HBA-MPM C.S.H.B. 2896 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 2896 By: Coleman Public Health 4/19/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE In 1993, Texas began the transition to managed care for certain recipients of Medicaid services, with pilot programs in Travis County and the tri-county area of Jefferson, Chambers, and Galveston counties. Since that time, Medicaid managed care has been implemented in four additional service areas: Bexar, Tarrant, Lubbock, and Harris Counties. The Dallas County and El Paso County service areas are scheduled for implementation in the fall of 1999, which would bring total enrollment in Medicaid managed care to more than 800,000 individuals. The transition to Medicaid managed care has produced difficulties with client enrollment, access to services, and provider reimbursement. The Health and Human Services Commission and the Texas Department of Health jointly operate the Medical program and are charged with ensuring that the implementation of Medicaid managed care meets the state's goals of improving the health of needy Texans while realizing cost efficiencies in the system. C.S.H.B. 2896 places a moratorium on future implementation of Medicaid managed care until the commission demonstrates that certain issues are resolved. Additionally, this bill requires the commission to develop rules regarding the sharing of annual profit earned by Medicaid managed care. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Health and Human Services Commission in SECTION 11 (Section 533.014, Government Code) and SECTION 13 (Section 2.07, Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997), of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter B, Chapter 531, Government Code, by adding Section 531.0218, as follows: Sec. 531.0218. EVALUATION OF ENTITIES CONTRACTING TO OPERATE MEDICAID PROGRAM. Requires the Health and Human Services Commission (commission) to evaluate and report biennially to the legislature and governor regarding the contractual performance and related costs of each of the administrative entities contracting with the commission to operate the state Medicaid program, including enrollment brokers, external quality review organizations, primary care case management administrators, and claims payors. SECTION 2. Amends Section 533.002, Government Code, as follows: Sec. 533.002. PURPOSE. Includes developing strategies to encourage more personal responsibility in health care maintenance and decisions among those tenets that are required to be set forth by the Health and Human Services Commission (commission) when contracting with managed care organizations (organizations). Makes a nonsubstantive change. SECTION 3. Amends Section 533.003, Government Code, as follows: Section 533.003. CONSIDERATIONS IN AWARDING CONTRACTS. Includes organizations that contract with school-based health centers among those organizations which the commission is required to give preference to when awarding contracts to managed care organizations. Additionally, requires the commission to consider the ability of organizations to process Medicaid claims electronically when making these awards. Makes nonsubstantive changes. SECTION 4. Amends Section 533.004, Government Code, by amending Subsection (a) and adding Subsection (e), as follows: (a) Requires the commission to contract with any, rather than at least one, managed care organization in a health care service region that meets certain criteria when providing health care services through Medicaid managed care to recipients in that area. Adds to the list of organizations that the commission may contract with, an organization that holds a certificate of authority as a health maintenance organization under Article 20A.05 (Issuance of Certificate of Authority), Insurance Code, and that is certified under Section 5.01(a), Article 4495b, V.T.C.S. (Medical Practice Act) and that is created by the University of Texas Medical Branch at Galveston. Makes conforming changes. (e) Defines "health care service region" or "region" for purposes of a managed care organization described by Subsection (a). SECTION 5. Amends Section 533.005, Government Code, to provide that a contract between a managed care organization and the commission for the provision of health care services must include a requirement that the commission, on the date of a recipient's enrollment in a managed care plan issued by the managed care organization, inform the organization of the recipient's certification, rather than recertification, date. SECTION 6. Amends Subchapter A, Chapter 533, Government Code, by adding Section 533.0055 and 533.0056, as follows: Sec. 533.0055. REVIEW OF PROPOSED CONTRACT BY PRIVATE ENTITY. (a) Requires the commission to contract with a private entity to review each proposed contract between the commission and a managed care organization to provide health care services to recipients in a region under this chapter. Requires the private entity to consider certain factors regarding proposed premium rates, sanctions for failure to meet performance goals, the ability of the managed care organizations to meet its contractual obligations and to process Medicaid claims electronically, and any other issue directed by the commission in conducting a review under this section. (b) Requires the commission to enter into a contract with a private entity to review a proposed contract under Subsection (a) no later than the 180th day before the contract renewal date for the region to which the contract applies. (c) Requires a private entity reviewing a proposed contract