I 115th CONGRESS 1st Session H. R. 542 IN THE HOUSE OF REPRESENTATIVES January 13, 2017 Mr. Collins of New York (for himself, Mr. Mullin , Mr. Guthrie , Mr. Bucshon , and Mr. Flores ) 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. Short title This Act may be cited as the Better Accounting for Medicaid Costs Act of 2017 . 2. Requiring rulemaking for costly Medicaid subregulatory policies (a) In general Section 1102 of the Social Security 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 expenditures 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 expenditures 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 expenditures by the Federal Government under such title for such year, as compared to the estimated expenditures by the Federal Government under such title for such year if such policy were not issued. (2) Rulemaking for certain costly policies If the Secretary determines under paragraph (1) that a Medicaid subregulatory policy, with respect to any year for which such determination is made, is projected to result in— (A) an increase described in subparagraph (A) of such paragraph of at least $50,000,000; or (B) an increase described in subparagraph (B) of such paragraph of at least $100,000,000; the Secretary may implement such policy only through notice and comment rulemaking under section 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 estimated expenditures determined under subparagraphs (A) and (B) of paragraph (1) with respect to such policy. (4) Medicaid subregulatory policy defined (A) In general In this subsection, the term Medicaid subregulatory policy means, subject to subparagraph (B), any written guidance, 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 include any guidance or other statement of policy that relates to the management or personnel of the Department of Health and Human Services. . (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.