{"data":{"id":"us-ky/krs-205.524","jurisdiction":"us-ky","citation":"KRS 205.524","heading":"Annual legislative review of Medicaid state plan and KCHIP state plan --","body":"Requirements and procedures for compliance.\n(1) As used in this section:\n(a) \"CMS\" means the federal Centers for Medicare and Medicaid Services;\n(b) \"Department\" means the Department for Medicaid Services;\n(c) \"KCHIP state plan\" means the federally approved, legally binding contract\nbetween the Commonwealth and CMS that outlines how the Commonwealth\nadministers the Kentucky Children's Health Insurance Program, commonly\nknown as KCHIP;\n(d) \"Medicaid state plan\" means the federally approved, legally binding contract\nbetween the Commonwealth and CMS that outlines how the Commonwealth\nadministers the state's medical assistance program, commonly known as\nMedicaid; and\n(e) \"SPA\" mea ns a Medicaid state plan or KCHIP state plan amendment or a\nrequest for a state plan amendment that has been submitted to CMS.\n(2) (a) The Commonwealth's Medicaid state plan and KCHIP state plan shall be\nsubject to an annual legislative review in accordance with this section.\n(b) The department shall, by July 1 of each year, submit to the Legislative\nResearch Commission, for referral to the Interim Joint Committee on Health\nServices and the Medicaid Oversight and Advisory Board established in KRS\n7A.273:\n1. A copy of the current Medicaid state plan;\n2. A copy of the current KCHIP state plan; and\n3. A copy and summary of each Medicaid and KCHIP SPA that has been:\na. Approved by CMS;\nb. Denied or rejected by CMS; and\nc. Submitted to, but not yet approved or denied by, CMS;\nsince July 1 of the preceding calendar year.\n(c) The Medicaid Oversight and Advisory Board shall, by August 31 of each\nyear, on a date determined by the co -chairs, review the Medicaid state plan,\nKCHIP state plan, and all Medicaid and KCHIP  SPAs submitted in\naccordance with paragraph (b) of this subsection, at which time\nrepresentatives from the department shall appear before, provide testimony to,\nand answer questions from the board concerning the Medicaid state plan, the\nKCHIP state plan, and all Medicaid and KCHIP SPAs submitted in\naccordance with paragraph (b) of this subsection.\n(d) The Interim Joint Committee on Health Services shall, by October 31 of each\nyear, on a date determined by the co -chairs, review the Medicaid state plan,\nKCHIP state plan, and all Medicaid and KCHIP SPAs submitted in\naccordance with paragraph (b) of this subsection, at which time\nrepresentatives from the department shall appear before, provide testimony to,\nand answer questions from the committee concerning the  Medicaid state plan,\nKCHIP state plan, all Medicaid and KCHIP SPAs submitted in accordance\nwith paragraph (b) of this subsection, and the department's response to any\nrecommendations made by the Medicaid Oversight and Advisory Board in\naccordance with subsection (4) of this section.\n(3) When submitting a copy and summary of a SPA to the Legislative Research\nCommission in accordance with subsection (2)(b) of this section, the department\nshall include:\n(a) A copy of all materials submitted to CMS related to the SPA;\n(b) A summary of the change or changes sought by the SPA;\n(c) A summary of how the SPA will improve the administration of the Medicaid\nor KCHIP program, access to services, or the overall health of the Medicaid\nor KCHIP population;\n(d) An explanation of the necessity of the SPA;\n(e) A determination of whether or not the SPA was subject to the authorization\nrequirements established in KRS 205.5372 and an explanation of that\ndetermination; and\n(f) An analysis of the anticipated fiscal and budgetary i mpacts of the SPA which\nshall include an analysis of costs over a one (1), two (2), and five (5) year\ntimeframe.\n(4) Following a review conducted pursuant to subsection (2)(c) of this section, the\nMedicaid Oversight and Advisory Board may, by a vote of a m ajority of the voting\nmembers appointed to the board under KRS 7A.276, make recommendations for\nchanges to a state plan or SPA. If the board elects to make recommendations for\nchanges to a state plan or SPA, the board shall submit those recommendations in\nwriting to the Governor, the secretary of the cabinet, and the commissioner of the\ndepartment within thirty (30) calendar days from the date on which the review was\nconducted.