; or (ii) is for a waiver that is the same or substantially similar to a waiver that the Secretary already has approved for another State. (B) Approval limitations for urgent situations (i) Provisional approval A waiver approved under the expedited determination process under subparagraph (A)(i) may extend over a period of not longer than 3 years. (ii) Full approval Subject to the requirements for approval otherwise applicable under this section, not later than 1 year before the expiration of a provisional waiver period described in clause (i) with respect to an application described in subparagraph (A)(i), the Secretary shall make a determination on whether to extend the term of such waiver for longer than the period described in clause (i), for a total waiver term not to exceed 6 years. The Secretary may request additional information as the Secretary determines appropriate to make such determination. (C) GAO study Not later than 5 years after the date of enactment of the State Flexibility and Patient Choice Act of 2019, the Comptroller General of the United States shall conduct a review of all waivers approved pursuant to an application under subparagraph (A)(ii) to evaluate whether such waivers met the requirements of subsection (b)(1) and whether the applications should have qualified for such an expedited determination. ; (4) in subsection (e), by inserting (or, in the case of an application under subsection (a)(1) submitted on or after the date of the enactment of the State Flexibility and Patient Choice Act of 2019, 6 years) after 5 years ; and (5) by adding at the end the following new subsection: (f) Additional provisions In carrying out this section, the Secretary shall— (1) issue guidance, not later than 30 days after the date of the enactment of this subsection, that includes initial examples of model State plans that may meet the requirements for approval under this section