Honorable Terry M. Wilson, Chair, House Committee on Higher Education
FROM:
Jerry McGinty, Director, Legislative Budget Board
IN RE:
SB2695 by Kolkhorst (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.), As Engrossed
The fiscal implications of the bill cannot be determined due to the unavailability of data required to estimate the number of participants eligible for the Rural Admission Medical Program; however, costs related to the administration and establishment of the Rural Advanced Practice Registered Nurse Delegation and Supervision Program by the Texas A&M University Health Science Center College of Medicine are estimated to be approximately $8.3 million in the 2026-27 biennium.
The bill would make no appropriation but could provide the legal basis for an appropriation of funds to implement provisions of the bill.
The Rural Admission Medical Program
The bill would establish the Rural Admission Medical Program (RAMP), which would support qualified students from Texas counties with a population less than 25,000 who are pursuing a medical education through undergraduate and graduate scholarships, summer stipends, and guaranteed admission to at least one participating medical school under certain circumstances.
The bill would require public medical schools in Texas and Baylor College of Medicine to establish the Rural Admission Medical Program Council to administer and implement the program. The bill would require each participating medical school to enter into an agreement with the RAMP Council to select a faculty member for participation in the council, commit faculty and administrative resources for the program, provide internship and mentoring programs for participating students, and provide support services to participating students.
The bill would require each general academic institution, private institution, and independent institution to enter into an agreement with the RAMP Council to provide academic counseling to a participating student enrolled at the institution, implement or expand appropriate degree programs as necessary to provide participating students with sufficient preparation for enrollment in medical school, and select a faculty director or health professions advisor to assist in implementing the program at the institution.
According to information provided by institutions of higher education, costs associated with administering the program as members of the RAMP Council cannot be determined due to the number of students who would participate in the program and receive the required support being unknown.
Rural Advanced Practice Registered Nurse (APRN) Delegation and Supervision Program
The bill would require the Texas Medical Board (TMB) to maintain records of all delegation and supervision agreements entered into between a physician and an APRN.
The bill would require the Texas A&M University Health Science Center College of Medicine (College) to establish and administer the Rural APRN Delegation and Supervision Program (Program) which would require the College to contract with a physician to enter into a delegation and supervision agreement with an APRN practicing in one of the required disciplines. The bill prohibits a physician from charging a fee to an APRN that enters into an agreement issued through the Program. The College would be required to maintain records of agreements entered through the Program and to produce a report of these records to certain state leadership offices.
According to the Texas A&M University System, the College would require additional funding to establish and administer the Program. Total estimated costs in the upcoming biennium would total approximately $4.3 million in fiscal year 2026 and $3.9 million in subsequent years. The estimate provided assumes Physician Supervisor Payments at a rate of $8,000 per year per APRN based on the supervision of 300 APRNs in the program ($2,400,000 annually). The Texas A&M University System anticipates needing an additional 5.25 full-time equivalents for the operation of the program ($582,818 annually) along with other overhead costs ($875,000 annually). This estimate assumes one-time costs in fiscal year 2026 for a Physician Recruiter ($250,000), start-up technology costs ($100,000), and other administrative overhead ($25,000).
Local Government Impact
No fiscal implication to units of local government is anticipated.
Source Agencies:
304 Comptroller of Public Accounts, 503 Texas Medical Board, 507 Texas Board of Nursing, 710 Texas A&M University System Administrative and General Offices, 720 The University of Texas System Administration, 758 Texas State University System, 768 Texas Tech University System Administration, 769 University of North Texas System Administration, 781 Higher Education Coordinating Board, 783 University of Houston System Administration