under subsection (a) to issue a report to the commission stating its findings, including any recommended changes, no later than the 120th day before the contract renewal date for the region to which the contract applies. (d) Authorizes the commission to make necessary changes to a proposed contract based on the findings of a review conducted by a private entity under this section. Sec. 533.0056. IMPLEMENTATION OF STATE-ADMINISTERED PLAN IN REGION. Prohibits the commission from implementing more than one state-administered managed care plan in a health care services region. SECTION 7. Amends Section 533.006(a), Government Code, to include each specialized pediatric laboratory in the region, including those located in children's hospitals, among those entities from which each managed care organization contracting with the commission to provide health care services is required to seek participation in the organization's provider network. SECTION 8. Amends Section 533.007(e), Government Code, to include the ability of the managed care organization to process claims electronically among those processes or systems required by a contract that a compliance and readiness review by the commission is required to address. SECTION 9. Amends Section 533.0075, Government Code, as follows: Sec. 533.0075. RECIPIENT ENROLLMENT. Requires the commission to develop and implement an expedited process for determining eligibility and enrolling pregnant women and newborn infants in managed care plans, among other requirements. Requires the commission to ensure immediate access to prenatal services and newborn care for pregnant women and infants enrolled in managed care plans, including ensuring that a pregnant woman may obtain an appointment with an obstetrical care provider for an initial maternity evaluation no later than the 30th day after the woman applies for Medicaid. Requires the commission to implement a process to reduce or eliminate the number of recipients classified as "on hold" with respect to the delivery of services under managed care plans or, in the alternative, to develop a method for continued payment to managed care organizations to avoid interruptions in recipient care. Requires the commission to also temporarily assign Medicaid-eligible newborn infants to the traditional fee-for-service component of the state Medicaid program for a period not to exceed the earlier of 60 days or the date on which the department has completed the newborn's Medicaid eligibility determination, including assignment of a newborn's eligibility number. Makes a nonsubstantive change. SECTION 10. Amends Subchapter A, Chapter 533, Government Code, by adding Section 533.0076, as follows: Sec. 533.0076. ELIGIBILITY DETERMINATION AND ENROLLMENT PILOT PROGRAM. (a) Requires the commission, no later than November 1, 1999, to develop and implement a pilot program to simplify, to the extent possible, the process for determining eligibility for enrolling recipients in managed care plans. Requires the commission to implement the pilot program in a single county in a region in which it has implemented Medicaid managed care. (b) Requires the commission, in implementing the pilot program and to the extent possible, to use continuous eligibility procedures and eliminate the use of resource requirements for determining eligibility. Requires the commission to evaluate certain aspects of the program with respect to Medicaid costs, health outcomes, and other issues the commission considers necessary. (c) Requires the commission, no later than November 1, 2002, to submit to the legislature a report concerning the pilot program, including recommendations for legislative action (d) Provides that this section expires September 1, 2003. SECTION 11. Amends Subchapter A, Chapter 533, Government Code, by adding Sections 533.012533.016, as follows: Sec. 533.012. MORATORIUM ON IMPLEMENTATION OF CERTAIN PILOT PROGRAMS; REVIEW; REPORT. (a) Prohibits the commission, notwithstanding any other law and after May 1, 2000, from implementing Medicaid managed care pilot programs, Medicaid behavioral health pilot programs, or Medicaid Star + Plus pilot programs (henceforth referred to as "Medicaid programs" for purposes of this section) in a region for which the commission has not received certain bids for health care services or entered into a contract with a managed health care organization to provide health care services for the region. (b) Requires the commission to: _review any outstanding administrative and financial issues with respect to the Medicaid programs implemented in health care service regions; _review the obligations and duties of the commission and each health and human services agency operating as part of the state Medicaid program with respect to administration issues; _review the impact of the Medicaid managed care delivery systems, including managed care organizations, prepaid health plans, and primary care case management on certain aspects of the system; _evaluate the feasibility of implementing a payment system based on patient severity and risk; _evaluate the progress of the state with respect to the development of reliable and informative data relating to services provided to recipients; and _review costs incurred and any savings realized by the state in implementing Medicaid managed care. (c) Provides that the commission's review must include an evaluation of Medicaid managed care programs in other states to determine the cost-effectiveness of using a single managed care delivery model in a service area or a mixture of delivery models. (d) Requires the