CAMHPRO State Peer Certification SB 614 Update & Input Meeting November 10, 2016

Transcription

1 CAMHPRO State Peer Certification SB 614 Update & Input Meeting November 10, 2016 California Funded by the U.S. Substance Abuse & Mental Health Services Administration (SAMHSA) State Consumer Network Grant 870 Market St., Suite 922; San Francisco, Karin Lettau, MS, Director of CA (415) Please follow us and like us on Face Book Training & Employment, see our new website: CAMHPRO

2 Webinar Format How to Participate 1. Polling Questions In-webinar, click box to choose best answer. We will show results. 2. Questions box--type in question or comment, send to all. One of us will try to answer the question during the web, or read it during question/contribution at the end. 3. Speak up during question/contribution at the end, raise your virtual hand to be unmuted to ask a question or make comment. If you have no microphone or if you are self-muted this won t work you could switch to using a telephone on control panel under audio, click telephone and dial in, enter code and audio pin provided in order to be heard. You may download all handouts from the control panel 2

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4 CAMHPRO s Mission The California Association of Mental Health Peer- Run Organizations (CAMHPRO) non-profit consumer-run statewide organization Members are consumer-run organizations and programs, and individuals. Empower, support, and ensure the rights of consumers, eliminate stigma, and advance selfdetermination and choice. Poll 1-3 4

5 Agenda Bottom Line Regroup & Refocus Identify options Workforce Education & Training (WET) $8 million Honor Stakeholders 17 Recommendations 5

6 Peer Certificate vs. State Certification Formal State Program that typically designates the State Department of Mental Health or another agency to establish certification components including: Lived experience required; work experience Responsibilities and practice guidelines Curriculum and core competencies Training and continuing education requirements Code of ethics Certification revocation process Billing status Supervision 6

7 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. 7

8 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 8

9 Bottom Line Known as California State Peer, Transition Age, Parent & Family Support Certification Program, Senate Bill 614 (Leno-D) is now dead. The shell, 'SB 614', was used for a new bill that has nothing to do with what we worked for. Gratefully, Senator Leno and bill sponsor, the County Behavioral Health Directors Association (CBHDA) refused to move the bill forward with the California Department of Health Care Services (DHCS) 'technical amendments' that undermined the intent of the bill and the essence of genuine peer support services. 9

10 Now what? Regroup Collectively craft new proposal for the next legislative session in Jan Identify options when choosing the agencies to implement State Certification. 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 California stakeholders. What else? What are more options? 10

11 How Can We Gain Formal State Validation and Billing for Peer Specialist Services? We have to ask ourselves the right questions to bring forth creative answers. 11

12 What Leverage Do We Have? DHCS is applying for Section 223 Demonstration Project Updated 2016 Peer Specialist Training & Certification Programs: National Overview What funding leverage do we have? 12

13 Background: US Section 223 Demo Project Requires Peer Support US Congress passed H.R Protecting Access to Medicare Act (PAMA) of 2014 and President signed into law April, Included Section 223 a two-year Demonstration Project: Improving Community Behavioral Health Services (also known as 223 Demo Project) Established criteria that states use to certify CCBHCs (SAMHSA): Certified BH Community Clinics (CCBH) include required Peer Support Services. Provided guidance on the development of a Prospective Payment System (CMS) increases federal share of cost to 65% for 2 years In Oct. 2015, awarded grants to 24 states to plan and apply for the Demonstration program (SAMHSA), included California 13

14 Section 223 Demonstration Project Requirements of Planning Grant Phase Oct, 2015-Oct 30, 2016 Certify Behavioral Health Clinics Establish PPS (prospective payment system) Robust process to solicit input from consumers, providers and stakeholders required Submit an application by Oct to be reviewed to be part of Demonstration 8 States to be selected to be part of the project by Dec. 31, Demonstration runs Jan to Jan Evaluate-Final report to Congress Dec

