H.R. 9468House119th Congress (2025-2027)In Committee

STAR Act

Sponsored by Kevin HernRep. Kevin Hern (R-OK)
Introduced June 25, 2026

AI-Generated Summary

Updated July 1, 2026 at 6:12 AM UTC

The STAR Act changes how Medicare pays long‑term care hospitals. It pushes back the end date for a temporary site‑neutral payment reduction to 2032 and creates a new “high‑acuity” rule that lets certain hospitals avoid the reduced rate if patients meet specific discharge and diagnosis conditions and the hospital meets construction or certification requirements. The bill also updates ICU and ventilator payment rules to include discharges from critical access hospitals after October 1, 2026.

Key Provisions

  • Extends the expiration of site‑neutral payment reductions for long‑term care hospitals from 2026 to 2032.
  • Adds a high‑acuity criterion that exempts hospitals from the reduced rate when a patient’s discharge follows a stay in a subsection (d) or critical access hospital, is assigned a specified MS‑LTC‑DRG (weight ≥ 0.8 and not ventilator‑based), and the hospital meets enrollment, qualifying period, mid‑build or certificate‑of‑need requirements, with the discharge occurring on or after Oct 1, 2026.
  • Defines “specified MS‑LTC‑DRG” and sets “mid‑build” requirements: a binding construction agreement, at least 10% (or $2.5 million) of estimated costs spent, and a certification to the Secretary within 60 days.
  • Modifies ICU and ventilator criteria to also apply when discharges from long‑term care hospitals occur after Oct 1, 2026 following a stay in a critical access hospital.

Legislative Activity

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3 earlier actions
HouseCommittee Latest Action

Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 40 - 0.

July 15, 2026

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HouseIntro Referral

Introduced in House

June 25, 2026

HouseIntro Referral

Referred to the House Committee on Ways and Means.

June 25, 2026

HouseCommittee

Committee Consideration and Mark-up Session Held

July 15, 2026

HouseCommittee

Ordered to be Reported in the Nature of a Substitute by the Yeas and Nays: 40 - 0.

July 15, 2026

Floor Debate

2 members

What members said about H.R. 9468 on the floor

1 Republican1 Democrat
Mark Takano
Rep. Mark TakanoD-CA-39 · Jul 21, 2025

Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, openness and transparency in the budgeting process are crucial to enabling Members of Congress to exercise our constitutional…

Mike Bost
Rep. Mike BostR-IL-12 · Jul 21, 2025

Mr. Speaker, I move to suspend the rules and pass the bill (S. 423) to protect regular order for budgeting for the Department of Veterans Affairs, and for other purposes. Mr. Speaker, I ask unanimous…

Bill Text

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Introduced in HouseIssued June 25, 2026

I

119th CONGRESS

2d Session

H. R. 9468

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.

1.

Short title

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

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.