How RehabAlpha Calculates Medicare Part A SNF Payments

This article explains how RehabAlpha calculates estimated Medicare Part A skilled nursing facility payments.

There's nothing special about RehabAlpha's implementation. It should match the guidelines, formulas, and rules put forth by Medicare. ..but we encourage you to double-check our work 😀

Before you start

If you want to test different inputs to see what the resulting reimbursements are, you can create free RehabAlpha account and follow along by entering fake data into our system.

Medicare Part A pays by the covered day

For Medicare Part A skilled nursing facility stays, Medicare uses a per diem payment model. That means Medicare pays a daily rate for each covered day of the patient's stay.

In other words, for a given patient-admission, Medicare agrees to pay the facility a daily amount that could look something like this:

Stay day	Reimbursement amount
Day 1	$825.75
Day 2	$825.75
Day 3	$825.75
Day 4	$635.40
Day 5	$635.40
...	...
Day 98	$548.90
Day 99	$548.90
Day 100	$548.90

Medicare Part A only covers up to 100 days of skilled nursing facility care in a benefit period.

note

A Medicare Part A benefit period begins the day a patient is admitted as an inpatient and ends only when they have gone 60 consecutive days without receiving hospital or skilled care.

How RehabAlpha calculates the daily rate

At a high level, Medicare starts with the patient's clinical and service information, assigns the stay to payment groups, applies the relevant Medicare rates and adjustments, and produces a daily payment amount. RehabAlpha follows that same sequence when estimating Medicare Part A SNF payment.

Details and formulas

Step 1: Calculate the Unadjusted daily PDPM rate

First, RehabAlpha calculates the Unadjusted daily PDPM rate for the covered day.

This combines the patient's case-mix component rates, the variable per diem adjustment factors that apply to the day of the stay, and the non-case-mix rate:

$$\begin{alignedat}{4} \text{Unadjusted daily PDPM rate} &={} & \phantom{{}+{}}\quad& \text{PT component rate} &{}\times{}& \text{PT variable per diem factor} \\ && {}+\quad& \text{OT component rate} &{}\times{}& \text{OT variable per diem factor} \\ && {}+\quad& \text{SLP component rate} && \\ && {}+\quad& \text{Nursing component rate} && \\ && {}+\quad& \text{NTA component rate} &{}\times{}& \text{NTA variable per diem factor} \\ && {}+\quad& \text{Non-case-mix rate} && \end{alignedat}$$

The result of this step is the daily PDPM rate before the wage index adjustment.

Step 2: Split the rate into labor and non-labor portions

Next, RehabAlpha splits Unadjusted daily PDPM rate into a Labor portion and a Non-labor portion.

$$\begin{alignedat}{3} \text{Labor portion} &={} & \text{Unadjusted daily PDPM rate} &{}\times{}& \text{Labor share} \\ \text{Non-labor portion} &={} & \text{Unadjusted daily PDPM rate} &{}\times{}& \text{Non-labor share} \end{alignedat}$$ $$\scriptstyle \text{where } \text{Non-labor share} = 1 - \text{Labor share}$$

Step 3: Apply the wage index to the labor portion

RehabAlpha then multiplies Labor portion by the facility's Wage index to determine the Wage-adjusted labor portion.

$$\begin{alignedat}{3} \text{Wage-adjusted labor portion} &={} & \text{Labor portion} &{}\times{}& \text{Wage index} \end{alignedat}$$

Step 4: Combine the wage-adjusted and non-labor portions

Finally, RehabAlpha adds Wage-adjusted labor portion back to Non-labor portion. This produces the Wage-adjusted daily PDPM rate for that covered day.

$$\begin{alignedat}{3} \text{Wage-adjusted daily PDPM rate} &={} & \text{Wage-adjusted labor portion} &{}+{}& \text{Non-labor portion} \end{alignedat}$$

The sections below define the main inputs used in those formulas and explain where each value comes from.

Case-mix groups

The first step is to identify the patient's case-mix groups, often shortened to CMGs. These groups describe the patient's clinical needs for each PDPM payment component.

PDPM component	Example Case-mix group
PT	TA
OT	TB
SLP	SA
Nursing	HDE2
NTA	NC

Fiscal year

The next step is to determine which fiscal year to use.

