Kolkhorst Rural Medicine Bill Creates A Council To Run The Program

The text as introduced · 3,559 words

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.