H.R. 9468: Saving Today’s Acute-Care Resources Act

This bill would change how Medicare pays long-term care hospitals (LTCHs), which are hospitals that treat patients needing extended inpatient care.

What the bill would do

• Extend current Medicare “site-neutral” payment cuts through 2032. Under current law, some LTCH cases are paid at a lower, site-neutral rate instead of the usual LTCH rate. This bill would push that policy out from 2026 to 2032.
• Add a new “high acuity” exception. Certain LTCH stays would still qualify for the higher LTCH payment rate if they meet specific conditions, including:
  • the patient came to the LTCH right after a stay in a regular acute-care hospital or a critical access hospital;
  • the patient was placed into a qualifying Medicare diagnosis group with a relative weight of 0.8 or higher, and not one based on ventilator use for 96 hours or more;
  • the LTCH meets one of several status requirements, such as being already enrolled before the bill becomes law, already having begun its qualifying period, meeting certain construction/renovation “mid-build” requirements, or having an approved state certificate of need if required;
  • the discharge occurs on or after October 1, 2026.
• Broaden existing ICU and ventilator-based exceptions. For discharges on or after October 1, 2026, some current rules would also allow a patient’s immediate prior stay to have been in another LTCH or a critical access hospital, not just a regular acute-care hospital.

Practical effect

The bill would likely affect how much Medicare pays LTCHs for certain patient stays. In general, it would keep lower site-neutral payments in place longer, while also creating a new pathway for some higher-acuity cases to receive LTCH-level payments. It may also matter for hospitals that were already under construction or otherwise far along in becoming LTCHs, since the bill contains special rules for them.

Relevant Companies

• LPNT - LifePoint Health (not publicly traded currently; no ticker on major exchanges) is not applicable.
• THC - Tenet Healthcare could be indirectly affected if its facilities or patient referrals involve long-term acute-care or Medicare inpatient payment flows.
• ACHC - Acadia Healthcare operates behavioral health facilities rather than LTCHs, so direct impact would likely be limited; included only because Medicare facility-payment changes can affect hospital networks broadly.
• HCA - HCA Healthcare could be indirectly affected through patient transfers and referral patterns with LTCHs and acute-care hospitals.
• UHS - Universal Health Services could be indirectly affected through hospital network and post-acute care relationships.
• ENSG - The Ensign Group operates skilled nursing and post-acute facilities and could be indirectly affected by changes in Medicare post-acute payment dynamics.