Medicare payment rates follow the federal fiscal year used by the U.S. government. A fiscal year starts on October 1 and ends on September 30 of the following calendar year.

Fiscal year	Starts	Ends
2024	October 1, 2023	September 30, 2024
2025	October 1, 2024	September 30, 2025
2026	October 1, 2025	September 30, 2026
2027	October 1, 2026	September 30, 2027

Because SNF stays are billed by day, a single stay can span more than one fiscal year. RehabAlpha associates each covered day with the fiscal year for that date, instead of applying one fiscal year to the entire stay.

For example, a patient admitted on September 28, 2025 has the first three covered days in fiscal year 2025 and the fourth covered day in fiscal year 2026:

Stay day	Date	Fiscal year used
1	September 28, 2025	2025
2	September 29, 2025	2025
3	September 30, 2025	2025
4	October 1, 2025	2026
5	October 2, 2025	2026

Area Type & Wage Index

This section explains...

how to determine the area type (used in the next section) as well as the wage index in this formula

$$\begin{alignedat}{3} \text{Wage-adjusted labor portion} &={} & \text{Labor portion} &{}\times{}& \textbf{Wage index} \end{alignedat}$$

For a given patient admission, RehabAlpha determines:

1. Area type - rural or urban
2. Wage index - a multiplier like 0.7899

CMS publishes SNF wage index files that map each county FIPS code to an area type and wage index, which RehabAlpha organizes into a lookup table like this:

Fiscal year	Status	County FIPS	Area type	Wage index
2026	Final	01001	Urban	0.7994
2026	Final	01003	Urban	0.8087
2026	Final	01005	Rural	0.6367
...	...	...	...	...
2026	Final	72151	Urban	0.3589
2026	Final	72153	Urban	0.3287
2026	Final	72990	Rural	0.2443
2026	Final	99948	Rural	0.5008
2026	Final	99965	Rural	0.9611
...	...	...	...	...
2027	Proposed	01001	Urban	0.7899
2027	Proposed	01003	Urban	0.8048
2027	Proposed	01005	Rural	0.6514
...	...	...	...	...
2027	Proposed	72151	Urban	0.3718
2027	Proposed	72153	Urban	0.3616
2027	Proposed	72990	Rural	0.2577
2027	Proposed	99948	Rural	0.4693
2027	Proposed	99965	Rural	0.9611

RehabAlpha uses the service location's county FIPS code, plus the date of each covered day, to look up the area type and wage index values that apply to that day.

Source data

The mapping comes from the SNF wage index file (ZIP) included with the CMS SNF PPS rulemaking datasets on the CMS SNF PPS regulations page.

Fiscal year	CMS rule	Source files	Status
2026	CMS-1827-F	SNF Wage Index (ZIP)	Final
2027	CMS-1843-P	SNF Wage Index (ZIP)	Proposed

Base rates and component rates

This section explains...

how to determine the component rates in this formula

$$\begin{alignedat}{4} \text{Unadjusted daily PDPM rate} &={} & \phantom{{}+{}}\quad& \textbf{PT component rate} &{}\times{}& \text{PT variable per diem factor} \\ && {}+\quad& \textbf{OT component rate} &{}\times{}& \text{OT variable per diem factor} \\ && {}+\quad& \textbf{SLP component rate} && \\ && {}+\quad& \textbf{Nursing component rate} && \\ && {}+\quad& \textbf{NTA component rate} &{}\times{}& \text{NTA variable per diem factor} \\ && {}+\quad& \textbf{Non-case-mix rate} && \end{alignedat}$$

Before the start of each fiscal year, CMS publishes a new set of federal per diem rates for urban and rural skilled nursing facilities. RehabAlpha organizes the data as follows:

Fiscal year	CMS rule status	Area type	PDPM component	Per diem amount
2026	Final	Urban	Nursing	$132.00
2026	Final	Urban	NTA	$99.59
2026	Final	Urban	Non-case-mix	$118.21
2026	Final	Urban	OT	$70.49
2026	Final	Urban	PT	$75.73
2026	Final	Urban	SLP	$28.28
...	...	...	...	...
2027	Proposed	Rural	Nursing	$128.98
2027	Proposed	Rural	NTA	$97.31
2027	Proposed	Rural	Non-case-mix	$123.13
2027	Proposed	Rural	OT	$81.09
2027	Proposed	Rural	PT	$88.29
2027	Proposed	Rural	SLP	$36.44

Each CMG has a corresponding case-mix index that acts as a multiplier against the base rate to determine the component rate used in the daily calculation.

