HB 1685

relating to the licensing and regulation of physician graduates and
the authority of an insured to select a physician graduate under the
insured's health insurance policy; requiring an occupational
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  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
(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
(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:
(B)  a legal permanent resident; or
(C)  otherwise authorized under federal law to
(2)  has proficiency in the English language;
(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
(ii)  a medical school located outside of
the United States and Canada that the board recognizes as
(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
(4)  has passed the first and second components of the
United States Medical Licensing Examination or equivalent
components of another board-approved licensing examination
(5)  is not enrolled in a board-approved postgraduate
(6)  meets any other requirement prescribed by board
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
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
(3)  is certified by a medical specialty member board
(A)  the American Board of Medical Specialties; or
(B)  the American Osteopathic Association Bureau
of Osteopathic Specialists; 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
(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
(A)  part of the sponsoring physician's physician
(B)  certified in the same specialty as the
sponsoring physician by a medical specialty member board of:
(i)  the American Board of Medical
(ii)  the American Osteopathic Association
Bureau of Osteopathic Specialists.
(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
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;
(2)  if asked, that the license holder has not
completed any formal specialized postgraduate or resident
(c)  A physician graduate may not prescribe a Schedule II
Sec. 155.208.  LIABILITY OF SPONSORING PHYSICIAN.  A
sponsoring physician who enters into a supervising practice
agreement with a physician graduate is responsible at all times for
the oversight of and is liable for any medical act performed or the
omission of any medical act by the physician graduate in the
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
(b)  A physician graduate may use the following titles or
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
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
(2)  in the manner provided by Chapter 164 and board
SECTION 2.  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.  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,
SECTION 4.  Not later than January 1, 2026, the Texas Medical
Board shall adopt rules as necessary to implement Subchapter E,
Chapter 155, Occupations Code, as added by this Act.
SECTION 5.  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,
SECTION 6.  This Act takes effect September 1, 2025.