,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #baai  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #bi1 #bjae ,mr4
 ,%imkus introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,en]gy &      
,comm]ce  ,a ,,bill  ,to am5d title ,,xi
 ( ! ,social ,security ,act to require t
 ,/ate applications = ,/ate plan waiv]s 
"u ! ,m$icaid program be approv$ only if
 su* applications are budget neutral1 & 
= o!r purposes4  #a4 ,budget neutrality 
requir$ = ,/ate plan waiv]s "u ,m$icaid 
7a7 ,9 g5]al ,section #aaae7;d7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acae7;d77 is am5d$-- 7#a7 by r$esignat+
 p>agraph 7#c7 z p>agraph 7#d72 &  7#b7 
by ins]t+ aft] p>agraph 7#b7 ! foll[+   
new p>agraph3  7#c7 7,a7 ,beg9n+ )      
fiscal ye> #bjaf1 ! ,secret>y %all      
require1 z a condition on ! approval ( a
 demon/ration project 9 a ,/ate "u ?is  
section1 t ! project be budget neutral1 
z det]m9$ by ! ,secret>y 9 accordance ) 
subp>agraph 7,b7 & subject to           
subp>agraph 7,c74  7,b7 ,a det]m9ation  

by ! ,secret>y "u ?is p>agraph on :e!r a
 demon/ration project is budget neutral 
%all be bas$ on-- 7i7 ! hi/orical ,f$]al
 & ,/ate exp5ditures made "u ! ,/ate    
plan "u title ,,xix1 includ+ any        
adju/m5ts to su* exp5ditures 7o!r ?an   
adju/m5ts to acc\nt = improp] or o!rwise
 unall[able paym5ts7 support$ by data or
 o!r docum5tation2  7ii7 ! ,/ate's      
hi/orical sp5d+ gr[? rates & population 
gr[? rates1 includ+ any adju/m5ts       
support$ by data or docum5tation2 &     
7iii7 any o!r crit]ia det]m9$           
appropriate by ! ,secret>y4  7,c7 ,!    
,secret>y may n det]m9e t a demon/ration
 project is budget neutral "u ?is       
p>agraph unless ! ,*ief ,actu>y ( !     
,c5t]s = ,m$ic>e  ,m$icaid ,s]vices     
c]tifies to ! ,secret>y t ! project is  
budget neutral4  7,d7 ,= purposes ( ?is 
p>agraph1 ! t]m budget neutral means1 ) 
respect to a demon/ration project1 t !  
,f$]al exp5ditures "u ! project 9 !     
,/ate d n exce$ ! ,f$]al exp5ditures t  
w\ld o!rwise h be5 made if ! ,/ate _h 9 

effect a plan approv$ "u title ,,xix4  2
 &  7#c7 9 p>agraph 7#d7 7z r$esignat$  
by p>agraph 7#a77-- 7,a7 by /rik+       
,congress conc]n+ actions & ins]t+      
,congress on1 & make available to !     
public in=mation on1 any actions2 &     
7,b7 by ins]t+ 1 includ+ any data or o!r
 in=mation relat+ to det]m9ations ( !   
,secret>y "u p>agraph 7#c7 t su*        
demon/ration projects are budget neutral
 be=e ! p]iod at ! end4  7b7            
,regulations ,n lat] ?an #ij days aft] !
 date ( ! enactm5t ( ?is ,act1 !        
,secret>y ( ,heal? & ,human ,s]vices    
%all issue regulations to c>ry out !    
am5dm5ts made by subsection 7a71 includ+
 regulations specify+ ! crit]ia to be   
us$ 9 mak+ det]m9ations "u p>agraph 7#c7
 ( section #aaae7;d7 ( ! ,social        
,security ,act 7#db ,u4,s4,c4           
#acae7;d771 z ins]t$ by subsection 7a74