Fiscal year	Status	Area type	PDPM component	HIPPS character	Case-mix group	Case-mix index
2026	Final	Urban	Nursing	A	ES3	3.84
2026	Final	Urban	Nursing	B	ES2	2.90
2026	Final	Urban	Nursing	C	ES1	2.77
2026	Final	Urban	Nursing	D	HDE2	2.27
2026	Final	Urban	Nursing	E	HDE1	1.88
...	...	...	...	...	...	...
2027	Proposed	Rural	PT	L	TL	1.03
2027	Proposed	Rural	SLP	I	SI	3.34
2027	Proposed	Rural	SLP	J	SJ	2.83
2027	Proposed	Rural	SLP	K	SK	3.50
2027	Proposed	Rural	SLP	L	SL	3.98

For an urban facility, an example set of component-rate calculations could look like this:

Component	Case-mix group	Case-mix index	Calculation	Component rate
PT	TA	1.45	$75.73 x 1.45	$109.80
OT	TB	1.41	$70.49 x 1.41	$99.39
SLP	SA	0.64	$28.28 x 0.64	$18.10
Nursing	ES3	3.84	$132.00 x 3.84	$506.88
NTA	NA	3.06	$99.59 x 3.06	$304.75
Non-case-mix	n/a	n/a	fixed daily amount	$118.21

Source data

The rate tables come from the SNF PPS annual rulemaking published in the Federal Register. RehabAlpha stores each rate set with its effective date range, the CMS rule that published the PT, OT, SLP, nursing, NTA, and non-case-mix per diem rates, and whether the rate set is final or proposed:

Fiscal year	CMS rule	Source tables	Status
2026	CMS-1827-F, 90 FR 37310, published August 4, 2025	FY 2026 urban and rural rates	Final
2027	CMS-1843-P, 91 FR 17678, published April 7, 2026	FY 2027 Tables 3 and 4	Proposed

Variable per diem adjustment factors

This section explains...

how to determine the variable per diem factors in this formula

$$\begin{alignedat}{4} \text{Unadjusted daily PDPM rate} &={} & \phantom{{}+{}}\quad& \text{PT component rate} &{}\times{}& \textbf{PT variable per diem factor} \\ && {}+\quad& \text{OT component rate} &{}\times{}& \textbf{OT variable per diem factor} \\ && {}+\quad& \text{SLP component rate} && \\ && {}+\quad& \text{Nursing component rate} && \\ && {}+\quad& \text{NTA component rate} &{}\times{}& \textbf{NTA variable per diem factor} \\ && {}+\quad& \text{Non-case-mix rate} && \end{alignedat}$$

Some PDPM components change based on the day of the stay. These variable per diem adjustment factors are why the daily rate can be different on Day 1, Day 21, or Day 98 even when the patient's CMGs stay the same.

PT and OT decrease gradually as the stay continues:

Day in Stay	PT and OT Adjustment Factor
1-20	1.00
21-27	0.98
28-34	0.96
35-41	0.94
42-48	0.92
49-55	0.90
56-62	0.88
63-69	0.86
70-76	0.84
77-83	0.82
84-90	0.80
91-97	0.78
98-100	0.76

NTA has a higher adjustment factor for the first three days of the stay, then returns to the standard factor for the rest of the covered stay:

Day in Stay	NTA Adjustment Factor
1-3	3.00
4-100	1.00

Source data

CMS finalized the PDPM variable per diem adjustment effective October 1, 2019, in the FY 2019 SNF PPS Final Rule. The final rule lists the PT/OT factors in Table 30 and the NTA factors in Table 31.

CMS also publishes the same schedules in the PDPM Variable Per Diem Adjustment Fact Sheet and the PDPM Calculation Worksheet for SNFs.

