S.B. No. 2655 establishes a health care provider participation program for certain counties in Texas that lack hospital districts or public hospitals, specifically targeting those with populations between 46,000 and 50,000 and adjacent to the state capital. The bill introduces 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 to create a local provider participation fund, which can be utilized for Medicaid payments and other health care-related expenses. 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 community involvement through public hearings.

Furthermore, the bill clarifies that the mandatory payments collected are not classified as taxes for hospital purposes under the Texas Constitution and outlines the procedures for their assessment and collection, including potential collection fees. It emphasizes that these payments must solely fund Medicaid programs and administrative costs, prohibiting their use for general revenue. 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 legislative houses or on September 1, 2025, if such a vote is not achieved.

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