15 223 Scope of Services CCBHCs directly provide services in green*** Additional required services are provided directly or through formal relationships with Designated Collaborating Organizations (DCOs) Referrals (R) are to providers outside the CCBHC and DCOs *** unless there is an existing state-sanctioned, certified, or licensed system or network for the provision of crisis behavioral health services that dictates otherwise. Outpatient Primary Care Screening & Monitoring DCO Community- Based Mental Health Care for Veterans DCO R Treatment Planning Targeted Case Management DCO Slide 15 Crisis Services*** Outpatient Mental Health & Substance Use Services Services are provided by CCBHCs directly and through formal relationships with DCOs Screening, Assessment, Diagnosis & Risk Assessment Peer, Family Support & Counselor Services DCO Psychiatric Rehab Services DCO

16 Section 223 Demonstration Project 24 States received grant (Oct. 2015) to develop a plan CA is one of the 24 states awarded a planning grant Planning Grant Phase Oct, 2015-Oct, 2016 Certify clinics Establish PPS (prospective payment system) Solicit input from consumers, providers and stakeholders Heidi has just recently gotten on a CCBH stakeholder group Submit an application by Oct to be part of Demonstration 8 States to be selected to be part of the project by Dec. 31, Demonstration runs Jan to Jan. 2019: Federal Medicaid Matching $ to States to Medicaid (Medi-CAL) enrollees equivalent to the Federally Qualified Health Centers (FQHC) rates. Evaluate-Final report to Congress Dec

17 State Peer Certification National Context Over 40 States have State Certified Peer Specialists protocols 2 States in process of developing State protocol for certifying peers Billing Medicaid for Peer Services is the primary impetus U.S. Veterans Administration Certifies Peer Specialists oemploys over 1,000 Peer Specialists (5 grades, career ladder) The International Association of Peer Specialists (INAPS) developed competencies for international Peer Certification SAMHSA drafted 62 Competencies for Peer Support workers in behavioral health (2015) Over 30 states have unique peer support Medicaid billing codes We may have a national certification before we have a CA 17 protocol

18 2016 Updated Report on National Peer Specialist Certification Peer Specialist Training & Certification Programs: National Overview 2016 Kaufman, L., Kuhn, W., & Stevens Manser, S Peer Specialist Training and Certification Programs: A National Overview. Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin. Also a handout Identify from other states their certifying bodies other mechanisms to allow for billing 18

19 Report & Map of Peer Specialist Training and Certification Programs by State As of July 2016, 41 states and the District of Columbia have established programs to train and certify peer specialists and 2 states are in the process of developing and/or implementing a program. [New Mexico also has a Certification Program] CA is the only State without a State Certification Program applying for the 223 Demonstration Project 16/07/peer-specialist-training-andcertification-programs-nationaloverview-2016-update.pdf 19

20 Peer Specialist Training & Certification Programs: National Overview 2016Kaufman, L., Kuhn, W., & Stevens Manser, S Peer Specialist Training and Certification Programs: A National Overview. Texas Institute for Excellence in Mental Health, School of Social Work, University of Texas at Austin. This map is challenging. Need to distinguish between different billing mechanisms. All methods are lumped together. CA is incorrectly listed. A handful of CA counties allow PS to bill under the Rehab Option, an existing clinical code Karin will do another analysis of what other States are doing Others? 20

21 Funding Options OSHPD Remaining Workforce Education & Training (WET) Funds $8 million remains slotted for Consumer/Family WET programming for next 1.5 years Advisory Committees have not met in months! SAMHSA Grants? Other grant opportunities? Other billing mechanisms? What else? 21

