CBHS Washington: Extra Medicaid Payments for Behavioral Health Care in Your Adult Family Home
Community Behavioral Health Support (CBHS) pays Washington adult family homes $36 to $528 per day on top of your regular DSHS rate for residents with qualifying behavioral health needs. Here's everything you need to know to sign up.
Quick Summary: CBHS replaces the old Behavioral Health Personal Care (BHPC) and Residential Support Waiver (RSW) programs. If you already have residents with behavioral health needs — anxiety, aggression, wandering, hallucinations — this program can significantly increase your per-resident revenue. Administered by the Health Care Authority (HCA), not DSHS.
📥 Free CBHS Guide for AFH Providers
Get the complete step-by-step enrollment guide — ProviderOne codes, MCO contacts, documentation checklist, and tier rates.
What CBHS Pays — The 6 Tiers
CBHS pays a per-diem add-on based on how many hours of one-on-one supportive supervision a resident needs each day. These payments are on top of your regular DSHS CARE base rate.
| Tier | Daily Hours | Code | Per Diem Add-On |
|---|---|---|---|
| Tier 1 | 0.5 – 2.0 hours | S5126 | $36.30 |
| Tier 2 | 2.1 – 6.0 hours | S5126 + TF | $98.01 |
| Tier 3 | 6.1 – 10.0 hours | S5126 + HE | $194.81 |
| Tier 4 | 10.1 – 15.0 hours | S5126 + TG | $303.71 |
| Tier 5 | 15.1 – 20.0 hours | S5126 + HK | $424.71 |
| Tier 6 | 20.1 – 24.0 hours | S5126 + HI | $528.00 |
Example: A resident classified as CARE C Med in King County (~$183/day base rate) who qualifies for CBHS Tier 3 ($194.81/day) brings in roughly $378/day total — more than double the base rate alone.
Rates effective July 1, 2024. Source: HCA CBHS Fee Schedule.
What Is CBHS?
Community Behavioral Health Support (CBHS) is a Washington State program that started 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 don't need to wait — you can enroll now.
Which Residents Qualify?
A resident qualifies for CBHS if they meet all of the following:
Eligibility Requirements
- Age 18+ and enrolled in Apple Health (Medicaid)
- Receiving home and community services — 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 mental health or TBI diagnosis and create a safety risk. Examples:
- Assault — multiple assaultive incidents during inpatient or long-term care
- Self-endangering behaviors — actions that would result in bodily harm
- Intrusiveness — rummaging, unawareness of safety risks
- Wandering / elopement — attempting to leave the facility unsafely
- Resistance to care — causing harm to self or others during care
- Verbal aggression — causing distress to other residents or staff
- Hallucinations or delusions — leading to unsafe behaviors
- Sexual inappropriateness
Important: A psychiatric symptom alone doesn't qualify. The behavior must pose a safety risk or require intervention to prevent escalation. Extra time needed for ADLs does not count toward tiering — only behavioral intervention time does.
Who Determines Eligibility?
A DSHS case manager assesses the resident during the CARE assessment. If they meet CBHS criteria, the case manager refers them to HCA or the resident's MCO, who authorizes the appropriate tier.
How to Enroll as a CBHS Provider
Enrolling as a CBHS provider involves two main steps: completing an application in the ProviderOne system (for HCA, not DSHS), and contracting with Managed Care Organizations (MCOs) to serve managed care enrollees.
Includes exact taxonomy codes, MCO billing contacts, documentation checklist, and step-by-step instructions.
Billing and Documentation
CBHS is billed under procedure code S5126 with tier-specific modifiers (TF, HE, TG, HK, HI). It's a per-diem rate — one service line per claim for the authorized tier.
Providers must submit a Supportive Supervision Reporting Spreadsheet to the client's MCO (or HCA for fee-for-service clients). Daily documentation is required that includes date, time, staff names, behaviors exhibited, and interventions provided.
Training and Support Resources
Known Issues With the Transition
The Adult Family Home Council has reported challenges since CBHS launched:
- Rate reductions for some residents compared to the old BHPC rates
- Payment delays — especially during the initial transition
- Increased administrative burden — separate spreadsheets per MCO
- Contracting challenges with individual MCOs
The Council has filed unfair labor practice claims over implementation. A centralized billing clearinghouse (CHPS) is being developed to simplify MCO billing.
Bottom line: Despite the transition headaches, CBHS is now the only path to get paid for behavioral health supportive supervision. Homes already enrolled are in a better position than those waiting to be converted.
CBHS vs. Other Payment Add-Ons
This isn't the only add-on available. Here's how CBHS fits with other programs:
| Program | Agency | Add-On Amount | For Whom |
|---|---|---|---|
| Community Integration (CI) | DSHS | ~$5–6/day | Any resident; 4 hrs/month community activities |
| CBHS / Supportive Supervision | HCA / MCO | $36–528/day | Residents with qualifying mental health / TBI diagnosis + behaviors |
| CARE Base Rate | DSHS | $132–255/day | All Medicaid residents (varies by county + classification) |
Use our Medicaid Rate Estimator → to calculate CARE base rates by county. Official base rates are published by DSHS Office of Rates Management.
Frequently Asked Questions
Do I need to wait until I have a qualifying resident to enroll?
No. Enroll now in ProviderOne for HCA. The enrollment process takes time, and you cannot backdate CBHS billing. If a CBHS-eligible resident moves in while you're still enrolling, you won't get paid for the support you're already providing. Download the free guide to get started →
Does CBHS replace my regular DSHS payment?
No. CBHS is additive. You continue to receive your regular CARE base rate from DSHS. CBHS pays an additional per-diem amount on top of that.
Do I need a special license or certification?
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.
What if my resident's needs change?
You can request a re-tiering assessment using the HCA re-tiering request form. The payor must respond within 5 days.
I already get BHPC payments for a resident. What changes?
BHPC is being phased out. When that resident's CARE assessment comes up for renewal, DSHS will stop authorizing BHPC and the resident will be evaluated for CBHS instead. You need to be enrolled as a CBHS provider to continue getting paid for their behavioral support needs.
What's the difference between DSHS and HCA?
DSHS (ALTSA) handles the CARE assessment, determines your base rate, and pays through ProviderOne. HCA runs Apple Health (Medicaid) and administers CBHS. For CBHS, you bill the MCO or HCA directly — not through your usual DSHS billing process.
Get Your Free CBHS Guide
Download the step-by-step enrollment guide with ProviderOne codes, MCO billing contacts, documentation checklist, and tier rates all in one printable PDF.
📥 Download Free CBHS Guide →