,i  #aadth ,,congress  #b;d ,session    
,h4 ,r4 #ejba  ,,in ,,the ,,house ,,of  
,,representatives  ,april #ba1 #bjaf    
,mr4 ,collins of ,new ,york introduced  
the following bill2 which was referred  
to the ,committee on ,energy and        
,commerce  ,a ,,bill  ,to amend title   
,,xi of the ,social ,security ,act to   
require the ,secretary of ,health and   
,human ,services to follow rulemaking   
procedures for costly ,medicaid         
subregulatory policies4  #a4 ,short     
title ,this ,act may be cited as the    
,better ,accounting for ,medicaid ,costs
 ,act of #bjaf4  #b4 ,requiring         
rulemaking for costly ,medicaid         
subregulatory policies  7a7 ,in general 
,section #aajb of the ,social ,security 
,act 7#db ,u4,s4,c4 #acjb7 is amended by
 adding at the end the following new    
subsection3  7c7 ,medicaid subregulatory
 policies  7#a7 ,effect on annual       
government expenditures ,before any     
,medicaid subregulatory policy 7as      
defined in paragraph 7#d77 may be       

issued1 the ,secretary shall determine  
the extent to which such policy1 with   
respect to each year in the #aj-year    
period beginning on the proposed        
effective date for such policy1 is      
projected to result in--  7,a7 an       
increase in total estimated expenditures
 by ,states under title ,,xix for such  
year1 as compared to the estimated      
expenditures by ,states under such title
 for such year if such policy were not  
issued2 or  7,b7 an increase in the     
estimated expenditures by the ,federal  
,government under such title for such   
year1 as compared to the estimated      
expenditures by the ,federal ,government
 under such title for such year if such 
policy were not issued4  7#b7           
,rulemaking for certain costly policies 
,if the ,secretary determines under     
paragraph 7#a7 that a ,medicaid         
subregulatory policy1 with respect to   
any year for which such determination is
 made1 is projected to result in--  7,a7
 an increase described in subparagraph  

7,a7 of such paragraph of at least      
#ej1jjj1jjj2 or  7,b7 an increase       
described in subparagraph 7,b7 of such  
paragraph of at least #ajj1jjj1jjj2  the
 ,secretary may implement such policy   
only through notice and comment         
rulemaking under section #eec of title  
#e1 ,united ,states ,code4  7#c7        
,inclusion of estimated expenditures in 
issuance of subregulatory policies ,if  
the ,secretary issues a ,medicaid       
subregulatory policy other than through 
rulemaking1 the ,secretary shall include
 in such issuance a specification of the
 estimated expenditures determined under
 subparagraphs 7,a7 and 7,b7 of         
paragraph 7#a7 with respect to such     
policy4  7#d7 ,medicaid subregulatory   
policy defined  7,a7 ,in general ,in    
this subsection1 the term ,medicaid     
subregulatory policy means1 subject to  
subparagraph 7,b71 any written guidance1
 or other written statement of policy1  
issued at the discretion of any official
 of the ,department of ,health and      

,human ,services with respect to the    
,medicaid program under title ,,xix1    
including a statement of policy in the  
form of a letter to ,state ,medicaid    
directors1 an ,informational ,bulletin1 
and ,frequently ,asked ,questions4  7,b7
 ,exception ,such term does not include 
any guidance or other statement of      
policy that relates to the management or
 personnel of the ,department of ,health
 and ,human ,services4  4  7b7          
,effective date ,the amendments made by 
subsection 7a7 shall apply with respect 
to policies issued on or after the date 
of the enactment of this ,act4