By: Kolkhorst, et al. S.B. No. 2695

(Bonnen)

A BILL TO BE ENTITLED

AN ACT

relating to an education program to enable certain students to practice medicine in certain rural counties and to physician delegation of certain medical acts to advanced practice registered nurses, including in certain rural counties.

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. RURAL ADVANCED PRACTICE REGISTERED NURSE DELEGATION AND

SUPERVISION PROGRAM

SECTION 3.001. Subchapter A, Chapter 157, Occupations Code, is amended by adding Section 157.008 to read as follows:

Sec. 157.008. RECORDS OF CERTAIN DELEGATION AND SUPERVISION AGREEMENTS. (a) The board shall maintain records of all delegation and supervision agreements entered into between a physician and an advanced practice registered nurse, including:

(1) the amount of any fee a physician charges an advanced practice registered nurse to enter into a delegation and supervision agreement; and

(2) the county in which the advanced practice registered nurse is practicing under a delegation and supervision agreement.

(b) The board shall adopt rules to implement this section.

SECTION 3.002. Section 157.0512(e), Occupations Code, is amended to read as follows:

(e) A prescriptive authority agreement must, at a minimum:

(1) be in writing and signed and dated by the parties to the agreement;

(2) state the name, address, and all professional license numbers of the parties to the agreement;

(3) state the nature of the practice, practice locations, or practice settings;

(4) identify the types or categories of drugs or devices that may be prescribed or the types or categories of drugs or devices that may not be prescribed;

(5) provide a general plan for addressing consultation and referral;

(6) provide a plan for addressing patient emergencies;

(7) state the general process for communication and the sharing of information between the physician and the advanced practice registered nurse or physician assistant to whom the physician has delegated prescriptive authority related to the care and treatment of patients;

(8) if alternate physician supervision is to be utilized, designate one or more alternate physicians who may:

(A) provide appropriate supervision on a temporary basis in accordance with the requirements established by the prescriptive authority agreement and the requirements of this subchapter; and

(B) participate in the prescriptive authority quality assurance and improvement plan meetings required under this section; and

(9) describe a prescriptive authority quality assurance and improvement plan and specify methods for documenting the implementation of the plan that include the following:

(A) chart review, with:

(i) for a prescriptive authority agreement between a physician and an advanced practice registered nurse, the physician reviewing at least five percent of the advanced practice registered nurse's charts, including authority to review the charts electronically from a remote location; and

(ii) for a prescriptive authority agreement between a physician and a physician assistant, the number of charts to be reviewed determined by the physician and [advanced practice registered nurse or] physician assistant; and

(B) periodic meetings between the advanced practice registered nurse or physician assistant and the physician.

SECTION 3.003. Chapter 157, Occupations Code, is amended by adding Subchapter D to read as follows:

SUBCHAPTER D. RURAL ADVANCED PRACTICE REGISTERED NURSE

DELEGATION AND SUPERVISION PROGRAM

Sec. 157.151. DEFINITIONS. In this subchapter:

(1) "Advanced practice registered nurse" has the meaning assigned by Section 301.152.

(2) "College" means The Texas A&M University System Health Science Center College of Medicine.

(3) "Delegation and supervision agreement" includes a prescriptive authority agreement under Subchapter B.

Sec. 157.152. RURAL ADVANCED PRACTICE REGISTERED NURSE DELEGATION AND SUPERVISION PROGRAM. (a) The Texas A&M University System Health Science Center College of Medicine shall establish and administer a program under which the college contracts with or otherwise retains a physician to enter into a delegation and supervision agreement with an advanced practice registered nurse practicing:

(1) in one of the following population foci:

(A) adult-gerontology primary care;

(B) family/individual across the lifespan;

(C) pediatrics primary care;

(D) psychiatric/mental health; or

(E) women's health/gender-related; and

(2) in a county with a population of not more than 30,000.

(b) The college may remove from participation in the program established under this section a physician who does not satisfy the supervision requirements of Section 157.0512(e)(9)(A)(i).

(c) Except as provided by Section 157.154, a delegation and supervision agreement entered into under this subchapter is subject to Subchapters A and B, as applicable.

(d) In establishing and administering the program under this section, the college may collaborate with similar institutions, agencies, and programs affiliated with a medical and dental unit as defined by Section 61.003, Education Code.

Sec. 157.153. DELEGATION AND SUPERVISION AGREEMENT FEE PROHIBITED. A physician may not charge a fee to an advanced practice registered nurse to enter into a delegation and supervision agreement under the program established under Section 157.152.

Sec. 157.154. NUMBER OF DELEGATION AND SUPERVISION AGREEMENTS. Notwithstanding Section 157.0512(c), a physician may enter into delegation and supervision agreements under the program established under Section 157.152 with not more than 10 advanced practice registered nurses or the full-time equivalent of 10 advanced practice registered nurses.

Sec. 157.155. RECORDS. (a) The college shall:

(1) maintain records of the delegation and supervision agreements entered into under the program established under Section 157.152; and

(2) collect data on:

(A) delegation and supervision interactions under the program; and

(B) the impact the program has on access to health care.

(b) The records maintained and data collected under Subsection (a):

(1) are confidential and privileged;

(2) are not subject to subpoena or discovery;

(3) are excepted from disclosure under Chapter 552, Government Code; and

(4) may not be introduced into evidence in any administrative, civil, or criminal proceeding against a patient, a patient's family member, a physician, or a health care provider.

(c) Notwithstanding Subsection (b), not later than September 1 of each even-numbered year, the college shall submit a report on the records maintained and data collected under this section to the governor, lieutenant governor, speaker of the house of representatives, and appropriate committees of the legislature that:

(1) contains only aggregated and anonymized information;

(2) does not identify or include any information that could be used to identify a patient or the patient's family;

(3) does not identify or include any information that could be used to identify a physician or health care provider; and

(4) complies with all state and federal laws relating to the transmission of health information, including the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) and rules adopted under that act.

Sec. 157.156. POLICIES. (a) The college shall adopt policies as necessary to implement this subchapter.

(b) A policy adopted under this section must prioritize delegation and supervision agreements with advanced practice registered nurses to practice in mental health and primary care in locations designated as health professional shortage areas by the Department of State Health Services.

ARTICLE 4. TRANSITION AND EFFECTIVE DATE

SECTION 4.001. 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 4.002. This Act takes effect September 1, 2025.