Community Integration (CI) Program for Adult Family Homes
A complete AFH provider's guide to the DSHS Community Integration add-on.
The Community Integration (CI) add-on is a daily rate supplement that reimburses Adult Family Homes for providing community-based activities to residents. Each qualifying resident receives 4 hours per month of funded community integration time, paid as an add-on to your base DSHS daily rate.
Quick Summary
$5.10/day add-on
Statewide rate paid on top of the base CARE classification daily rate. Adds approximately $153/month per qualifying resident.
4 hours/month per resident
Funded staff time for planning, transporting to, and accompanying residents on community activities. Includes mileage reimbursement.
No special contract required
CI is an add-on to the standard DSHS AFH contract, not a separate specialty contract. Any DSHS-contracted AFH can receive it for qualifying residents.
Determined by CARE assessment
Eligibility is based on the resident's DSHS CARE assessment. The case manager determines whether the resident has an assessed need for community integration support.
What is the Community Integration Program?
The Community Integration (CI) program is a DSHS-funded add-on to the standard Medicaid daily rate for Adult Family Home residents who have an assessed need for support to participate in community activities. It was established to ensure that AFH residents have meaningful opportunities to engage with their communities, reducing social isolation and improving quality of life.
The program is available to any DSHS-contracted AFH — no specialty contract is required. CI is an add-on to the base rate, billed on the same service line in ProviderOne. Unlike the Meaningful Day Activity Contract (which requires a separate application, minimum 12 months of operation, and no unresolved citations), CI is triggered by the resident's CARE assessment and administered through the standard contract.
Key Distinction: CI is not a specialty contract — it is a rate add-on available to any AFH with a standard DSHS Medicaid contract. This is a critical distinction from programs like Meaningful Day or ECS, which require separate applications and qualification processes.
What CI Covers
Each qualifying resident receives 4 hours per month of funded CI staff time. These hours can be used for:
- Planning: Helping the resident identify, plan, and arrange community activities that match their interests
- Transportation: Arranging or providing transportation to and from the activity (mileage is separately reimbursable)
- Accompaniment: Accompanying the resident during the activity when needed for safety or support
- Discovery: Researching additional community activity opportunities the resident may want to participate in
CI activities are person-centered and individualized. They are intended to be provided one-on-one, tailored to each resident's interests, preferences, and abilities. The activities must be documented in the resident's negotiated care plan.
Important: CI is not the same as Meaningful Day. Meaningful Day is a specialty contract that funds structured, proactive behavioral activities for residents with behavioral challenges. CI is a broader, lower-barrier add-on for any resident with an assessed need for community participation support. An AFH can have both programs simultaneously for different residents (or the same resident, if they meet criteria for both).
Sources: HCA Complex Discharge Task Force, July 2024; DSHS Specialty Contracts Page
CI Rates and Financial Impact
Current Rate
As of July 1, 2024, the CI add-on rate is $5.10 per day — a single statewide rate that no longer varies by county or metropolitan area.
CI Rate History
| Effective Date | King County | Metro Service Area | Non-Metro |
|---|---|---|---|
| July 1, 2017 | $1.82 | $1.77 | $1.71 |
| July 1, 2019 | $2.44 | $2.33 | $2.21 |
| July 1, 2020 – June 30, 2023 | $2.48 | $2.37 | $2.25 |
| July 1, 2023 – June 30, 2024 | $4.05 (statewide) | ||
| July 1, 2024 – Present | $5.10 (statewide) | ||
Revenue Impact Analysis
The CI add-on has significant revenue implications, especially at scale:
Per Resident
$5.10/day = ~$153/month = ~$1,861/year per qualifying resident, on top of the base rate.
Per Home (3 residents)
$15.30/day = ~$459/month = ~$5,584/year, assuming 3 qualifying residents in a 6-bed home.
Per Home (6 residents)
$30.60/day = ~$918/month = ~$11,168/year for a fully qualified 6-bed home. The 4 hours/month per resident of staff time must be provided; the math still works in the provider's favor because CI hours can often be layered with existing outings.