commission, in performing duties and functions under Subsection (b), to seek input from the state Medicaid managed care advisory committee created by Subchapter C. (e) Authorizes the commission, notwithstanding Subsection(a), to implement Medicaid programs in a region described by that subsection if the commission makes certain findings with respect to outstanding administrative and financial issues and the benefit of the programs to recipients and providers. (f) Requires the commission, no later than November 1, 2000, to submit a report to the governor and the legislature that includes certain information and recommendations. (g) Prohibits this section, to the extent practicable, from being construed to affect the duty of the commission to plan the continued expansion of Medicaid programs in health care service regions described by Subsection (a) after July 1, 2001. (h) Provides that this section expires July 1, 2001. Sec. 533.013. PREMIUM PAYMENT RATE DETERMINATION; REVIEW AND COMMENT. (a) Requires the commission, in determining premium rates paid to a managed care organization under a managed care plan, to consider certain factors with respect to a particular region. (b) Prohibits the commission, in determining premium payment rates paid to a managed care organization licensed under Chapter 20A, V.T.C.S. (Texas Health Maintenance Organization Act), from discounting premium payment rates in an amount that is more than necessary to meet federal budget neutrality requirements for projected fee-for-service costs except under certain conditions. (c) Requires the premium payment rates paid to a managed care organization licensed under Chapter 20A, V.T.C.S. (Texas Health Maintenance Organization Act), to be established by competitive bidding. Prohibits the rates from exceeding the maximum premium payment rates established by the commission under Subsection (b). Sec. 533.014. PROFIT SHARING. (a) Requires the commission to develop rules regarding the sharing of profits earned by a managed care organization through a managed health care plan providing health care services under a contract with the commission under this chapter. (b) Requires any amount received by the state under this section to be deposited in the general revenue fund for the purpose of funding Medicaid outreach and education activities. Sec. 533.015. COORDINATION OF EXTERNAL OVERSIGHT AND UNIFORM DOCUMENT REVIEW. (a) Requires the commission to coordinate all external oversight activities to minimize duplication of oversight of managed care plans under the state Medicaid program and disruption of operations under those plans. (b) Requires the commission to develop and administer a single uniform procedure for the review of documents a managed care organization under contract with the commission under this chapter is required to submit for state approval. Requires each agency involved in administering Medicaid managed care for acute care, long-term care, or behavioral health services to use the procedure developed by the commission under this subsection to review documents submitted by managed care organizations. Sec. 533.016. COORDINATION OF MEDICAID LONG-TERM CARE. Requires the commission, if it delegates all or part of its functions, powers, and duties related to long-term care under Section 532.002, Health and Safety Code, or Subchapter B, or Subchapter C, Chapter 532, Government Code, including the operation of pilot projects, to: _designate a single health and human services agency to serve as lead agency to ameliorate the impact of multiple agencies with responsibility for functions related to long-term care; and _ensure that long-term care is administered by each of the appropriate health and human services agencies as efficiently and effectively as if care were being administered by a single state agency. SECTION 12. Amends Chapter 533, Government Code, by adding Subchapter C, as follows: SUBCHAPTER C. STATEWIDE ADVISORY COMMITTEE. Sec. 533.041. APPOINTMENT AND COMPOSITION. (a) Requires the commission to appoint a state Medicaid managed care advisory committee (committee) and sets for the committee's composition. (b) Provides that the committee must include a member of each regional Medicaid managed care advisory committee appointed by the commission under Subchapter B (Medicaid Delivery System), Chapter 532 (Medicaid Managed Care Delivery System), Government Code. Sec. 533.042. MEETINGS. Requires the committee to meet at least quarterly and makes it subject to Chapter 551 (Open Meetings), Government Code. Sec. 533.043. POWERS AND DUTIES. Requires the committee to perform certain functions with respect to Medicaid managed care. Sec. 533.045. OTHER LAW. Makes the committee subject to Chapter 2110 (State Agency Advisory Committees), Government Code, except as provided by this subchapter. SECTION 13. Amends Section 2.07(c), Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997, to require the commission to study the feasibility of authorizing providers to reenroll in the program online or through other electronic means, and, on completion of the study, to develop and implement an electronic method of reenrollment for providers no later than September 1, 2000, if the commission deems it feasible. Provides that a provider must enroll in the state Medicaid program or make necessary contract modifications no later than March 31, 2000, rather than September 1, 1999, to retain eligibility to participate in the program unless the commission implements under this subsection an electronic method of reenrollment for providers, in which event, a provider must reenroll or