This presentation will address the growing disconnect between Medicaid reimbursement policies and the realities of care delivery in nursing facilities, with a focus on key policy areas impacting operations, clinical services, and financial sustainability. Attendees will gain insight into recent updates and initiatives related to non-available bed plan flexibility, dialysis reimbursement, ventilator-dependent care unit rates, home office direct care cost treatment, and capital asset value limits. The session will highlight how these policies influence staffing, service availability, and facility investment decisions, while also identifying areas where reimbursement does not adequately reflect current care models. Participants will leave with a clearer understanding of how to align clinical operations and strategic decision-making with evolving reimbursement frameworks to support high-quality, sustainable care delivery.

Nurse Learner Outcome: 

Learner Objectives:

1. Describe key Medicaid reimbursement policies.
2. Explain their impact on clinical operations.
3. Analyze misalignments between payment and care delivery.
4. Evaluate policy changes.
5. Apply this knowledge to support operational and strategic decision-making.