I am the Supervisor for the SMI, SED and SUD case management team with the Eastern Shore CSB.  So, my comment is from experience serving individuals who struggle with SMI, SED and SUD.  I have concerns regarding the tiered case management system.  Given the nature of SMI, SED and SUD, an individual's level of functioning can fluctuate due to various factors, including stressors, changes in medication, or life events.  The nature of SMI, SED and SUD makes it challenging to categorize individuals into fixed tiers.  A tier system may not adequately accommodate the changing needs of individuals.  Case managers should have the flexibility to adjust levels of service based on real-time needs rather than relying solely on predetermined tiers.  Individuals assessed at a lower level tier would be at risk because the unpredictable nature of SMI, SED and SUD is not taken into account when assigning a person to a rigid tier system.