PUBLIC LAW 101-508—NOV. 5, 1990 104 STAT. 1388-45 as rural primary care hospitals under this subparagraph, the Secretary shall give preference to facilities not meeting the requirements of clause (i) of subparagraph (A) that have entered into an agreement described in subsection (g)(2) with a rural health network located in a State receiving a grant under subsection (a)(1).". (2) ELIGIBILITY OF CERTAIN CLOSED HOSPITALS. —Section 1820(f)(1)(B) (42 U.S.C. 1395i-4(f)(l)(B)) is amended by striking "is a hospital," and inserting the following: "is a hospital (or, in the case of a facility that closed during the 12-month period that ends on the date the facility applies for such designation, at the time the facility closed),". (3) ELIGIBILITY OF URBAN HOSPITALS.— Section 1820(f)(1)(A) (42 U.S.C. 1395i-4(f)(l)(A)) is amended by striking the semicolon and inserting the following: ", or is located in a county whose geographic area is substantially larger than the average geographic area for urban counties in the United States and whose hospital service area is characteristic of service areas of hospitals located in rural areas;". (4) EFFECTIVE DATE. —The amendments made by paragraphs (1), (2), and (3) shall take effect on the date of the enactment of this Act. (e) SKILLED NURSING FACILITY ROUTINE COST LIMITS. — (1) IN GENERAL.— Section 6024 of the Omnibus Budget Reconciliation Act of 1989 is amended by adding at the end the following new sentence: "The Secretary shall update such costs under such section for cost reporting periods beginning on or after October 1, 1989, by using cost reports submitted by skilled nursing facilities for cost reporting periods ending not earlier than January 31, 1988, and not later than December 31, 1988.". (2) 2-YEAR UPDATES REQUIRED.—Section 1888(a) (42 U.S.C. 13953ry(a)) is amended in the matter following paragraph (4) by striking the period and inserting the following: ", and shall, for cost reporting periods beginning on or after October 1, 1992 and every 2 years thereafter, provide for an update to the per diem cost limits described in this subsection". (3) EFFECTIVE DATE. — The amendments made by paragraphs (1) and (2) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. (f) CLARIFICATION OF EXTENSION OF WAIVER FOR FINGER LAKES AREA HOSPITAL CORPORATION. — (1) IN GENERAL.—The second sentence of section 1886(c)(4) (42 U.S.C. 1395ww(c)(4)) is amended by striking "rate of increase from" and inserting "payments under the State system as compared to aggregate payments which would have been made under the national system since". (2) EFFECTIVE DATE. —The amendment made by paragraph (1) shall take effect as if included in the enactment of the Omnibus Budget Reconciliation Act of 1989. (g) ENROLLMENT IN PART A FOR HMO MEMBERS. — (1) IN GENERAL.—Section 1818(c) (42 U.S.C. 1395i-2(c)) is amended— (A) by striking "and" at the end of paragraph (5), (B) by striking the period at the end of paragraph (6) and inserting a semicolon, and (C) by adding at the end the following new paragraphs: 42 USC 1395i-4 note. 42 USC 1395yy note. 42 USC 1395yy note. 42 USC 1395WW note.