Labor share

This section explains...

how to determine the labor share in these formulas

$$\begin{alignedat}{3} \text{Labor portion} &={} & \text{Unadjusted daily PDPM rate} &{}\times{}& \textbf{Labor share} \\ \text{Non-labor portion} &={} & \text{Unadjusted daily PDPM rate} &{}\times{}& \textbf{Non-labor share} \end{alignedat}$$$$\scriptstyle \text{where } \text{Non-labor share} = 1 - \text{Labor share}$$

After RehabAlpha calculates the Unadjusted daily PDPM rate, it applies the Labor share to determine the Labor portion and Non-labor portion.

The Labor share is a percentage CMS establishes in SNF PPS rulemaking. RehabAlpha uses the Labor share that applies to the fiscal year for each covered day.

Fiscal year	Status	Labor share	Non-labor share
2026	Final	71.9%	28.1%
2027	Proposed	72.0%	28.0%

For example, if the Unadjusted daily PDPM rate is $700.00 and the Labor share is 71.9%, RehabAlpha splits the rate like this:

$$\begin{array}{rclcl} \text{Labor portion} &=& \$700.00 &\times& 0.719 &=& \$503.30 \\ \text{Non-labor portion} &=& \$700.00 &-& \$503.30 &=& \$196.70 \end{array}$$

Source data

The labor share values come from the SNF PPS annual rulemaking published in the Federal Register. RehabAlpha stores each labor share with its effective date range, the CMS rule that published the value, and whether the value is final or proposed:

Fiscal year	CMS rule	Source value	Status
2026	CMS-1827-F, 90 FR 37310, published August 4, 2025	Labor share	Final
2027	CMS-1843-P, 91 FR 17678, published April 7, 2026	Labor share	Proposed

Interrupted stays

An interrupted stay occurs when a patient stops receiving Part A-covered SNF care and returns to that coverage soon enough that Medicare treats the return as a continuation of the prior stay. This can happen when the patient leaves the SNF and returns to the same SNF, or when the patient remains in the facility but leaves and returns to Part A coverage. This matters because it can affect the Stay day and the Benefit day.

Stay day vs Benefit day

Stay day determines which variable per diem adjustment factors to use.

Benefit day refers to one of the patient's 100 allowed benefit days within their Medicare Part A SNF benefit period.

Usually these are the same.

For example

The Stay day is 7 and the Benefit day is also 7.

However, these values can diverge when Medicare treats the return as a new SNF stay while the same Medicare Part A benefit period continues.

For example

The Stay day is 21 and the Benefit day is 23.

Interrupted-stay window

The interrupted-stay window is the 3-day period after a patient stops receiving Part A-covered SNF care. The interrupted-stay window decides whether a return is treated as the same SNF stay or a new SNF stay.

• If the patient physically leaves the SNF, the interrupted-stay window starts on the day they leave.
• If the patient remains in the facility but leaves Part A coverage, the interrupted-stay window starts the day after the final Part A-covered day.

Interruption days

Interruption days are non-covered days inside the interrupted-stay window.

• They are skipped for SNF Part A payment.
• They do not use SNF benefit days.
• When the patient has left the SNF, CMS uses the midnight census time to identify these days.

Covered SNF days

A covered SNF day is a day Medicare Part A pays the SNF for covered skilled nursing facility care.

Covered SNF days use the patient's SNF benefit days. Interruption days do not.

In RehabAlpha, enter same-stay interruption dates on the SNF Part A coverage episode. RehabAlpha skips those dates in the Part A revenue table and resumes both Stay day and Benefit day counting on the next covered SNF day. If the patient returns after the interrupted-stay window or to a different SNF, create a new SNF Part A coverage episode.

Midnight census helps identify interruption days, but it does not decide every covered SNF day. Admission days, discharge days, leaves of absence, and same-day transfers have separate CMS billing rules.

When the patient returns

• If the patient returns to the same SNF by the end of the interrupted-stay window, Medicare treats the return as the same SNF stay. The Stay day and Benefit day both resume.
• If the patient returns after the interrupted-stay window or to a different SNF, Medicare treats the return as a new SNF stay. The Stay day resets to 1, but the Benefit day resumes unless the Medicare Part A benefit period has reset.

Benefit period

Starting a new SNF stay does not automatically reset the Medicare Part A benefit period.

