H.B. No. 2038         AN ACT   relating to the issuance by the Texas Medical Board of certain   licenses to practice medicine and the authority of an insured to   select certain license holders under the insured's health policy;   requiring an occupational license; authorizing fees.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:   ARTICLE 1.  SHORT TITLE          SECTION 1.001.  This Act shall be known as the Decreasing   Occupational Certification Timelines, Obstacles, and Regulations   (DOCTOR) Act.   ARTICLE 2.  FOREIGN LICENSE HOLDERS          SECTION 2.001.  Subchapter C, Chapter 155, Occupations Code,   is amended by adding Section 155.1015 to read as follows:          Sec. 155.1015.  ISSUANCE OF PROVISIONAL LICENSE TO CERTAIN   FOREIGN MEDICAL LICENSE HOLDERS WITH OFFERS OF EMPLOYMENT.  (a)     Subject to Subsection (b), on application, the board shall issue an   initial provisional license to practice medicine to an applicant   who:                (1)  has been granted a degree of doctor of medicine or   a substantially similar degree by a program of medical education   that meets eligibility requirements for the applicant to apply for   certification by the Educational Commission for Foreign Medical   Graduates;                (2)  has been licensed in good standing to practice   medicine in another country and is not the subject of any pending   disciplinary action before the licensing body;                (3)  has completed a residency or a substantially   similar postgraduate medical training required by the applicant's   country of licensure;                (4)  passes the Texas medical jurisprudence   examination;                (5)  has proficiency in the English language;                (6)  is authorized under federal law to work in the   United States;                (7)  has been offered employment in this state as a   physician by a person who provides health care services in the   normal course of business in a facility-based or group practice   setting, including a health system, hospital, hospital-based   facility, freestanding emergency facility, or urgent care clinic;                (8)  has passed the first and second steps of the   examination described by Section 155.0511(7) in accordance with   Section 155.056(a); and                (9)  meets any other requirement the board prescribes   by rule.          (b)  Unless the applicant is a citizen of the United States   or has been issued a visa to legally work in the United States, the   board may not issue a provisional license under Subsection (a) to an   applicant who is a citizen of a country:                (1)  identified by the United States Director of   National Intelligence as a country that poses a risk to the national   security of the United States in the most recent Annual Threat   Assessment of the U.S. Intelligence Community issued pursuant to   Section 108B, National Security Act of 1947 (50 U.S.C. Section   3043b); or                (2)  identified as a country subject to prohibitions in   the International Traffic in Arms Regulations (22 C.F.R. Part   126.1).          (c)  A provisional license issued under Subsection (a)   expires on the second anniversary of the date the provisional   license was issued.          (d)  The holder of a provisional license issued under   Subsection (a) may practice only in:                (1)  a facility-based or group practice setting with:                      (A)  an Accreditation Council for Graduate   Medical Education residency program; or                      (B)  an American Osteopathic Association   residency program;                (2)  an Accreditation Council for Graduate Medical   Education-affiliated setting; or                (3)  an American Osteopathic Association-affiliated   setting.          (e)  On application, the board shall renew a provisional   license to practice medicine issued under Subsection (a) if the   applicant:                (1)  has passed the first and second steps of the   examination described by Section 155.0511(7) in accordance with   Section 155.056(a); and                (2)  holds a valid certificate issued by the   Educational Commission for Foreign Medical Graduates.          (f)  The holder of a provisional license renewed under   Subsection (e):                (1)  may practice only in a rural community or   medically underserved area or health professional shortage area, as   designated by the United States Department of Health and Human   Services, that has a current shortage of physicians; and                (2)  is not subject to the restrictions of Subsection   (d).          (g)  Subject to Subsection (h), the board on application   shall issue a license under this subtitle to the holder of a   provisional license under this section if the provisional license   holder satisfies the examination requirements of Section 155.051.          (h)  The board may not issue as provided by Subsection (g) a   license under this subtitle to an applicant who:                (1)  is subject to board investigation or discipline   for conduct that occurred while holding the provisional license; or                (2)  has been convicted of, is on deferred adjudication   community supervision or deferred disposition for, or is under   active investigation for the commission of:                      (A)  a felony; or                      (B)  a misdemeanor involving moral turpitude.          (i)  The board shall adopt rules for the issuance of a   provisional license under Subsection (a), the renewal of a   provisional license under Subsection (e), and the issuance of a   license under this subtitle as provided by Subsection (g),   including rules establishing eligibility for and fees applicable to   the licenses.  