; and (B) in clause (iv), by striking 2024 and the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024 and inserting 2025 . (2) Permitting hospitals to decline reclassification Section 13501(e)(2) of the Omnibus Budget Reconciliation Act of 1993 ( 42 U.S.C. 1395ww note) is amended by striking 2024, or the portion of fiscal year 2025 beginning on October 1, 2024, and ending on December 31, 2024 and inserting 2025 . 203. Extension of add-on payments for ambulance services (a) In general Section 1834(l) of the Social Security Act ( 42 U.S.C. 1395m(l) ) is amended— (1) in paragraph (12)(A), by striking January 1, 2025 and inserting October 1, 2025 ; and (2) in paragraph (13), by striking January 1, 2025 in each place it appears and inserting October 1, 2025 in each such place. (b) Program instruction authority Notwithstanding any other provision of law, the Secretary of Health and Human Services may implement the provisions of, including amendments made by, this section through program instruction or otherwise. III Offsets 301. Revising phase-in of Medicare clinical laboratory test payment changes (a) Revised phase-In of reductions from private payor rate implementation Section 1834A(b)(3) of the Social Security Act ( 42 U.S.C. 1395m–1(b)(3) ) is amended— (1) in subparagraph (A), by striking 2027 and inserting 2028 ; and (2) in subparagraph (B)— (A) in clause (ii), by striking 2024 and inserting 2025 ; and (B) in clause (iii), by striking 2025 through 2027 and inserting 2026 through 2028 . (b) Revised reporting period for reporting of private sector payment rates for establishment of Medicare payment rates Section 1834A(a)(1)(B) of the Social Security Act ( 42 U.S.C. 1395m–1(a)(1)(B) ) is amended— (1) in clause (i), by striking 2024 and inserting 2025