Karin Lettau, MS, Director of Training & Employment, CAMHPRO

Transcription

1 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. 2

3 In US, CA is in Dark Ages on Peer Certification In CA, many agencies/colleges offer certificates for completion of trainings/courses to become MH peer/family providers These are NOT state recognized In CA a State peer support certification process does NOT exist Now 42 states plus the District of Columbia and the VA system have implemented protocols to certify peer specialists Four additional states are in the process of creating certification programs CA is thus one of only four US states without a state protocol plan for peer certification in mental health SB 614 Peer, parent, transition-age, and family support specialist certification program passed CA Senate and was about to pass Assembly. Now inactive State Agencies are holding up progress on peer certification 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 Peer Specialist vs CPRP Services Similar recovery, resiliency, and strengths-based approach, similar Codes of Ethics Differences Peer Specialists use their lived experience to connect with person, to demonstrate the use of one s strengths, and to encourage and inspire those they support. tell strategic stories of their personal recovery in relation to current struggles faced by those who are being supported. model recovery behaviors at work and act as ambassadors of recovery in all aspects of their work. Views and accepts the whole person, is curious 5

6 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 6

7 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 614 7

8 California Practices 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. 8

9 CA 58 Counties = 58 Different Peer Standards 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 ) 9

10 Key CA Peer Specialist Vetted Documents 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 10

11 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. 11

12 US Centers for Medicaid (Medi-CAL) (CMS) Peer support providers are a distinct provider type for the delivery of counseling and other support services to Medicaid eligible adults with mental illnesses and/or substance use disorders. CMS recognizes that the experiences of peer support providers, as consumers of behavioral health care services, can be an important component in a State's delivery of effective treatment. (2007) 12

13 California Medi-Caid (MEDI-CAL) Billing Practices Current State Plan allows billing for 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 13

14 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. 14

15 Official National & State Certifications 42 States & D.C. have State Certified Peer Specialists 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. 15

16 Peer Specialist Training and Certification 2014

17 Medicaid Billing for Mental Health Peer Provider Services by State 2014 Over 30 States and DC have unique Peer Specialist Service Billing Codes 17

18 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 18

19 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 19

20 Kansas Certified Specialists bill Help the member to develop a network for information and support from others who have been through similar experiences Assist the member with regaining the ability to make independent choices and to take a proactive role in treatment, including discussing questions or concerns about medications, diagnoses or treatment approaches with the treating clinician Assist identifying and effectively responding to or avoiding identified precursors or triggers that result in functional impairments H0038 Peer Support Individual H0038 HQ Peer Support Group 20

21 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 21

22 Impactful Outcomes Certified Peer Specialist Services result in substantial savings by reducing the high-cost of care 22

23 Senate Bill (h) Intent It is the intent of the Legislature that the peer, parent, transitionage, and family support specialist certification program achieve all of the following Encourage employment to reflect the culture, ethnicity, sexual orientation, gender identity, mental health service experiences, and substance use disorder experiences of the people whom they serve. 23

24 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 o 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 24

25 Supporters 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 25

26 SB 614 Content as Amended 8/31/15 Would amend Medicaid state plan allowing Medi-Cal billing to include peer and family support specialist as Provider TYPE and as Provider Service 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. 26

27 SB 614 Certification Requirements as of 8/31/15 Amendments Be at least 18 years of age. 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 TBD 27

28 SB-614--Where are we now? Still inactive 28

29 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 29

30 Major Challenges & Roadblocks 30

31 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

32 SB 614 Negotiations DHCS CBHDA? Stakeholders Refuses to open State Plan to create unique Peer Support Service/Provider billing codes. Submitted technical amendments to CBHDA CBHDA makes recommendations in response to DHCS 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 Tied to the MHSA & funding 32

33 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 33

34 How Do We Advocate for SB 614? Attend State meetings and speak up Write letters we have been called on to write at least 1,000 letters Call, Fax Letters to editors of publications Meet with legislators and government officials Organize a local rally or sit-in Social Media: Facebook, Twitter 34

35 Advocacy Avenues Individual Agency or Group County Regional State Letter, to lawmaker, gov t official, or to Editor Unless contracts prohibits Often prohibited CBHDA Rally, Sit-in Info & input webinars Media, social media 35

36 Who Do We Advocate To? Governor Jerry Brown CA Health & Human Services, Secretary Diana Dooley Dept. of Health Care Services, Director Jennifer Kent Your individual CA Representatives and Senators Find your representative 36

37 Contact Governor Jerry Brown Phone: Mailing address c/o State Capitol, Suite 1173, Sacramento, CA FAX:

38 Contact CA Health & Human Services Secretary Diana S. Dooley Phone: Mailing address: 1600 Ninth St., Room #460, Sacramento, CA Fax:

39 Contact Dept. of Health Care Services Director Jennifer Kent Phone: Mailing Address: PO BOX , Sacramento, CA

40 Bill Author Senator Mark Leno Contacts sd11.senate.ca.gov Fax Leno s Aide on SB 614: Sunday Balalis: Sunday.balalis@sen.ca.gov 40

41 Advocacy Alert: MHSOAC MHSOAC Commission Meeting April 28, 2016 Calaveras County Health & Human Services Agency Sequoia Community Meeting Room, 509 East St. Charles Street, San Andreas, CA Call-In Number: ; Participant Code:

42 CAMHPRO Day at the Capitol April 21, pm 42

43 CAMHPRO Inaugural Annual Conference Unify! Act! The Time is Now! April 22 April 23, Sacramento Registration Packet PDF Register Online at Eventbrite Rush Registration (April 1 April 19): $ Onsite Registration: $

44 Thank you for your commitment and action! Next Peer Certification Update Webinar 2 nd Thursday, May 12, 2016 at noon If you are registered you will be reminded CAMHPRO Public Policy Committee on Peer Certification Meeting 2 nd Wednesday, 4pm Use your microphone and speakers (VoIP) - a headset is recommended. Or, call in using your telephone. Dial +1 (646) , Access Code:

45 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 45