House Bill No. 4799 aims to create a County Health Care Provider Participation Program for specific Texas counties that lack a hospital district or public hospital, have populations between 46,000 and 50,000, and are adjacent to the state capital. 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 establish a local provider participation fund, which can be utilized for Medicaid payments and other health care-related expenses. The bill requires the commissioners court to authorize these payments through a majority vote and mandates public hearings to discuss the payment amounts and their intended use.

Furthermore, the bill clarifies that these mandatory payments are not classified as taxes for hospital purposes under the Texas Constitution and outlines the assessment and collection procedures, including potential collection fees. It ensures that the funds collected are strictly for Medicaid programs and cannot be used for general revenue or to expand Medicaid eligibility under the Affordable Care Act. The legislation also allows counties to adopt alternative procedures to maintain eligibility for federal matching funds and includes provisions for delaying implementation if federal waivers are necessary. The act will take effect immediately upon a two-thirds vote from both houses or on September 1, 2025, if such a vote is not achieved.

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