S.B. No. 1578 establishes a health care provider participation program for specific Texas counties that lack a hospital district, have populations over 900,000, and border two counties with populations of two million or more. The bill introduces a new Chapter 292E to the Health and Safety Code, which outlines the program's definitions, applicability, and operational framework. It allows these counties to collect mandatory payments from institutional health care providers, which will be deposited into a local provider participation fund to support Medicaid payments for nonpublic hospitals. The bill also details the responsibilities of the county commissioners court, including the requirement for a majority vote to authorize payment collections and the establishment of rules for program administration, while ensuring transparency through public hearings.

Additionally, the bill specifies that mandatory payments must be proportionate to each provider's net patient revenue and sets limits on the total amount collected. It allows counties to assess and collect these payments, with collection fees not exceeding customary charges for similar services. If collected by a county official, the fees must go into the county general fund. The legislation emphasizes that these payments are intended to support Medicaid programs without increasing general revenue or exceeding necessary funding amounts. It also provides a framework for counties to adopt alternative procedures to maintain eligibility for federal matching funds, ensuring that such changes do not increase liabilities for the county or healthcare providers. The bill is set to take effect on September 1, 2025, and includes provisions for state agencies to seek federal waivers as needed.

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