; subsequent redesignation of community outpatient hospitals as CAHs Section 1820(c)(2) of the Social Security Act ( 42 U.S.C. 1395i–4(c)(2) ) is amended— (1) in subparagraph (B)(i)(I), by inserting , subject to subparagraph (F), before is located ; and (2) by adding at the end the following: (F) Option to waive distance requirement The State may waive the distance requirement described in subparagraph (B)(i)(I) with respect to a facility located in the State that is seeking designation as a critical access hospital under this paragraph if the total number of waivers for such facilities does not exceed the number of facilities that are critical access hospitals without such a waiver. (G) Redesignation of a critical access hospital as a community outpatient hospital A community outpatient hospital may elect to be redesignated as a community outpatient hospital by notifying the Secretary at the same time and in the same manner as notifications under section 1861(iii)(1)(I) if such community outpatient hospital— (i) meets the requirements in paragraphs (1) and (3) of section 1820(e); and (ii) was designated as a critical access hospital under this paragraph on the date that the Secretary first considered such community outpatient hospital to be a community outpatient hospital. . (c) Conforming amendments (1) Reasonable cost for COHs Section 1861(v)(7) of the Social Security Act ( 42 U.S.C. 1395x(v)(7) ) is amended by adding at the end the following: (E) For additional items included in reasonable cost for community outpatient hospitals and for determination of payment amounts for qualified outpatient services, see section 1834(r). . (2) C OH s as covered services Section 1832(a)(2)(H) of the Social Security Act ( 42 U.S.C. 1395k(a)(2)(H) ) is amended by inserting and qualified outpatient services (as defined in section 1861(iii)(2)) before the semicolon. (3) COH payments Section 1833(a) of the Social Security Act ( 42 U.S.C. 1395l(a) ) is amended— (A) in paragraph (8), by striking ; and