SEC. 2. REQUIRING RULEMAKING FOR COSTLY MEDICAID 
SUBREGULATORY POLICIES. 
(a) IN GENERAL.—Section 1102 of the Social Secu-
rity Act (42 U.S.C. 1302) is amended by adding at the 
end the following new subsection: 
‘‘(c) MEDICAID SUBREGULATORY POLICIES.— 
‘‘(1) EFFECT
ON
ANNUAL
GOVERNMENT
EX-
PENDITURES.—Before any Medicaid subregulatory 
policy (as defined in paragraph (4)) may be issued, 
the Secretary shall determine the extent to which 
such policy, with respect to each year in the 10-year 
period beginning on the proposed effective date for 
such policy, is projected to result in— 
‘‘(A) an increase in total estimated expend-
itures by States under title XIX for such year, 
as compared to the estimated expenditures by 
States under such title for such year if such 
policy were not issued; or 
‘‘(B) an increase in the estimated expendi-
tures by the Federal Government under such 
title for such year, as compared to the esti-
mated expenditures by the Federal Government 
under such title for such year if such policy 
were not issued. 
‘‘(2) RULEMAKING FOR CERTAIN COSTLY POLI-
CIES.—If the Secretary determines under paragraph 
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(1) that a Medicaid subregulatory policy, with re-
spect to any year for which such determination is 
made, is projected to result in— 
‘‘(A) an increase described in subpara-
graph (A) of such paragraph of at least 
$50,000,000; or 
‘‘(B) an increase described in subpara-
graph (B) of such paragraph of at least 
$100,000,000; 
the Secretary may implement such policy only 
through notice and comment rulemaking under sec-
tion 553 of title 5, United States Code. 
‘‘(3) INCLUSION OF ESTIMATED EXPENDITURES 
IN ISSUANCE OF SUBREGULATORY POLICIES.—If the 
Secretary issues a Medicaid subregulatory policy 
other than through rulemaking, the Secretary shall 
include in such issuance a specification of the esti-
mated expenditures determined under subpara-
graphs (A) and (B) of paragraph (1) with respect to 
such policy. 
‘‘(4) MEDICAID
SUBREGULATORY
POLICY
DE-
FINED.— 
‘‘(A) IN GENERAL.—In this subsection, the 
term ‘Medicaid subregulatory policy’ means, 
subject to subparagraph (B), any written guid-
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ance, or other written statement of policy, 
issued at the discretion of any official of the 
Department of Health and Human Services 
with respect to the Medicaid program under 
title XIX, including a statement of policy in the 
form of a letter to State Medicaid directors, an 
Informational Bulletin, and Frequently Asked 
Questions. 
‘‘(B) EXCEPTION.—Such term does not in-
clude any guidance or other statement of policy 
that relates to the management or personnel of 
the Department of Health and Human Serv-
ices.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to policies issued 
on or after the date of the enactment of this Act. 
Æ 
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