2025S0021-1 01/10/25     By: Sparks S.B. No. 881     A BILL TO BE ENTITLED   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) Upon receiving an application, the board shall   issue a 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 in the five years preceding application   under this section and is not the subject of any pending   disciplinary action before the licensing body;                (3)  either:                      (A)  has completed a residency or substantially   similar postgraduate medical training required by the applicant's   country of licensure and has practiced medicine as a licensed   physician in that country for at least five years after the   completion of the required postgraduate medical training; or                      (B)  if the applicant's country of licensure does   not require postgraduate medical training, has practiced as a   medical professional performing the duties of a physician in that   country for at least five years and has practiced medicine as a   licensed physician in that country for at least 10 years after   completing medical school;                (4)  satisfies the examination requirements of Section   155.051;                (5)  has proficiency in the English language;                (6)  is authorized under federal law to work in the   United States; and                (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, including a health system, hospital,   hospital-based facility, freestanding emergency facility, or   urgent care clinic.          (b)  A provisional license issued under this section expires   on the earlier of:                (1)  the date the board issues the provisional license   holder a license under this subtitle or denies the provisional   license holder's application for a license under Subsection (c); or                (2)  the third anniversary of the date the provisional   license was issued.          (c)  Upon receiving an application, the board shall issue a   license under this subtitle to the holder of a provisional license   under this section if the provisional license holder:                (1)  will have practiced under the provisional license   for at least three years at the time the license will be issued; and                (2)  has not been and is not currently subject to board   investigation or discipline for conduct that occurred while holding   the provisional license.   ARTICLE 3. MILITARY VETERANS          SECTION 3.001.  Subchapter C, Chapter 155, Occupations Code,   is amended by adding Section 155.108 to read as follows:          Sec. 155.108.  LICENSE FOR MILITARY VETERAN TO PRACTICE IN   CERTAIN AREAS. (a)  In this section, "active duty" and "armed   forces of the United States" have the meanings assigned by Section   55.001.           (b)  The board shall issue a medical license to practice   medicine to an applicant who:                (1)  is licensed in good standing as a physician in   another state;                (2)  is a veteran of the armed forces of the United   States who retired from or otherwise left military service not more   than three years before the application date for a license under   this section;                (3)  was, at the time of retiring from or leaving   military service:                      (A)  serving on active duty in this state; and                      (B)  authorized as a physician to treat persons   enlisted in the armed forces of the United States or veterans; and                (4)  has passed the Texas medical jurisprudence   examination.          (c)  The board may not issue a license under this section to   an applicant who:                (1)  was discharged or separated from the armed forces   of the United States:                      (A)  on the basis of substandard conduct; or                      (B)  for any act of misconduct or moral or   professional dereliction;                (2)  holds a medical license or a license to prescribe,   dispense, administer, supply, or sell a controlled substance that:                      (A)  is currently under active investigation; or                      (B)  is or was subject to a disciplinary order or   action or to denial by another jurisdiction; or                (3)  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.   ARTICLE 4. PHYSICIAN GRADUATES          SECTION 4.001.  Chapter 155, Occupations Code, is amended by   adding Subchapter E to read as follows:   SUBCHAPTER E.  PHYSICIAN GRADUATE          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 supervision by the sponsoring physician 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. Upon receiving an   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 or a legal permanent   resident; or                      (B)  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 is recognized by the board 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 is recognized   by the board 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;                (6)  has not been and is not currently the subject of   disciplinary action by the board or the medical licensing authority   of any other jurisdiction; and                (7)  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)  has not been and 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)  a medical specialty member board of the   American Board of Medical Specialties;                       (B)  a medical specialty member board of the   American Osteopathic Association Bureau of Osteopathic   Specialists;                      (C)  the American Board of Oral and Maxillofacial   Surgery; or                      (D)  any other medical specialty member board   recognized by the Texas Medical Board; 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:                            (i)  a medical specialty member board of the   American Board of Medical Specialties;                            (ii)  a medical specialty member board of   the American Osteopathic Association Bureau of Osteopathic   Specialists;                            (iii)  the American Board of Oral and   Maxillofacial Surgery; or                            (iv)  any other medical specialty member   board recognized by the Texas Medical 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 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:                (1)  that the license holder is a physician graduate;   and                (2)  that the license holder has not completed any   formal specialized postgraduate or resident training.          Sec. 155.208.  LIABILITY OF SUPERVISING 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 4.002.  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 4.003.  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 4.004.  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 5. RULEMAKING          SECTION 5.001.  (a)  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)  Sections 155.1015 and 155.108; and                (2)  Subchapter E, Chapter 155.                      (b)  In adopting rules under Subsection (a) of   this section, the Texas Medical Board shall develop a process to   create a "whitelist" of countries whose licensure requirements   include residency or a substantially similar postgraduate medical   training under Section 155.1015(a)(3)(A), Occupations Code, as   added by this Act. The process must include a review by the Texas   Medical Board of at least 10 countries per year for inclusion on the   whitelist, and if after the review a country is not included, the   Texas Medical Board must identify, with specificity, the aspects of   the country's requirements that caused the country to not be   included.   ARTICLE 6. EFFECTIVE DATE          SECTION 6.001.  This Act takes effect September 1, 2025.