IBSS or CBHS: Which One Fits Your Resident?
Updated: 3 days ago
If you run an adult family home in Washington, you have probably heard of both IBSS and CBHS and wondered which one your resident needs.
Here is the short answer to IBSS vs CBHS in Washington: both programs pay for the same kind of one-on-one supportive supervision, but they are built for different residents.
CBHS is for residents whose risky behaviors come from a qualifying mental health condition.
IBSS is for residents with severe cognitive impairment, such as dementia, a brain injury or a developmental disability, who need a high level of supervision and individualized support, and other options have already been tried and have proven unsuccessful.
Below, we walk through what the two programs share, how they differ, and how to work out which one fits your resident.
What do IBSS and CBHS have in common?
Both programs pay for supportive supervision. That means one-on-one, in-person monitoring, redirection, diversion and cueing to prevent behavior that could harm your resident or the people around them. Both run through Washington's Health Care Authority (HCA) and the Apple Health (Medicaid) managed care plans, and adult family homes can provide both.
They share the same limits, too. Neither one pays for personal care, and neither pays for room and board or a private room. Both programs use a tier system to categorize the level of one-on-one supervision required, based on the average number of hours your resident needs each day.
What is CBHS?
CBHS stands for Community Behavioral Health Support. It started on July 1, 2024, and it replaced most of the older Behavioral Health Personal Care funding.
CBHS is for adults on Apple Health whose risky behaviors are driven by a qualifying mental health diagnosis, such as schizophrenia, bipolar disorder, major depression or PTSD. One brain injury code is on the list as well. Your resident also needs to be eligible for long-term care services, and there needs to be a real pattern of risk in the past year: assaultive incidents, self-endangering behavior, or symptoms that push residents into crisis if staff does not step in.
CBHS eligibility is set for up to one year at a time.
What is IBSS?
IBSS stands for Intensive Behavioral Supportive Supervision. It became available in January 2024 as an "in lieu of service," which means an Apple Health managed care plan can offer it instead of a hospital or institutional stay.
IBSS is for adults with severe, long-lasting cognitive impairment paired with risky behaviors. Examples include dementia, traumatic brain injury, autism, a developmental disability, or a mental health or substance use condition that affects thinking. These are residents who cannot be kept safe in the community without a high level of staffing.
The bar for IBSS is high, and HCA's current policy guide spells it out:
Other Apple Health options must be tried first and have proven unsuccessful.
For the first approval, your resident must need Tier 4 support or higher, which is more than 10 hours of one-on-one supervision a day.
There must have been a medically necessary hospital admission in the 12 months before the first approval.
The health plan must approve it in advance, for no more than 12 months at a time.
Your plan of care must cover the qualifying behaviors, a staffing schedule, a crisis response plan, staff training, and a plan to re-evaluate the hours.
For the application itself, see our guide on how to apply for IBSS in Washington State.
IBSS vs CBHS: the differences at a glance
Who it is for: CBHS follows a qualifying mental health diagnosis. IBSS follows severe cognitive impairment.
Who offers it: CBHS is an Apple Health benefit. IBSS is offered only through the Apple Health managed care plans.
Getting in: CBHS needs long-term care eligibility and a pattern of risky behavior in the past year. IBSS needs other options tried first, a recent hospital admission, and Tier 4 level need or higher.
How long it lasts: CBHS eligibility runs up to one year. Each IBSS approval runs up to 12 months.
What neither pays for: personal care, room and board, or a private room.
How do you find out which one fits your resident?
Start with what drives the behavior. Is it a mental health condition, or a cognitive impairment such as dementia or a brain injury? That is the first fork in the road. Many residents have both, and that is where a clinical eye helps most.
Look back over the last 12 months. Write down the incidents, any hospital stays, and any placements that did not work out. Both programs look at the past year.
Be honest about the hours. How many hours a day does your resident truly need one-on-one support? If the answer is under 10, IBSS will not be approved.
Talk to the case manager and the health plan. The DSHS case manager assesses your resident, and the health plan approves the service. Ask which program they see as the right fit and exactly what they need from you.
The most common mistake: logging the care, not the behavior
Daily logs often describe what staff did but leave out what the resident did, or what was happening right before. HCA's guidance asks for three things in each entry: the behavior that needed an intervention, the intervention provided, and what happened just before the behavior began.
That last part is the one most often missing, and it matters. Your daily log is the record that supports your tier every time it comes up for review.
How Precision Assess helps
Ambar, RN-BSN, looks at your resident's situation and tells you honestly which program fits, or whether neither does. We prepare IBSS and CBHS applications, the plan of care, daily supportive supervision logs and re-tiering requests, and we can prepare your monthly CBHS and IBSS billing too.
Every document is written by an experienced registered nurse. Your residents' information is handled with clinical care.
Frequently asked questions
Do IBSS or CBHS pay for personal care?
No. Both pay only for supportive supervision: the one-on-one monitoring and redirection that keeps your resident safe. Personal care, room and board, and private rooms are not covered by either program.
What if my resident needs fewer than 10 hours of one-on-one support a day?
Then IBSS will not be approved, because it needs Tier 4 or higher. If the behaviors come from a qualifying mental health condition, CBHS may be the better fit. Talk to the case manager about what the records show.
Does our home need a contract to provide IBSS or CBHS?
Yes. Your home needs to be enrolled as an Apple Health provider through ProviderOne and contracted with the managed care plans you will bill. If you are still deciding who provides IBSS services, start there.
How long does an approval last?
CBHS eligibility runs for up to one year before renewal. Each IBSS approval runs for up to 12 months, and the health plan reviews it again before it continues. Good daily logs make both renewals much easier.
Not sure which one fits your resident?
Ambar, RN-BSN, will look at your resident's situation with you and tell you honestly which program fits. Happy to answer questions even if you don't need anything right now.
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