BHDDH Funding Tiers and SIS-A Assessment in Rhode Island

How the SIS-A Assessment Works

After BHDDH confirms clinical eligibility for developmental disability services, the next step is the Supports Intensity Scale (SIS-A) assessment. This is a two-hour structured evaluation that measures the pattern, frequency, and intensity of support the individual needs across daily living activities.

The SIS-A is not an IQ test or a diagnostic evaluation — it's a support-needs assessment. It looks at how much assistance the person requires to complete tasks like managing personal hygiene, preparing meals, handling money, navigating community settings, and maintaining social relationships. The interviewer speaks with the individual and people who know them well (parents, caregivers, teachers) to build a complete picture.

The assessment results place the individual into one of five funding tiers, each carrying a different annual service budget.

The Five Funding Tiers

The tier determines the individual budget — the total dollar amount available annually for services. Higher tiers mean larger budgets, which fund more hours of direct support, more specialized staff, or more intensive residential arrangements.

Agency-Directed vs. Self-Directed Services

Once the tier and budget are established, families choose between two service delivery models:

Agency-directed services mean a licensed provider agency employs the direct-care workers, manages scheduling, handles payroll and training, and coordinates services under the Person-Centered Plan. The family works with the agency to shape the plan, but the agency handles the administrative side.

Self-directed services give the individual (or their family) direct control over hiring, scheduling, and managing support staff. Organizations like the Fogarty Center help families set up and manage self-directed budgets. The trade-off is more administrative work in exchange for more control over who provides the care and how it's delivered.

Self-directed budgets allow purchases of specialized goods and services through BHDDH's Flexible Budget Request Form, though modifications require a $325 plan modification fee from the individual's allocated DD service funds.

When the Tier Feels Wrong

Families sometimes feel the SIS-A assessment didn't capture their young adult's actual needs — maybe the person had a good day during the assessment, or the questions didn't address a specific behavioral pattern that causes real challenges in daily life.

Two paths for addressing this:

Request a reassessment. If circumstances have changed or you believe the original assessment was inaccurate, you can request a new SIS-A evaluation through BHDDH.

File a funding appeal. If you believe the tier assignment doesn't match documented needs, you can appeal to the BHDDH Review Committee. The appeal should include specific documentation: incident reports, medical records showing escalating needs, letters from current service providers describing the gap between what the current tier funds and what the individual actually requires.

The Rhode Island SSI at 18 & Adult Disability Benefits Guide includes a Work Incentive Planning Checklist and the BHDDH Dual-Agency Application Checklist that walks families through the SIS-A preparation process and documents what evidence to bring.

The 45-Day Person-Centered Plan Timeline

After tier assignment, a Conflict-Free Case Management (CFCM) agency develops the Person-Centered Plan (PCP). Under the EOHHS CFCM Program Manual V2.0 (effective December 2025), the case manager must initiate contact within 3 business days of assignment and submit the completed, signed PCP within 45 calendar days. If that timeline is slipping, push back — the CFCM Program Manual is specific, and delays here translate directly into delays in receiving services.

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