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".