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 an education program to enable certain students to practice medicine in certain rural counties and to encourage physician delegation of certain medical acts to advanced practice registered nurses in certain rural counties.), Committee Report 1st House, Substituted
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.
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 Program
The bill would establish the Rural APRN Delegation Program which would require the Texas Medical Board (TMB) to contract with or retain a physician to enter into a delegation agreement with an APRN practicing in certain rural Texas counties. TMB would be required to maintain records of the delegation agreements, collect data, and study the impact the program has on access to health care. The bill would prohibit a physician from charging a fee to an APRN to enter into a delegation agreement under the Rural APRN Delegation Program.
According to TMB, the agency would require additional staffing resources to implement the provisions of the bill. Total estimated costs would be $111,516 in fiscal year 2026 and $101,516 in subsequent years. The agency anticipates needing 1.0 additional Program Specialist full-time equivalent position ($66,353 each year with $19,852 in estimated benefits) to help facilitate the delegation agreements, collect the required data, and conduct the analysis of the program. This estimate assumes an additional annual cost of $15,310 for operating costs of the new staff, and a one-time technology cost of $10,000 in fiscal year 2026 for programming costs related to the reporting requirements. Texas Occupations Code, Section 153.051, requires TMB to generate sufficient revenues to cover the cost of agency appropriations and the other direct and indirect costs appropriated to other state agencies. The estimate provided assumes that the amount of fee revenue generated by the agency that exceeds its appropriation will be sufficient to cover the costs of implementing the provisions of the bill.
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