Providing Youth and Young Adult Peer Support through Medicaid RESOURCE AUGUST 2016

Transcription

1 RESOURCE Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid AUGUST 2016 Dayana Simns Taylr Hendricks Jessica Lipper Center fr Health Care Strategies Jhanna Bergan Brianne Masselli Yuth M.O.V.E. Natinal

2 The Natinal Technical Assistance Netwrk fr Children s Behaviral Health (TA Netwrk), perates the Natinal Training and Technical Assistance Center fr Child, Yuth, and Family Mental Health (NTTAC), funded by the Substance Abuse and Mental Health Services Administratin, Child, Adlescent and Family Branch t prvide training and technical assistance t states, tribes, territries and cmmunities funded by the Cmprehensive Cmmunity Mental Health Services fr Children and Their Families Prgram, as well as jurisdictins and entities withut system f care grants, including yuth and family leadership and rganizatins. This resurce was prduced by the Center fr Health Care Strategies (CHCS) and Yuth M.O.V.E. Natinal (YMN) in their rle as a cre partners in the TA Netwrk. CHCS is a nnprfit health plicy resurce center dedicated t advancing health care access, quality, and cst-effectiveness in publicly financed care. CHCS wrks with state and federal agencies, health plans, prviders, and cnsumer grups t develp innvative prgrams that better serve peple with cmplex and high-cst health care needs. YMN is a yuth led natinal rganizatin devted t imprving services and systems that supprt psitive grwth and develpment by uniting the vices f individuals wh have lived experience in varius systems including mental health, juvenile justice, educatin, and child welfare. YMN wrks with yuth, prviders, families and ther adults t: prvide cnsultatin and caching; create yuth mvement principles and plicies; develp training tls and resurces; unite the vices and causes f yuth and prvide natinal yuth leadership representing yuth served by mental health and ther yuth-serving systems. This dcument was prepared fr the Natinal Technical Assistance Netwrk fr Children s Behaviral Health under cntract with the U.S. Department f Health and Human Services, Substance Abuse and Mental Health Services Administratin, Cntract #HHSS C. Hwever, these cntents d nt necessarily represent the plicy f the U.S. Department f Health and Human Services, and yu shuld nt assume endrsement by the Federal Gvernment. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 2

3 Cntents Intrductin... 4 Defining Yuth Peer Supprt... 4 Distinguishing Yuth Peer Supprt frm Adult r Parent/Caregiver Supprt... 4 Understanding the Rle f Medicaid... 5 Key Cnsideratins befre Becming a Medicaid Prvider... 5 Weighing the Optins... 5 Understanding State Medicaid Prgrams... 6 Cllabrating with Gvernment Agencies and Prviders... 7 Wrkfrce Cnsideratins... 8 Yuth Engagement... 8 Training and Credentialing... 8 Retaining and Supervising Staff... 9 Meeting Medicaid Reprting Requirements... 9 Medicaid Billing and Rates... 9 Understanding Medicaid Rates Establishing Billing Prcesses Auditing Cnclusin State and Cmmunity Snapshts: Yuth Peer Supprt as a Medicaid-Funded Service STATE: Gergia STATE: Kentucky STATE: Massachusetts STATE: Mississippi STATE: Oklahma STATE: Oregn STATE: Pennsylvania Appendix A Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 3

4 Intrductin Parent and Yuth Peer Supprt Services Defined Defining Yuth Peer Supprt Parent and yuth supprt services include Acrss child- and adult-serving systems, there is develping and linking with frmal and infrmal interest amng cmmunities and rganizatins t supprts; instilling cnfidence; assisting in the prvide transitinal supprt t yung adults with a develpment f gals; serving as an advcate, strng fcus n yuth peer supprt (YPS). Often mentr, r facilitatr fr reslutin f issues; and rganizatins that prvide parent/caregiver and teaching skills necessary t imprve cping abilities. adult peer services are interested in adding YPS t The prviders f peer supprt services are family their array f services. Many f the cnsideratins members r yuth with lived experience wh and lessns learned in the implementatin f parent have persnally faced the challenges f cping with peer supprts can be useful t rganizatins in serius mental health cnditins, either as a cmmunities and states building YPS. 1 Hwever, it cnsumer r a caregiver. These peers prvide is imprtant t nte that these tw supprts are supprt, educatin, skills training, and advcacy in ways that are bth accessible and acceptable t distinct in their appraches t training, hiring, and families and yuth. supervisin practices because yuth peer prviders are individuals wh are wrking t maintain May 2013 Jint CMCS and SAMHSA Infrmatinal persnal wellness while als prviding supprts. In Bulletin n Cverage f Behaviral Health Services fr additin, as recipients f services they ften Children, Yuth, and Yung Adults with Significant experience systems and cultures differently. YPS Mental Health Cnditins spans bth child- and adult-serving systems t supprt successful transitin. The ppulatin receiving the supprt (i.e., yung adults) is unique, and YPS must be develpmentally apprpriate, useful, and appealing t yung adults in transitin. Because peer services fr individuals with behaviral health needs have been defined in multiple ways, and peer prviders are called upn t prvide a range f services, it is essential t establish a cmmn definitin fr YPS services and yuth peer prvider. In May 2013, the Centers fr Medicare & Medicaid Services (CMS) and the Substance Abuse and Mental Health Services Administratin (SAMHSA) issued a jint infrmatinal bulletin 2 with guidance fr states arund establishing a Medicaid benefit fr children, yuth, and yung adults with significant mental health cnditins. The bulletin highlighted parent and yuth peer supprt services as an imprtant service fr this ppulatin and referenced clarifying guidance n peer supprt services t further address the scpe and access f peer supprt services. Distinguishing Yuth Peer Supprt frm Adult r Parent/Caregiver Supprt YPS uses bth lived experience within the child serving systems, and ften in the adult system, as well as skills learned in frmal training, t deliver services t yung adults f transitin age. Shifts in systems and practice ccurring ver the past decade (e.g., decreased use f ut-f-hme placements and increased cmmunity based and hlistic appraches t mental health) have impacted the experience f yuth and yung adults invlved with the mental health system. These shifts in practice have shaped the systems that YPS must navigate tday that are different frm thse navigated by the family mvement and the adult peer mvement in the past. YPS ffers a unique pprtunity t supprt yung adults in transitin t adulthd by cllabrating acrss child and adult systems. As yung adults mve frm receiving care in the child serving system t accessing services within the adult system r graduate frm system invlvement, YPS can be the bridge that ensures a smth transitin. Therefre, YPS prviders must understand bth the child- and adultserving systems as they functin tday and the resurces available in each. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 4

