CAMHPRO Peer Certification SB 614 Update & Input Meeting

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1 CAMHPRO Peer Certification SB 614 Update & Input Meeting July 14, 2016 Karin Lettau, MS, Director of Training & Employment, CAMHPRO Please follow us and like us on Face Book Market St., Suite 922; San Francisco, CA (415) see our new website:

2 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

3 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

4 Defining Peer Support as a Distinct Practice A relationship of mutual learning Key principles are hope, equality, respect, personal responsibility and self-determination Therapeutic interactions between people who have a shared lived experience Key distinctions are: WHO does it and HOW the service is done. Peer Providers may also provide any other allowable mental health service to their scope of practice. A relationship without the constraints of the traditional expert/patient or expert/family member role Peer Support is differentiated from other mental health services such as: rehabilitation, targeted case management or collateral. 4

5 The Case for Certification Defines the service of peer support. Provides formal validation of the role of peer support. Assures that practitioners receive standardized training and demonstrate competency. Standardizes the quality of services provided by Peer Support Specialists that employers can rely on. Certification is portable to any CA county. Provides a scope of practice that service recipients can benefit from. Can be utilized as a basis for the ability to bill Medi-Cal for services provided. 5

6 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

7 Official National & State Certifications 42 States & D.C. have State Certified Peer Specialists protocol 4 States in process of developing State protocol for certifying peers 14 States have State Certified Family or Parent Specialists Billing Medicaid for Peer Services is the primary impetus U.S. Veterans Administration Certifies Peer Specialists o Employs over 1,000 Peer Specialists (5 grades) The International Association of Peer Specialists (INAPS) develops competencies for international Peer Certification SAMHSA drafted 62 Competencies for Peer Support workers in behavioral health (2015) CA could be the first state in the nation to adopt certification for peer providers across the life span. Over 30 states have unique peer support Medicaid billing codes 7

8 Peer Specialist Training and Certification 2014

9 Medicaid Billing for Mental Health Peer Provider Services by State 2014 Over 30 States have unique Peer Specialist Service Medicaid Billing Codes 9

10 Example: Georgia Certified Specialists bill Structured activities that promote socialization, recovery, wellness, selfadvocacy, 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

11 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

12 Oregon Certified Peer Specialists bill Peer Delivered Services means an array of agency or communitybased 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

13 Impactful Outcomes Certified Peer Specialist Services result in substantial savings by reducing the high-cost of care 13

14 Peer Certification Movement in California Originally evaluated by California Network (CNMHC) Working Well Together (WWT) ( ) 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

15 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 hours. Only 5 of the 31 Counties required training prior to hire. 15

16 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

17 WWT Stakeholder Process & Involvement Used multiple methods of gathering input, including four research reports & Written surveys Focus groups Comment and question sessions in face-to-face meetings Webinars 4 Specialized workgroups & monthly teleconferences 165 people attended five regional stakeholder meetings 223 people attended the Statewide Summit in May, Vetted the recommendations at this meeting utilizing a modified consensus model. On-going monthly teleconferences Member list has over 700 people Resulted in 17 Stakeholder Recommendations for CA Peer/Family Specialist Certification, mostly reflected in SB

18 Key CA Peer Specialist Vetted Documents Four Research & Stakeholder Recommendations Reports, links: 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

19 California Medi-Caid (MEDI-CAL) Billing Practices Current State Medi-Cal Plan allows billing under rehabilitation, targeted case management and collaterals provided by Other Qualified Providers, which includes Peer Specialists. Each County Mental Health Director has discretion to use more strict guidelines than required by the State Plan. Only a few counties currently allow peer specialists to bill under existing codes. Even counties allowing peers to bill under existing codes, lose at least 25% of billing ability because some peer services provided are not billable under current codes Free-standing Peer or Family Run agencies cannot bill currently SB 614 would create a distinct peer specialist provider and service type for these unique services, adding Medi-Cal reimbursement to counties for peer services already being provided It would be up to the Dept. Health Care Services (DHCS) to create new billing 19

20 SB-614--Where are we now? Still inactive 20

21 SB 614 Negotiations DHCS Refuses to create unique Peer Support Service/Provider billing codes. Submitted technical amendments to CBHDA Considered CBHDA and submits final changes with minor concessions CBHDA CBHDA makes recommendations in response to DHCS CBHDA had Stakeholder meeting held 5/31/16 to review changes. CBHDA met with Stakeholder leaders on DHCS version in late June Stakeholders voted to NOT support DHCS amendments Stakeholders Want progress without compromising the integrity of genuine peer support services and specialists -Accurate definitions of peer support specialist and others -Stakeholder involvement -Multiple trainers -Grandfathering in -Requirements for Cert. -Use of best practices 21 -Tied to the MHSA & funding

22 Bottom Line Since Last Month Indicators are the County BH Directors Assoc. (CBHDA), sponsor of bill SB 614, will NOT go with the Dept. of Health Care Services (DHCS) technical amendments that would butcher the bill, but CBHDA has not decided yet. If so, the author Senator Leno could push the bill through anyway, as it currently reads but face a veto from Governor Brown, since DHCS will not support this. If vetoed, it would make it very difficult to pass a new version or rendition of the bill in future legislative sessions. It may be best to pull the bill this session and start over for a chance to pass a new version of the bill. 22

23 Bottom Line Since Last Month Since DHCS will NOT support new unique billing for peer support, an integral part of the current bill, DHCS would not be needed in a new bill. A new State Peer Certification legislative proposal could omit DHCS & omit the new billing to focus on the other key elements of the current bill. If so, WE WILL NEED ALL OF YOUR SUPPORT & ACTIVE INVOLVEMENT TO GET A LEGISLATIVE PROPOSAL READY BY JAN, 2017, REFLECTING THE 17 RECOMMENDATIONS MADE BY OVER 700 STAKEHOLDERS. VIEW 23

