By: Nelson, et al. S.B. No. 8
A BILL TO BE ENTITLED
AN ACT
relating to the provision and delivery of certain health and human
services in this state, including the provision of those services
through the Medicaid program and the prevention of fraud, waste,
and abuse in that program and other programs.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter A, Chapter 531, Government Code, is
amended by adding Section 531.0082 to read as follows:
Sec. 531.0082. DATA ANALYSIS UNIT. (a) The executive
commissioner shall establish a data analysis unit within the
commission to establish, employ, and oversee data analysis
processes designed to:
(1) improve contract management;
(2) detect data trends; and
(3) identify anomalies relating to service
utilization, providers, payment methodologies, and compliance with
requirements in Medicaid and child health plan program managed care
and fee-for-service contracts.
(b) The commission shall assign staff to the data analysis
unit who perform duties only in relation to the unit.
(c) The data analysis unit shall use all available data and
tools for data analysis when establishing, employing, and
overseeing data analysis processes under this section.
(d) Not later than the 30th day following the end of each
calendar quarter, the data analysis unit shall provide an update on
the unit's activities and findings to the governor, the lieutenant
governor, the speaker of the house of representatives, the chair of
the Senate Finance Committee, the chair of the House Appropriations
Committee, and the chairs of the standing committees of the senate
and house of representatives having jurisdiction over the Medicaid
program.
SECTION 2. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.02115 to read as follows:
Sec. 531.02115. MARKETING ACTIVITIES BY PROVIDERS
PARTICIPATING IN MEDICAID OR CHILD HEALTH PLAN PROGRAM. (a) A
provider participating in the Medicaid or child health plan
program, including a provider participating in the network of a
managed care organization that contracts with the commission to
provide services under the Medicaid or child health plan program,
may not engage in any marketing activity, including any
dissemination of material or other attempt to communicate, that:
(1) involves unsolicited personal contact, including
by door-to-door solicitation, solicitation at a child-care
facility or other type of facility, direct mail, or telephone, with
a Medicaid client or a parent whose child is enrolled in the
Medicaid or child health plan program;
(2) is directed at the client or parent solely because
the client or the parent's child is receiving benefits under the
Medicaid or child health plan program; and
(3) is intended to influence the client's or parent's
choice of provider.
(b) In addition to the requirements of Subsection (a), a
provider participating in the network of a managed care
organization described by that subsection must comply with the
marketing guidelines established by the commission under Section
533.008.
(c) Nothing in this section prohibits:
(1) a provider participating in the Medicaid or child
health plan program from:
(A) engaging in a marketing activity, including
any dissemination of material or other attempt to communicate, that
is intended to influence the choice of provider by a Medicaid client
or a parent whose child is enrolled in the Medicaid or child health
plan program, if the marketing activity involves only the general
dissemination of information, including by television, radio,
newspaper, or billboard advertisement, and does not involve
unsolicited personal contact;
(B) as permitted under the provider's contract,
engaging in the dissemination of material or another attempt to
communicate with a Medicaid client or a parent whose child is
enrolled in the Medicaid or child health plan program, including
communication in person or by direct mail or telephone, for the
purpose of:
(i) providing an appointment reminder;
(ii) distributing promotional health
materials;
(iii) providing information about the types
of services offered by the provider; or
(iv) coordinating patient care; or
(C) engaging in a marketing activity that has
been submitted for review and obtained a notice of prior
authorization from the commission under Subsection (d); or
(2) a provider participating in the Medicaid STAR +
PLUS program from, as permitted under the provider's contract,
engaging in a marketing activity, including any dissemination of
material or other attempt to communicate, that is intended to
educate a Medicaid client about available long-term care services
and supports.
(d) The commission shall establish a process by which
providers may submit proposed marketing activities for review and
prior authorization to ensure that providers are in compliance with
the requirements of this section and, if applicable, Section
533.008, or to determine whether the providers are exempt from a
requirement of this section and, if applicable, Section 533.008.
The commission may grant or deny a provider's request for
authorization to engage in a proposed marketing activity.
(e) The executive commissioner shall adopt rules as
necessary to implement this section, including rules relating to
provider marketing activities that are exempt from the requirements
of this section and, if applicable, Section 533.008.