A benefit period resets only after 60 consecutive days without inpatient hospital care or skilled care. Even then, the next SNF stay still has to qualify for Medicare Part A SNF coverage.

Source data

These rules come from the CMS Medicare Claims Processing Manual, Chapter 6, especially §40.3.3 for same-day transfers, §40.3.5 for discharge-day and leave-of-absence utilization, and §120.2 for the SNF PDPM interrupted-stay policy.

Example 1: The patient goes to the hospital for 2 days, then returns

1. The patient is admitted to the SNF on Jun 1 at 1PM
2. On Jun 3 at 8PM, the patient goes to the hospital
3. On Jun 5 at 10AM, the patient returns to the SNF

The interrupted-stay window is Jun 3 through Jun 5.

   covered     covered    interrupt   interrupt    covered     covered
-------------------------------------------------------------------------
|   Jun 1   |   Jun 2   |   Jun 3   |   Jun 4   |   Jun 5   |   Jun 6   |
-------------------------------------------------------------------------
      ^                          ^                  ^
    admit                     transfer            return

                        |-----------------------------------|
                        interrupted-stay window

Because the patient returns to the same SNF within the interrupted-stay window, Medicare treats the return as the same SNF stay. The hospital days are interruption days. They are not covered SNF days, and they do not use SNF benefit days. When the patient returns on Jun 5, the Benefit day and Stay day both resume.

Date	Covered SNF day?	Interruption day?	Benefit day	Stay day
Jun 1	Yes	No	1	1
Jun 2	Yes	No	2	2
Jun 3	No	Yes	—	—
Jun 4	No	Yes	—	—
Jun 5	Yes	No	3	3
Jun 6	Yes	No	4	4
Jun 7	Yes	No	5	5
Jun 8	Yes	No	6	6
...	...	...	...	...
Sep 9	Yes	No	100	100

Example 2: The patient goes to the hospital for 4 days, then returns

1. The patient is admitted to the SNF on Jun 1 at 1PM
2. On Jun 3 at 8PM, the patient goes to the hospital
3. On Jun 7 at 10AM, the patient returns to the SNF

The interrupted-stay window is Jun 3 through Jun 5.

   covered     covered    interrupt   interrupt   interrupt    neither     covered
-------------------------------------------------------------------------------------
|   Jun 1   |   Jun 2   |   Jun 3   |   Jun 4   |   Jun 5   |   Jun 6   |   Jun 7   |
-------------------------------------------------------------------------------------
      ^                          ^                                         ^
    admit                     transfer                                   return

                        |-----------------------------------|
                        interrupted-stay window

Because the patient returns after the interrupted-stay window, Medicare treats the return as a new SNF stay for PDPM payment. Jun 6 is still a non-covered hospital day, but it is outside the window. When the patient returns on Jun 7, the Benefit day resumes at 3, but the Stay day resets to 1.

Date	Covered SNF day?	Interruption day?	Benefit day	Stay day
Jun 1	Yes	No	1	1
Jun 2	Yes	No	2	2
Jun 3	No	Yes	—	—
Jun 4	No	Yes	—	—
Jun 5	No	Yes	—	—
Jun 6	No	No	—	—
Jun 7	Yes	No	3	1
Jun 8	Yes	No	4	2
Jun 9	Yes	No	5	3
Jun 10	Yes	No	6	4
...	...	...	...	...
Sep 12	Yes	No	100	98

Example 3: The patient goes home for 61 days, then returns

1. The patient is admitted to the SNF on Jun 1 at 1PM
2. On Jun 3 at 8PM, the patient goes home
3. On Aug 3 at 10AM, the patient returns to the SNF

The interrupted-stay window is Jun 3 through Jun 5.

   covered     covered    interrupt   interrupt    interrupt   neither            covered
-------------------------------------------------------------------------      -------------
|   Jun 1   |   Jun 2   |   Jun 3   |   Jun 4   |   Jun 5   |   Jun 6   | ...  |   Aug 3   |
-------------------------------------------------------------------------      -------------
      ^                          ^                                                ^
    admit                     goes home                                         return

                        |-----------------------------------|
                        interrupted-stay window

In this example, the days away from the SNF are home days. They are not covered SNF days, and they do not use SNF benefit days. Because the patient has gone 60 consecutive days without inpatient hospital care or skilled care, the Medicare Part A benefit period resets. If the Aug 3 return qualifies for Medicare Part A SNF coverage, the Benefit day and Stay day both start over at 1.

