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from scores on all the items tested by the Scale. These results are organized into service classifications -- "tiers" -- that correspond to level of need and the available service options. 2. Situational Assessment of Need (SAN) -- The SAN is used to determine if a person with high needs levels requires the 24-hour supervision of a group home or shared living settings by evaluating behavioral health and legal risk factors. If the results of the SAN demonstrate that the person requires 24-hour supervision, then the beneficiary may be offered the option of placement in a community group home or shared living setting. The service options available do not change with the new placement, however. 5.7.3 Service Classifications A. The service classifications for Medicaid for LTSS for adults with disabilities are the tiers generated by the SIS assessment of needs levels. 1. Needs levels and associated tiers --The SIS assessment results are categorized as follows: a. Tier A (High)- Qualifying Disability with mild support needs b. Tier B (High)- Qualifying Disability with moderate support needs c. Tier C (Highest)- Qualifying Disability with identified medical/behavioral needs requiring significant supports d. Tier D (Highest)- Qualifying Disability with extraordinary medical issues requiring significant medical supports e. Tier E (Highest)- Qualifying Disability with extraordinary behavioral issues requiring significant behavioral supports 2. Service classifications -- The State has established service classifications based on the SIS tiers: a. Highest level of need. Tiers E, D and C: (1) Tier E (extraordinary needs) -- Adults at this tier have extraordinary behavioral issues requiring significant behavioral supports including one-to-one supervision for at least a significant portion of each day. Many persons at this tier have a mental health condition in addition to a developmental disability and may pose a safety risk to themselves and/or the community without continuous on-site support.