SECTION 3. Section 531.02414, Government Code, is amended
by amending Subsection (d) and adding Subsections (g) and (h) to
read as follows:
(d) Subject to Section 533.00254, the [The] commission may
contract with a public transportation provider, as defined by
Section 461.002, Transportation Code, a private transportation
provider, or a regional transportation broker for the provision of
public transportation services, as defined by Section 461.002,
Transportation Code, under the medical transportation program.
(g) The commission shall enter into a memorandum of
understanding with the Texas Department of Motor Vehicles and the
Department of Public Safety for purposes of obtaining the motor
vehicle registration and driver's license information of a provider
of medical transportation services, including a regional
contracted broker and a subcontractor of the broker, to confirm
that the provider complies with applicable requirements adopted
under Subsection (e).
(h) The commission shall establish a process by which
providers of medical transportation services, including providers
under a managed transportation delivery model, that contract with
the commission may request and obtain the information described
under Subsection (g) for purposes of ensuring that subcontractors
providing medical transportation services meet applicable
requirements adopted under Subsection (e).
SECTION 4. Subchapter B, Chapter 531, Government Code, is
amended by adding Section 531.076 to read as follows:
Sec. 531.076. REVIEW OF PRIOR AUTHORIZATION AND UTILIZATION
REVIEW PROCESSES. (a) The commission shall periodically review in
accordance with an established schedule the prior authorization and
utilization review processes within the Medicaid fee-for-service
delivery model to determine if those processes need modification to
reduce authorizations of unnecessary services and inappropriate
use of services. The commission shall also monitor the processes
described in this subsection for anomalies and, on identification
of an anomaly in a process, shall review the process for
modification earlier than scheduled.
(b) The commission shall monitor Medicaid managed care
organizations to ensure that the organizations are using prior
authorization and utilization review processes to reduce
authorizations of unnecessary services and inappropriate use of
services.
SECTION 5. Section 531.102, Government Code, is amended by
amending Subsection (a) and adding Subsection (l) to read as
follows:
(a) The [commission, through the] commission's office of
inspector general[,] is responsible for the prevention, detection,
audit, inspection, review, and investigation of fraud, waste, and
abuse in the provision and delivery of all health and human services
in the state, including services through any state-administered
health or human services program that is wholly or partly federally
funded, and the enforcement of state law relating to the provision
of those services. The commission may obtain any information or
technology necessary to enable the office to meet its
responsibilities under this subchapter or other law.
(l) Nothing in this section limits the authority of any
other state agency or governmental entity.
SECTION 6. (a) Subchapter A, Chapter 533, Government Code,
is amended by adding Section 533.00254 to read as follows:
Sec. 533.00254. DELIVERY OF MEDICAL TRANSPORTATION PROGRAM
SERVICES. (a) In this section:
(1) "Managed transportation organization" means:
(A) a rural or urban transit district created
under Chapter 458, Transportation Code;
(B) a public transportation provider defined by
Section 461.002, Transportation Code;
(C) a regional contracted broker defined by
Section 531.02414;
(D) a local private transportation provider
approved by the commission to provide Medicaid nonemergency medical
transportation services; or
(E) any other entity the commission determines
meets the requirements of this section.
(2) "Medical transportation program" has the meaning
assigned by Section 531.02414.
(3) "Transportation service area provider" means a
for-profit or nonprofit entity that provides demand response,
curb-to-curb, nonemergency transportation under the medical
transportation program.
(b) Subject to Subsection (h), the commission shall provide
medical transportation program services on a regional basis through
a managed transportation delivery model using managed
transportation organizations and providers, as appropriate, that:
(1) operate under a capitated rate system;
(2) assume financial responsibility under a full-risk
model;
(3) operate a call center;
(4) use fixed routes when available and appropriate;
and
(5) agree to provide data to the commission if the
commission determines that the data is required to receive federal
matching funds.
(c) The commission shall procure managed transportation
organizations under the medical transportation program through a
competitive bidding process.
(d) A managed transportation organization that participates
in the medical transportation program must attempt to contract with
medical transportation providers that:
(1) are considered significant traditional providers,
as defined by rule by the executive commissioner;
(2) meet the minimum quality and efficiency measures
required under Subsection (g) and other requirements that may be
imposed by the managed transportation organization; and
(3) agree to accept the prevailing contract rate of
the managed transportation organization.