make the contractual modifications no later than September 1, 2000. Authorizes the commission, by rule, to extend a reenrollment deadline prescribed by this subsection if a significant number of providers, as determined by the commission, have not met the reenrollment requirements by the applicable deadline. SECTION 14. (a) Requires the commission, no later than January 1, 2000, to implement the expedited process for determining eligibility for and enrollment of certain recipients in Medicaid managed care plans required by Section 533.0075(4), Government Code, as added by this Act. (b) Requires the commission to report quarterly to the standing committees of the senate and house of representatives with primary jurisdiction over Medicaid managed care regarding the status of the expedited process described by Subsection (a) of this section, and requires the commission to submit quarterly reports under this subsection until it determines that the process is fully implemented and functioning successfully. SECTION 15. Requires the commission, if it determines that a waiver or other authorization from a federal agency is necessary before implementing any provision of this Act, to request the waiver or authorization and to delay implementing the provision under the waiver or authorization is granted. SECTION 16. Effective date: September 1, 1999, with the exception of Section 533.013 Government Code, which is effective the first date it may take effect under Section 39, Article III, Texas Constitution. SECTION 17. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 2896 modifies the original bill as follows: SECTION 1. The substitute redesignates SECTION 1of the original to SECTION 2 of the substitute. SECTION 1 of the substitute amends Subchapter B, Chapter 531, Government Code, by adding Section 531.0218 (Evaluation of Entities Contracting to Operate Medicaid Program), Health and Safety Code, to require the Health and Human Services Commission (commission) to evaluate and report biennially to the legislature and governor regarding the performance and costs of the administrative entities it contracts with to operate the state Medicaid program. SECTION 2. Redesignated from SECTION 1 of the original. SECTION 3. The substitute modifies Section 533.003, Government Code, amended in SECTION 2 of the original, to include organizations that contract with school-based health centers among those organizations which the commission is required to give preference to when awarding contracts to managed care organizations. Additionally, the substitute requires the commission to consider the ability of organizations to process Medicaid claims electronically when making these awards, and makes nonsubstantive changes. The original bill required the commission to give extra consideration to organizations demonstrating provider-friendly policies, such as flexible authorization periods and polices, electronic billing, and electronic payment when awarding contracts. SECTION 4. The substitute modifies the original by adding entirely new text for this section, which amends Section 533.004, Government Code, by amending Subsection (a) and adding Subsection (e), as follows: (a) Requires the commission to contract with any, rather than at least one, managed care organization in a health care service region that meets certain criteria when providing health care services through Medicaid managed care to recipients in that area. Adds to the list of organizations that the commission may contract with, an organization that holds a certificate of authority as a health maintenance organization under Article 20A.05 (Issuance of Certificate of Authority), Insurance Code, and that is certified under Section 5.01(a), Article 4495b, V.T.C.S. (Medical Practice Act) and that is created by the University of Texas Medical Branch at Galveston. Makes conforming changes. (e) Defines "health care service region" or "region" for purposes of a managed care organization described by Subsection (a). SECTION 5. The substitute modifies Section 533.005, Government Code, amended in SECTION 3 of the original, to provide that a contract between a managed care organization and the commission for the provision of health care services must include a requirement that the commission, on the date of a recipient's enrollment in a managed care plan issued by the managed care organization, inform the organization of the recipient's certification, rather than recertification, date. The substitute deletes proposed language in the original bill which provides that a contract between an organization and the commission for the organization to provide health care services to recipients must contain, in addition to other procedures and requirements, a prohibition that the managed care plan not delegate any function or functions to a physician network that includes exclusivity clauses in its contracts with physicians or other providers and a requirement that the organization provide patient education and referral through a 24-hour hotline which adheres to certain procedures. The original also makes conforming changes. SECTION 6. Redesignated from SECTION 4 of the original. The substitute amends Subchapter A, Chapter 533, Government Code, by adding Section 533.0056, in addition to Section 533.0055, as introduced in the original, and making the following changes: Sec. 533.0055. Changes the title of this section from "External Review of Contracts" to "Review of Proposed Contract by Private Entity." (a) Requires the commission to contract with a private entity, rather than an external entity, to review