Nursing Assistant Certified Reimbursement Forms

If you have any questions about Nursing Assistant Certified (NAC) training reimbursement, please contact Katy Hartman, Analyst, at (360) 725-2475 or, or Tiffany Hills, Nursing Home Rates Manager, at (360) 725-2472 or

REMINDER: Per the Reimbursement Form Instructions, the reimbursement packets must be postmarked and submitted thirty days after the end of the quarter. The deadline schedule is as follows:

Quarter 1 – April 30th

Quarter 2 – July 31st

Quarter 3 – October 31st

Quarter 4 - January 31st (following year)


If you have any questions about the Nursing Assistant program, please visit the Nursing Assistant program website.

Reimbursement Form - Updated

2016 Facility Totals

Online Module Training Reimbursement Policy

Reimbursement Form Instructions 

Help Sheet and Common Errors 

Policy & Procedures

2017 Medicaid percentage used to calculate reimbursement Excel | PDF