HB 2038

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:
SECTION 1.001.  This Act shall be known as the Decreasing
Occupational Certification Timelines, Obstacles, and Regulations
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
(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
(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;
(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
(4)  satisfies the examination requirements of Section
(5)  has proficiency in the English language;
(6)  is authorized under federal law to work in the
(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
(b)  A provisional license issued under this section expires
(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
(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
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
(b)  The board shall issue a medical license to practice
(1)  is licensed in good standing as a physician in
(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
(3)  was, at the time of retiring from or leaving
(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
(c)  The board may not issue a license under this section to
(1)  was discharged or separated from the armed forces
(A)  on the basis of substandard conduct; or
(B)  for any act of misconduct or moral or
(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:
(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
(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
(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
(B)  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 is recognized by the board 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 is recognized
(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)  has not been and is not currently the subject of
disciplinary action by the board or the medical licensing authority
(7)  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
(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
(C)  the American Board of Oral and Maxillofacial
(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
(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
(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
(iii)  the American Board of Oral and
(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
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)  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
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 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,
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,
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
SECTION 6.001.  This Act takes effect September 1, 2025.