H.B. No. 3348 establishes a County Health Care Provider Participation Program for 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 Chapter 292E to the Health and Safety Code, detailing the program's definitions, applicability, and operational framework. It allows counties to collect mandatory payments from institutional health care providers to create a local provider participation fund, which can be used for Medicaid payments and other health care-related expenses. Key provisions include public hearings by the commissioners court regarding these payments, rules for program administration, and a cap on total collections not exceeding six percent of providers' aggregate net patient revenue.

The bill also introduces new sections concerning the assessment and collection of mandatory payments, specifically for funding the nonfederal share of certain Medicaid programs. Under Section 292E.152, counties can collect or contract for these payments, with a provision for a collection fee that must be deposited into the county general fund if collected by a county official. Section 292E.153 outlines the limitations on counties' authority to collect these payments, ensuring they are only for Medicaid-related expenses and not for general revenue. Additionally, the bill allows state agencies to delay implementation until necessary federal waivers are obtained, with an effective date of September 1, 2025.

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