(e) To the extent allowed under federal law, a managed
transportation organization may own, operate, and maintain a fleet
of vehicles or contract with an entity that owns, operates, and
maintains a fleet of vehicles.
(f) The commission shall consider the ownership, operation,
and maintenance of a fleet of vehicles by a managed transportation
organization to be a related-party transaction for purposes of
applying experience rebates, administrative costs, and other
administrative controls determined by the commission.
(g) The commission shall require that managed
transportation providers participating in the medical
transportation program meet minimum quality and efficiency
measures as determined by the commission.
(h) The commission may delay providing medical
transportation program services through a managed transportation
delivery model in areas of this state in which the commission on
September 1, 2013, is operating a full-risk transportation broker
model.
(b) The Health and Human Services Commission shall begin
providing medical transportation program services through the
delivery model required by Section 533.00254, Government Code, as
added by this section, not later than September 1, 2014, subject to
Subsection (h), Section 533.00254, Government Code, as added by
this section.
SECTION 7. Section 773.0571, Health and Safety Code, is
amended to read as follows:
Sec. 773.0571. REQUIREMENTS FOR PROVIDER LICENSE. The
department shall issue to an emergency medical services provider a
license that is valid for two years if the department is satisfied
that:
(1) the emergency medical services provider has
adequate staff to meet the staffing standards prescribed by this
chapter and the rules adopted under this chapter;
(2) each emergency medical services vehicle is
adequately constructed, equipped, maintained, and operated to
render basic or advanced life support services safely and
efficiently;
(3) the emergency medical services provider offers
safe and efficient services for emergency prehospital care and
transportation of patients; [and]
(4) the emergency medical services provider has a
letter of credit evidencing that the provider has sufficient
financial resources;
(5) the emergency medical services provider employs a
medical director; and
(6) the emergency medical services provider complies
with the rules adopted by the board under this chapter.
SECTION 8. Section 32.0322, Human Resources Code, is
amended by amending Subsection (b) and adding Subsections (b-1),
(e), and (f) to read as follows:
(b) Subject to Subsections (b-1) and (e), the [The]
executive commissioner of the Health and Human Services Commission
by rule shall establish criteria for the department or the
commission's office of inspector general to suspend a provider's
billing privileges under the medical assistance program, revoke a
provider's enrollment under the program, or deny a person's
application to enroll as a provider under the program based on:
(1) the results of a criminal history check;
(2) any exclusion or debarment of the provider from
participation in a state or federally funded health care program;
(3) the provider's failure to bill for medical
assistance or refer clients for medical assistance within a
12-month period; or
(4) any of the provider screening or enrollment
provisions contained in 42 C.F.R. Part 455, Subpart E.
(b-1) In adopting rules under this section, the executive
commissioner of the Health and Human Services Commission shall
require revocation of a provider's enrollment or denial of a
person's application for enrollment as a provider under the medical
assistance program if the person has been excluded or debarred from
participation in a state or federally funded health care program as
a result of:
(1) a criminal conviction or finding of civil or
administrative liability for committing a fraudulent act, theft,
embezzlement, or other financial misconduct under a state or
federally funded health care program; or
(2) a criminal conviction for committing an act under
a state or federally funded health care program that caused bodily
injury to:
(A) a person who is 65 years of age or older;
(B) a person with a disability; or
(C) a person under 18 years of age.
(e) The department may reinstate a provider's enrollment
under the medical assistance program or grant a person's previously
denied application to enroll as a provider, including a person
described by Subsection (b-1), if the department finds:
(1) good cause to determine that it is in the best
interest of the medical assistance program; and
(2) the person has not committed an act that would
require revocation of a provider's enrollment or denial of a
person's application to enroll since the person's enrollment was
revoked or application was denied, as appropriate.
(f) The department must support a determination made under
Subsection (e) with written findings of good cause for the
determination.
