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HR 9468

STAR Act

119th Congress Introduced by Mike Carey and 4 co-sponsors

Extends site-neutral LTCH payments to 2032 and adds a high-acuity criterion, linking certain higher-severity LTCH discharges to reduced reimbursements.

Committee Consideration and Mark-up Session Held
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Bill Summary · HR 9468

Summary of HR 9468 (116th? actually 119th Congress, STAR Act)

Note: This summary reflects the bill text as introduced in the 119th Congress and its stated provisions.

Purpose and intent

  • The bill is titled the Saving Today's Acute-Care Resources Act (STAR Act).
  • Its primary purpose is to adjust Medicare long-term care hospital (LTCH) payment rates under Title XVIII of the Social Security Act (Medicare).

Key provisions and changes

  1. Extension of site-neutral payment reductions for LTCHs

    • Repeal/extend the current phase-in of site-neutral payments. Specifically, the act amends Section 1886(m)(6)(B)(iv) to extend the deadline for site-neutral payment reductions from 2026 to 2032.
    • Implication: LTCH payments would continue to be subject to site-neutral reductions at least through fiscal years up to 2032, delaying further reductions beyond 2026.

  2. Addition of a new high-acuity criterion for site-neutral calculations

    • Adds a new eligibility criterion for determining site-neutral LTCH payments, described as the “high acuity criterion.”
    • The high acuity criterion applies to LTCH discharges in a fiscal year and has several subconditions:
      • The LTCH discharge must have ended a prior stay in a subsection (d) hospital or in a critical access hospital.
      • The patient must be assigned to an MS-LTC-DRG (Medicare-Severity Long-Term-Care-DRG) that is a “specified MS-LTC-DRG.”
      • The LTCH must have certain eligibility characteristics:
      • The LTCH enrolled as such before the date of enactment.
      • The LTCH had a qualifying period beginning before enactment (as defined by applicable CFR provisions).
      • The LTCH met “mid-build” requirements (detailed below) or had an approved state Certificate of Need (CON) or similar authorization before enactment, if required by state law.
      • The discharge occurred on or after October 1, 2026.
    • Specified MS-LTC-DRG criteria:
      • The DRG must have a relative weight of at least 0.8.
      • It must not be based on ventillator (ventilator) services of at least 96 hours.
    • Mid-build requirements, as defined for this criterion:
      • The LTCH must have a binding written agreement with an unrelated outside party for construction/renovation/lease/demolition and have at least 10 percent of the estimated cost expended (or at least $2.5 million if lower) prior to enactment.
      • The LTCH must submit a written certification from the hospital’s CEO/COO within 60 days after enactment confirming the mid-build requirement was met.

  3. Expansion of ICU and ventilator criteria for site-neutral payments

    • The bill broadens the criteria used to determine site-neutral payments by:
      • Allowing discharges that occur on or after October 1, 2026 from LTCHs to include discharges from stays in LTCHs or critical access hospitals (CAHs) within the ICU/ventilator-related criteria.
      • Updating both clause (iii)(I) and clause (iv)(I) of the relevant statute to reflect this broader scope.

Who is affected

  • Long-term care hospitals (LTCHs) participating in Medicare, including those with:
    • Existing site-neutral payment arrangements or those seeking to qualify under the new high-acuity criterion.
    • LTCHs that previously relied on certain MS-LTC-DRGs or ventilator-based criteria.
  • Critical Access Hospitals and subsection (d) hospitals, insofar as their discharges may be counted toward LTCH site-neutral criteria after October 1, 2026.
  • Medicare beneficiaries treated in LTCHs, insofar as payment methodologies and DRG assignments influence reimbursements and potentially access to LTCH services.

Procedural and timeline aspects

  • Effective date references:
    • Extended site-neutral payment reductions: extended through fiscal year 2032 (by replacing “2026” with “2032” in the statute).
    • High acuity criterion discharges and mid-build requirements: to be applicable to discharges occurring on or after October 1, 2026.
  • Implementation specifics:
    • LTCHs must meet mid-build requirements and submit certifications within 60 days after enactment.
    • The specified MS-LTC-DRGs are defined by relative weight thresholds and exclusions related to long-duration ventilator use.
  • Legislative status:
    • Introduced in the House on June 25, 2026.
    • Referred to the Ways and Means Committee.
    • As of July 15, 2026, reported to the House floor in the nature of a substitute, with committee consideration completed.

Notable details

  • The bill creates a new “high acuity” criterion to determine which LTCH discharges are subject to site-neutral payment adjustments.
  • It aligns LTCH payment reform with conditions tied to MS-LTC-DRG weights and prior hospital discharge pathways, aiming to target higher-acuity LTCH cases while extending site-neutral reductions.
  • The mid-build requirements appear intended to encourage capital investment and expansion activity among LTCHs seeking eligibility under the new criterion, with verifiable certifications due shortly after enactment.

Compiled from official sources — confirm details with the bill’s official record.

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