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.