Washington Administrative Code › Title 182 - Health Care Authority › WASHINGTON APPLE HEALTH › Chapter 182-561 - Community Behavioral Health Support Services Benefit › Section 182-561-0500 - Service tiers

Current through Register Vol. 24-14, July 15, 2024
(1) The agency has
				established tiers for community behavioral health support services using the
				needs-based criteria and risk criteria in WAC 182-561-0300.
(2) At a minimum, a person determined
				eligible for supportive supervision qualifies to receive Tier 1 services for an
				average of two hours per day.
(3)
				The agency determines tiers based on medical appropriateness and clinical
				acuity, using the following tier structure:
Tier Level
Eligibility
							 Criteria
Renewal or Reassessment
							 Criteria
Tier 1 Services
A person is eligible for Tier 1 services if
							 they:
* Demonstrate a qualifying behavior that requires
							 daily intermittent monitoring, redirection, and cueing to promote community
							 stability and to ensure the safety of the person and other residents; or
* Have a significant history of behaviors that are
							 well-managed in a highly structured setting but are at risk of recurring in a
							 community setting if not met with the appropriate level of supportive
							 supervision.
For renewal or assessment, the person has a history
							 of behaviors meeting the guidelines for Tier 1, which are currently prevented
							 only by additional skilled staff intervention.
Tier 2 Services
A person is eligible for Tier 2 services if
							 they:
* Demonstrate current qualifying behaviors at a
							 frequency that requires an average of 2.1 to 6 hours per day of dedicated staff
							 to redirect, deescalate, and cue to promote community stability and to ensure
							 the safety of the person and the other residents;
* Have demonstrated multiple qualifying behaviors
							 requiring an average of 2.1 to 6 hours per day of one-on-one staffing within
							 the past month. Behaviors may be well-managed in a highly structured setting
							 but are at risk of recurring in a community setting if not met with the
							 appropriate level of supportive supervision.
For renewal or reassessment, the person has a history
							 of behavior or behaviors meeting the guidelines for Tier 2, which are currently
							 prevented only by additional skilled staff intervention at this tier
							 level.
Tier 3 Services
A person is eligible for Tier 3 services if
							 they:
* Demonstrate multiple qualifying behaviors at a
							 frequency and intensity that requires an average of 6.1 to 10 hours per day of
							 one-on-one staffing to redirect, engage, deescalate, and cue to promote
							 community stability and to ensure the safety of the person and other residents;
							 or
* Have demonstrated multiple qualifying behaviors
							 requiring an average of 6.1 to 10 hours per day of one-on-one staffing within
							 the past month. Behaviors may be well-managed in a highly structured setting
							 but are at risk of recurring or increasing in frequency or severity in a
							 community setting if not met with the appropriate level of supportive
							 supervision.
For renewal or reassessment, the person has a history
							 of behaviors meeting the guidelines for Tier 3, which are currently preventable
							 only by additional skilled staff intervention at this tier level.
Tier 4 Services
A person is eligible for Tier 4 services if
							 they:
* Demonstrate multiple qualifying behaviors at a
							 frequency and intensity that requires an average of 10.1 to 16 hours per day of
							 one-on-one staffing to redirect, engage, deescalate, and cue to promote
							 community stability and to ensure the safety of the person and other residents;
							 or
* Have demonstrated multiple qualifying behaviors
							 requiring an average of 10.1 to 16 hours per day of one-on-one staffing within
							 the past month. Behavior requires at least one-on-one intervention, even in a
							 structured setting, but the behavior may be at risk of increasing in frequency,
							 or severity, or both, in a community setting if not met with the appropriate
							 level of supportive supervision.
For renewal or reassessment, the person has a history
							 of behavior meeting the guidelines for Tier 4, which are currently prevented
							 only by additional skilled staff interventions at this tier level.
Tier 5 Services
A person is eligible for Tier 5 services when:
* The person demonstrates multiple behaviors at a
							 frequency and intensity that requires an average of 16.1 to 20 hours per day of
							 one-on-one staffing to redirect, engage, deescalate, and cue to promote
							 community stability and to ensure the safety of the person and other residents;
							 or
* The person's behavior requires daily one-on-one
							 intervention even in the context of a structured setting, and there would be an
							 imminent risk of harm if the person does not receive an average of 16.1 to 20
							 hours per day of at least one-on-one staffing in a community setting.
For renewal or reassessment, the person has a history
							 of behavior meeting the guidelines for Tier 5, which are currently prevented
							 only by additional skilled staff intervention at this tier level.
Tier 6 Services
A person is eligible for Tier 6 services when:
* The person demonstrates multiple qualifying
							 behaviors at a frequency and intensity that requires an average of 20.1 to 24
							 hours per day of one-on-one staffing or has regular episodes that require
							 multiple staff to redirect, engage, deescalate, and cue to promote community
							 stability and to ensure the safety of the person and other residents; or
* The person's behavior requires constant one-on-one
							 monitoring and intervention, even in the context of a structured setting, and
							 there would be an imminent risk of harm if the person does not receive an
							 average of 20.1 to 24 hours per day of at least one-on-one staffing in a
							 community setting.
For renewals or reassessment, the person has a
							 history of behavior meeting the guidelines for Tier 6, which are currently
							 prevented only by additional skilled staff intervention at this tier
							 level.