5 Understanding the Rle f Medicaid Medicaid the natin s health insurance prgram fr lw-incme individuals can play an imprtant rle in financing YPS. A number f states are wrking tward establishing yuth/yung adult peer supprt as a Medicaid-cvered service, distinct frm adult r family/caregiver peer supprt. States can establish Medicaid cverage fr YPS thrugh state plan amendments r waivers. A state Medicaid plan is the cntract between a state and the federal gvernment thrugh which the state agrees t administer the Medicaid prgram in accrdance with federal law and plicy. The plan utlines the scpe f the Medicaid prgram, including cvered individuals and services and payment plicy. A state plan can be amended t add services r make ther changes, which are then subject t apprval by the Centers fr Medicare & Medicaid Services (CMS). States can include yuth/yung adult peer supprt as a billable service via state plan amendment, allwing any Medicaid-eligible yuth in the state t receive this service. States may als chse t fund peer services fr yuth and yung adults using Medicaid administrative funds r the Medicaid rehabilitative services ptin 3 bth f which have implicatins fr the scpe and definitin f the services prvided. Waivers are vehicles states can use t test new r existing mdels f service delivery and payment, allwing Medicaid t pay fr additinal services nt cvered in the state plan r that are therwise ineligible fr federal matching funds. Waivers are financed using state and federal mney and must be apprved by CMS. Key Cnsideratins Befre Becming a Medicaid Prvider Weighing the Optins The decisin t ffer YPS requires cnsideratin f several key issues. One ptin available t rganizatins is funding YPS thrugh the Medicaid service delivery system. Agencies prviding YPS shuld cnsider all f the pprtunities and challenges assciated with becming Medicaid prviders f YPS services and ensure that yuth are engaged in the prcess early, ften, and n every level. CONSIDERATION: Training What D Yuth Peer Supprt Prviders D? Prvide ne n ne supprt and encuragement t yung adults; assist with gal setting and identificatin f psitive envirnments and resurces; advcate fr yuth in team meetings; and participate as requested in meetings and services. Facilitate grup meetings f yung adult peers. Cnduct utreach in the cmmunity; and prvide educatin n yuth engagement, yuth peer supprt, and recruitment f yung adults t access available supprts and services. Advcate fr yuth vice and the value f lived experience within agencies, cmmunities, and systems. Training fr yuth peer prviders must build n the systems knwledge and shared experience that each brings t the wrk. When develping curriculum and training pprtunities fr YPS prviders, rganizatins must cnsider hw the cntent is presented and adapted t meet the learning styles and develpmental needs f individuals with lived experience. Training shuld include explratin f safe sharing f lived experience fr yuth peers and hw shared experience can be used t build mutuality and cnnectin. Agencies hiring yuth peer prviders must als prvide training t all staff within the agency abut the rle and added value f YPS, and the agency s leadership must ffer supprt as yuth peer prviders are added t the staff. CONSIDERATION: Defining the Rle It is imprtant t cnsider the rle f the yuth peer prvider as bth filling a prfessinal service rle t supprt yuth and as an individual wh is currently wrking t maintain wellness and transitin t Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 5

6 adulthd themselves. The rle and respnsibilities f peer prviders must be understd by all agency staff in rder fr peer supprt t be effective. Agencies with an rganizatinal culture that values lived systems experience and yuth vice are supprtive envirnments fr yuth peer prviders and may help increase staff retentin. Opprtunities fr Relatinship Building CONSIDERATION: Defining the Service Yuth Pwer New Yrk and Yuth M.O.V.E. Maine have representatin n YPS can be ffered in a variety f ways; it can be their states blck grant cmmittees. categrized as indirect supprt, which is based in the cmmunity and can be available t a large ppulatin f yung adults, r as direct supprt ffered in service settings. Direct peer supprt is a frmalized service that has a specified threshld f requirements bth fr the yuth peer prviding the service and fr the yuth receiving it. Prviders f direct peer supprt must be trained, and may smetimes be certified and hired within service settings. Yuth accessing these services must meet eligibility criteria fr service, which ften includes a mental health r substance use diagnsis r c-ccurring mental health and substance use diagnsis, as well as ther categrical requirements. Suth Carlina s System f Care, a leader in advancing a yuth peer supprt apprach, has a strng, cllabrative relatinship with Medicaid and yuth representatives. CONSIDERATION: Financing and Sustainability Maine s Financing Strategy Financial sustainability f YPS prgrams is imprtant fr states and agencies t cnsider beginning in the planning prcess. Medicaid billing ptins explained thrughut this guide as well as lking at ther creative funding mechanisms t ensure sustainability shuld be explred. Creative funding ptins seen in states currently pilting YPS include the use f blck grant dllars and redeplyment f state general funds. Prviders als have ptins t cnsider when financing YPS such as the use f grant and fundatin funding. Additinal cmpnents t factr int financing and sustainability include the csts f training and curriculum develpment that may nt be billable t Medicaid; determining wh will train yuth peer prviders; and wrkfrce develpment and retentin f yuth peer prviders. CONSIDERATION: Wrkplace Culture Maine utilizes mental health blck grant funding t supprt a variety f peer delivered services in the adult mental health system as well as cmmunity based, family driven prgrams. These funds have been used t build infrastructure supprt fr the develpment f a statewide yuth mvement in Maine by allwing funds t be used t hire staff; design frmal and infrmal cmmunity based, yuth led prgraming; and establish yuth peer supprt prgrams. Maine currently disburses all blck grant dllars evenly (50/50) between child mental health and adult mental health systems and uses a large prtin f thse funds t supprt the family, peer and, yuth mvements within the state. The readiness f agencies t supprt yuth peer prviders is largely based n the culture f the wrkplace. Key cmpnents include plicies and practices that are welcming and supprtive f individuals newly entering the wrkfrce, value placed n lived experience and yuth vice, and the ability t be flexible and adaptable in supprting the yuth peer prviders. Organizatins shuld demnstrate an understanding f the values and principles f yuth driven care and YPS, in additin t recgnizing the value added by peers in the service setting. Understanding State Medicaid Prgrams Each state administers its wn Medicaid prgram, with partial funding frm the federal gvernment (called Federal Medical Assistance Percentage (FMAP) r federal match ), which means that the structure and financing fr Medicaid prgrams may lk very different frm state t state. In sme states, Medicaid perates primarily under a fee-fr-service structure, where prviders are reimbursed Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 6

