,i  #aad? ,,congress  #b;d ,session  ,h4
 ,r4 #ejba  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,april #ba1 #bjaf ,mr4
 ,coll9s ( ,new ,york 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 ! ,secret>y ( ,heal? & ,human  
,s]vices to foll[ rulemak+ proc$ures =  
co/ly ,m$icaid subregulatory policies4  
#a4 ,%ort title ,?is ,act may be cit$ z 
! ,bett] ,acc\nt+ = ,m$icaid ,co/s ,act 
( #bjaf4  #b4 ,requir+ rulemak+ = co/ly 
,m$icaid subregulatory policies  7a7 ,9 
g5]al ,section #aajb ( ! ,social        
,security ,act 7#db ,u4,s4,c4 #acjb7 is 
am5d$ by add+ at ! end ! foll[+ new     
subsection3  7c7 ,m$icaid subregulatory 
policies  7#a7 ,effect on annual        
gov]nm5t exp5ditures ,be=e any ,m$icaid 
subregulatory policy 7z def9$ 9 p>agraph
 7#d77 may be issu$1 ! ,secret>y %all   
det]m9e ! ext5t to :i* su* policy1 )    
respect to ea* ye> 9 ! #aj-ye> p]iod    
beg9n+ on ! propos$ effective date = su*

 policy1 is project$ to result 9--  7,a7
 an increase 9 total e/imat$ exp5ditures
 by ,/ates "u title ,,xix = su* ye>1 z  
comp>$ to ! e/imat$ exp5ditures by      
,/ates "u su* title = su* ye> if su*    
policy 7 n issu$2 or  7,b7 an increase 9
 ! e/imat$ exp5ditures by ! ,f$]al      
,gov]nm5t "u su* title = su* ye>1 z     
comp>$ to ! e/imat$ exp5ditures by !    
,f$]al ,gov]nm5t "u su* title = su* ye> 
if su* policy 7 n issu$4  7#b7 ,rulemak+
 = c]ta9 co/ly policies ,if ! ,secret>y 
det]m9es "u p>agraph 7#a7 t a ,m$icaid  
subregulatory policy1 ) respect to any  
ye> = :i* su* det]m9ation is made1 is   
project$ to result 9--  7,a7 an increase
 describ$ 9 subp>agraph 7,a7 ( su*      
p>agraph ( at lea/ #ej1jjj1jjj2 or  7,b7
 an increase describ$ 9 subp>agraph 7,b7
 ( su* p>agraph ( at lea/ #ajj1jjj1jjj2 
! ,secret>y may implem5t su* policy only
 ?r\gh notice & comm5t rulemak+ "u      
section #eec ( title #e1 ,unit$ ,/ates  
,code4  7#c7 ,inclusion ( e/imat$       
exp5ditures 9 issuance ( subregulatory  

policies ,if ! ,secret>y issues a       
,m$icaid subregulatory policy o!r ?an   
?r\gh rulemak+1 ! ,secret>y %all include
 9 su* issuance a specification ( !     
e/imat$ exp5ditures det]m9$ "u          
subp>agraphs 7,a7 & 7,b7 ( p>agraph 7#a7
 ) respect to su* policy4  7#d7 ,m$icaid
 subregulatory policy def9$  7,a7 ,9    
g5]al ,9 ?is subsection1 ! t]m ,m$icaid 
subregulatory policy means1 subject to  
subp>agraph 7,b71 any writt5 guidance1  
or o!r writt5 /atem5t ( policy1 issu$ at
 ! discretion ( any (ficial ( !         
,dep>tm5t ( ,heal? & ,human ,s]vices )  
respect to ! ,m$icaid program "u title  
,,xix1 includ+ a /atem5t ( policy 9 ! =m
 ( a lett] to ,/ate ,m$icaid directors1 
an ,in=mational ,bullet91 & ,frequ5tly  
,ask$ ,que/ions4  7,b7 ,exception ,su*  
t]m does n include any guidance or o!r  
/atem5t ( policy t relates to !         
managem5t or p]sonnel ( ! ,dep>tm5t (   
,heal? & ,human ,s]vices4  4  7b7       
,effective date ,! am5dm5ts made by     
subsection 7a7 %all apply ) respect to  

policies issu$ on or aft] ! date ( !    
enactm5t ( ?is ,act4