each proposed contract between the commission and managed care organization to provide health care services to recipients in a region under this chapter. The substitute expands and modifies the factors the private entity is required to consider, rather than comment on. (b) The substitute requires the commission to enter into a contract with a private entity to review a proposed contract under Subsection (a) no later than the 180th day before the contract renewal date for the region to which the contract applies. The original requires the commission to enter into the contract with an external entity no later than the 180th day before the reenrollment date for a region and required the external entity to report to the commission no later than 60 days before the enrollment date for a region. (c) The substitute adds this subsection to require a private entity reviewing a proposed contract under subsection (a) to issue a report to the commission stating its findings, including any recommended changes, no later than the 120th day before the contract renewal date for the region to which the contract applies. (d) The substitute authorizes the commission to make necessary changes to a proposed contract based on the findings of a review conducted by a private entity under this section. The substitute adds new Section 533.0056 (Implementation of State-Administered Plan in Region) to prohibit the commission from implementing more than one state-administered managed care plan in a health care service region. SECTION 7. The substitute adds entirely new text or this section to amend Section 533.006(a), Government Code, to include each specialized pediatric laboratory in the region, including those located in children's hospitals, among those entities from which each managed care organization contracting with the commission to provide health care services is required to seek participation in the organization's provider network. SECTION 8. Redesignated from SECTION 5 of the original. The substitute modifies the original by amending Section 533.007(e), Government Code, rather than adding Subsection (g), to include the ability of the managed care organization to process claims electronically among those processes or systems required by a contract that a compliance and readiness review by the commission is required to address. The original added Subsection (g) to this section, to require the commission to evaluate and report on the performance of all managed care plans and other contractors to the state participating in support of the Medicaid managed care program and to hold all plans and any other contractors to the state who participate in support of the program to equal standards of accountability. SECTION 9. Redesignated from SECTION 6 of the original. The substitute modifies Section 533.0075, Government Code, to make conforming changes with respect to expediting the process for determining eligibility and enrolling pregnant women into Medicaid and ensuring them immediate access to prenatal services. The substitute further expands on the services provided to pregnant women and newborns, and requires the commission to implement a process to reduce or eliminate the number of recipients classified as "on hold" with respect to the delivery of services under managed care plans or, in the alternative, to develop a method for continued payment to managed care organizations to avoid interruptions in recipient care. Makes a nonsubstantive change. SECTION 10. The substitute adds this new section to amend Subchapter A, Chapter 533, Government Code, to add Section 533.0076 (Eligibility Determination and Enrollment Pilot Program), Health and Safety Code, which requires the commission to develop and implement a pilot program with respect to determining eligibility for enrolling recipients in managed care programs. SECTION 11. Redesignated from SECTION 7 of the original. The substitute modifies Subchapter A, Chapter 533, Government Code, by changing proposed Sections 533.012-533.016, as follows: Sec. 533.012. The substitute changes the title of the original from "Moratorium on Implementation; Review; Report" to "Moratorium on Implementation of Certain Pilot Programs; Review; Report." The substitute introduces new text with respect to this section, regarding the implementation of specific Medicaid programs (Medicaid behavioral health pilot programs, or Medicaid Star + Plus pilot programs) in a region for which the commission has not received certain bids for health care services or entered into a contract with a managed health care organization to provide health care services for the region. The original prohibited the commission from implementing Medicaid managed care or Medicaid long-term care pilot programs in any additional regions after implementation of Medicaid managed care or Medicaid long-term care pilot programs in currently bid and contracted regions until the commission reviews certain data and submits a report by January 1, 2001 to the governor and the 77th Legislature including certain information and recommendations. Sec. 533.013. The substitute changes the proposed title from "Premium Rate Determination and Comment" to "Premium Payment Rate Determination; Review and Comment." (a) The substitute modifies the original, in requiring the commission, in determining premium rates paid to a managed care organization under a managed care plan, to consider an expanded list of factors with respect to a particular region. (b) The substitute replaces the language of the original to prohibit the commission, in determining premium payment rates paid