7 directly by Medicaid fr services delivered t beneficiaries. Increasingly, hwever, states are establishing Medicaid managed care arrangements fr all r a subset f their Medicaid recipients thrugh which the state cntracts with ne r mre managed care rganizatins (MCOs) t prvide a range f services t beneficiaries under a fixed rate (i.e., capitatin) thrugh a netwrk f MCO cntracted prviders. Bth f these arrangements have implicatins fr the number and types f yuth and yung adults that an rganizatin may serve. Understanding hw a particular state s Medicaid prgram wrks invlves researching the state s plicies and engaging with state partners especially the Medicaid agency. Medicaid funds are used differently frm state t state. In sme states, rganizatins may bill the state directly as Medicaid prviders, while in thers, these rganizatins deliver direct peer supprt services thrugh sub-cntracts with traditinal prviders wh bill Medicaid. In sme states, the rganizatin prviding YPS services may be funded with Medicaid administrative dllars, which is nt technically cnsidered billing Medicaid because n claims are submitted. There are states (e.g., Massachusetts and Gergia) where peer supprt (but nt necessarily specifically YPS) is a stand-alne service, and states (e.g., Califrnia) where peer supprt is a cmpnent f anther service (e.g., cmmunity supprt r case management). States can als establish Medicaid cverage fr YPS thrugh state plan amendments r waivers. State Medicaid plans serve as the cntract between a state and the federal gvernment whereby the state agrees t administer the Medicaid prgram in accrdance with federal law and plicy. The plan utlines the scpe f the Medicaid prgram, including cvered grups and services, and payment plicy. Under the Medicaid State Plan, states can include YPS as a billable service, allwing any Medicaid-eligible child, yuth, r yung adult t receive this service. States may fund YPS services thrugh 1915(c) hme- and cmmunity-based services (HCBS) waivers, which allw fr the prvisin f lng-term care services in hme- and cmmunity-based settings. 4 States can prvide a cmbinatin f standard medical and nn-medical services thrugh HCBS waivers, and can prpse services t divert and/r transitin individuals frm institutinal settings int their cmmunities. Waiver funding includes state and federal mney, and the Medicaid waiver plan must be apprved by CMS. Cllabrating with Gvernment Agencies and Prviders Effective wrking relatinships with state agencies and prvider systems are vital fr rganizatins lking t becme Medicaid prviders f YPS. Ideally, the transitin t becming a Medicaid prvider will nt adversely influence relatinships that have already been built, but will ptentially enhance them. It is imprtant t ensure that the yuth vice is represented at decisin-making tables within the rganizatin and yung adults are included in relatinship building with state agencies and prvider systems. Hw Medicaid Is Billed fr YPS Agencies are billing Medicaid fr yuth peer supprt in multiple ways. Yuth M.O.V.E. Next in Glenn Cunty, Califrnia hires and trains yuth peer mentrs between the ages f This is unique, as mst prvider agencies emply an lder age range f yuth peer prviders. Yuth peer supprt is billed under the state s rehabilitatin ptin as cllateral cntact. Yuth engagement and cmmunity utreach are built int the jb descriptins f peer mentrs. Allegheny Cunty, Pennsylvania created a unique training and wrkplace culture t meet the needs f yung adults with lived experience wrking as yuth peer prviders. Yuth Peer Supprt in High Fidelity Wraparund is funded thrugh the managed care rganizatin s administratin budget and reinvestment dllars. Fr mre infrmatin, see Allegheny Cunty prfile n page 40. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 7

