speaker of the house of representatives not later than December
31 of each even-numbered year.
(b) The report must contain detailed information regarding:
(1) any problems the council identifies in
implementing the rural program, with recommended solutions for
those problems;
(2) the expenditure of any money received under this
subchapter, including legislative appropriations; and
(3) the number of students who are admitted to the
program and who are enrolled in each year of a baccalaureate,
graduate, or professional degree program offered by a general
academic teaching institution, a private or independent
institution of higher education, or a participating medical school,
as applicable.
ARTICLE 3. MEDICALLY EXTENDED GEOGRAPHIC ACCESS (MEGA) ADVANCED
PRACTICE REGISTERED NURSE TO PHYSICIAN PATHWAY PROGRAM
SECTION 3.001. Chapter 301, Occupations Code, is amended by
adding Subchapter O to read as follows:
SUBCHAPTER O. MEGA ADVANCED PRACTICE REGISTERED NURSE TO PHYSICIAN
PATHWAY PROGRAM
Sec. 301.701. DEFINITIONS. In this subchapter:
(1) "Coordinating board" means the Texas Higher
Education Coordinating Board.
(2) "Program" means the Medically Extended Geographic
Access (MEGA) Advanced Practice Registered Nurse to Physician
Pathway program established under this subchapter.
Sec. 301.702. PROGRAM ESTABLISHMENT AND GENERAL
ELIGIBILITY. The Medically Extended Geographic Access (MEGA)
Advanced Practice Registered Nurse to Physician Pathway program is
established under this subchapter. The coordinating board shall
accept into the program an individual licensed in this state as an
advanced practice registered nurse who:
(1) applies to the coordinating board in the manner
the board prescribes;
(2) is physically located in and actively engaged in
practice as an advanced practice registered nurse in a county with a
population of less than 25,000;
(3) has practiced as an advanced practice registered
nurse for at least seven years in primary care in this state under
physician delegation and supervision in a county with a population
of less than 25,000;
(4) signs an agreement attesting that, if the
individual participates in the program and ultimately obtains a
license to practice medicine in this state after completing medical
school in this state, the individual will return to practice in a
primary care specialty for at least five of the first eight years
after obtaining the license in a county with a population of less
than 25,000;
(5) meets other criteria as required by coordinating
board rule; and
(6) is not otherwise ineligible to participate in the
program under Section 301.703.
Sec. 301.703. INELIGIBILITY OF CERTAIN PROCEDURES AND TYPES
OF PRACTICE. An individual may not participate in the program if
the individual:
(1) has been convicted of or placed on deferred
adjudication community supervision or deferred disposition for any
offense;
(2) has ever held a license authorizing the practice
of nursing and been subject to discipline by a licensing agency in
any state or a federal or foreign jurisdiction, excluding any
action related to nonpayment of fees related to a license;
(3) has had a controlled substance license suspended
or revoked by a state or the United States Drug Enforcement
Administration;
(4) is under active investigation by a licensing
agency or law enforcement authority in any state or a federal or
foreign jurisdiction; or
(5) has a practice that is exclusively conducted
virtually.
Sec. 301.704. ELIGIBILITY FOR MEDICAL SCHOOL ADMISSION AND
ADVANCED COURSEWORK. (a) An individual who participates in the
program is eligible to apply for admission to a medical school in
this state as a third-year medical student if the individual:
(1) satisfies the requirements described by Section
301.702; and
(2) successfully completes step one of the United
States Medical Licensing Examination.
(b) This subchapter does not require a medical school in
this state to accept an applicant who participates in the program.
A medical school applicant who participates in the program must
complete the medical school's application and selection process in
addition to satisfying the criteria described by Subsection (a).
Sec. 301.705. ELIGIBILITY FOR MEDICAL LICENSING
EXAMINATION. An individual who participates in the program is
eligible to take step one of the United States Medical Licensing
Examination if the individual:
(1) has practiced as an advanced practice registered
nurse for at least seven years in primary care under physician
delegation and supervision in a county with a population of less
than 25,000; and
(2) meets all other requirements established by board
rule for continued participation in the program.
Sec. 301.706. ELIGIBILITY FOR MEDICAL SCHOOL LOAN
REPAYMENT. (a) An individual who participates in the program is
eligible for loan repayment to cover the full cost of the final two
years of medical school if the individual:
(1) was admitted to medical school after applying
under Section 301.704;
(2) graduates from medical school;
(3) graduates from residency from an accredited
residency training program in this state in a primary care
specialty;
(4) applies to the coordinating board for medical
school loan repayment assistance under Subchapter J, Chapter 61,
Education Code; and
(5) fulfills the individual's commitment under Section
301.702 to practice in a primary care specialty for at least five of
the first eight years after the individual becomes licensed in a
county in this state with a population of less than 25,000.
