; and (B) changes with respect to the criteria for such classifications that would promote financial sustainability for rural hospitals and improve access to health care for individuals in rural areas. (4) The projected effects of allowing sole community hospitals (as described in paragraph (1)(D) ) and medicare-dependent, small rural hospitals (as described in paragraph (1)(E) ) to use a cost reporting period beginning during fiscal year 2019 for the purpose of calculating adjusted payments under section 1886(d)(5) of the Social Security Act ( 42 U.S.C. 1395ww(d)(5) ).