Mileage Reimbursement
Providers are also eligible for mileage reimbursement for transporting residents to and from CI activities, up to 100 miles per month per client, at the IRS standard mileage rate. This is billed separately from the daily rate add-on.
Source: DSHS Complex Discharge Task Force Interim Recommendations, July 2024; AFH Council Rate Notices.
Eligibility Requirements
Resident Eligibility
A resident qualifies for the CI add-on when their DSHS CARE assessment identifies an assessed need for community participation support. Specifically:
- The resident must have a current DSHS CARE assessment
- The assessment must indicate the resident has an unmet need for community activity support
- The resident (or their guardian/representative) must express interest in participating in community activities
- The CI services must be written into the resident's negotiated care plan
There is no minimum CARE classification required for CI. Unlike Exceptional Care Support (ECS), which requires Group E classification, or certain add-ons that require specific ADL thresholds, CI is available across all classification groups. However, the resident's CARE assessment must document the need.
Provider Eligibility
Any DSHS-contracted Adult Family Home in Washington State can receive CI payments for qualifying residents. There is:
- No separate application or specialty contract required
- No minimum time in operation requirement (unlike Meaningful Day, which requires 12 months)
- No citation-free requirement — CI attaches to the resident, not the facility
Bottom line: If you have a standard DSHS AFH contract and a resident whose CARE assessment indicates community integration need, you can receive the CI add-on for that resident. There is no additional hoops to jump through at the provider level.
How Eligibility Is Determined
The process flows through the resident's DSHS case manager:
- CARE Assessment: DSHS conducts a Comprehensive Assessment Reporting Evaluation (CARE) of the resident, evaluating ADLs, cognitive performance, clinical complexity, mood/behavior, and exceptional care needs.
- Case Manager Review: The case manager reviews the CARE results and determines if the resident has an assessed need for community integration support. This is based on the resident's current living situation, social engagement, and ability to access community activities independently.
- Care Plan: If CI is indicated, it is included in the resident's negotiated care plan, specifying the types of community activities, frequency, and any special considerations (e.g., wheelchair accessibility, one-on-one accompaniment needs).
- Rate Activation: The CI add-on is activated in ProviderOne on the same service line as the base daily rate. The provider should verify that the add-on appears correctly in their payment statements.
Source: DSHS CARE Overview; WAC 388-106-0115 (CARE Classification)
How to Implement CI at Your AFH
A practical step-by-step guide to getting the CI add-on for your residents and delivering the services.
Implementation
Cost-Benefit Analysis for Providers
The Upside
Revenue uplift
$5.10/day adds up. For a 6-bed home where all residents qualify, that's $11,168/year in additional revenue — pure margin after the cost of providing 4 hours/month of community activities per resident.
Quality metric
Regular community outings improve resident satisfaction, family engagement, and survey outcomes. This makes your home more attractive to both private-pay and Medicaid residents.
No additional staffing
CI hours (24 hours/month for a 6-bed home) can typically be absorbed by existing staff within their regular schedules. The incremental cost is mostly mileage and activity fees, both of which are reimbursed or minimal.
The Costs
Mileage
Reimbursed at the IRS rate (approx. $0.65-$0.70/mile) up to 100 miles/month per resident. For a typical weekly outing within 10 miles of the home, mileage costs are fully covered.
Activity fees
Entry fees, meal costs, or activity supplies (e.g., movie tickets, museum admission, coffee). Many community activities offer senior discounts or free admission. These are not separately reimbursed by DSHS but are low-cost.
Documentation
Requires staff time to document each outing. A simple log (date, activity, duration, mileage) for each resident takes 5 minutes per outing. Can be integrated into existing care note systems.
