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.