42 C.F.R. § 412.620

Current through March 31, 2024
Section 412.620 - Patient classification system
(a)Classification methodology.
(1) A patient classification system is used to classify patients in inpatient rehabilitation facilities into mutually exclusive case-mix groups.
(2) For purposes of this subpart, case-mix groups are classes of Medicare patient discharges by functional-related groups that are based on a patient's impairment, age, comorbidities, functional capabilities, and other factors that may improve the ability of the functional-related groups to estimate variations in resource use.
(3) Data from admission assessments under § 412.610(c)(1) are used to classify a Medicare patient into an appropriate case-mix group.
(4) Data from the discharge assessment under § 412.610(c)(2) are used to determine the weighting factors under paragraph (b)(4) of this section.
(b)Weighting factors -
(1)General. An appropriate weight is assigned to each case-mix group that measures the relative difference in facility resource intensity among the various case-mix groups.
(2)Short-stay outliers. We will determine a weighting factor or factors for patients that are discharged and not transferred (as defined in § 412.602 ) within a number of days from admission as specified by us.
(3)Patients who expire. We will determine a weighting factor or factors for patients who expire within a number of days from admission as specified by us.
(4)Comorbidities. We will determine a weighting factor or factors to account for the presence of a comorbidity, as defined in § 412.602 , that is relevant to resource use in the classification system.
(c)Revision of case-mix group classifications and weighting factors. We may periodically adjust the case-mix groups and weighting factors to reflect changes in-
(1) Treatment patterns;
(2) Technology;
(3) Number of discharges; and
(4) Other factors affecting the relative use of resources.

42 C.F.R. §412.620