Senate Bill No. 2655 establishes a health care provider participation program for specific counties in Texas that do not have 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, defining terms such as "institutional health care provider" and "paying hospital." It allows these counties to collect mandatory payments from institutional health care providers to create a local provider participation fund, which will be used for health care-related expenses, including Medicaid payments. The bill outlines the responsibilities of the commissioners court, including the requirement for a majority vote to authorize payments and the establishment of rules for program administration, while mandating public hearings on payment amounts and revenue utilization.

Additionally, the bill specifies that mandatory payments must be based on the net patient revenue of each provider and sets limits on the total amount collected. It prohibits paying hospitals from adding these payments as surcharges to patients and allows counties to collect or contract for the assessment and collection of these payments, with collection fees capped at customary charges. The bill also emphasizes compliance with federal requirements, allowing counties to adopt alternative provisions to maintain eligibility for federal matching funds. Reporting requirements to the Health and Human Services Commission are included, along with provisions for interest and penalties on delinquent payments. The bill will take effect immediately upon a two-thirds vote from both houses or on September 1, 2025, if that vote is not achieved.

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