\n(5) (a) As part of a review conducted under subsection (2)(d) of this section of  the\nMedicaid state plan, KCHIP state plan, and all Medicaid and KCHIP SPAs\nsubmitted in accordance with subsection (2)(b) of this section, the Interim\nJoint Committee on Health Services may, by a vote of a majority of the\nmembers appointed to the committe e, find a state plan to be, in part or in\nwhole, deficient because it:\n1. Appears to be in conflict with an existing state statute governing the\nMedicaid or KCHIP program, including but not limited to the\nrequirements imposed under KRS 205.525;\n2. Appears to be in conflict with federal law governing the Medicaid or\nCHIP program;\n3. Appears to exceed the cabinet's or department's statutory authority,\nincluding but not limited to restrictions imposed under KRS 205.5372;\n4. Appears to impose an unreasonable bu rden on state government,\nMedicaid-participating providers, or Medicaid beneficiaries;\n5. Was submitted for review in a manner that does not fully comply with\nsubsection (3) of this section;\n6. Fails to fully incorporate recommendations made by the Medicai d\nOversight and Advisory Board under subsection (4) of this section; or\n7. Appears to be deficient in any other manner, except that the committee\nshall not find a state plan to be deficient on the basis of a SPA that was:\na. Denied or rejected by CMS; or\nb. Submitted to, but not yet approved or denied by, CMS.\n(b) Notwithstanding paragraph (a)7. of this subsection, the Interim Joint\nCommittee on Health Services may make recommendations to the Governor,\nsecretary of the cabinet , commissioner of the department, or the General\nAssembly related to a SPA that was denied or rejected by CMS or that has\nbeen submitted to, but not yet approved by, CMS.\n(c) If the Interim Joint Committee on Health Services finds the Medicaid state\nplan to be, in part or in whole, deficient, the committee shall transmit to the\nGovernor, the secretary of the cabinet, and the commissioner of the\ndepartment:\n1. A copy of the finding of deficiency and other relevant findings,\nrecommendations, or comments; and\n2. A request that the Governor determine whether the Medicaid or KCHIP\nstate plan shall:\na. Be amended to resolve concerns identified by the committee that\nlead to its finding of deficiency; or\nb. Remain in effect notwithstanding the finding of deficiency.\n(6) The Governor shall transmit his or her determination on any request made under\nsubsection (5)(c)2. of this section to the Legislative Research Commission for\nreferral to the Interim Joint Committee on Health Services and the Medicaid\nOversight and Advisory Board within thirty (30) calendar days of the date on which\nthe Interim Joint Committee on Health Services found the Medicaid or KCHIP state\nplan, in part or in whole, to be deficient.\n(7) The department shall, within thirty (30) days after April 14,  2026, publish to its\nwebsite, in an easily accessible manner:\n(a) A copy of the current, in effect Medicaid and KCHIP state plans, including a\nclear notation of the date of the most recent approved SPA to each plan; and\n(b) A copy of each Medicaid and KCH IP SPA that has been submitted to CMS\nand the Legislative Research Commission, as required under KRS 205.525,\nincluding a copy of the summary and statement of benefits as required under\nKRS 205.525.\n(8) Notwithstanding provisions of this section to the contrary:\n(a) When conducting the initial legislative review of the Medicaid and KCHIP\nstate plans in 2026, the Medicaid Oversight and Advisory Board and the\nInterim Joint Committee on Health Services shall review the Medicaid state\nplan and the KCHIP state p lan in their entirety and may, by June 1, 2026,\nrequest a summary, to be prepared in accordance with subsection (3) of this\nsection, for any part of the Medicaid state plan; and\n(b) The department shall, within five (5) calendar days after April 14, 2026,\nprovide the Legislative Research Commission with a copy of the current, in\neffect Medicaid and KCHIP state plans for referral to the Interim Joint\nCommittee on Health Services and the Medicaid Oversight and Advisory\nBoard.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56928","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"fb5bca6f6e7ba1ef8ab8ee752468df18e598323c2edfc0353351cbf79b7cbd8e","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.522","next":"us-ky/krs-205.525"},"notice":"GroundRules: Original legal text. Not legal advice."}