8 Organizatins prviding YPS can serve an imprtant rle wrking with state and cunty gvernments and service delivery netwrks t increase yuth vice in service planning and quality assurance prcesses. State agencies and prvider netwrks that have embraced the value f yuth vice and lived experience are mre prepared t build a wrkfrce inclusive f YPS service psitins. Organizatins prviding YPS services can als play a rle in the develpment f services with the state and lcal system f care. These rganizatins may be helpful advisrs arund system f care develpment, particularly arund yuth driven care and YPS services. It is therefre imprtant t educate and plan with state agencies, MCOs, and prviders n hw this rle as a cllabrative system partner can be maintained when an rganizatin als becmes a Medicaid prvider. There is an pprtunity fr the rganizatin t serve as bth a valued advisry grup, infused with yung adults, that partners with managed care and prvider systems and assists the state with plicy develpment while als serving as a prvider that is imprving utcmes fr yuth and yung adults at the service level. Becming a Medicaid prvider can als enhance an rganizatin s perspective with regard t their rle in helping t reslve systemic issues. Organizatins that want t becme Medicaid prviders f YPS must be able t demnstrate staff prductivity and skill cmpetency based n defined mdels f effective and evidence-based practice. This requires wrking with state and cunty agencies t recgnize ne r mre mdels f YPS service delivery, and designing training and certificatin fr peer supprt prviders. An rganizatin must decide if it will hire a supervisr with experience in bth the practice mdel and the caching skills t wrk n building required skill sets with staff. Sme rganizatins enter int subcntract arrangements with cnsultants r ther prvider agencies in rder t help with supervisin, training, and certificatin. Wrkfrce Cnsideratins Yuth Engagement Identificatin f a cntinuum f yuth engagement activities fr yung adults with lived systems experience t participate in thrughut the cmmunity is imprtant. Such a cntinuum includes yuth advisry grups, yuth advcacy grups, infrmal YPS grups, etc. Yung adults participating in these activities develp leadership and advcacy skills and can learn t share stries f lived experience strategically. A cntinuum f yuth engagement creates bth a base f yung adults ready t enter the yuth peer wrkfrce, as well as a cmmunity supprt system fr yung adults referred by yuth peer prviders. Yuth engagement thrughut the planning, implementatin, and evaluatin prcess is key. Many state and prvider agencies are incrprating yuth vice including bth yuth receiving services and peers prviding the supprts in YPS evaluatin and quality imprvement prcesses. Yuth vice n advisry cuncils fr state decisin-making bdies and fr agencies hiring and prviding YPS shuld ideally be standard practice. KEEP IN MIND Medicaid pays claims 90 days after submissin, s rganizatins must accunt fr a three mnth delay in payment fr services rendered. Billing Medicaid alne fr YPS services is unlikely t sustain a prvider rganizatin, s view Medicaid funds as ne cmpnent f a diversified funding strategy fr the rganizatin. Training and Credentialing Sme cmmunities require nly training in rder t prvide peer services, while thers require a mre indepth credentialing prcess. Credentialing requires cmprehensive training and testing upn cmpletin that shws mastery f the skills taught. Credentialing requirements may als include participatin in cntinuing learning pprtunities r cntinuing educatin credits as well as fidelity mnitring r evaluative activity that shws adherence t the particular practice mdel. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 8

9 States that require credentialing fr YPS prviders ften base their mdels n existing prcesses already in place fr adult r parent peer supprt. Few states have identified a unique credentialing prcess specifically fr YPS prviders. Current appraches t curriculum develpment, training, and credentialing fr YPS invlve the adaptatin f adult peer curriculums. These training mdels may be used as-is, r may be enhanced, tailred, r infrmed by yuth vice. Training must teach yuth peer prviders hw t deliver effective services while maintaining persnal wellness. Sme states are develping specific YPS curriculums t meet the develpmental needs f their staff. Training and credentialing can be a time and mney-intensive prcess. The amunt an rganizatin invests in a yuth peer prvider must be determined and factred int its cst planning. The prcess required t maintain credentialing might be cst prhibitive in the lng term. Sme states have identified the perceived expense f training as a barrier t buy-in fr prvider agencies that wuld ptentially hire yuth peers. Thus, despite the inclusin f effective peer supprt and the utreach and educatin effrts f system f care cmmunities t agencies that are able t hire peers, it has been a challenge t sustain YPS services beynd grant funding. Retaining and Supervising Staff Retaining YPS staff requires a cmmitment t ensure cntinuing educatin, effective and supprtive supervisin, and an rganizatinal culture supprtive f the yuth peer prvider rle. Cntinuing educatin is critical fr these psitins, as peers and prvider rganizatins are cntinually learning hw t meet the prfessinal needs f the emerging yuth peer prvider wrkfrce. Onging educatin pushes peer prviders t excel prfessinally and ffers the basis fr a career path, which is essential t develping and retaining staff. Additinally, YPS prviders require safe and respectful supervisin in tw frms: (1) internal supervisin frm a clinical perspective t mnitr and supprt the day-t-day service delivery f peer supprt; and (2) external supervisin received frm a peer with lived experience and peer supprt experience. External supervisin is ften established t cnnect YPS prviders frm varius prvider agencies tgether in reginal meetings fr sharing and prcessing f cmmn challenges, pprtunities, and experiences related t prviding peer supprt. Creating an envirnment that prmtes the nging maintenance f persnal wellness thrugh structured prgramming, internal/external supervisin, cntinuing educatin, and the use f self-care plans fr yung adults prviding supprt are imprtant strategies in YPS staff retentin. Meeting Medicaid Reprting Requirements Becming Medicaid prviders f YPS means that prvider rganizatins must cllect and reprt infrmatin related t the yuth and yung adults they serve. Federal Medicaid regulatins als require prviders t cmply with dcumentatin and reprting requirements under the Health Infrmatin Prtability and Accuntability Act (HIPAA). This invlves ensuring privacy and cnfidentiality; securing all apprpriate releases; cmplying with mandated reprting regulatins; establishing and maintaining grievance prcedures; and using secure electrnic data systems t cllect prgress ntes and detailed demgraphic and persnal infrmatin. A YPS prvider rganizatin is likely t need designated internal staff r external cntractrs t cmpile these data and submit reprts fr Medicaid reimbursement. Medicaid Billing and Rates State Medicaid agencies are respnsible fr setting rates and determining which billing/current Prcedural Terminlgy (CPT) cdes are used fr peer supprt services. Rates cver specific cmpnents f services. Fr example, Medicaid rates may cver time spent n cmmunity-based face-t-face meetings, but nt text message-based cmmunicatins between a yuth/yung adult and YPS prvider. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 9