Net Calculation
| Item | Per Resident / Month | 6-Bed Home / Month |
|---|---|---|
| CI add-on revenue | $153.00 | $918.00 |
| Mileage reimbursement (est.) | $26.00–$70.00 | $156.00–$420.00 |
| Total Revenue | ~$179–$223 | ~$1,074–$1,338 |
| Staff time (4 hrs @ $25/hr) | ($100.00) | ($600.00) |
| Activity costs (est.) | ($10.00–$30.00) | ($60.00–$180.00) |
| Net Monthly Margin | ~$49–$93 | ~$294–$558 |
Note: Staff time costs assume a dedicated CI shift. In practice, CI activities can often be layered into existing staff schedules (e.g., a caregiver already on shift takes one resident on a 30-minute outing while another staff covers the home). Actual margin is typically higher than the conservative estimate above.
Verification and Payment Monitoring
The most common issue providers face with CI payments is that they are not automatically adjusted during rate changes. Because CI is paid on the same service line as the base rate in ProviderOne, the system may not recognize it as a distinct rate component requiring adjustment.
What to Watch For
- Rate change periods: Most errors occur around July 1 (annual rate updates) and January 1 (semi-annual adjustments).
- New resident setup: When a new resident is added with CI authorization, verify the add-on appears on the first payment.
- Classification changes: If a resident's CARE classification changes, the CI add-on should stay at $5.10/day regardless (it does not vary by classification).
How to Verify
- Review your ProviderOne payment statements each month
- Calculate the expected daily rate: Base Rate + $5.10 (if CI authorized)
- Compare against actual payments
- If the CI add-on is missing, contact the resident's DSHS case manager first
- If the case manager cannot resolve it, escalate to DSHS Office of Rates Management
CPA Insight: The AFH Council has documented that during rate changes, case managers will sometimes reduce an ETR by the same amount the base rate increased, which is inappropriate and should not happen. While this guidance specifically addresses ETRs, the same vigilance applies to CI add-ons. Never assume rate adjustments are applied correctly — verify every time.
CI and Other Programs: How They Fit Together
Washington offers several AFH rate supplements and specialty contracts. Here is how CI compares:
| Program | Type | Approx. Value | Barrier to Entry |
|---|---|---|---|
| Community Integration (CI) | Rate add-on | $5.10/day | None — attaches to qualifying resident |
| Exceptional Care Support (ECS) | Rate add-on | $32.38 – $49.76/day | Group E CARE classification (ADL 22+ + turning program + equipment) |
| Meaningful Day Activity | Specialty contract | Varies (separate contract rate) | 12 months licensed, no citations, application required |
| Community Stability Supports (CSS) | Specialty contract | Varies | ALF license required |
| Capital Add-On | Rate add-on | Varies | Application, capital improvement documentation |
| Bridge Rate | Rate add-on | Varies | EARC or higher license, specific resident criteria |
Key takeaway: CI is the lowest-barrier rate enhancement available. You don't need to apply, you don't need a specialty contract, and it works across all CARE classification levels. If you have residents with an assessed need for community participation who are not receiving CI, you are leaving money on the table.
Documentation Best Practices
Proper documentation is essential for audit compliance and care plan reviews. DSHS may request documentation of CI services during routine inspections or focused reviews.
What to Document for Each CI Outing
- Date and time of the activity
- Type of activity (e.g., park walk, coffee shop, library visit, community event)
- Duration of the activity (tracking toward the 4 hours/month target)
- Staff involved (name and role)
- Resident participation — notes on engagement, preferences, any issues
- Mileage driven (if provider transport was used)
- Any costs incurred (though these are not separately reimbursed)
Suggested Documentation System
For homes with 4-6 residents on CI, a simple monthly log per resident is sufficient. This can be:
- A section in your existing care note system
- A printed monthly calendar with outing notes
- A simple spreadsheet tracking date, activity, hours, mileage per resident
The documentation should be stored in the resident's file and available for review by the DSHS case manager, RCS inspector, or during contract audits.
Ideal CI Activities
CI activities should be person-centered — they should reflect the resident's actual interests and preferences, not a one-size-fits-all program. Here are examples organized by common interest areas:
Outdoor & Nature
Park visits, botanical gardens, waterfront walks, community gardens, bird watching at local nature preserves. Many Washington parks offer senior passes or free admission.
Arts & Culture
Museum visits, library programs, art galleries, community theater, senior center classes, music performances. Many venues offer free or discounted admission for seniors.
