; and (II) a description of any challenges, including infrastructure challenges, provider shortages, and financing challenges, for so including such program enhancements and a plan to ameliorate any such challenges. (ii) The plan submitted under clause (i) shall be treated as approved by the Secretary not later than 180 days after the date of submission of the plan unless within such 180-day period the Secretary disapproves such plan and notifies Puerto Rico of such disapproval with the reason for such disapproval. In the case of such a disapproval, the Governor of Puerto Rico shall, within the 90-day period following such notification, submit to the Secretary a Territory Transition Plan that addresses the reason specified in such notification for such disapproval. Such resubmitted plan shall be treated as approved by the Secretary under this clause unless the Secretary notifies Puerto Rico within the 30-day period following such submission of its disapproval with a reason for such disapproval. The Governor of Puerto Rico may develop and submit to the Secretary, in the same manner and subject to the same conditions as apply under clause (i) to the development and submission of the Territory Transition Plan, modifications to the plan and such modifications shall be treated as approved by the Secretary and incorporated into the plan in the same manner and subject to the same conditions that apply under this clause to the approval of the plan. (B) For purposes of this paragraph, the requirements described in this subparagraph, with respect to Puerto Rico, are the following: (i) For 2027, the State plan under title XIX includes at least 2 of the program enhancements described in subparagraph (C). (ii) For 2029, the State plan includes at least 4 of such program enhancements. (iii) For 2031, the State plan includes at least 6 of such program enhancements. (iv) For 2033 and each subsequent year, the State plan includes all of such program enhancements. (C) For purposes of this paragraph, the program enhancements