10 Medicaid rates may als include limits n the number f allwable r billable cntacts (e.g., hurs per day r times per week), which are determined by a state s Medicaid plan, waiver, r bth. The rates guide prvider rganizatins in determining peer specialist salaries and benefits. Understanding Medicaid Rates An rganizatin prviding YPS must develp a gd understanding f the activities that can be billed fr under its Medicaid cntract and hw they are billed. Depending n the Medicaid envirnment in a particular state fee-fr-service r managed care rates may be set in 15-minute increments (fee-frservice) with specific cdes that a YPS prvider may bill t. Fr example, in Kentucky, the state Medicaid agency identified billing cde H0038 fr self-help/peer services, which is paid in 15-minute increments and cvers a range f peer supprt activities including YPS. Alternatively, YPS services may be prvided as part f a brader service categry, such as cmmunity-based wraparund, which is paid fr thrugh a fixed case rate r mnthly, per member per mnth amunt (i.e., capitatin). Typically, under this type f arrangement, nly yuth/yung adults eligible fr wraparund services are able t receive YPS. Understanding restrictins such as requirements fr medical necessity is key. Establishing Billing Prcesses Medicaid billing plicies and prcedures, which are develped by each state alng with sme verarching federal prvisins, guide rganizatins in establishing training, dcumentatin, and reprting functins. Prvider rganizatins must carry ut tw prcesses when billing Medicaid fr YPS services. First, staff prviding YPS services must cmplete and submit accurate dcumentatin f the services they deliver. Prvider rganizatin staff may need extensive training and mnitring t ensure cntact (prgress) ntes and/r plans f care are written in cmpliance with these guidelines. Organizatins shuld nte that if a Medicaid audit is cnducted and dcumentatin is determined t be inaccurate r incmplete, the rganizatin may be required t return funds t the state Medicaid agency, r the state may have t return funds t the federal gvernment. Secnd, the rganizatin must establish administrative prcedures arund billing and have staff dedicated t billing functins. A prvider rganizatin can hire billing staff internally r utsurce this functin t an external cntractr. Directly hiring billing staff creates additinal rganizatinal capacity as these emplyees may wrk n ther prjects t. On the ther hand, it is cstly t supprt billing staff in staying current with ever-changing Medicaid guidelines in an nging way, and thus, utsurcing billing may be mre cst-effective. Auditing Medicaid requires meticulus attentin t billing and payment. Because states are matched r reimbursed with federal funds, CMS has the authrity t review a state s Medicaid prvider actins, audit claims, and identify verpayments. In additin, depending n the service delivery and financing arrangement in a particular state, YPS prvider rganizatins may be audited by a state ffice f behaviral health licensing, a managed care rganizatin, r a prvider with which it is cntracted, underscring the need t develp internal prcesses fr cmpliance. In sme ways, this prcess is nt much different frm the internal financial audits that prvider rganizatins are required t have each year; hwever, the audits becme mre cmplex as the rganizatin s budget grws and its cntracts are diversified. Cnclusin As states and traditinal service prviders recgnize the imprtance f peer supprts in serving families, yuth, and yung adults, there has been grwing interest in the prvisin f transitinal supprt t yung adults. YPS has been added t the array f services prvided by rganizatins whse primary rles have Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 10

11 been the prvisin f parent/caregiver r adult peer supprt services. While sme f the cnsideratins and lessns learned in the implementatin f parent peer supprts are applicable t YPS and can facilitate its design and implementatin, it is essential t understand the ways in which YPS is distinct frm parent/caregiver and adult peer supprts in its apprach t training, hiring, and staff supprt/supervisin practices. Because f the ppulatin YPS serves (i.e., yung adults), it must span bth the child- and adult-serving systems t supprt successful transitin. Individuals receiving the supprt are unique in their needs and presentatin, s YPS must be develpmentally apprpriate, useful, and appealing t yung adults in transitin. The decisin t ffer YPS requires cnsideratin f several key issues including financing and sustainability. One f the ptins pen t rganizatins is t finance YPS thrugh the Medicaid service delivery system. Understanding hw Medicaid wrks in a specific state is an imprtant factr in determining the viability f including YPS as part f an rganizatin s services. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 11

12 State and Cmmunity Snapshts: Yuth Peer Supprt as a Medicaid Funded Service The fllwing state and cmmunity snapshts ffer examples f hw YPS has been peratinalized and financed as a service using Medicaid in six states (Gergia, Kentucky, Massachusetts, Mississippi, Oklahma and Oregn), and ne cunty (Allegheny Cunty, PA). A prgram verview and infrmatin n eligibility, financing/billing, wrkfrce develpment and prgram evaluatin is included fr each prfile. STATE: Gergia COUNTY (if applicable): N/A ORGANIZATION PROVIDING YPS SERVICES: Gergia Department f Behaviral Health and Develpmental Disabilities (DBHDD) GEORGIA PROGRAM OVERVIEW 1. Which agency/agencies versee(s) the prvisin f yuth/yung adult peer supprt (YPS) services? 2. Wh is the principal purchaser/cntractr fr YPS in the state/designated regin/cunty? DBHDD Purchaser: DBHDD, with supprt frm the Department f Cmmunity Health (DCH) as a fee fr service reimbursement surce. Primary cntractr: Medicaid enrlled prvider agencies 3. Which rganizatin(s) prvide(s) YPS in the state? Family supprt rganizatins and tw cmmunity based behaviral health centers. 4. What are the cmpnents f YPS in the state? Were yung adults invlved in the develpment? 5. Des the state have a definitin f YPS? Were yuth/yung adults invlved in the develpment (e.g., advcacy effrts, etc.)? In develpment. Yung adults have been invlved, via wrkgrups and rund table discussins, in reviewing prpsed CPS Y curriculum/training utline. Develping a definitin. The state has a definitin fr adult peer supprt 5 in its State Plan. Bth parent peer supprt and YPS will be incrprated under the adult peer supprt definitin with the additin f specific language and criteria fr prviders f the service (e.g., individual lived experience r as a parent). Yuth have been invlved in all aspects f creating the yuth peer training and definitin. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 12

