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TexasHB 334889th Legislature Regular SessionHouse

Relating to the creation and operations of a health care provider participation program in certain counties.

Sponsored By: Tan Parker (Republican), Jared Patterson, Mihaela Plesa, Keresa Richardson, Ellen Troxclair

Signed by Governor

DENTON COUNTYCounty Government--FinanceHealth Care ProvidersSpecial Districts & Authorities--HospitalMEDICAIDPUBLIC NOTICE

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Bill Overview

Analyzed Economic Effects

3 provisions identified: 1 benefits, 0 costs, 2 mixed.

Certain counties gain hospital funding tool

The law lets qualifying Texas counties without a hospital district start a hospital-funded Medicaid payment program by commissioners court majority vote. Counties must meet one of three population and location tests. The first covers counties with more than 46,000 but fewer than 50,000 residents next to the county containing the state capital. The second covers counties with at least 900,000 residents bordering two counties that each have at least 2 million residents. The third requires at least 1 million residents, all or part of a city with at least 1 million residents, and a neighboring county with at least 2.5 million residents. Counties can assess hospitals only when a qualifying Medicaid waiver, rate enhancement, or similar payment program is available.

County hospital funds face spending safeguards

Counties must keep hospital assessments, penalties, interest, returned state transfers, and earnings in a separate county-controlled fund. Money can cover the local share of qualifying Medicaid supplemental payments, including uncompensated care, rate enhancements, and directed hospital payments. It can also cover permitted administration and hospital refunds, including mistaken collections and proportional shares of unused money returned by the state. Annual administration caps are $20,000 for the small capital-adjacent county group, $150,000 for the two-large-neighbor group, and $300,000 for the largest group. Transfer money cannot expand Medicaid eligibility or fund the local share of Medicaid disproportionate share hospital payments. Counties cannot collect extra general revenue and must report assessments, collections, and spending to the Texas Health and Human Services Commission. The commission can require alternative procedures to preserve federal matching funds or refuse money whose acceptance may violate federal law; its rules cannot create or materially expand county or hospital liability.

Hospitals pay assessments, not patient surcharges

Participating counties assess nonpublic hospitals providing inpatient care each year, with quarterly payments based proportionately on net patient revenue. Total assessments cannot exceed 6% of those hospitals’ combined net patient revenue from hospital services in the county. Hospitals must pay within 30 days after written notice and cannot charge patients a surcharge for the assessment. First-year amounts use the latest state-reported financial data, or the latest Medicare cost report when state data is unavailable; amounts update annually. Hospitals must also send the county their required state financial and service-use reports, and counties can inspect records. Counties can hire collectors, charge usual collection fees, and impose late-payment interest and penalties up to other county-payment limits.

Sponsors & Cosponsors

Sponsors

  • Tan Parker

    Republican • Senate

  • Jared Patterson

    House

  • Mihaela Plesa

    House

  • Keresa Richardson

    House

  • Ellen Troxclair

    House

Cosponsors

  • Angela Paxton

    Republican • Senate

Roll Call Votes

All Roll Calls

Yes: 245 • No: 49

House vote • 5/28/2025

Record vote

Yes: 106 • No: 29

Senate vote • 5/22/2025

Record vote

Yes: 0 • No: 0

Senate vote • 5/22/2025

Record vote

Yes: 0 • No: 0

House vote • 5/6/2025

Record vote

Yes: 124 • No: 19

House vote • Unknown

Committee vote: Intergovernmental Affairs

Yes: 8 • No: 1

Senate vote • Unknown

Committee vote: Local Government

Yes: 7 • No: 0

Actions Timeline

  1. Effective immediately

    6/20/2025House

  2. Signed by the Governor

    6/20/2025House

  3. Sent to the Governor

    5/31/2025House

  4. Signed in the Senate

    5/31/2025Senate

  5. Signed in the House

    5/30/2025House

  6. Reported enrolled

    5/29/2025House

  7. House concurs in Senate amendment(s)-reported

    5/28/2025Senate

  8. Text of Senate Amendment(s)

    5/28/2025House

  9. Statement(s) of vote recorded in Journal

    5/28/2025House

  10. Record vote (RV#3952)

    5/28/2025House

  11. House concurs in Senate amendment(s)

    5/28/2025House

  12. Senate Amendments Analysis distributed

    5/23/2025House

  13. Senate Amendments distributed

    5/23/2025House

  14. Senate passage as amended reported

    5/22/2025House

  15. Record vote

    5/22/2025Senate

  16. Passed

    5/22/2025Senate

  17. Read 3rd time

    5/22/2025Senate

  18. Record vote

    5/22/2025Senate

  19. Three day rule suspended

    5/22/2025Senate

  20. Vote recorded in Journal

    5/22/2025Senate

  21. Passed to 3rd reading as amended

    5/22/2025Senate

  22. Vote recorded in Journal

    5/22/2025Senate

  23. Amended

    5/22/2025Senate

  24. Amendment(s) offered (FA3 Parker)

    5/22/2025Senate

  25. Amendment withdrawn

    5/22/2025Senate

Bill Text

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