To amend title XVIII of the Social Security Act to extend until October 1, 1994, the period during which medicare-dependent, small rural hospitals may be paid under alternative reimbursement methodologies for the operating costs of inpatient hospital services under the medicare program.

Amends title XVIII (Medicare) of the Social Security Act to extend special payments under Medicare part A (Hospital Insurance) for the operating costs of inpatient services of Medicare-dependent, small rural hospitals.

Requires the Secretary of Health and Human Services to permit such hospitals which have been reclassified as urban to decline such reclassification.