13 GEORGIA PROGRAM OVERVIEW 6. Hw many YPS staff are currently emplyed by the prgram? Hw many YPS staff are emplyed elsewhere in the state? Pending the cmpletin f the curriculum and training, a chrt f yuth/yung adults are anticipated t be emplyed by February Additinally, Gergia has ne part time yuth crdinatr psitin at the state level and has partnered with the statewide family netwrk, Gergia Parent Supprt Netwrk, t cntract with several yuth cnsultants frm acrss the state with lived experience in mental health, substance abuse, c ccurring disrders, and fster care. These yung adults participated in all activities cnnected t the design and implementatin f the Certified Peer Specialist Yuth (CPS Y) curriculum and wrkfrce develpment. They are nt currently prviding YPS, but are expected t be amng the first chrt certified by the state as CPS Ys. 7. Are yu aware f any plans fr expanding r enhancing the yuth/yung adult peer prvider wrkfrce in the state? ELIGIBILITY Yes, it is anticipated that CPS Y will be added t the Medicaid State Plan n 1/1/ Wh is eligible t receive YPS services in the state? YPS is in develpment and nt yet a defined service. Currently peer supprt services are nly available in the adult system. 9. What are the eligibility requirements fr becming a YPS prvider? Gergia YPS prviders must: Be 18 years f age. Have a diagnsis f mental illness, substance use, r a dual diagnsis f mental illness and addictive disease and a strng desire t identify themselves as a persn with mental illness (currently r frmerly receiving mental health services). Be able t advcate fr themselves. Have a high schl diplma r GED. Be able and willing t actively seek and manage their wn apprpriate care. Be able t share their wn persnal stry in a safe and apprpriate way. FINANCING/BILLING 10. Hw is YPS funded? YPS is currently funded n a limited basis thrugh the Cmmunity Based Alternatives fr Yuth prgram that was riginally funded thrugh the 1915(c) Alternatives t Psychiatric Residential Treatment Demnstratin Waiver. 11. Is YPS a Medicaid billable service in the state? Yes, n a limited basis. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 13

14 GEORGIA PROGRAM OVERVIEW a. What Medicaid vehicle (e.g., waiver, State Plan Amendment, etc.) is used in yur state t prvide YPS services as a Medicaidbillable service? b. What is the Medicaid rate fr peer supprt? Hw is it billed (e.g., 15 minute increments, etc.)? c. What Medicaid (CPT) cde(s) is/are used t bill fr YPS services? 12. Which funds are used fr training and nging develpment f YPS prviders? Currently: The Balancing Incentives Prgram (BIP) and Mney Fllws the Persn (MFP). Gergia is wrking tward inclusin f YPS in the Medicaid State Plan, which wuld expand access t all eligible beneficiaries. $8.93 per 15 minute unit H0038 CPS Y will be billed using the established cde, but will include a mdifier t specifically indicate YPS services. CMS CHIPRA grant, state funds, and SAMHSA grant funds. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 14

15 GEORGIA PROGRAM OVERVIEW WORKFORCE DEVELOPMENT 13. What is the selectin and hiring prcess fr YPS prviders? 14. Are there training and/r certificatin requirements fr YPS prviders? Were yung adults invlved in the develpment? In develpment. Gergia has implemented a yuth wrkfrce develpment wrkgrup made up f yuth, prfessinals frm all child serving agencies, and adult/parent peer allies t develp the selectin and hiring prcess fr YPS prviders. CPS Y candidates will be required t g thrugh a five day training and certificatin. In additin, they will receive required nging caching and cntinuing educatin. The yuth wrkgrup has been invlved in all aspects f this wrk. The curriculum includes a mdule fr supervisrs. Prviders wh wish t deliver YPS will be required t participate in this segment f the training. The day is divided int tw segments; during the first half f the day, supervisrs learn the definitin, rle, and respnsibilities f CPS Y and acquire a better understanding f the unique cnsideratins in supprting and strengthening the success f these new yuth prfessinals. The secnd half f the day includes bth supervisrs and yuth peers develping a self care plan fr themselves. This self care plan will include a wrk based wellness apprach as well as strategies t identify a sense f accmplishment and develpment. The training includes cmpnents frm the adult mental health/substance abuse and parent peer trainings. 15. Des yur rganizatin have a curriculum t train YPS prviders? Yuth Certified Peer Specialist (CPS Y) Five Day Training Elements: Was the curriculum specifically develped fr YPS r has an existing peer supprt training curriculum (e.g. parent peer supprt r adult peer supprt) been mdified? Were yung adults invlved in the develpment r mdificatin? Defining peer supprt purpse and rle; Learning t use language t cmbat stigma and skillfully use persnal stries; Building supprt thrugh CRAVE (Cmmunicatin, Relatinship, Acceptance, Value, and Empwerment); System rientatin, Gergia System f Care verview, and dcumentatin prcedures; Science f Addictin and Recvery (SOAR) and five stages f recvery; Individual Resiliency Planning (IRP) and bundaries; Supervisin and caching (bth yung adults and supervisrs); and Wrk readiness and ethics. 16. What is the rati f peers t yuth/yung adults served? TBD Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 15

16 GEORGIA PROGRAM OVERVIEW 17. What supervisin and supprt is in place fr yuth peers? In develpment. The state has a yuth wrkfrce develpment wrkgrup made up f yuth, prfessinals frm all the child serving agencies and adult/parent peer allies wh are wrking n creating the supervisin and supprt structures. PROGRAM EVALUATION 18. D yu track utcmes related t YPS services? TBD Cntact Name: Wendy White Tiegreen Wendy.Tiegreen@dbhdd.ga.gv Phne: Name: Dana McCrary, Dana.McCrary@dbhdd.ga.gv Phne: Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 16

