(1) RECLASSIFICATIONS
UNDER
SECTION
508 
OF MMA.—Section 508 of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 
(Pub. Law 108–173, 42 U.S.C. 1395ww note) is 
amended— 
(A) in subsection (a)(3), by striking ‘‘3- 
year period beginning with April 1, 2004’’ and 
inserting ‘‘period beginning on April 1, 2004, 
and ending on September 30, 2010’’; 
(B) in subsection (b), by striking ‘‘3-year- 
period’’ and inserting ‘‘period’’; and 
(C) 
in 
subsection 
(e), 
by 
striking 
‘‘$900,000,000’’ 
and 
inserting 
‘‘$1,950,000,000’’. 
(2) SPECIAL EXCEPTION RECLASSIFICATIONS.— 
The Secretary of Health and Human Services shall 
extend for discharges occurring through September 
30, 2010, the special exception reclassification of a 
sole community hospital located in a State with less 
than 10 people per square mile, made under the au-
thority of section 1886(d)(5)(I)(i) of the Social Se-
curity Act (42 U.S.C. 1395ww(d)(5)(I)(i)) and con-
tained in the final rule promulgated by the Secretary 
in the Federal Register on August 11, 2004 (69 
Fed. Reg. 49107). 
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(b) DISREGARDING SECTION 508 HOSPITAL RECLAS-
SIFICATIONS FOR PURPOSES OF GROUP RECLASSIFICA-
TIONS.—Section 508 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Pub. Law 
108–173, 42 U.S.C. 1395ww note) is further amended by 
adding at the end the following new subsection: 
‘‘(g) DISREGARDING HOSPITAL RECLASSIFICATIONS 
FOR PURPOSES
OF GROUP RECLASSIFICATIONS.—For 
purposes of the reclassification of a group of hospitals in 
a geographic area under section 1886(d), a hospital reclas-
sified under this section shall not be taken into account 
and shall not prevent the other hospitals in such area from 
establishing such a group for such purpose.’’. 
SEC. 103. CRITICAL ACCESS HOSPITAL IMPROVEMENTS. 
(a) CLARIFICATION
OF PAYMENT
FOR CLINICAL 
LABORATORY TESTS FURNISHED BY CRITICAL ACCESS 
HOSPITALS.— 
(1) IN GENERAL.—Section 1834(g)(4) of the 
Social Security Act (42 U.S.C. 1395m(g)(4)) is 
amended— 
(A) in the heading, by striking ‘‘NO BENE-
FICIARY COST-SHARING’’ and inserting ‘‘TREAT-
MENT OF’’; and 
(B) by adding at the end the following new 
sentence: ‘‘For purposes of the preceding sen-
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tence and section 1861(mm)(3), clinical diag-
nostic laboratory services furnished by a critical 
access hospital shall be treated as being fur-
nished as part of outpatient critical access serv-
ices without regard to whether— 
‘‘(A) the individual with respect to whom 
such services are furnished is physically present 
in the critical access hospital at the time the 
specimen is collected; 
‘‘(B) such individual is registered as an 
outpatient on the records of, and receives such 
services directly from, the critical access hos-
pital; or 
‘‘(C) payment is (or, but for this sub-
section, would be) available for such services 
under the fee schedule established under section 
1833(h).’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to cost reporting peri-
ods beginning on or after October 1, 2003. 
(b) ELIMINATION OF ISOLATION TEST FOR COST- 
BASED AMBULANCE REIMBURSEMENT.— 
(1) IN
GENERAL.—Section 1834(l)(8) of the 
Social Security Act (42 U.S.C. 1395m(l)(8)) is 
amended— 
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