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.