; and (2) by adding at the end the following new subparagraph: (D) National testing of model for global payments to hospitals in rural areas In the case where the Secretary selects the model described in clause (ii) of this subparagraph for testing pursuant to clause (xxviii) of subparagraph (B), the following shall apply: (i) National testing (I) In general Subject to subclause (II), the Secretary shall allow each State to develop and submit to the Secretary an application to begin testing such model in accordance with this clause within 1 year of the date on which the model is selected for such testing. (II) State designation of entities A State may designate an entity or organization for purposes of developing and submitting an application under subclause (I) with respect to the State, which may include the implementation of such model in the State. In the case where a State makes such a designation, with respect to any activities covered by the designation, the entity or organization so designated shall be subject to any requirements applicable to the implementing State under this subparagraph in the same manner as such requirements are applicable to the implementing State. (III) No effect on ongoing models or demonstration projects Nothing in this subparagraph shall effect the testing of any model under this subsection or any demonstration project under this Act that is implemented prior to the date of the enactment of this subparagraph. (ii) Model described The model described in this clause seeks to increase rural Americans’ access to quality care in order to improve health, while also reducing the growth of hospital expenditures across payers, including Medicare, and increasing the financial viability of rural hospitals to ensure continued access to care. Under this model, participating rural hospitals would— (I) be paid based on all-payer global budget, a fixed amount that is set in advance for inpatient and outpatient hospital-based services and paid monthly by Medicare fee-for-service, State Medicaid