Quick Answer
No. Homes are not tiered. Four separate systems get called tiers or levels: DSHS CARE classifications (A Low through E High) that set each Medicaid resident's base daily rate; CBHS supportive supervision tiers (1 through 6) for residents with qualifying behavioral health needs; owner-held specialty contracts such as ECS and SBS; and private-pay care levels each home sets for itself.
Owners talk about Tier 3 residents, C High, Level 4 care and the ECS contract as if they were one system. They are four, set by different agencies, attached to different things, and they behave differently when a home is sold.
A CARE classification is assigned by DSHS to every Medicaid resident and sets the base daily rate. A CBHS tier is a separate Health Care Authority benefit for residents with qualifying behavioral needs, defined by hours of dedicated staff supervision per day.
CARE classifications and CBHS tiers follow each resident. Specialty contracts such as ECS, SBS and Meaningful Day belong to the owner and do not transfer in a change of ownership. Private-pay rates are set by the home and can be changed by the next owner.
About the author: David Stein is a Washington State licensed real estate broker (eXp Realty, license #133972) and a Washington State certified residential appraiser (Stein Appraisal, license #1702080), with more than 20 years of experience in both disciplines. More about David.
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