Social & Community
Coffee shop outings, restaurant meals, farmers markets, community center events, religious services, volunteer opportunities appropriate to ability level.
Errands & Shopping
Grocery shopping, pharmacy visits, haircut appointments, banking. While routine, these provide meaningful community engagement for residents who cannot go independently.
Activity planning tip: Batch residents by interest and ability to maximize staff efficiency. Two residents who both enjoy coffee outings can share a single staff accompaniment. The 4 hours/month is per resident, but group outings with appropriate staffing ratios can make the economics more favorable.
💰 Don't Leave Money on the Table
Estimate Your Rate with CI Included
Use our Medicaid Rate Estimator to see what your daily rate would be with and without the CI add-on for each CARE classification level.
Official Resources and References
Washington Administrative Code
WAC 388-106-0115 — CARE classification criteria (how residents are classified into rate groups)
Chapter 388-106 WAC — Long-term care services (complete chapter)
DSHS Office of Rates Management
Office of Rates Management — Official DSHS rate tools, including the County Rates Tool with current AFH base and CI rates by county.
County Rates Tool (July 2026) — Direct link to the current rate spreadsheet.
DSHS AFH Provider Resources
AFH Provider Information — Licensing, regulations, and compliance.
CARE Assessment Overview — How the CARE assessment works.
Adult Family Home Council
Adult Family Home Council — Industry advocacy group that negotiated the $5.10 CI rate. Provides rate change alerts, payment monitoring guidance, and provider support.
Specialty Contracts
DSHS Specialty Contracts Page — Information on Meaningful Day, CSS, and other specialty contracts for comparison.
HCA Task Force Report
Complex Discharge Task Force Interim Recommendations (July 2024) — Includes the policy description of the CI program as an AFH rate add-on.
Frequently Asked Questions
Is CI a separate contract or just an add-on?
It is a rate add-on to your existing DSHS AFH contract, not a separate specialty contract. No additional application is required. If a resident's CARE assessment indicates the need, the add-on is activated through the care plan process.
Can I get CI for all my residents?
Only residents whose CARE assessment identifies an assessed need for community participation support and who express interest in community activities will qualify. It is not automatic for all residents — it must be justified by the assessment and documented in the care plan.
Do I need to track the 4 hours separately?
Yes. While there is no requirement to submit the tracking to DSHS on a routine basis, you must be able to produce documentation showing that CI services were provided if audited or during care plan reviews. A simple monthly log per resident is sufficient.
Does CI affect the base rate?
No. CI is paid on the same service line but is additive to the base rate. The base rate is determined by the CARE classification (e.g., D Med, C High), and CI is added on top. If a resident is no longer eligible for CI, only the add-on drops — the base rate continues.
Can family members provide CI activities?
CI activities must be provided by the AFH or arranged by the AFH provider. Family members volunteering to take residents on outings does not substitute for the AFH's obligation to provide CI services if they are in the care plan. However, the 4 hours can be a combination of staff-facilitated and family-supported activities if documented in the care plan.
What happens if a resident declines activities some months?
The care plan should be flexible. If a resident is hospitalized, ill, or temporarily declines activities, you are not required to force participation. Document the reason for any month where the full 4 hours were not provided. The CI add-on should not be disrupted for temporary changes in participation — but if a resident permanently refuses community activities, the care plan should be updated and the add-on may be discontinued.
Does CI apply to all CARE classification levels?
Yes. CI is not tied to a specific classification level. A resident in Group A Low with a documented need for community support qualifies just as a resident in Group E would. The classification drives the base rate; the CI add-on is independent.
Where can I look up the current CI rate?
The official DSHS Office of Rates Management publishes the County Rates Tool spreadsheet, which includes CI rates for every county. You can also use SALN's Medicaid Rate Estimator to see CI-adjusted rates for any classification in any county.
Need Help Understanding Your Rates?
Not sure whether your residents qualify for CI, or whether you're being paid correctly? We can help.
SALN works with AFH providers across Washington to optimize their DSHS rate structures. Contact us for a consultation.