I 

114TH CONGRESS 

1ST SESSION H. R. 2119 

To amend title XI of the Social Security Act to require that State applications 

for State plan waivers under the Medicaid program be approved only 

if such applications are budget neutral, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 29, 2015 

Mr. SHIMKUS 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 

that State applications for State plan waivers under the 

Medicaid program be approved only if such applications 

are budget neutral, and for other purposes. 

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

3 SECTION 1. BUDGET NEUTRALITY REQUIRED FOR STATE 

4 PLAN WAIVERS UNDER MEDICAID. 

5 (a) IN GENERAL.—Section 1115(d) of the Social Se6 curity Act (42 U.S.C. 1315(d)) is amended— 

7 (1) by redesignating paragraph (3) as para8 graph (4); and 


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1 (2) by inserting after paragraph (2) the fol2 lowing new paragraph: 

3 ‘‘(3)(A) Beginning with fiscal year 2016, the 

4 Secretary shall require, as a condition on the ap5 proval of a demonstration project in a State under 

6 this section, that the project be budget neutral, as 

7 determined by the Secretary in accordance with sub8 paragraph (B) and subject to subparagraph (C). 

9 ‘‘(B) A determination by the Secretary under 

10 this paragraph on whether a demonstration project 

11 is budget neutral shall be based on— 

12 ‘‘(i) the historical Federal and State ex13 penditures made under the State plan under 

14 title XIX, including any adjustments to such 

15 expenditures (other than adjustments to ac16 count for improper or otherwise unallowable 

17 payments) supported by data or other docu18 mentation; 

19 ‘‘(ii) the State’s historical spending growth 

20 rates and population growth rates, including 

21 any adjustments supported by data or docu22 mentation; and 

23 ‘‘(iii) any other criteria determined appro24 priate by the Secretary. 


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1 ‘‘(C) The Secretary may not determine that a 

2 demonstration project is budget neutral under this 

3 paragraph unless the Chief Actuary of the Centers 

4 for Medicare & Medicaid Services certifies to the 

5 Secretary that the project is budget neutral. 

6 ‘‘(D) For purposes of this paragraph, the term 

7 ‘budget neutral’ means, with respect to a demonstra8 tion project, that the Federal expenditures under the 

9 project in the State do not exceed the Federal ex10 penditures that would otherwise have been made if 

11 the State had in effect a plan approved under title 

12 XIX.’’; and 

13 (3) in paragraph (4) (as redesignated by para14 graph (1))— 

15 (A) by striking ‘‘Congress concerning ac16 tions’’ and inserting ‘‘Congress on, and make 

17 available to the public information on, any ac18 tions’’; and 

19 (B) by inserting ‘‘, including any data or 

20 other information relating to determinations of 

21 the Secretary under paragraph (3) that such 

22 demonstration projects are budget neutral’’ be23 fore the period at the end. 

24 (b) REGULATIONS.—Not later than 90 days after the 

25 date of the enactment of this Act, the Secretary of Health 


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1 and Human Services shall issue regulations to carry out 

2 the amendments made by subsection (a), including regula3 tions specifying the criteria to be used in making deter4 minations under paragraph (3) of section 1115(d) of the 

5 Social Security Act (42 U.S.C. 1315(d)), as inserted by 

6 subsection (a). 

Æ 


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