Honorable Lois W. Kolkhorst, Chair, Senate Committee on Health & Human Services
FROM:
Jerry McGinty, Director, Legislative Budget Board
IN RE:
SB2695 by Kolkhorst (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.), As Introduced
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 programs outlined in the bill's provisions.
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.
The Medically Extended Geographic Access (MEGA) Advanced Practice Registered Nurse (APRN) to Physician Pathway Program
The bill would establish the MEGA APRN to Physician Pathway Program to be administered by the Texas Higher Education Coordinating Board (THECB) and provide a pathway for advanced practice registered nurses practicing in Texas counties with a population of less than 25,000 to enter medical school as a third-year medical student. An individual who participates in the program would be eligible for loan repayment to cover the full cost of the remaining years of medical school under certain circumstances defined in the bill.
According to information provided by THECB, it is assumed the cost of administering the MEGA APRN to Physician Pathway Program could be absorbed within existing resources. However, the remaining fiscal impact cannot be determined and would be dependent on the number of APRNs that would satisfy the requirements of the program and qualify for loan repayment.
Delegation Agreements
The bill would limit the fee a physician may charge to an APRN or physician assistant to enter into a delegation agreement and would require the Texas Medical Board to adopt criteria for determining if a fee is reasonable. It is assumed any associated Texas Medical Board costs could be absorbed within existing resources.
The bill would allow physicians to seek $45,000 in additional medical school loan repayment assistance from THECB if the physician delegates and supervises the exercise of prescriptive authority in a Texas county with a population of less than 25,000 under a prescriptive authority agreement. The fiscal impact associated with providing additional medical school loan repayment to such physicians cannot be determined due to the number of physicians who would meet the conditions for repayment being unknown.
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