ABSTRACT Background:This is a case study of an advanced practice nurse (APN) practice response to 2003 Medicare D-associated payer changes. Description: Case study of changes in population/services after implementation of Medicare D policy considerations Study design: Case study with data at 3 time points and analyzed using descriptive statis- tics/central measures of tendency/dispersion Results: Largest changes found to affect public sector recipients/practice solvency Conclusions: Unintended consequences of healthcare policy change affect APN prac- tice/health of vulnerable populations. Recommendations for entrepreneur APNs include supportive policy in addition to business preparation, education, and tools that generate safe strategies for alternate income streams during policy/payer changes. Keywords: APN, APN entrepreneur, behavioral health, Medicaid waiver, Medicare, Medicare D, private practice, reimbursement strategies, TennCare © 2010 American College of Nurse Practitioners www.npjournal.org The Journal for Nurse Practitioners - JNP 707 Kathleen McCoy, Michael Carter, Patricia D. Cunningham, Patricia M. Speck, and Cynthia Rector Effects of Medicare Changes on a Behavioral Health APN Practice