to a managed care organization licensed under Chapter 20A, V.T.C.S. (Texas Health Maintenance Organization Act), from discounting premium payment rates in an amount that is more than necessary to meet federal budget neutrality requirements for projected fee-for-service costs except under certain conditions. The original requires the Texas Department of Insurance (department) to concurrently review and comment on the premium rates developed by the commission, with special focus on the requirements set forth in Subsection (a). (c) The substitute adds this new subsection to require the premium payment rates paid to a managed care organization licensed under Chapter 20A, V.T.C.S. (Texas Health Maintenance Organization Act), to be established by competitive bidding. Prohibits the rates from exceeding the maximum premium payment rates established by the commission under Subsection (b). Sec. 533.014. The substitute modifies the original by requiring the commission to adopt, rather than develop, rules regarding the sharing of profits earned by a managed care organization through a managed care plan providing health care services under a contract with the commission under this chapter, rather than managed care plans under the Medicaid program. (b) Requires any amount received by the state under this section to be deposited in the general revenue find for specific purposes, rather than requires all profit shared with the state or returned to the state under this section to be deposited into the state's general revenue fund. Sec. 533.015. The substitute changes the title of this proposed section from "Uniform Document Review" to "Coordination of External Oversight and Uniform Document Review." (a) The substitute adds new text to require the commission to coordinate external oversight activities to avoid duplication of managed care plans under Medicaid and disruption of services. (b) The substitute makes conforming changes with respect to the original by conforming the text of the original section (Uniform Document Review) to Legislative Council format. Sec. 533.016. The substitute modifies the original by changing the title of this proposed section from "Coordination of Medicaid Long-Term Care Pilots" to "Coordination of Medicaid Long-Term Care." The substitute requires the commission, if it delegates all or part of its functions, powers, and duties related to long-term care under Section 532.002, Health and Safety Code, or Subchapter B, or Subchapter C, Chapter 532, Government Code, including the operation of pilot projects, to: _designate a single health and human services agency to serve as lead agency to ameliorate the impact of multiple agencies with responsibility for functions related to long-term care; and _ensure that long-term care is administered by each of the appropriate health and human services agencies as efficiently and effectively as if care were being administered by a single state agency. The original bill requires the commission, if it delegates all or part of its functions, powers, and duties under Section 532.002, Subchapter B, or Subchapter C, Government Code, related to long-term care, including but not limited to the operation of pilot projects, to designate a single lead agency to ameliorate the impact of multiple agencies responsible for the functions related to long-term care. It also requires the commission to ensure that long-term care is administered as efficiently and effectively as if it were administered by a single state agency. The substitute deletes SECTION 8 of the original, which repealed Chapter 1153, Section 2.07 (Development of New Provider Contract), Government Code (Acts of the 75th Legislature, Regular Session, 1997). This section states that as soon as possible after the effective date of this section, the commission is required to develop a new provider contract for health care services that contains provisions designed to strengthen the commission's ability to prevent provider fraud under the state Medicaid program. Sets forth the process by which this contract shall be implemented. SECTION 12. The substitute adds this new section, which amends Chapter 533, Government Code, to add Subchapter C (Statewide Advisory Committee), which establishes the Medicaid managed care advisory committee, and sets forth its composition, meeting requirements, and powers and duties. SECTION 13. The substitute adds this new section, which amends Section 2.07(c), Chapter 1153, Acts of the 75th Legislature, Regular Session, 1997, to require the commission to study the feasibility of implementing a program whereby providers may reenroll by electronic means. Sets deadlines for reenrollment and authorizes the commission, by rule, to extend deadlines under certain conditions. SECTION 14. The substitute adds this new section to implement procedures with respect to determining eligibility for and enrollment of certain recipients in Medicaid managed care plans and requires the commission to submit certain reports to certain state entities with respect to these issues. SECTION 15. The substitute adds this new section to require the commission, if it determines that a waiver or other authorization from a federal agency is necessary before implementing any provision of this Act, to request the waiver or authorization and to delay implementing the provision until the waiver or authorization is granted. SECTION 16. The substitute adds this section to provide certain effective dates. SECTION 17. Redesignates the long emergency clause from SECTION 9 of the original and replaces it with the modified long emergency clause.