17 STATE: Kentucky COUNTY (if applicable): N/A ORGANIZATION PROVIDING YPS SERVICES: Kentucky Department fr Behaviral Health, Develpmental and Intellectual Disabilities KENTUCKY PROGRAM OVERVIEW 1. Which agency/agencies versee(s) the prvisin f yuth/yung adult peer supprt (YPS) services? Kentucky Department fr Behaviral Health, Develpmental and Intellectual Disabilities (DBHDID) and Kentucky Department fr Medicaid Services (Medicaid) 2. Wh is the principal purchaser/cntractr fr YPS in DBHDID and Medicaid the state/designated regin/cunty? 3. Which rganizatin(s) prvide(s) YPS in the state? The fllwing prvider types are eligible t prvide Medicaidbillable yuth peer supprt services in Kentucky if they meet the requirements set frth in regulatin: Cmmunity mental health centers; Independent prviders; Behaviral health service rganizatins; Outpatient behaviral health services prvided by level I and II psychiatric residential treatment facilities; Outpatient hspital services; and Residential crisis stabilizatin units. 4. What are the cmpnents f YPS in the state? Were yung adults invlved in the develpment? The Yuth Empwerment Prgram (YES) was frmed t develp the YPS psitin in Kentucky. Transitin age yuth (TAY) were active members f this grup. The cre cmpetencies are: System f care philsphy and wraparund prcess; Yuth supprt; Grup prcess; Cultural and linguistic cmpetence; Cmmunicatin; Organizatin; Self care; and Leadership, ethics, and values. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 17

18 KENTUCKY PROGRAM OVERVIEW 5. Des the state have a definitin f YPS? Were yuth/yung adults invlved in the develpment (e.g., advcacy effrts, etc.)? The Kentucky Medicaid State Plan definitin states: Peer Supprt (fr yuth and adults) is emtinal supprt that is prvided by persns having a mental health, substance use, r c ccurring mental health and substance use disrder t thers sharing a similar mental health, substance use, r c ccurring mental health and substance use disrder in rder t bring abut a desired scial r persnal change. It is an evidence based practice. Peer Supprt Services are structured and scheduled nnclinical, but therapeutic activities with individual clients r grups prvided by a self identified cnsumer f mental health, substance use, r c ccurring mental health and substance use disrder services wh has been trained and certified in accrdance with state regulatins. Services shuld prmte scializatin, recvery, self advcacy, preservatin, and enhancement f cmmunity living skills fr the client. Kentucky Peer Supprt Specialist (KYPSS) duties include: Using relevant persnal stries t teach thrugh experience; Serving as a rle mdel fr clients; Ensuring and empwering client vice and chice during develpment and implementatin f plans; Supprting clients by attending team meetings, upn request; Supprting clients by imprving their cnfidence t be a self advcate; Helping individuals wrking with yuth t understand yuth culture; and Helping clients enhance their relatinships with cmmunity partners. 6. Hw many YPS staff are currently emplyed by the prgram? Hw many YPS staff are emplyed elsewhere in the state? 7. Are yu aware f any plans fr expanding r enhancing the yuth/yung adult peer prvider wrkfrce in the state? Fur acrss the state SAMHSA Healthy Transitins grant, which will fcus n YPS as a vital part f the cntinuum f care in drp in centers that will be pening. Transfrmatin Transfer Initiative (TTI) grant by SAMHSA s Center fr Mental Health Services, which will fcus n prviding YPS in state hspitals t facilitate smther transitin back int the cmmunity. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 18

19 KENTUCKY PROGRAM OVERVIEW ELIGIBILITY 8. Wh is eligible t receive YPS services in the state? Individuals with a behaviral health diagnsis. The service is nt limited t child r adult serving system. There is n age specificatin. 9. What are the eligibility requirements fr becming a YPS prvider? Each applicant must: Meet the criteria f a yuth with lived experience with an emtinal, scial, behaviral, and/r substance use disability; Pssess, at a minimum, a high schl diplma r GED equivalency; Have successfully cmpleted the Kentucky Family Leadership Academy; Discuss experience f receiving state funded services frm at least ne child serving agency n the applicant s respnses n the shrt essay frm; Demnstrate experience with leadership and advcacy in the field f behaviral health, as well as the ability t demnstrate his r her wn effrts at self directed leadership develpment; and Cmplete the KYPSS training. FINANCING/BILLING 10. Hw is YPS funded? Medicaid, DBHDID 11. Is YPS a Medicaid billable service in the state? Yes a. What Medicaid vehicle (e.g., waiver, State Plan Amendment, etc.) is used in yur state t prvide YPS services as a Medicaid billable service? b. What is the Medicaid rate fr peer supprt? Hw is it billed (e.g., 15 minute increments, etc.)? c. What Medicaid (CPT) cde(s) is/are used t bill fr YPS services? 12. Which funds are used fr training and nging develpment f YPS prviders? Kentucky Medicaid State Plan Amendment (SPA), available at: 2A D1 DAD /0/KY14006ApprvalLetter179andPlanPages.pdf $8.61 per 15 minute unit H0038 Cmmunity Mental Health Services Blck Grant funds, ther grant funds Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 19

