STAR Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 9468 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                                H. R. 9468

  To amend title XVIII of the Social Security Act to adjust long-term
        care hospital payment rates under the Medicare program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             June 25, 2026

 Mr. Hern of Oklahoma (for himself, Mrs. Miller of West Virginia, and
 Mr. Smucker) introduced the following bill; which was referred to the
                      Committee on Ways and Means

_______________________________________________________________________

                                 A BILL

  To amend title XVIII of the Social Security Act to adjust long-term
        care hospital payment rates under the Medicare program.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Saving Today's Acute-Care Resources
Act'' or the ``STAR Act''.

SEC. 2. ADJUSTING LONG-TERM CARE HOSPITAL PAYMENT RATES UNDER THE
              MEDICARE PROGRAM.

    (a) Extension of Site Neutral Payment Reductions.--Section
1886(m)(6)(B)(iv) of the Social Security Act (42 U.S.C.
1395ww(m)(6)(B)(iv)) is amended by striking ``2026'' and inserting
``2032''.
    (b) Modification of Criteria for Nonapplication of Site Neutral
Payment Rate.--
            (1) Addition of high acuity criterion.--Section
        1886(m)(6)(A) of the Social Security Act (42 U.S.C.
        1395ww(m)(6)(A)) is amended--
                    (A) in clause (ii)(I), by striking ``or the
                ventilator criterion under clause (iv)'' and inserting
                ``, the ventilator criterion under clause (iv), or the
                high acuity criterion described in clause (v)''; and
                    (B) by adding at the end the following new clause:
                            ``(v) High acuity criterion.--
                                    ``(I) In general.--The criterion
                                specified in this clause (in this
                                paragraph referred to as the `high
                                acuity criterion') for a discharge from
                                a long-term care hospital in a fiscal
                                year is that--
                                            ``(aa) the stay in the
                                        long-term care hospital ending
                                        with such discharge was
                                        immediately preceded by a
                                        discharge from a stay in a
                                        subsection (d) hospital or a
                                        stay in a critical access
                                        hospital;
                                            ``(bb) the individual
                                        discharged was assigned to a
                                        Medicare-Severity-Long-Term-
                                        Care-Diagnosis-Related-Group
                                        (MS-LTC-DRG) that was a
                                        specified MS-LTC-DRG (as
                                        described in subclause (II))
                                        with respect to such fiscal
                                        year;
                                            ``(cc) the discharge was
                                        from a long-term care
                                        hospital--

                                                    ``(AA) that
                                                enrolled under this
                                                title as such a
                                                hospital before the
                                                date of the enactment
                                                of this clause;

                                                    ``(BB) whose
                                                qualifying period (as
                                                described in section
                                                412.23(e)(4)(iv) of
                                                title 42, Code of
                                                Federal Regulations (or
                                                a successor
                                                regulation)) began
                                                before such date;

                                                    ``(CC) that met the
                                                mid-build requirements
                                                described in subclause
                                                (III); or

                                                    ``(DD) that had
                                                obtained an approved
                                                certificate of need
                                                from the State in which
                                                such hospital is
                                                located before such
                                                date, if required by
                                                State law; and

                                            ``(dd) the discharge
                                        occurred on or after October 1,
                                        2026.
                                    ``(II) Specified ms-ltc-drg
                                defined.--For purposes of subclause
                                subclause (I)(bb), the term `specified
                                MS-LTC-DRG' means, with respect to a
                                fiscal year, an MS-LTC-DRG--
                                            ``(aa) with a relative
                                        weight of 0.8 or greater; and
                                            ``(bb) that is not assigned
                                        on the basis of the receipt of
                                        ventilator services of at least
                                        96 hours.
                                    ``(III) Mid-build requirements
                                described.--For purposes of subclause
                                (I)(cc), the mid-build requirements
                                described in this clause are, with
                                respect to a long-term care hospital,
                                that--
                                            ``(aa) such hospital had a
                                        binding written agreement with
                                        an outside, unrelated party for
                                        the actual construction,
                                        renovation, lease, or
                                        demolition of such hospital in
                                        effect as of the date of the
                                        enactment of this clause and,
                                        prior to such date, had
                                        expended at least 10 percent
                                        (or, if less, $2,500,000) of
                                        the estimated cost of such
                                        construction, renovation,
                                        lease, or demolition; and
                                            ``(bb) the Secretary
                                        receives, not later than 60
                                        days after such date, from the
                                        chief executive officer or
                                        chief operating officer of such
                                        hospital a written
                                        certification that the hospital
                                        met the requirement under item
                                        (aa).''.
            (2) Modification of icu and ventilator criteria.--Section
        1886(m)(6)(A) of the Social Security Act (42 U.S.C.
        1395ww(m)(6)(A)) is amended--
                    (A) in clause (iii)(I), by inserting ``or, with
                respect to discharges from a long-term care hospital
                occurring on or after October 1, 2026, by a discharge
                from a stay in such a hospital or a stay in a critical
                access hospital,'' after ``in a subsection (d)
                hospital''; and
                    (B) in clause (iv)(I), by inserting ``or, with
                respect to discharges from a long-term care hospital
                occurring on or after October 1, 2026, by a discharge
                from a stay in such a hospital or a stay in a critical
                access hospital'' after ``in a subsection (d)
                hospital''.
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