Date	Covered SNF day?	Interruption day?	Benefit day	Stay day
Jun 1	Yes	No	1	1
Jun 2	Yes	No	2	2
Jun 3-Jun 5	No	Yes	—	—
Jun 6-Aug 2	No	No	—	—
Aug 3	Yes	No	1	1
Aug 4	Yes	No	2	2
Aug 5	Yes	No	3	3
Aug 6	Yes	No	4	4
...	...	...	...	...
Nov 10	Yes	No	100	100

Example 4: The patient goes to the hospital for 61 days, then returns

1. The patient is admitted to the SNF on Jun 1 at 1PM
2. On Jun 3 at 8PM, the patient goes to the hospital
3. On Aug 3 at 10AM, the patient returns to the SNF

The interrupted-stay window is Jun 3 through Jun 5.

   covered     covered    interrupt   interrupt    interrupt   neither            covered
-------------------------------------------------------------------------      -------------
|   Jun 1   |   Jun 2   |   Jun 3   |   Jun 4   |   Jun 5   |   Jun 6   | ...  |   Aug 3   |
-------------------------------------------------------------------------      -------------
      ^                          ^                                                ^
    admit                     transfer                                          return

                        |-----------------------------------|
                        interrupted-stay window

In this example, the days away from the SNF are inpatient hospital days. They are not covered SNF days, and they do not use SNF benefit days. Because the patient was receiving inpatient hospital care during the absence, the Medicare Part A benefit period does not reset. When the patient returns on Aug 3, the Benefit day resumes at 3, but the Stay day resets to 1.

Date	Covered SNF day?	Interruption day?	Benefit day	Stay day
Jun 1	Yes	No	1	1
Jun 2	Yes	No	2	2
Jun 3-Jun 5	No	Yes	—	—
Jun 6-Aug 2	No	No	—	—
Aug 3	Yes	No	3	1
Aug 4	Yes	No	4	2
Aug 5	Yes	No	5	3
Aug 6	Yes	No	6	4
...	...	...	...	...
Nov 8	Yes	No	100	98

Worked example

This example follows one urban SNF stay through the same calculation RehabAlpha uses for the Part A revenue table.

Assume the stay has these inputs:

Input	Example value
Service dates	October 1-21, 2025
Fiscal year	2026
Area type	Urban
County FIPS	01001
Wage index	0.7994
Labor share	71.9%
Non-labor share	28.1%

Assume the PDPM assessment maps to these component rates:

Component	Case-mix group	Component rate
PT	TA	$109.80
OT	TB	$99.39
SLP	SA	$18.10
Nursing	ES3	$506.88
NTA	NA	$304.75
Non-case-mix	n/a	$118.21

Day 1 calculation

Day 1 uses the PT/OT adjustment factor of 1.00 and the NTA adjustment factor of 3.00.

$$\begin{array}{rcl} \text{PT} &=& \$109.80 \times 1.00 = \$109.80 \\ \text{OT} &=& \$99.39 \times 1.00 = \$99.39 \\ \text{SLP} &=& \$18.10 \\ \text{Nursing} &=& \$506.88 \\ \text{NTA} &=& \$304.75 \times 3.00 = \$914.25 \\ \text{Non-case-mix} &=& \$118.21 \end{array}$$

Add those component values to get the unadjusted total:

$$\$109.80 + \$99.39 + \$18.10 + \$506.88 + \$914.25 + \$118.21 = \$1{,}766.63$$

Split the unadjusted total into labor and non-labor portions:

$$\begin{array}{rcl} \text{Unadjusted labor} &=& \$1{,}766.63 \times 0.719 = \$1{,}270.21 \\ \text{Non-labor} &=& \$1{,}766.63 \times 0.281 = \$496.42 \end{array}$$

Apply the wage index to the labor portion:

$$\$1{,}270.21 \times 0.7994 = \$1{,}015.40$$

Then add the wage-adjusted labor portion back to the non-labor portion:

$$\$1{,}015.40 + \$496.42 = \$1{,}511.83$$

The Day 1 wage-adjusted daily PDPM rate is $1,511.83.

