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.

89(R) SB 2695 - House Committee Report version - Bill Text

By: Kolkhorst, et al.

S.B. No. 2695

(Bonnen)

A BILL TO BE ENTITLED

AN ACT

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.

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. RURAL ADVANCED PRACTICE REGISTERED NURSE DELEGATION AND

SUPERVISION PROGRAM

SECTION 3.001. Subchapter A, Chapter 157, Occupations Code,

is amended by adding Section 157.008 to read as follows:

Sec.

157.008.

RECORDS OF CERTAIN DELEGATION AND SUPERVISION

AGREEMENTS. (a) The board shall maintain records of all delegation

and supervision agreements entered into between a physician and an

advanced practice registered nurse, including:

(1)

the amount of any fee a physician charges an

advanced practice registered nurse to enter into a delegation and

supervision agreement; and

(2)

the county in which the advanced practice

registered nurse is practicing under a delegation and supervision

agreement.

(b) The board shall adopt rules to implement this section.

SECTION 3.002. Section 157.0512(e), Occupations Code, is

amended to read as follows:

(e) A prescriptive authority agreement must, at a minimum:

(1) be in writing and signed and dated by the parties

to the agreement;

(2) state the name, address, and all professional

license numbers of the parties to the agreement;

(3) state the nature of the practice, practice

locations, or practice settings;

(4) identify the types or categories of drugs or

devices that may be prescribed or the types or categories of drugs

or devices that may not be prescribed;

(5) provide a general plan for addressing consultation

and referral;

(6) provide a plan for addressing patient emergencies;

(7) state the general process for communication and

the sharing of information between the physician and the advanced

practice registered nurse or physician assistant to whom the

physician has delegated prescriptive authority related to the care

and treatment of patients;

(8) if alternate physician supervision is to be

utilized, designate one or more alternate physicians who may:

(A) provide appropriate supervision on a

temporary basis in accordance with the requirements established by

the prescriptive authority agreement and the requirements of this

subchapter; and

(B) participate in the prescriptive authority

quality assurance and improvement plan meetings required under this

section; and

(9) describe a prescriptive authority quality

assurance and improvement plan and specify methods for documenting

the implementation of the plan that include the following:

(A) chart review, with
:

(i)

for a prescriptive authority agreement

between a physician and an advanced practice registered nurse, the

physician reviewing at least five percent of the advanced practice

registered nurse's charts, including authority to review the charts

electronically from a remote location; and

(ii)

for a prescriptive authority agreement

between a physician and a physician assistant,
the number of charts

to be reviewed determined by the physician and [
advanced practice

registered nurse or
] physician assistant; and

(B) periodic meetings between the advanced

practice registered nurse or physician assistant and the physician.

SECTION 3.003. Chapter 157, Occupations Code, is amended by

adding Subchapter D to read as follows:

SUBCHAPTER D. RURAL ADVANCED PRACTICE REGISTERED NURSE

DELEGATION AND SUPERVISION PROGRAM

Sec. 157.151. DEFINITIONS. In this subchapter:

(1)

"Advanced practice registered nurse" has the

meaning assigned by Section 301.152.

(2)

"College" means The Texas A&M University System

Health Science Center College of Medicine.

(3)

"Delegation and supervision agreement" includes a

prescriptive authority agreement under Subchapter B.

Sec.

157.152.

RURAL ADVANCED PRACTICE REGISTERED NURSE

DELEGATION AND SUPERVISION PROGRAM. (a) The Texas A&M University

System Health Science Center College of Medicine shall establish

and administer a program under which the college contracts with or

otherwise retains a physician to enter into a delegation and

supervision agreement with an advanced practice registered nurse

practicing:

(1) in one of the following population foci:

(A) adult-gerontology primary care;

(B) family/individual across the lifespan;

(C) pediatrics primary care;

(D) psychiatric/mental health; or

(E) women's health/gender-related; and

(2)

in a county with a population of not more than

30,000.

(b)

The college may remove from participation in the program

established under this section a physician who does not satisfy the

supervision requirements of Section 157.0512(e)(9)(A)(i).

(c)

Except as provided by Section 157.154, a delegation and

supervision agreement entered into under this subchapter is subject

to Subchapters A and B, as applicable.

(d)

In establishing and administering the program under

this section, the college may collaborate with similar

institutions, agencies, and programs affiliated with a medical and

dental unit as defined by Section 61.003, Education Code.

Sec.

157.153.

DELEGATION AND SUPERVISION AGREEMENT FEE

PROHIBITED. A physician may not charge a fee to an advanced

practice registered nurse to enter into a delegation and

supervision agreement under the program established under Section

157.152.

Sec.

157.154.

NUMBER OF DELEGATION AND SUPERVISION

AGREEMENTS. Notwithstanding Section 157.0512(c), a physician may

enter into delegation and supervision agreements under the program

established under Section 157.152 with not more than 10 advanced

practice registered nurses or the full-time equivalent of 10

advanced practice registered nurses.

Sec. 157.155. RECORDS. (a) The college shall:

(1)

maintain records of the delegation and supervision

agreements entered into under the program established under Section

157.152; and

(2) collect data on:

(A)

delegation and supervision interactions

under the program; and

(B)

the impact the program has on access to

health care.

(b)

The records maintained and data collected under

Subsection (a):

(1) are confidential and privileged;

(2) are not subject to subpoena or discovery;

(3)

are excepted from disclosure under Chapter 552,

Government Code; and

(4)

may not be introduced into evidence in any

administrative, civil, or criminal proceeding against a patient, a

patient's family member, a physician, or a health care provider.

(c)

Notwithstanding Subsection (b), not later than

September 1 of each even-numbered year, the college shall submit a

report on the records maintained and data collected under this

section to the governor, lieutenant governor, speaker of the house

of representatives, and appropriate committees of the legislature

that:

(1)

contains only aggregated and anonymized

information;

(2)

does not identify or include any information that

could be used to identify a patient or the patient's family;

(3)

does not identify or include any information that

could be used to identify a physician or health care provider; and

(4)

complies with all state and federal laws relating

to the transmission of health information, including the Health

Insurance Portability and Accountability Act of 1996 (Pub. L.

No.

104-191) and rules adopted under that act.

Sec.

157.156.

POLICIES. (a) The college shall adopt

policies as necessary to implement this subchapter.

(b)

A policy adopted under this section must prioritize

delegation and supervision agreements with advanced practice

registered nurses to practice in mental health and primary care in

locations designated as health professional shortage areas by the

Department of State Health Services.

ARTICLE 4. TRANSITION AND EFFECTIVE DATE

SECTION 4.001. 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 4.002. This Act takes effect September 1, 2025.