(b) In administering loan repayment under Subsection (a),
the coordinating board may disburse payments monthly or according
to any other schedule to allow physicians to participate in
existing federal student loan repayment plans.
ARTICLE 4. PROVISIONS APPLICABLE TO CERTAIN DELEGATION AGREEMENTS
SECTION 4.001. Subchapter A, Chapter 157, Occupations Code,
is amended by adding Section 157.008 to read as follows:
Sec. 157.008. FEE FOR DELEGATION AGREEMENT. (a) A
physician may not charge more than a reasonable fee to an advanced
practice registered nurse or physician assistant to enter into a
delegation agreement, including a prescriptive authority
agreement.
(b) The board by rule shall adopt criteria for consideration
in determining whether a fee is reasonable for purposes of
Subsection (a), including:
(1) the types of medical acts delegated and supervised
under the agreement;
(2) the time required of the physician to provide
adequate supervision of medical acts under the agreement; and
(3) the liability risks associated with the delegation
and supervision of medical acts under the agreement.
SECTION 4.002. Section 157.0512, Occupations Code, is
amended by amending Subsections (c), (d), and (f) and adding
Subsections (c-1) and (f-1) to read as follows:
(c) Except as provided by Subsection (c-1) and subject to
Subsection (d), the combined number of advanced practice registered
nurses and physician assistants with whom a physician may enter
into a prescriptive authority agreement may not exceed seven
advanced practice registered nurses and physician assistants or the
full-time equivalent of seven advanced practice registered nurses
and physician assistants.
(c-1) Notwithstanding Subsection (c) and subject to
Subsection (d), if a physician delegates and supervises the
exercise of prescriptive authority exclusively in a county with a
population of less than 25,000, the combined number of advanced
practice registered nurses and physician assistants with whom the
physician may enter into a prescriptive authority agreement may not
exceed:
(1) a total of nine advanced practice registered
nurses and physician assistants; or
(2) the full-time equivalent of a total of nine
advanced practice registered nurses and physician assistants.
(d) Subsections [Subsection] (c) and (c-1) do [does] not
apply to a prescriptive authority agreement if the prescriptive
authority is being exercised in:
(1) a practice serving a medically underserved
population; or
(2) a facility-based practice in a hospital under
Section 157.054.
(f) The periodic meetings described by Subsection (e)(9)(B)
must:
(1) include:
(A) the sharing of information relating to
patient treatment and care, needed changes in patient care plans,
and issues relating to referrals; and
(B) discussion of patient care improvement;
(2) be documented; and
(3) except as provided by Subsection (f-1), take place
at least once a month in a manner determined by the physician and
the advanced practice registered nurse or physician assistant.
(f-1) Notwithstanding Subsection (f)(3), if a physician
delegates and supervises the exercise of prescriptive authority
exclusively in a county with a population of less than 25,000, the
periodic meetings described by Subsection (e)(9)(B) must take place
at least quarterly in a manner determined by the physician.
SECTION 4.003. Subchapter B, Chapter 157, Occupations Code,
is amended by adding Section 157.061 to read as follows:
Sec. 157.061. ADDITIONAL LOAN REPAYMENT ASSISTANCE FOR
CERTAIN PHYSICIANS WHO DELEGATE AND SUPERVISE. (a) A physician may
apply to the Texas Higher Education Coordinating Board for an
additional $45,000 in medical school loan repayment assistance
under Subchapter J, Chapter 61, Education Code, if the physician
delegates and supervises the exercise of prescriptive authority
exclusively in a county with a population of less than 25,000 under
a prescriptive authority agreement that satisfies the requirements
of this subchapter.
(b) In administering the loan repayment assistance under
this section, the Texas Higher Education Coordinating Board may
disburse payments monthly or according to any other schedule to
allow physicians to participate in existing federal student loan
repayment plans.
ARTICLE 5. TRANSITION AND EFFECTIVE DATE
SECTION 5.001. Not later than February 1, 2026, the Texas
Higher Education Coordinating Board and the Texas Medical Board
shall adopt rules necessary to implement the changes in law made by
this Act.
SECTION 5.002. This Act takes effect September 1, 2025.