CAMHPRO Peer Certification SB 614 Update & Input Meeting July 14, 2016 870 Market St., Suite 922; San Francisco, Karin Lettau, MS, Director of Training & Employment, CA 94102 ▪ (415) 341-9460 ▪ Please follow us and like us on Face Book CAMHPRO klettau7@gmail.com see our new website:http://camhpro.org/ https://www.facebook.com/camhpro
California Association of Mental Health Peer Run Organizations (CAMHPRO) • Non profit statewide organization of consumer run programs and individuals…to empower, support, and ensure the rights of consumers, eliminate stigma, and advance self-determination for all those affected by MH issues… • Promotes involvement of consumers at all levels of planning, policy, and programming for MH and related systems. • Poll 1-4 2
Peer Support Guiding Values: • Core belief systems and worldview • People can and do recover from psychiatric difficulties • To help others is to also help one’s self • Choice, empowerment, and responsibility • Acceptance and respect for diversity • Reciprocity, mutuality in relationships • Social action 3
Defining Peer Support as a Distinct Practice • A relationship of mutual learning • Peer Providers may also provide any other allowable mental health • Key principles are hope, equality, service to their scope of practice. respect, personal responsibility and • A relationship without the self-determination constraints of the traditional • Therapeutic interactions between expert/patient or expert/family people who have a shared lived member role experience • Peer Support is differentiated from • Key distinctions are: WHO does it and other mental health services such HOW the service is done. as: rehabilitation, targeted case management or collateral. 4
The Case for Certification • Defines the service of peer • Certification is portable to any support. CA county. • Provides a scope of practice that • Provides formal validation of the service recipients can benefit role of peer support. from. • Assures that practitioners • Can be utilized as a basis for the receive standardized training ability to bill Medi-Cal for and demonstrate competency. services provided. • Standardizes the quality of services provided by Peer Support Specialists that employers can rely on. 5
CMS Guidelines to States Allowing Peer Specialist Billing • In 2007, the Centers for Medi-Care and Medi-Caid Services (CMS) disseminated a set of guidelines for states to establish Peer Providers and Peer Services as a unique Medi-CAL billable services. • Guidelines minimally require a State Plan to: 1. Train and Certify Peer Providers 2. Address the supervision of Peer Providers 3. Ensure care coordination in the context of a comprehensive and individualized plan of care with goals. 6
Official National & State Certifications • 42 States & D.C. have State Certified • The International Association of Peer Specialists protocol Peer Specialists (INAPS) develops competencies for international Peer • 4 States in process of developing Certification State protocol for certifying peers • SAMHSA drafted 62 Competencies • 14 States have State Certified Family for Peer Support workers in or Parent Specialists behavioral health (2015) • Billing Medicaid for Peer Services is • CA could be the first state in the the primary impetus nation to adopt certification for • U.S. Veterans Administration peer providers across the life span. Certifies Peer Specialists • Over 30 states have unique peer o Employs over 1,000 Peer support Medicaid billing codes Specialists (5 grades) 7
Peer Specialist Training and Certification 2014
Medicaid Billing for Mental Health Peer Provider Services by State 2014 Over 30 States have unique Peer Specialist Service Medicaid Billing Codes 9
Example: Georgia Certified Specialists bill • Structured activities that promote socialization, recovery, wellness, self- advocacy, development of natural supports, and maintenance of community living skills. • Activities provided between and among individuals who have common issues and needs, are consumer motivated, initiated and/or managed, and assist individuals in living as independently as possible. • Peer Support ( H0038 ),Psych rehab (H2017), Community support (H2015), ACT (H0039), • Health and Wellness Supports, (H0025) — Whole Health o Supporting the individual in building skills that enable whole health improvements 10
Michigan Certified Specialists bill • “Because of their life experience, Peer Support Specialists provide expertise that professional disciplines cannot replicate.” • Service Codes: • Assertive Community Treatment (ACT) H0039 • Peer-Directed and -Operated Support Services, H0023, H0038 , H0046 • H0023: Drop-in center 11
Oregon Certified Peer Specialists bill • “Peer Delivered Services” means an array of agency or community - based services and supports provided by peers, and peer support specialists, to individuals or family members with similar lived experience, that are designed to support the needs of individuals and families as applicable. • H2021 Community-Based Wraparound • H2027 Psycho-educational Services • H0038 Self-Help/Peer Support 12
Impactful Outcomes • Certified Peer Specialist Services result in substantial savings by reducing the high-cost of care 13
Peer Certification Movement in California • Originally evaluated by California Network (CNMHC) • Working Well Together (WWT) (2008-2014) Training and Technical Assistance Collaborative: CNMHC, then in 2012, CAMHPRO-PEERS - California Association of Mental Health Peer Run Organizations – Peers Envisioning and Engaging in Recovery Services NAMI California - National Alliance on Mental Illness - California UACF - United Advocates for Children and Families CiMH - California Institute for Mental Health 14
California Practices WWT 2012 Research: • Survey sent to 58 CA counties • Of 32 Counties responding to stakeholder survey • 31 reported Consumer, Family Members &/or Parent/Caregiver Peer Support Specialists are employed in their county. • Learned there is no statewide standard in job tasks, job training, job title • Only standard was that someone had “lived experience”. • Required training hours ranged from 12-480 hours. • Only 5 of the 31 Counties required training prior to hire. 15
CA 58 Counties = 58 Different Peer Standards • Many agencies/colleges offer “certificates” for completion of trainings/courses to become MH peer/family providers • These are NOT state recognized • Most counties employ/contract for peer, parent/family support specialist providers • But Most Counties… • require no training or require no training standardized to the role of peer/family/parent support specialist • if training exists it is mostly provided by clinicians/trainers not familiar with peer practices • have no practice guidelines • have no appropriate supervision requirements • don’t allow peer providers to bill under existing codes (rehab…) 16
WWT Stakeholder Process & Involvement 165 people attended five regional Used multiple methods of gathering input, including four research reports & stakeholder meetings 223 people attended the Statewide Written surveys Summit in May, 2013. Focus groups Vetted the recommendations at this Comment and question sessions meeting utilizing a modified in face-to-face meetings consensus model. Webinars On-going monthly teleconferences 4 Specialized workgroups & Member list has over 700 people monthly teleconferences Resulted in 17 Stakeholder Recommendations for CA Peer/Family Specialist Certification, mostly reflected in SB 614 17
Key CA Peer Specialist Vetted Documents • Four Research & Stakeholder Recommendations Reports, links: • https://camhpro.org/peer-certification-sb614/ • Definitions • Values & Code of Ethics • Informational Brief • Scope of Practice • 17 Recommendations • National Medicaid Peer Specialist Matrix • Consumer, Family Member & Parent or Caregiver Peer Specialist Training Crosswalk • Draft Core Content Areas & Competencies 18
California Medi-Caid (MEDI-CAL) Billing Practices • Even counties allowing peers to bill • Current State Medi-Cal Plan allows under existing codes, lose at least 25% of billing under rehabilitation, targeted billing ability because some peer case management and collaterals services provided are not billable under provided by “Other Qualified Providers”, current codes which includes Peer Specialists. • Free-standing Peer or Family Run • Each County Mental Health Director has agencies cannot bill currently discretion to use more strict guidelines • SB 614 would create a distinct peer than required by the State Plan. specialist provider and service type for these unique services, adding Medi-Cal • Only a few counties currently allow reimbursement to counties for peer peer specialists to bill under existing services already being provided codes. • It would be up to the Dept. Health Care Services (DHCS) to create new billing 19
SB-614--Where are we now? Still ‘inactive’ 20
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