Day 4 calculation

Day 4 still uses the PT/OT adjustment factor of 1.00, but the NTA adjustment factor drops to 1.00.

$$\begin{array}{rcl} \text{PT} &=& \$109.80 \times 1.00 = \$109.80 \\ \text{OT} &=& \$99.39 \times 1.00 = \$99.39 \\ \text{SLP} &=& \$18.10 \\ \text{Nursing} &=& \$506.88 \\ \text{NTA} &=& \$304.75 \times 1.00 = \$304.75 \\ \text{Non-case-mix} &=& \$118.21 \end{array}$$

The unadjusted total is lower because the NTA component is no longer tripled:

$$\$109.80 + \$99.39 + \$18.10 + \$506.88 + \$304.75 + \$118.21 = \$1{,}157.13$$

Split, wage-adjust, and recombine:

$$\begin{array}{rcl} \text{Unadjusted labor} &=& \$1{,}157.13 \times 0.719 = \$831.98 \\ \text{Non-labor} &=& \$1{,}157.13 \times 0.281 = \$325.15 \\ \text{Adjusted labor} &=& \$831.98 \times 0.7994 = \$665.08 \\ \text{Adjusted total} &=& \$665.08 + \$325.15 = \$990.24 \end{array}$$

The Day 4 wage-adjusted daily PDPM rate is $990.24.

Day 21 calculation

Day 21 uses the PT/OT adjustment factor of 0.98 and the NTA adjustment factor of 1.00.

$$\begin{array}{rcl} \text{PT} &=& \$109.80 \times 0.98 = \$107.60 \\ \text{OT} &=& \$99.39 \times 0.98 = \$97.40 \\ \text{SLP} &=& \$18.10 \\ \text{Nursing} &=& \$506.88 \\ \text{NTA} &=& \$304.75 \times 1.00 = \$304.75 \\ \text{Non-case-mix} &=& \$118.21 \end{array}$$

The unadjusted total is:

$$\$107.60 + \$97.40 + \$18.10 + \$506.88 + \$304.75 + \$118.21 = \$1{,}152.95$$

Split, wage-adjust, and recombine:

$$\begin{array}{rcl} \text{Unadjusted labor} &=& \$1{,}152.95 \times 0.719 = \$828.97 \\ \text{Non-labor} &=& \$1{,}152.95 \times 0.281 = \$323.98 \\ \text{Adjusted labor} &=& \$828.97 \times 0.7994 = \$662.68 \\ \text{Adjusted total} &=& \$662.68 + \$323.98 = \$986.66 \end{array}$$

The Day 21 wage-adjusted daily PDPM rate is $986.66.

Resulting per-diem table

Using the same inputs for each covered day, RehabAlpha's revenue table would look like this. The cumulative column includes every covered day, even though this example only shows selected rows.

Day	Date	Adj. Total	Adj. Total Cmltv	PT	OT	SLP	N	NTA	Non CMG	Unadj. Total	Non labor	Unadj. Labor	Adj. Labor
1	Oct 1	$1,511.83	$1,511.83	$109.80	$99.39	$18.10	$506.88	$914.25	$118.21	$1,766.63	$496.42	$1,270.21	$1,015.40
2	Oct 2	$1,511.83	$3,023.65	$109.80	$99.39	$18.10	$506.88	$914.25	$118.21	$1,766.63	$496.42	$1,270.21	$1,015.40
3	Oct 3	$1,511.83	$4,535.48	$109.80	$99.39	$18.10	$506.88	$914.25	$118.21	$1,766.63	$496.42	$1,270.21	$1,015.40
4	Oct 4	$990.24	$5,525.71	$109.80	$99.39	$18.10	$506.88	$304.75	$118.21	$1,157.13	$325.15	$831.98	$665.08
5	Oct 5	$990.24	$6,515.95	$109.80	$99.39	$18.10	$506.88	$304.75	$118.21	$1,157.13	$325.15	$831.98	$665.08
21	Oct 21	$986.66	$22,356.14	$107.60	$97.40	$18.10	$506.88	$304.75	$118.21	$1,152.95	$323.98	$828.97	$662.68

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