42 USC 1395 l note. 

42 USC 1396r–4 note. 

‘‘(B) A rural health clinic described in this subparagraph is a rural health clinic that— 

(b) ADDITIONAL AMOUNT FOR CERTAIN HOSPITALS WITH HIGH DISPROPORTIONATE SHARE.—Effective as if included in the enact- ment of section 203(a) of title II of division CC of Public Law 116–260, subsection (g) of section 1923 of the Social Security Act (42 U.S.C. 1396r–4), as amended by such section, is amended by adding at the end the following: 

(B) by striking subparagraph (B) and inserting the following: 

‘‘(i) as of December 31, 2020, was in a hospital with less than 50 beds and after such date such hospital continues to have less than 50 beds (not taking into account any increase in the number of beds pursuant to a waiver under subsection (b)(1)(A) of section 1135 during the emergency period described in subsection (g)(1)(B) of such section); and 

‘‘(ii)(I) as of December 31, 2020, was enrolled under section 1866(j) (including temporary enrollment during such emergency period for such emergency period); or 

‘‘(II) submitted an application for enrollment under section 1866(j) (or a request for such a temporary enrollment for such emergency period) that was received not later than December 31, 2020.’’. 

(2) EFFECTIVE DATE.—The amendments made by this sub- section shall take effect as if included in the enactment of the Consolidated Appropriations Act, 2021 (Public Law 116– 260). 

‘‘(3) CONTINUED APPLICATION OF GRANDFATHERED TRANSI- TION RULE.—Notwithstanding paragraph (2) of this subsection (as in effect on October 1, 2021), paragraph (2) of this subsection (as in effect on September 30, 2021, and as applied under section 4721(e) of the Balanced Budget Act of 1997, and amended by section 607 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (Public Law 106– 113)) shall apply in determining whether a payment adjustment for a hospital in a State referenced in section 4721(e) of the 

‘‘(aa) the per visit payment amount applicable to such rural health clinic for rural health clinic services furnished in 2020, increased by the percentage increase in the MEI applicable to pri- mary care services furnished as of the first day of 2021; or 

‘‘(bb) the limit described in paragraph (2)(A); and 

‘‘(II) with respect to a rural health clinic that did not have a per visit payment amount established for services furnished in 2020— 

‘‘(aa) the per visit payment amount applicable to such rural health clinic for rural health clinic services furnished in 2021; or 

‘‘(bb) the limit described in paragraph (2)(A); and’’; and 

(ii) in clause (ii)(I), by striking ‘‘under clause (i)(I)’’ and inserting ‘‘under subclause (I) or (II) of clause (i), as applicable,’’; and 

