107 STAT. 576 PUBLIC LAW 103-66—AUG. 10, 1993 42 USC 1395WW note. (1) EXTENSION OF ADDITIONAL PAYMENTS. —Section 1886(d)(5)(G) (42 U.S.C. 1395ww(d)(5)(G)) is amended— (A) in clause (i) in the matter preceding subclause (I), by striking en(Ung on or before March 31, 1993," and all that follows and inserting the following: 'Isefore October 1, 1994, in the case of a subsection (d) hospital which is a medicare-dependent, small rural hospital, payment under paragraph (I)(A) shall be equal to the simi of the amount determined under clause (ii) and the amount determined under paragraph (IXAXiii). "; (B) by redesignating clauses (ii) and (iii) as clauses (iii) and (iv); and (C) by inserting after clause (i) the following new clause: "(ii) The amount determined under this clause is— "(I) for discharges occurring during the first 3 12-month cost reporting periods that begin on or after April 1, 1990, the amount by which the hospital's target amount for the cost reporting period (as defined m subsection (b)(3)(D)) exceeds the amount determined under paragraph (l)(A)(iii); and "(II) for discharges occurring during any subsequent cost reporting period (or portion thereof) and before October 1, 1994, 50 percent of the amount by which the hospital's target amount for the cost reporting period (as defined in subsection (b)(3)(D)) exceeds the amount determined under paragraph (IXAXiii).". (2) PERMITTING HOSPITALS TO DECLINE RECLASSIFICATION.— If any hospital fails to qualify as a medicare-dependent, small rural hospital under section 1886(d)(5)(G)(i) of the Social Security Act as a result of a decision by the Medicare Geographic Classification Review Board under section 1886(d)(10) of such Act to reclassify the hospital as being located in an urban area for fiscal year 1993 or fiscal ye£ur 1994, the Secretary of Health and Human Services shall— (A) notify such hospital of such failure to qualify, (B) provide an opportunity for such hospital to decline such reclassification, and (C) if the hospital declines such reclassification, administer the Social Security Act (other than section 1886(d)(8)(D)) for such fiscal year as if the decision by the Review Board had not occurred. (3) REQUIRING LUMP-SUM RETROACTIVE PAYMENT. — (A) IN GENERAL.—In the case of a hospital treated as a medicare-dependent, small rural hospital under section 1886(d)(5)(G) of the Social Security Act, the Secretary of Health and Human Services shall make a lump-sum pay- ment to the hospital equal to the difference between the aggregate payment made to the hospital under section 1886 of such Act (excluding outlier payments under subsection (d)(5)(A) of such section) during the period of applicability described in subparagraph (B) and the aggregate payment that would have been made to the hospital under such section if, during the period of applicability, section 1886(d)(5)(G) of such Act had been applied as if the amendments made by paragraph (1) had been in effect. (B) PERIOD OF APPLICABILITY. —In subparagraph (A), the "period of applicability" is, with respect to a hospital, the period that begins on the first day of the hospital's
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