SECTION 9. Section 36.005, Human Resources Code, is amended
to read as follows:
Sec. 36.005. SUSPENSION OR REVOCATION OF AGREEMENT;
PROFESSIONAL DISCIPLINE. (a) A health and human services agency,
as defined by Section 531.001, Government Code:
(1) shall suspend or revoke:
(A) a provider agreement between the agency and a
person, other than a person who operates a nursing facility or an
ICF-MR facility, found liable under Section 36.052; and
(B) a permit, license, or certification granted
by the agency to a person, other than a person who operates a
nursing facility or an ICF-MR facility, found liable under Section
36.052; and
(2) may suspend or revoke:
(A) a provider agreement between the agency and a
person who operates a nursing facility or an ICF-MR facility and who
is found liable under Section 36.052; or
(B) a permit, license, or certification granted
by the agency to a person who operates a nursing facility or an
ICF-MR facility and who is found liable under Section 36.052.
(b) A provider found liable under Section 36.052 for an
unlawful act may not, for a period of 10 years, provide or arrange
to provide health care services under the Medicaid program or
supply or sell, directly or indirectly, a product to or under the
Medicaid program. The executive commissioner of the Health and
Human Services Commission may by rule:
(1) provide for a period of ineligibility longer than
10 years; or
(2) grant a provider a full or partial exemption from
the period of ineligibility required by this subsection if the
executive commissioner finds that enforcement of the full period of
ineligibility is harmful to the Medicaid program or a beneficiary
of the program.
(b-1) The period of ineligibility begins on the date on
which the judgment finding the provider liable under Section 36.052
is entered by the trial court [determination that the provider is
liable becomes final].
(b-2) Subsections (b) and (b-1) do not apply to a provider
who operates a nursing facility or an ICF-MR facility.
(c) A person licensed by a state regulatory agency who
commits an unlawful act is subject to professional discipline under
the applicable licensing law or rules adopted under that law.
(d) For purposes of this section, a person is considered to
have been found liable under Section 36.052 if the person is found
liable in an action brought under Subchapter C.
(e) Notwithstanding Subsection (b-1), the period of
ineligibility for an individual licensed by a health care
regulatory agency or a physician begins on the date on which the
determination that the individual or physician is liable becomes
final.
(f) For purposes of Subsection (e), a "physician" includes a
physician, a professional association composed solely of
physicians, a single legal entity authorized to practice medicine
owned by two or more physicians, a nonprofit health corporation
certified by the Texas Medical Board under Chapter 162, Occupations
Code, or a partnership composed solely of physicians.
(g) For purposes of Subsection (e), "health care regulatory
agency" has the meaning assigned by Section 774.001, Government
Code.
SECTION 10. Subchapter C, Chapter 36, Human Resources Code,
is amended by adding Section 36.1041 to read as follows:
Sec. 36.1041. NOTIFICATION OF SETTLEMENT. (a) Not later
than the 10th day after the date a person described by Section
36.104(b) reaches a proposed settlement agreement with a defendant,
the person must notify the attorney general. If the person fails to
notify the attorney general as required by this section, the
proposed settlement is void.
(b) Not later than the 30th day after the date the attorney
general receives notice under Subsection (a), the attorney general
shall file any objections to the terms of the proposed settlement
agreement with the court.
(c) On filing of objections under Subsection (b), the court
shall conduct a hearing. On a showing of good cause, the hearing
may be held in camera. If, after the hearing, the court determines
that the proposed settlement is fair, adequate, and reasonable
under all the circumstances, the court may allow the parties to
settle notwithstanding the attorney general's objection.
(d) If, after the hearing, the court determines that the
attorney general's objection is well founded, the settlement shall
not be approved by the court. The court may order the parties to
renegotiate the settlement to address the attorney general's
objection.
SECTION 11. (a) The Health and Human Services Commission,
in cooperation with the Department of State Health Services and the
Texas Medical Board, shall:
(1) as soon as practicable after the effective date of
this Act, conduct a thorough review of and solicit stakeholder
input regarding the laws and policies related to the use of
non-emergent services provided by ambulance providers under the
medical assistance program established under Chapter 32, Human
Resources Code;
(2) not later that January 1, 2014, make
recommendations to the legislature regarding suggested changes to
the law that would reduce the incidence of and opportunities for
fraud, waste, and abuse with respect to the activities described by
Subdivision (1) of this subsection; and
(3) amend the policies described by Subdivision (1) of
this subsection as necessary to assist in accomplishing the goals
described by Subdivision (2) of this subsection.
(b) This section expires September 1, 2015.
