CBHS Documentation Guidance
Updated February 2025
Please note: The AFH Council is working to understand the full scope of CBHS changes and is engaging in conversations with the Health Care Authority and DSHS. We will provide additional updates as soon as we have them.
From the Health Care Authority and the Department of Social and Health Services:
This cross-agency memo provides updated guidance on operationalizing Community Behavioral Health Support (CBHS) Supervision services, particularly for facilities with enhanced staffing ratio requirements, such as Assisted Living Facilities contracted for Community Stability Supports (CSS) and Enhanced Services Facilities (ESF).
Documentation: July 1, 2024 - December 31, 2024
Some CSS/ESF providers shared they have not been billing for CBHS services since the program went live in July 2024 due to the provider’s concern about how to operationalize the documentation requirements within facilities with enhanced staffing ratios. For CBHS services provided between July 2024-December 2024, the following guidance is applicable regarding documentation the provision of CBHS services:
- Allowable documentation for CBHS billing during this initial implementation period includes using the following: the client’s current Behavior Support Plan, daily chart notes, and other client-specific notes captured manually or within your electronic health records to describe the work done by facility staff to support the client.
Claims Submission: July 1, 2024 - December 31, 2024
Facilities must submit claims timely. Any CSS/ESF facilities who have not been submitting claims for services rendered in the first 6 months of this program, must submit these claims. All claims for this period must be submitted no later than March 31, 2025.
Documentation: January 1, 2025 - forward
Beginning January 1, 2025, providers must provide evidence of, at a minimum, a daily summative note signed by at least one provider for each client receiving CBHS Supportive Supervision that includes:
- The date the services were provided;
- The approximate time / duration of the intervention(s);
- The name(s) of the staff who provided the services throughout the day;
- What caused staff to become involved (i.e. heard screaming, resident asked for help, scheduled one-on-one time);
- What actions staff took with the resident to help them get back to or stay at baseline; and
- The outcome of the one-on-one time spent with the resident.
Check boxes may be utilized for identifying behaviors exhibited but will not meet the documentation requirements and must also include a summative note.
A copy of the HCA documentation template can be found here. Providers may use their own electronic health record, as long as they include the six items above in their summary. An example of the summary is below.
Please note: an electronic signature is approved to sign documentation.
The information in this memo is meant to provide operational details to support the CBHS Billing Guide and Program Guide. These guides and the sample documentation form are being updated and will be posted by in early January to clarify the information in this guidance document.
Re-tiering
The average hours of CBHS services rendered monthly should align with the client’s authorized tier. If a facility believes a client is inappropriately authorized in a tier, it should submit the Supportive Supervision Re-Tiering Request Form.
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