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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. BUDGET NEUTRALITY REQUIRED FOR STATE 
PLAN WAIVERS UNDER MEDICAID. 
(a) IN GENERAL.—Section 1115(d) of the Social Se-
curity Act (42 U.S.C. 1315(d)) is amended— 
(1) by redesignating paragraph (3) as para-
graph (4); and 
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(2) by inserting after paragraph (2) the fol-
lowing new paragraph: 
‘‘(3)(A) Beginning with fiscal year 2016, the 
Secretary shall require, as a condition on the ap-
proval of a demonstration project in a State under 
this section, that the project be budget neutral, as 
determined by the Secretary in accordance with sub-
paragraph (B) and subject to subparagraph (C). 
‘‘(B) A determination by the Secretary under 
this paragraph on whether a demonstration project 
is budget neutral shall be based on— 
‘‘(i) the historical Federal and State ex-
penditures made under the State plan under 
title XIX, including any adjustments to such 
expenditures (other than adjustments to ac-
count for improper or otherwise unallowable 
payments) supported by data or other docu-
mentation; 
‘‘(ii) the State’s historical spending growth 
rates and population growth rates, including 
any adjustments supported by data or docu-
mentation; and 
‘‘(iii) any other criteria determined appro-
priate by the Secretary. 
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‘‘(C) The Secretary may not determine that a 
demonstration project is budget neutral under this 
paragraph unless the Chief Actuary of the Centers 
for Medicare & Medicaid Services certifies to the 
Secretary that the project is budget neutral. 
‘‘(D) For purposes of this paragraph, the term 
‘budget neutral’ means, with respect to a demonstra-
tion project, that the Federal expenditures under the 
project in the State do not exceed the Federal ex-
penditures that would otherwise have been made if 
the State had in effect a plan approved under title 
XIX.’’; and 
(3) in paragraph (4) (as redesignated by para-
graph (1))— 
(A) by striking ‘‘Congress concerning ac-
tions’’ and inserting ‘‘Congress on, and make 
available to the public information on, any ac-
tions’’; and 
(B) by inserting ‘‘, including any data or 
other information relating to determinations of 
the Secretary under paragraph (3) that such 
demonstration projects are budget neutral’’ be-
fore the period at the end. 
(b) REGULATIONS.—Not later than 90 days after the 
date of the enactment of this Act, the Secretary of Health 
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and Human Services shall issue regulations to carry out 
the amendments made by subsection (a), including regula-
tions specifying the criteria to be used in making deter-
minations under paragraph (3) of section 1115(d) of the 
Social Security Act (42 U.S.C. 1315(d)), as inserted by 
subsection (a). 
Æ 
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