SECTION 12. (a) The Department of State Health Services,
in cooperation with the Health and Human Services Commission and
the Texas Medical Board, shall:
(1) as soon as practicable after the effective date of
this Act, conduct a thorough review of and solicit stakeholder
input regarding the laws and policies related to the licensure of
nonemergency transportation providers;
(2) not later than January 1, 2014, make
recommendations to the legislature regarding suggested changes to
the law that would reduce the incidence of and opportunities for
fraud, waste, and abuse with respect to the activities described by
Subdivision (1) of this subsection; and
(3) amend the policies described by Subdivision (1) of
this subsection as necessary to assist in accomplishing the goals
described by Subdivision (2) of this subsection.
(b) This section expires September 1, 2015.
SECTION 13. (a) The Texas Medical Board, in cooperation
with the Department of State Health Services and the Health and
Human Services Commission, shall:
(1) as soon as practicable after the effective date of
this Act, conduct a thorough review of and solicit stakeholder
input regarding the laws and policies related to:
(A) the delegation of health care services by
physicians or medical directors to qualified emergency medical
services personnel; and
(B) physicians' assessment of patients' needs for
purposes of ambulatory transfer or transport or other purposes;
(2) not later than January 1, 2014, make
recommendations to the legislature regarding suggested changes to
the law that would reduce the incidence of and opportunities for
fraud, waste, and abuse with respect to the activities described by
Subdivision (1) of this subsection; and
(3) amend the policies described by Subdivision (1) of
this subsection as necessary to assist in accomplishing the goals
described by Subdivision (2) of this subsection.
(b) This section expires September 1, 2015.
SECTION 14. (a) This section is a clarification of
legislative intent regarding Subsection (s), Section 32.024, Human
Resources Code, and a validation of certain Health and Human
Services Commission acts and decisions.
(b) In 1999, the legislature became aware that certain
children enrolled in the Medicaid program were receiving treatment
under the program outside the presence of a parent or another
responsible adult. The treatment of unaccompanied children under
the Medicaid program resulted in the provision of unnecessary
services to those children, the exposure of those children to
unnecessary health and safety risks, and the submission of
fraudulent claims by Medicaid providers.
(c) In addition, in 1999, the legislature became aware of
allegations that certain Medicaid providers were offering money and
other gifts in exchange for a parent's or child's consent to receive
unnecessary services under the Medicaid program. In some cases, a
child was offered money or gifts in exchange for the parent's or
child's consent to have the child transported to a different
location to receive unnecessary services. In some of those cases,
once transported, the child received no treatment and was left
unsupervised for hours before being transported home. The
provision of money and other gifts by Medicaid providers in
exchange for parents' or children's consent to services deprived
those parents and children of the right to choose a Medicaid
provider without improper inducement.
(d) In response, in 1999, the legislature enacted Chapter
766 (H.B. 1285), Acts of the 76th Legislature, Regular Session,
1999, which amended Section 32.024, Human Resources Code, by
amending Subsection (s) and adding Subsection (s-1). As amended,
Subsection (s), Section 32.024, Human Resources Code, requires that
a child's parent or guardian or another adult authorized by the
child's parent or guardian accompany the child at a visit or
screening under the early and periodic screening, diagnosis, and
treatment program in order for a Medicaid provider to be reimbursed
for services provided at the visit or screening. As filed, the bill
required a child's parent or guardian to accompany the child. The
house committee report added the language allowing an adult
authorized by the child's parent or guardian to accompany the child
in order to accommodate a parent or guardian for whom accompanying
the parent's or guardian's child to each visit or screening would be
a hardship.
(e) The principal purposes of Chapter 766 (H.B. 1285), Acts
of the 76th Legislature, Regular Session, 1999, were to prevent
Medicaid providers from committing fraud, encourage parental
involvement in and management of health care of children enrolled
in the early and periodic screening, diagnosis, and treatment
program, and ensure the safety of children receiving services under
the Medicaid program. The addition of the language allowing an
adult authorized by a child's parent or guardian to accompany the
child furthered each of those purposes.