24 Supporters of Bill as amended Aug., 2015 Include: County Behavioral Health Directors Association of California (sponsor) Association of California Health Care Districts CA Association of Mental Health Peer- Run Organizations CA Association of Social Rehabilitation Agencies CA Mental Health Oversight & Accountability Commission CA Council of Community Mental Health Agencies CA State Association of Counties Disability Rights California National Alliance on Mental Illness California Pacific Clinics Peers Envisioning and Engaging in Recovery Services (PEERS) REMHDCO Sacramento County Board of Supervisors SEIU California Steinberg Institute Western Center on Law and Poverty United Advocates for Children & Families 24

25 Senate Bill 614 introduced in 2015 by Senator Mark Leno (D) as Amended 8/31/15 Called peer, parent, transition-age, and family support specialist certification program o DHCS would create Certification by July, 2017, Sponsored by CBHDA o Statewide certification for: Adult peer specialists, 18 years of age or older Parent peer support specialists Transition-age Youth Peer Support Specialists (18 or older) Family Peer support specialists Department of Health Care Services (DHCS) would administer Amendments pending: Removal of categories? to be placed under specialties Removal of substance use references? 25

26 SB 614 Certification Requirements as of 8/31/15 Amendments Be at least 18 years of age. (will add HS Diploma or GED?) Have/had a primary diagnosis of mental illness, substance use disorder, or both, which is self-disclosed. (or to be family member of adult or parent of child/youth) Have received/is receiving MH services, substance use disorder services, or both. Be willing to share his or her experience of recovery. Demonstrate leadership & advocacy skills. Have a strong dedication to recovery. Agree to uphold and abide by a code of ethics. Successful completion of the curriculum and training requirements for peer/family support specialist. Pass a certification exam approved by DHCS for peer/family support specialist. Successful completion of required continuing education, training, & recertification Grandfathering-in process 26

27 SB 614 (Leno-D) Continued Would amend Medicaid state plan allowing Medi-Cal billing to include peer and family support specialist as Provider TYPE and as Provider Service Will be amended out. May emphasize the ability for peer providers to bill under EXISTING billing codes, already allowable if County BH Director of each county permits. Could use Mental Health Services Act funds, and WET resources to develop and administer Program? Could enter into exclusive or nonexclusive contracts on a bid or negotiated basis, including contracts for the purpose of obtaining subject matter expertise or other technical assistance. Contracts may be statewide or on a more limited geographic basis? 27

28 Life Cycle SB 614 (Leno-D) CNMHC & WWT Stakeholder Input Legislative proposal CBHDA sponsors Stakeholders Senate Senator Leno authors SB 614 & intros bill Passes Senate unanimously 6/1/15 Goes to Assembly Passes 2 Committees Ordered to 3 rd Reading on floor 9/1/15 Ordered to Assembly Inactive file 9/3/15 Assembly Governor signs or dies CNMHC=CA Network of MH Clients WWT=Working Well Together CBHDA= County BH Directors Association 28

29 Major Challenges & Roadblocks The Division of Government & Legislation--Lines Blurred 29

30 Our State System State Legislature: Senate & Assembly Governor CA BH Directors Association (CBHDA) State Health & Human Svcs (CHHS) MH Services Oversight & Accountability Commission (MHSOAC) OSHPD Heath Planning & Dev. Dept. of Public Health (CDPH) Dept. of Health Care Services (DHCS) Office of Health Equity (OHE) CA MH Planning Council (CMHPC) Mental Health & Substance Use Services CA Health Facilities Financing Authority

31 Last month s polling results 37 Attendees polled 31

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36 POLLING YOUR PRIORITIES What are your priorities: 36 Poll 5-8

37 How Can We Advocate for State Peer Certification? Budget for, or ask your agency to budget discretionary funds and time for advocacy activities Attend State and County meetings and speak up Participate on workgroups to support activities/legislation Letters to editors of publications Meet with legislators and government officials Attend CAMHPRO Day at the Capitol in May Organize a local rally or sit-in Educate continuously Social Media: Facebook, Twitter 37

38 Advocacy Avenues Individual Agency or Group County Regional State Letter, to, or meeting with lawmaker, gov t official, or to Editor Unless contracts prohibits Often prohibited CBHDA Rally, Sit-in Info & input webinars Media, social Poll 9-10 media 38

39 How to Track a Legislative Bill CA Legislative Info.website Go to Bill Information, enter bill number or key word Click on bill # View Tabs Click on Track Bill Register for notice of changes to bill address only required Create password to log in 39

40 Advocacy Alert: MHSOAC July Meeting MHSOAC Commission Meeting July 28, :00 am 1325 J St, Suite 1700 Sacramento, CA Call-In Number: Participant Code:

41 Thank you for your commitment and action! Next Peer Certification Update Webinar 2 nd Thursday, August 11, 2016 at noon If you are registered you will be reminded Registration URL:

42 References Specialist-Training-and-Certification-Programs-A-National-Overview Update.pdf Using Peers to Support Physical and Mental Health Integration for Adults with Serious Mental Illness Jan 2016, The National Academy for State Health Policy Chapman, S., Blash, L., and Chan, K. (2015). The Peer Provider Workforce in Behavioral Health: A Landscape Analysis. San Francisco, CA: UCSF Health Workforce Research Center on Long-Term Care. rt-peer_provider_workforce_in_behavioral_health- A_Landscape_Analysis.pdf 42