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CBHS Washington: Extra Medicaid Payments for Your Adult Family Home
Community Behavioral Health Support (CBHS) pays qualifying adult family homes $36 to $528 per day on top of regular DSHS rates for residents with behavioral health needs.
If you serve residents with anxiety, aggression, wandering, hallucinations, or other behavioral health challenges, you may be leaving money on the table. CBHS is a Washington State program that provides additional per-diem payments for one-on-one supportive supervision.
What Is CBHS?
Community Behavioral Health Support (CBHS) is a Washington State program that began July 1, 2024. It pays adult family homes to provide supportive supervision — one-on-one monitoring, redirection, and cueing — for residents with significant mental health or behavioral needs.
The program is administered by the Health Care Authority (HCA), not DSHS. It replaced two older programs:
- Behavioral Health Personal Care (BHPC) — old MCO wrap-around funding (being phased out)
- Residential Support Waiver (RSW) — including Expanded Community Support (ECS) and Specialized Behavior Support (SBS)
If you currently have residents on BHPC or RSW, they will be transitioned to CBHS as their CARE assessments come up for renewal. You can enroll now — you don't need to wait.
Quick Facts
- Administered by: HCA (Health Care Authority)
- Started: July 1, 2024
- Payment: Per-diem add-on, paid on top of your DSHS base rate
- Eligible facilities: Adult family homes, assisted living, enhanced services facilities
- No special certification needed: Any licensed WA AFH can apply
Does Nurse Delegation Fit In?
CBHS supportive supervision is separate from nurse delegation. You can provide both. The supportive supervision focuses on behavioral monitoring and redirection — not medical tasks. If your resident also needs medication administration or treatment delegation, you'd still need an RN delegator for those services separately.
The 6 Tiers & What They Pay
Payments are based on the average hours of one-on-one supportive supervision a resident needs per day.
| Tier | Daily Hours | Per Diem Add-On |
|---|---|---|
| Tier 1 | 0.5 – 2.0 hours | $36.30 |
| Tier 2 | 2.1 – 6.0 hours | $98.01 |
| Tier 3 | 6.1 – 10.0 hours | $194.81 |
| Tier 4 | 10.1 – 15.0 hours | $303.71 |
| Tier 5 | 15.1 – 20.0 hours | $424.71 |
| Tier 6 | 20.1 – 24.0 hours | $528.00 |
Example: A C Med resident in King County (~$183/day base) who qualifies for CBHS Tier 3 ($194.81/day) brings in roughly $378/day total — more than double the base rate alone.
Which Residents Qualify?
Eligibility Requirements
- Age 18+ and enrolled in Apple Health (Medicaid)
- Receiving MPC, COPES, CFC, or Residential Support
- Income at or below 150% FPL
- Qualifying diagnosis — mental illness or traumatic brain injury
- Needs assistance with 3+ ADLs or hands-on help with 1+ ADL
- Exhibits qualifying behaviors within the last 12 months
Qualifying Behaviors
The behavior must be related to their diagnosis and create a safety risk:
- Multiple assaultive incidents
- Self-endangering behaviors
- Intrusiveness / rummaging
- Wandering / elopement risk
- Resistance to care causing harm
- Verbal aggression
- Hallucinations / delusions
- Sexual inappropriateness
Get the Complete CBHS Provider Guide
Download the free step-by-step guide with enrollment instructions, MCO billing contacts, and documentation requirements.
Download Free CBHS Provider Guide →Full guide hosted by our partner, Seattle Assisted Living Network
Frequently Asked Questions
Does CBHS affect my nurse delegation services?
No. CBHS supportive supervision and nurse delegation are completely separate. You can provide both for the same resident. The supportive supervision covers behavioral monitoring and redirection. If the resident also needs medication administration, insulin injections, or treatment delegation, you still need an RN delegator for those tasks.
Do I need a special license to provide CBHS?
No. Any licensed Washington adult family home can apply. You need a signed Core Provider Agreement (CPA) with HCA, which you complete during ProviderOne enrollment. No additional behavioral health certification is required.
How do I enroll as a CBHS provider?
Two steps: 1) Complete an application in ProviderOne (for HCA, not DSHS), and 2) Contract with Managed Care Organizations (MCOs) to serve managed care enrollees. The free guide linked above has the exact taxonomy codes and MCO contacts.
What if my resident already receives BHPC payments?
BHPC is being phased out. When their CARE assessment comes up for renewal, DSHS will stop BHPC and they'll be evaluated for CBHS instead. Enroll now so there's no gap in payment.
Need Help With Nurse Delegation for Behavioral Health Residents?
Our RN delegators serve adult family homes throughout Washington. We can help you navigate both CBHS supportive supervision and your nurse delegation needs.
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