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.

“(3)

“(A) Beginning with fiscal year 2016, the Secretary shall require, as a condition on the approval of a demonstration project in a State under this section, that the project be budget neutral, as determined by the Secretary in accordance with subparagraph (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 expenditures made under the State plan under title XIX, including any adjustments to such expenditures (other than adjustments to account for improper or otherwise unallowable payments) supported by data or other documentation;

“(ii) the State’s historical spending growth rates and population growth rates, including any adjustments supported by data or documentation; and

“(iii) any other criteria determined appropriate by the Secretary.

“(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 demonstration project, that the Federal expenditures under the project in the State do not exceed the Federal expenditures that would otherwise have been made if the State had in effect a plan approved under title XIX.”