CBHS, IBSS, and SBS Support for Washington Adult Family Homes
Behavioral support funding is often the difference between keeping a resident and having to discharge them. I handle the whole of it: the application, the documentation that has to hold up month after month, the re-tiering requests, and the monthly billing.
I'm Ambar, a registered nurse, and I own Precision Assess. Supportive supervision work is unusually unforgiving. The clinical case, the daily records, and the billing all have to agree with each other, and a gap in any one of them shows up as a denial or a lower tier than the care you are actually providing.
What I handle
• Applications: IBSS and CBHS, assembled and written to show what your resident actually needs
• Plans of care: the clinical plan behind the request, including staffing and crisis response
• Daily supportive supervision logs: compiled properly, in the form reviewers expect
• Behavioral logs: 30 day logs for re-certification
• Re-tiering requests: when the funded level no longer matches the care you deliver
• SBS activity calendars and activity logs: the records that evidence the one to one time your contract requires
• Monthly MCO billing: the billing sheet for your client, prepared and checked before it goes out
Billing, and how it fits with the clearinghouse
This is the part homes ask about most, and there is a common misunderstanding worth clearing up.
The state has a clearinghouse that submits CBHS and IBSS claims for adult family homes. It is a genuinely useful service and you should use it. What it does not do is build the clinical case behind the claim: the application, the tier justification, the daily records, or the monthly billing sheet itself.
That is my part. I prepare your monthly billing accurately, from the records for that month, so what reaches the clearinghouse is clean and matches the documentation sitting behind it. A claim that does not agree with the log is the one that comes back.
If you are already working with the clearinghouse, nothing about that changes. We are doing different jobs.
Tiering, and why documentation decides what you get paid
Your tier decides your rate, and your tier is decided by how much supportive supervision your documentation shows you are providing.
That is where most homes lose money. The care is real and it is happening, but the records do not capture it in the detail a reviewer needs, so the authorized tier sits below the work being done. Every day of that authorization period is then paid at less than the care costs you.
I write the records so they reflect what your staff are actually doing. If the care genuinely supports a higher tier, the documentation should say so plainly, and that is what a re-tiering request is built from. If it does not, I will tell you that too. I am not going to help you claim hours you are not providing.
Specialized Behavior Support (SBS)
SBS is a different program from CBHS and IBSS. It runs through DSHS rather than through your client's managed care plan, and it carries its own contract and its own documentation expectations.
What an SBS contract asks of a home is additional one to one time with the resident, every day. That time has to be evidenced, not just delivered, and a home that is genuinely providing it can still come unstuck if the records do not show it clearly.
I produce the records that do: the SBS activity calendar showing what is planned, and the SBS activity log showing what actually happened, who provided it, and for how long.
If you are not certain which program a resident is in, or you have been told they are being assessed for more than one, that is worth a conversation before any paperwork gets submitted.
Why an experienced RN, not software
Supportive supervision documentation is a clinical description of behavior, not a form-filling exercise. A reviewer is reading for whether the behavior, the intervention, and what triggered it hang together and justify the hours claimed. Automated tools can produce a document. They cannot make that clinical judgment, and they have not met your resident.
Every application, log, and billing sheet I produce, I produce myself. Your residents' information is handled with clinical care.
Common questions
Do you handle the behavioral log too?
Yes. If your staff have been charting, I'll compile it into a proper log. If the charting has gaps, I'll tell you what's missing before we submit.
We have an SBS contract. Is that the same as CBHS?
No. They are separate programs with separate paperwork. SBS runs through DSHS. CBHS and IBSS run through your client's Apple Health managed care plan. Some residents get assessed for more than one. If you are not sure which program a resident is in, tell me and we will work it out before anything gets submitted.
Can you do our monthly billing?
Yes. I prepare the monthly billing sheet for each client from that month's records, including any days the client was not served, so the claim matches the documentation behind it.
We already use the state clearinghouse. Do we still need you?
Very likely yes, because we do different jobs. The clearinghouse submits claims. I build the application, the tier justification, the daily records, and the billing sheet that the claim is made from.
What if the application is denied?
Talk to me about what came back. Often the fix is documentation, not eligibility.
Can you help us request a higher tier?
Yes, where the care you are providing supports it. A re-tiering request is only as good as the records behind it, so that is where we start.
Can you help if we're already mid-process?
Yes. I'm happy to pick up an application someone else started.
What does it cost?
Contact me for pricing. Application work, ongoing documentation, and monthly billing are priced separately.
Serving Adult Family Homes across Washington
King, Pierce, Snohomish, Clark, and Thurston counties, including Seattle, Kent, and Bothell. In-home, virtual, or telehealth.
Call (425) 415-7926 or email info@precisionassess.com.