; 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.