Rural-Access Solution Goes Before Senate Committee
By Amy Lynn Sorrel

The culmination of many months and meetings, a Texas Medical Association-backed rural-access solution bill was unveiled to the Senate Health and Human Services Committee that opens a new pipeline for rural access to care while preserving Texas’ physician-led care model.   

Committee Chair Sen. Lois Kolkhorst (R-Brenham) authored Senate Bill 2695 in response to Lt. Gov. Dan Patrick’s interim charge to examine “whether regulatory and licensing flexibilities could improve access to care, particularly in medically underserved areas of Texas” and to make recommendations, if any, “to improve access to care while maintaining patient safety.” She spearheaded a spirited hearing on that charge back in September 2024 as well as stakeholder meetings since then that included TMA and the lieutenant governor.   

“If it’s always been about rural areas, let’s do this in rural areas,” Senator Kolkhorst said as she introduced her bill at the hearing, adding she was “very cautious” in addressing the interim charge. “Senate Bill 2695 is a step in that direction.”  

The legislation specifically targets counties with populations of less than 25,000. According to the committee substitute version of SB 2695 presented during the hearing, the measure would:   

• Establish the Rural Admission Medical Program – or RAMP – to provide financial and academic support to encourage students from rural areas to pursue medical school and practice in rural communities after graduation. Qualified students would be guaranteed admission to a participating state medical school.  

• Help ensure rural APRNs have access to a delegating and supervising physician by setting up a program with a pool of licensed physicians at the Texas Medical Board, including retired physicians, to provide delegation and supervision in rural areas that may be lacking physicians.    

• Prohibit delegation fees, which APRNs have claimed act as a barrier to being able to practice in rural areas, from being charged to an APRN to enter into a delegation agreement under the program.   

In testimony, TMA Council on Legislation Chair Zeke Silva, MD, emphasized the bill ensures “the best care possible” for patients across the state, including in rural communities, “by enabling physician-led care, while also acknowledging and respecting the important contributions that APRNs make to that care."  

He also affirmed TMA workforce data showing medical students from rural areas are more likely to return to rural communities and hospitals to practice, adding the new TMB program as envisioned provides yet another way “to tap into the physician workforce we are not currently tapping into.”   

RAMP mirrors what Senator Kolkhorst called the “very successful” Joint Admission Medical Program – or JAMP – in Texas, which encourages economically disadvantaged undergraduate students to pursue careers in medicine by offering scholarships, paid internships, mentorship, and other support.   

“This is about growing our own rural providers,” she said.  

Some senators pushed back on the lack of a similar pathway for APRNs to be able to practice independently, which other bills percolating through the legislature attempt to do, including House Bill 3794 and Senate Bill 3055, and which TMA firmly opposes.   

In an appearance before the committee, Sen. Donna Campbell, MD, a former nurse herself, elaborated on the significant differences between nursing and physician education and training.   

“Texans do not want watered down medical care under the guise of medical access,” she said.   

In an earlier hearing on House Bill 3794, TMA President G. Ray Callas, MD, further discredited nurses’ arguments claiming that expensive delegation agreements are a major access-to-care barrier. He refuted those claims, pointing to 2019 National Journal of Nursing Regulation survey in supervisory states, which reported 80% of nurse practitioners paid zero fees for physician supervision of their patient care; 14.4% said their employers paid the physician oversight fee; and only 5.6% reported paying for physician oversight fees, which average about $500 a month.     

Senator Kolkhorst also cited a surplus of APRNs in Texas – 15,000 by the year 2035 – amid a shortage of MDs and DOs.  

SB 2695 alleviates concerns expressed during the September 2024 hearing and meetings afterward regarding “the impact on access to care in rural areas as a result of unreasonable delegation fees,” she said.   

“If this has always been about getting more practitioners to the rural areas ... we need to do that in different ways,” Senator Kolkhorst said. “What this bill is looking to do is to really pinpoint … rural areas where they're underserved, and let's take away that fee … take away those arguments … while still having these [health care] teams doctor-delegated.”  

Continue to read Texas Medicine Today for coverage of other fast-moving bills. Now is also the time to watch for TMA email alerts urging action on particular pieces of legislation.   

Check out TMA’s Grassroots Action Center for more information on these Action Alerts and other ways to stay involved in TMA state advocacy. And be sure to sign up for the final First Tuesdays at the Capitol advocacy event of the session on May 6.