I 

114TH CONGRESS 

2D SESSION H. R. 5021 

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 policies. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 21, 2016 

Mr. COLLINS of New York introduced the following bill; 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 

policies. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Better Accounting for 

5 Medicaid Costs Act of 2016’’. 

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1 SEC. 2. REQUIRING RULEMAKING FOR COSTLY MEDICAID 

2 SUBREGULATORY POLICIES. 

3 (a) IN GENERAL.—Section 1102 of the Social Secu4 rity Act (42 U.S.C. 1302) is amended by adding at the 

5 end the following new subsection: 

6 ‘‘(c) MEDICAID SUBREGULATORY POLICIES.— 

7 ‘‘(1) EFFECT ON ANNUAL GOVERNMENT EX8 PENDITURES.—Before any Medicaid subregulatory 

9 policy (as defined in paragraph (4)) may be issued, 

10 the Secretary shall determine the extent to which 

11 such policy, with respect to each year in the 10-year 

12 period beginning on the proposed effective date for 

13 such policy, is projected to result in— 

14 ‘‘(A) an increase in total estimated expend15 itures by States under title XIX for such year, 

16 as compared to the estimated expenditures by 

17 States under such title for such year if such 

18 policy were not issued; or 

19 ‘‘(B) an increase in the estimated expendi20 tures by the Federal Government under such 

21 title for such year, as compared to the esti22 mated expenditures by the Federal Government 

23 under such title for such year if such policy 

24 were not issued. 

25 ‘‘(2) RULEMAKING FOR CERTAIN COSTLY POLI26 CIES.—If the Secretary determines under paragraph 

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1 (1) that a Medicaid subregulatory policy, with re2 spect to any year for which such determination is 

3 made, is projected to result in— 

4 ‘‘(A) an increase described in subpara5 graph (A) of such paragraph of at least 

6 $50,000,000; or 

7 ‘‘(B) an increase described in subpara8 graph (B) of such paragraph of at least 

9 $100,000,000; 

10 the Secretary may implement such policy only 

11 through notice and comment rulemaking under sec12 tion 553 of title 5, United States Code. 

13 ‘‘(3) INCLUSION OF ESTIMATED EXPENDITURES

14 IN ISSUANCE OF SUBREGULATORY POLICIES.—If the 

15 Secretary issues a Medicaid subregulatory policy 

16 other than through rulemaking, the Secretary shall 

17 include in such issuance a specification of the esti18 mated expenditures determined under subpara19 graphs (A) and (B) of paragraph (1) with respect to 

20 such policy. 

21 ‘‘(4) MEDICAID SUBREGULATORY POLICY DE22 FINED.— 

23 ‘‘(A) IN GENERAL.—In this subsection, the 

24 term ‘Medicaid subregulatory policy’ means, 

25 subject to subparagraph (B), any written guidmstockstill on DSK3G9T082PROD with BILLS

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1 ance, or other written statement of policy, 

2 issued at the discretion of any official of the 

3 Department of Health and Human Services 

4 with respect to the Medicaid program under 

5 title XIX, including a statement of policy in the 

6 form of a letter to State Medicaid directors, an 

7 Informational Bulletin, and Frequently Asked 

8 Questions. 

9 ‘‘(B) EXCEPTION.—Such term does not in10 clude any guidance or other statement of policy 

11 that relates to the management or personnel of 

12 the Department of Health and Human Serv13 ices.’’. 

14 (b) EFFECTIVE DATE.—The amendments made by 

15 subsection (a) shall apply with respect to policies issued 

16 on or after the date of the enactment of this Act. 

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