The board may adopt rules for the reporting of board   specialty certification requirement information as requested by a   board specialty organization.   ARTICLE 3.  PHYSICIAN GRADUATES          SECTION 3.001.  Chapter 155, Occupations Code, is amended by   adding Subchapter E to read as follows:   SUBCHAPTER E.  PHYSICIAN GRADUATES          Sec. 155.201.  DEFINITIONS. In this subchapter:                (1)  "Physician graduate" means an individual issued a   limited license under this subchapter to practice medicine under a   supervising practice agreement with a sponsoring physician.                (2)  "Sponsoring physician" means a physician who   enters into a supervising practice agreement with a physician   graduate.                (3)  "Supervising practice agreement" means an   agreement between a sponsoring physician and a physician graduate   regarding the sponsoring physician's supervision of the physician   graduate's practice of medicine.          Sec. 155.202.  RULES. The board shall adopt rules in   accordance with this subchapter relating to the licensing and   regulation of physician graduates, including rules relating to:                (1)  procedures and fees for the issuance, term, and   renewal of a license under this subchapter, including continuing   medical education requirements for renewal of the license;                (2)  practices and requirements for the supervision of   physician graduates; and                (3)  any other matter necessary to ensure protection of   the public, including disciplinary procedures.          Sec. 155.203.  LICENSE ISSUANCE. On application, the board   shall issue a limited license to practice medicine under this   subchapter to an applicant who:                (1)  is a resident of this state and is:                      (A)  a United States citizen;                      (B)  a legal permanent resident of the United   States; or                      (C)  otherwise authorized under federal law to   work in the United States;                (2)  has proficiency in the English language;                (3)  has graduated:                      (A)  in the two years preceding the date that the   applicant initially applies for a physician graduate license, from:                            (i)  a board-recognized accredited medical   school or osteopathic medical school in the United States or   Canada; or                            (ii)  a medical school located outside of   the United States and Canada that the board recognizes as   acceptable; or                      (B)  if the applicant is licensed in good standing   to practice medicine in another country, from a medical school   located outside of the United States and Canada that the board   recognizes as acceptable;                (4)  has passed the first and second components of the   United States Medical Licensing Examination or equivalent   components of another board-approved licensing examination   described by Section 155.0511;                (5)  is not enrolled in a board-approved postgraduate   residency program; and                (6)  meets any other requirement prescribed by board   rule.          Sec. 155.204.  FEES. The amount of a fee for the issuance or   renewal of a license under this subchapter may not exceed the amount   of a fee for the issuance or renewal of a physician assistant   license under Chapter 204.          Sec. 155.205.  SPONSORING PHYSICIAN. (a)  A physician is   eligible to enter into a supervising practice agreement as a   sponsoring physician if the physician:                (1)  holds a full and unrestricted license to practice   medicine issued under this subtitle;                (2)  is not currently the subject of disciplinary   action by the board or the medical licensing authority of any other   jurisdiction;                (3)  is certified by a medical specialty member board   of:                      (A)  the American Board of Medical Specialties;                      (B)  the American Osteopathic Association Bureau   of Osteopathic Specialists;                      (C)  the American Board of Oral and Maxillofacial   Surgery; or                      (D)  any other medical specialty member   organization the board recognizes; and                (4)  practices medicine in the specialty for which the   physician is certified under Subdivision (3).          (b)  A sponsoring physician who enters into a supervising   practice agreement with a physician graduate shall comply with all   board rules related to the supervision of physician graduates.          (c)  The board by rule shall establish the maximum number of   physician graduates that a sponsoring physician may supervise under   supervising practice agreements.          Sec. 155.206.  SUPERVISING PRACTICE AGREEMENT REQUIRED. (a)   A physician graduate shall enter into a supervising practice   agreement with a sponsoring physician.          (b)  A physician graduate who has not entered into a   supervising practice agreement may not practice or attempt to   practice medicine.           (c)  A physician graduate who enters into a supervising   practice agreement may practice under the delegation and   supervision of another physician if:                (1)  the sponsoring physician authorizes the practice   of the physician graduate under the delegation and supervision of   the other physician in a written document that identifies the other   physician by name; and                (2)  the other physician is:                      (A)  part of the sponsoring physician's physician   group or facility; and                      (B)  certified in the same specialty as the   sponsoring physician by a medical specialty member board of:                            (i)  the American Board of Medical   Specialties;                            (ii)  the American Osteopathic Association   Bureau of Osteopathic Specialists;                            (iii)  the American Board of Oral and   Maxillofacial Surgery; or                            (iv)  any other medical specialty member   organization recognized by the board.          (d)  The physician profile under Section 154.006 of a   sponsoring physician or physician graduate must indicate in the   manner prescribed by board rule that the sponsoring physician or   physician graduate has entered into a supervising practice   agreement.          Sec. 155.207.  LIMITED PRACTICE BY LICENSE HOLDER. (a) A   physician graduate may:                (1)  practice only in a county with a population of less   than 100,000; and                (2)  provide only medical services in the specialty in   which the physician graduate's sponsoring physician is certified as   described by Section 155.205(a)(3) under supervision in accordance   with a supervising practice agreement.          (b)  Before a license holder under this subchapter provides a   treatment, consultation, or other medical service, the license   holder must disclose to the patient that the license holder:                (1)  is a physician graduate; and                (2)  has not completed any formal specialized   postgraduate or resident training.          Sec. 155.208.  LIABILITY OF SPONSORING PHYSICIAN. A   sponsoring physician who enters into a supervising practice   agreement with a physician graduate retains legal responsibility   for a physician graduate's patient care activities, including the   provision of care and treatment to a patient in a health care   facility.          Sec. 155.209.  IDENTIFICATION REQUIREMENTS; USE OF TITLE.   (a) The holder of a license issued under this subchapter shall at   all times while practicing as a physician graduate display a   personal identification document identifying the license holder as   a physician graduate.           (b)  A physician graduate may use the following titles or   abbreviations:                (1)  "doctor"; or                (2)  "Dr." or "doc."          Sec. 155.210.  STATUS OF PHYSICIAN GRADUATE. A physician   graduate license holder is considered a general practitioner for   purposes of regulations of the federal Centers for Medicare and   Medicaid Services.          Sec. 155.211.  LICENSE RENEWAL. The board may not renew a   license issued under this subchapter unless:                (1)  the board verifies that the license holder has   practiced in accordance with this subchapter under a supervising   practice agreement with a sponsoring physician in the license term   preceding the application for renewal; and                (2)  the license holder satisfies the continuing   medical education requirements established by board rule.          Sec. 155.212.  DENIAL, SUSPENSION, OR REVOCATION OF LICENSE.   The board may deny an application for licensure or suspend or revoke   a license issued under this subchapter:                (1)  for any ground provided by Chapter 164 or board   rule; and                (2)  in the manner provided by Chapter 164 and board   rule.          SECTION 3.002.  Section 1451.001, Insurance Code, is amended   by adding Subdivision (16-a) to read as follows:                (16-a) "Physician graduate" has the meaning assigned   by Section 155.201, Occupations Code.          SECTION 3.003.  Subchapter C, Chapter 1451, Insurance Code,   is amended by adding Section 1451.129 to read as follows:          Sec. 1451.129.  SELECTION OF PHYSICIAN GRADUATE. An insured   may select a physician graduate to provide the services scheduled   in the health insurance policy that are within the scope of the   physician graduate's license under Subchapter E, Chapter 155,   Occupations Code.          SECTION 3.004.  Section 1451.129, Insurance Code, as added   by this Act, applies only to a health insurance policy that is   delivered, issued for delivery, or renewed on or after January 1,   2026.   ARTICLE 4.  RULEMAKING          SECTION 4.001.  Not later than January 1, 2026, the Texas   Medical Board shall adopt rules as necessary to implement the   following provisions of the Occupations Code, as added by this Act:                (1)  Section 155.1015; and                (2)  Subchapter E, Chapter 155.   ARTICLE 5.  EFFECTIVE DATE          SECTION 5.001.  This Act takes effect September 1, 2025.       ______________________________ ______________________________      President of the Senate Speaker of the House                   I certify that H.B. No. 2038 was passed by the House on May 6,   2025, by the following vote:  Yeas 144, Nays 0, 2 present, not   voting; and that the House concurred in Senate amendments to H.B.   No. 2038 on May 29, 2025, by the following vote:  Yeas 108, Nays 31,   1 present, not voting.     ______________________________   Chief Clerk of the House               I certify that H.B. No. 2038 was passed by the Senate, with   amendments, on May 26, 2025, by the following vote:  Yeas 30, Nays   1.     ______________________________   Secretary of the Senate      APPROVED: __________________                   Date                       __________________                 Governor