(f) The legislature, in amending Subsection (s), Section
32.024, Human Resources Code, understood that:
(1) the effectiveness of medical, dental, and therapy
services provided to a child improves when the child's parent or
guardian actively participates in the delivery of those services;
(2) a parent is responsible for the safety and
well-being of the parent's child, and that a parent cannot casually
delegate this responsibility to a stranger;
(3) a parent may not always be available to accompany
the parent's child at a visit to the child's doctor, dentist, or
therapist; and
(4) Medicaid providers and their employees and
associates have a financial interest in the delivery of services
under the Medicaid program and, accordingly, cannot fulfill the
responsibilities of a parent or guardian when providing services to
a child.
(g)(1) On March 15, 2012, the Health and Human Services
Commission notified certain Medicaid providers that state law and
commission policy require a child's parent or guardian or another
properly authorized adult to accompany a child receiving services
under the Medicaid program. This notice followed the commission's
discovery that some providers were transporting children from
schools to therapy clinics and other locations to receive therapy
services. Although the children were not accompanied by a parent or
guardian during these trips, the providers were obtaining
reimbursement for the trips under the Medicaid medical
transportation program. The commission clarified in the notice
that, in order for a provider to be reimbursed for transportation
services provided to a child under the Medicaid medical
transportation program, the child must be accompanied by the
child's parent or guardian or another adult who is not the provider
and whom the child's parent or guardian has authorized to accompany
the child by submitting signed, written consent to the provider.
(2) In May 2012, a lawsuit was filed to enjoin the Health and
Human Services Commission from enforcing Subsection (s), Section
32.024, Human Resources Code, and 1 T.A.C. Section 380.207, as
interpreted in certain notices issued by the commission. A state
district court enjoined the commission from denying eligibility to
a child for transportation services under the Medicaid medical
transportation program if the child's parent or guardian does not
accompany the child, provided that the child's parent or guardian
authorizes any other adult to accompany the child. The court also
enjoined the commission from requiring as a condition for a
provider to be reimbursed for services provided to a child during a
visit or screening under the early and periodic screening,
diagnosis, and treatment program that the child be accompanied by
the child's parent or guardian, provided that the child's parent or
guardian authorizes another adult to accompany the child. The
state has filed a notice of appeal of the court's order.
(3) The legislature declares that a rule or policy
adopted by the Health and Human Services Commission before the
effective date of this Act to require that, in order for a Medicaid
provider to be reimbursed for services provided to a child under the
early and periodic screening, diagnosis, and treatment program or
the medical transportation program, the child must be accompanied
by the child's parent or guardian or another adult whom the child's
parent or guardian has authorized to accompany the child is
conclusively presumed, as of the date the rule or policy was
adopted, to be a valid exercise of the commission's authority and
consistent with the intent of the legislature, provided that the
rule or policy:
(A) was adopted pursuant to Subsection (s),
Section 32.024, Human Resources Code; and
(B) prohibits the child's parent or guardian from
authorizing the provider or the provider's employee or associate as
an adult who may accompany the child.
(4) Subdivision (3) of this subsection does not apply
to:
(A) an action or decision that was void at the
time the action was taken or the decision was made;
(B) an action or decision that violates federal
law or the terms of a federal waiver; or
(C) an action or decision that, under a statute
of this state or the United States, was a misdemeanor or felony at
the time the action was taken or the decision was made.
(5) This section does not apply to:
(A) an action or decision that was void at the
time the action was taken or the decision was made;
(B) an action or decision that violates federal
law or the terms of a federal waiver; or
(C) an action or decision that, under a statute
of this state or the United States, was a misdemeanor or felony at
the time the action was taken or the decision was made.
SECTION 15. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall establish the data analysis unit required
under Section 531.0082, Government Code, as added by this Act. The
data analysis unit shall provide the initial update required under
Subsection (d), Section 531.0082, Government Code, as added by this
Act, not later than the 30th day after the last day of the first
complete calendar quarter occurring after the date the unit is
established.
SECTION 16. Section 773.0571, Health and Safety Code, as
amended by this Act, applies only to an application for an original
emergency medical services provider license submitted to the
Department of State Health Services on or after the effective date
of this Act. An application submitted before the effective date of
this Act, or the renewal of a license issued before that date, is
governed by the law in effect immediately before the effective date
of this Act, and that law is continued in effect for that purpose.
SECTION 17. If before implementing any provision of this
Act a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 18. This Act takes effect September 1, 2013.