20 KENTUCKY PROGRAM OVERVIEW WORKFORCE DEVELOPMENT 13. What is the selectin and hiring prcess fr YPS prviders? 14. Are there training and/r certificatin requirements fr YPS prviders? Were yung adults invlved in the develpment? Each prvider has their wn hiring prcess and must adhere t Kentucky Administrative Regulatins regarding the selectin f Yuth Peer Supprt Specialists: Cmpletin f a 30 hur certificatin curse (per Medicaid SPA) and nging cntinuing educatin units. TAY were invlved in the curriculum develpment. See als: Des yur rganizatin have a curriculum t train YPS prviders? Was the curriculum specifically develped fr YPS r has an existing peer supprt training curriculum (e.g. parent peer supprt r adult peer supprt) been mdified? Were yung adults invlved in the develpment r mdificatin? 16. What is the rati f peers t yuth/yung adults served? There is a YPS training curriculum develped by a subcmmittee f Yuth Empwerment Prgram (YEP). Sme f the cmpetencies were based n the existing family peer supprt curriculum. TBD Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 20

21 KENTUCKY PROGRAM OVERVIEW 17. What supervisin and supprt is in place fr yuth peers? Kentucky YPS services must be prvided under the supervisin f ne f the fllwing prfessinals wh cmpleted the department apprved YPS 101 training: physician; psychiatrist; advanced practice registered nurse; physician assistant; licensed psychlgist; licensed psychlgical practitiner; licensed clinical scial wrker; licensed prfessinal clinical cunselr; licensed marriage and family therapist; certified psychlgist; certified psychlgist with autnmus functining; licensed psychlgical assciate; marriage and family therapy assciate; certified scial wrker; licensed prfessinal cunselr assciate; licensed prfessinal art therapist; prfessinal equivalent; certified alchl and drug cunselr; r psychiatric nurse. Individual supervisin meetings must be cnducted face tface; ccur n less than nce a week fr the first year and mnthly thereafter; and be dcumented. The supervising prfessinal must maintain a written recrd fr supervisin that is dated and signed by bth the KYPSS and supervisr fr each meeting; and includes a descriptin f the encunter that specifies: The tpic discussed; Any specific actin t be taken; An update fr any issue previusly discussed that required fllw up; and A plan fr additinal training needs if any were identified. See mre here: PROGRAM EVALUATION 18. D yu track utcmes related t YPS services? N Cntact Name: Beth Jrdan beth.jrdan@ky.gv Phne: Name: Kate Tiltn ktiltn@kypartnership.rg Phne: Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 21

22 STATE: Massachusetts COUNTY (if applicable): N/A ORGANIZATION PROVIDING YPS SERVICES: Department f Mental Health and the Children s Behaviral Health Initiative and Cmmunity Services Agencies MASSACHUSETTS PROGRAM OVERVIEW 1. Which agency/agencies versee(s) the prvisin f yuth/yung adult peer supprt (YPS) services? Department f Mental Health (DMH) and Children s Behaviral Health Initiative (CBHI) 2. Wh is the principal purchaser/cntractr fr YPS in DMH the state/designated regin/cunty? 3. Which rganizatin(s) prvide(s) YPS in the state? Cmmunity Service Agencies (CSAs) that cntract with Medicaid Managed Care Entities and prvider agencies that cntract with DMH 4. What are the cmpnents f YPS in the state? Were yung adults invlved in the develpment? Yung adults have been invlved ver the last several years in develping YPS services thrugh the state s CSAs. Yung adults chair cmmittees, review cntract prpsals, participate in hiring cmmittees, design trainings, and engage in full and part time emplyment as peer mentrs in inpatient, residential, and cmmunity based service systems. Medicaid billing fr YPS is under Therapeutic Mentring with the apprval f the state Medicaid ffice. 5. Des the state have a definitin f YPS? Were yuth/yung adults invlved in the develpment (e.g., advcacy effrts, etc.)? In develpment. Generally, YPS prvides ne t ne mentring and supprt by sharing ne's recvery with yuth/yung adults wh are experiencing serius mental health cnditins; assisting yuth in navigating and understanding the service system; and helping yuth t find their vice in treatment decisins. Fr mre infrmatin, see: mentring services ps.pdf yuth initiative.html prject/ Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 22

23 MASSACHUSETTS PROGRAM OVERVIEW 6. Hw many YPS staff are currently emplyed by the prgram? Hw many YPS staff are emplyed elsewhere in the state? There are 14 part time emplyees in the CBHI CSAs thrugh the Success fr Transitin Age Yuth (STAY) Prject as yung adult peer mentrs. The yung adult peer mentrs mentr lder adlescents and yung adults in the CSAs. They participate in team meetings and cach the yung adults hw t have a strnger vice and assist the yung adults in develping their wn gals and taking the lead. They wrk t meet the needs f the yung adults by supprting them in the areas f educatin, emplyment, husing, and ther needs. Tw ther individuals are emplyed thrugh the SAMHSA Nw is the Time (NITT) grant. Apprximately 25 additinal YPS are emplyed in ther prgrams and services acrss the state, including Caring Tgether prgrams, DMH, and several thers. 7. Are yu aware f any plans fr expanding r enhancing the yuth/yung adult peer prvider wrkfrce in the state? Expansin effrts are currently nging thrugh SAMHSA grants and als with effrts by ther state agencies such as the Department f Public Health (DPH), the Department f Children and Families (DCF), and the Department f Yuth Services (DYS). YPS services will be funding thrugh three streams: state agency funds, grants, and Medicaid. A challenge Massachusetts faces is the medical necessity criteria fr Medicaid, s state agencies are lking at ther ways t supprt YPS. ELIGIBILITY 8. Wh is eligible t receive YPS services in the state? Yuth under age 21 wh meet medical necessity criteria fr utpatient, In Hme Therapy r Intensive Care Crdinatin fr CBHI Therapeutic Mentring and individuals in the child and adult mental health systems wh meet eligibility criteria. Fr mre infrmatin, see: mentring services.pdf. Currently, the child mental health system in Massachusetts has mre yung adult peer mentrs than the adult system, but in the cming years, the gal is t engage mre yung adult peer mentrs in emplyment pprtunities within adult services. Prviding Yuth and Yung Adult Peer Supprt thrugh Medicaid 23