STAR Act
Sponsored By: Representative Hern, Kevin [R-OK-1]
In Committee
Summary
This bill would reshape Medicare payments to long-term care hospitals by extending site-neutral payment rules while adding a new high‑acuity exception for certain discharges. It keeps reduced payment rules in place longer but lets some very sick patients trigger higher LTCH payment rates under tight conditions.
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- Long-term care hospitals (LTCHs) would see the site-neutral payment reduction period extended to 2032 instead of 2026. The bill would create a new high‑acuity test that allows nonapplication of the site‑neutral rate if four conditions are met, including an immediate prior stay in a subsection (d) hospital or a critical access hospital, assignment to a specified high‑weight MS‑LTC‑DRG, meeting enrollment and mid‑build or Certificate of Need conditions, and a discharge on or after October 1, 2026.
- ICU and ventilator counting rules would change so that, for discharges on or after October 1, 2026, qualifying ICU or ventilator days may include discharges from an LTCH or a critical access hospital after a prior stay in an LTCH or CAH.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 1 benefits, 0 costs, 1 mixed.
Exceptions for long-term care hospital payments
This bill would create a new "high acuity" exception so some long-term care hospital discharges on or after October 1, 2026, would not get the site-neutral payment rate. To qualify, the LTCH stay must follow a discharge from a regular (subsection (d)) hospital or a critical access hospital. The patient must be assigned to an MS-LTC-DRG with a relative weight of at least 0.8 and not because of 96+ hours of ventilator use. The hospital must have enrolled and started its qualifying period before enactment and must have been mid-build (binding construction/lease agreement and at least 10% or $2,500,000 spent) or have an approved State certificate of need if required. The hospital must certify this to the Secretary within 60 days after enactment. The bill would also let a prior stay in a long-term care hospital or a critical access hospital count for the ICU and ventilator tests for discharges on or after October 1, 2026.
Long-term care hospital payments extended
This bill would keep reduced Medicare payments to long-term care hospitals through 2032 by replacing the statutory expiration year 2026 with 2032. The change would apply on enactment and extends the period when site-neutral payment rules can reduce payments to these hospitals. Hospitals that treat long-stay patients would face lower Medicare payments for a longer time. This could indirectly affect access for some Medicare patients who need long-term hospital care.
Sponsors & CoSponsors
Sponsor
Hern, Kevin [R-OK-1]
OK • R
Cosponsors
Rep. Miller, Carol D. [R-WV-1]
WV • R
Sponsored 6/25/2026
Rep. Smucker, Lloyd [R-PA-11]
PA • R
Sponsored 6/25/2026
Rep. Kelly, Mike [R-PA-16]
PA • R
Sponsored 7/13/2026
Rep. Carey, Mike [R-OH-15]
OH • R
Sponsored 7/15/2026
Roll Call Votes
No roll call votes available for this bill.
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