When You Receive a Waiver (Support Coordination, SIS, Levels, Tiers, Rates)
Support Coordination Services (case management) continues with a choice of support coordinators from CSB or private support coordination companies.
The Support Intensity Scale (SIS) Assessment is performed by Ascend, a contractor for the state to determine the individual’s support level.
Using the results of the SIS, DBHDS uses a formula to assign the individual’s support level and send the support level to the CSB.
The Support Coordinator convenes a person centered planning meeting to identify the supports and services needed for the individual. The planning meetings occur at least once a year. At any time new services can be requested or explored.
If there are barriers to accessing services, request that the support coordinator contact the Community Resource Consultant (CRC). If the CRC is unable to address the barrier then a referral should go to the Regional Support Team (RST).
What is the SIS?
The Supports Intensity Scale or “SIS” is a standardized assessment tool used to determine the support level of individuals receiving waiver services.
For adults it is performed every three years or sooner if there are significant changes in the individual’s situation such as medical circumstances.
For children the SIS is performed every two years.
The SIS measures the individual’s support needs in the areas of home living, community living, lifetime learning, employment, health and safety, social activity, and protection and advocacy
DBHDS uses a formula to assign a “SIS Score” and support level. The Support Level is tied to a reimbursement rate to providers.
Two weeks after the SIS is performed ask the CSB for the SIS score and the Support Level.
The SIS score is not appealable; only the standard operating procedures can be appealed.
Support Levels and Reimbursement Tiers
The SIS score places an individual into a Support Level. The Support Level reflects the level of need an individual has.
There are 7 support levels and 4 reimbursement tiers:
Tier 1: Support Level 1
Tier 2: Support Level 2
Tier 3: Support Level 3 & Level 4
Tier 4: Support Level 5, Level 6 & Level 7
Some services have tiered reimbursement rates:
- Group Home
- Sponsored Residential
- Supportive Living
- Independent Living (*2 tiers)
- Group Day Services
- Community Engagement
- Group Supportive Employment
Reimbursement increases based on the support level of an individual.
Reimbursement decreases based on the size of the licensed home of the number of people supported.
The goal is to incentivize access to smaller, more individualized person centered supports.
ROS = Rest of the state; NOVA = Northern Virginia