22 Item Number WET FIVE-YEAR PLAN BUDGET ( ) WET Funding Allocated for State Administered Programs in 2008 Mental Health Workforce Education and Training (WET) Five-Year Plan Budget WET Funding Spent via State Administered Programs in WET Five-Year Plan WET Funding Remaining for State Administered Programs for WET Five-Year Plan State Administered WET Program $234,500,000 $119,755,910 $114,744,090 State WET Funding for 4 Year Budget Fiscal Year 14/15 Original Plan Jan, 2014 Fiscal Year 15/16 Fiscal Year 16/17 Fiscal Year 17/18 Total $114,744,090 $31,936,023 $31,936,023 $26,936,023 $23,936,023 1 Stipends $35,000,000 $8,750,000 $8,750,000 $8,750,000 $8,750,000 Psych Nurse Practioner $7,200,000 $1,800,000 $1,800,000 $1,800,000 $1,800,000 Clinical Psychologist $1,800,000 $450,000 $450,000 $450,000 $450,000 Marriage and Family Therapist $12,400,000 $3,100,000 $3,100,000 $3,100,000 $3,100,000 Social Worker $13,600,000 $3,400,000 $3,400,000 $3,400,000 $3,400,000 2 Loan Assumption $40,000,000 $10,000,000 $10,000,000 $10,000,000 $10,000,000 3 Education Capacity $15,000,000 $3,750,000 $3,750,000 $3,750,000 $3,750,000 Psychiatrist $9,000,000 $2,250,000 $2,250,000 $2,250,000 $2,250,000 Psych Nurse Practioner $6,000,000 $1,500,000 $1,500,000 $1,500,000 $1,500,000 4 Consumer and Family Member $10,000,000 $5,000,000 $5,000,000 $0 $0 5 Regional Partnership $9,000,000 $3,000,000 $3,000,000 $3,000,000 $0 6 Recruitment (Career Awareness) and Retention $3,000,000 $750,000 $750,000 $750,000 $750,000 Mini-Grants $1,000,000 $250,000 $250,000 $250,000 $250,000 CalSEARCH $1,000,000 $250,000 $250,000 $250,000 $250,000 Retention $1,000,000 $250,000 $250,000 $250,000 $250, Evaluation $2,744,090 $686,023 $686,023 $686,023 $686,023

23 WET Budget Reassessment

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28 Dec, oshpd.ca.go v/document s/hwdd/w ET/2015/Pre sentation- on-wet- Budget-Re- Assessment- Proposed- Modificatio ns.pdf 28

29 In the past year Members of 2 OSHPD WET Advisory Committees recommended more than proposed $7 million At Jan, 2016 California Mental Health Planning Council (CMHPC) Presented the final proposal after reassessment, which added another million to the $7 already proposed for a total of $8 million for Consumer/Family member WET funds. It was approved by CMHPC No records of this proposal online 29

30 Background & Stakeholder Recommendations for California Certification of Peer Specialists 30

31 Original 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 31

32 CA 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 the former SB

33 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 ) 33

34 Stakeholder Recommendation Certifying Body Composition Establish Certifying Body NOT Dept. of Health Care Services Agency plus collaborative cluster of state organizations representing youth, consumer, family of adult, parents of child, etc. Completely separate from training entities 34

35 Stakeholder Recommendation: Certifying Body Function For each category of peer support specialist: youth, adult, family of adult, parent of child/youth, Certifying Body develops Formal Definitions, Scope of Practice, Values & Ethics Core competencies and standardized training content Trainer and training entity qualifications Standards for supervision of peer support specialists Certification exam Certifies training entities throughout the state for trainings that meet competencies, to retain cultural & regional diversity Administers exam 35

36 Stakeholder Recommendation: Training & Experience State Certification Training 80 hours of training by accredited programs with testing Plus 25 optional hours for specialty emphasis whole health, forensics, co-occurring, foster care, etc. Continuing Education for re-certification Experience Lived experience with mental health challenges or family 6 months as full time peer specialist intern, work or volunteer Poll 4 36

37 Stakeholder Recommendation--Supervision Policy that outlines key qualifications necessary for the Supervision of Peer Support Specialists Prefer supervisors have lived experience & expertise in peer support Define specific qualities and skills required for the supervision of Peer Specialists, that align with the values and philosophy of peer support Consider federal billing requirements regarding qualified supervision for the future Research other State Certification supervision requirements to determine what is acceptable 37

38 Stakeholder Recommendations-Training to County Administrations Plan for extensive & expansive training to County BH Administrations and Staff on Values, philosophy and efficacy of peer support services County and Organizational cultures that welcome peer support specialists fully onto teams Definitions of the unique service components of peer support, separate & distinct from other disciplines and services 38

39 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. 39

40 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 40

41 Official National & State Certifications Over 40 States have State Certified Peer Specialists protocol 2 States in process of developing State protocol for certifying peers Billing Medicaid for Peer Services is the primary impetus U.S. Veterans Administration Certifies Peer Specialists oemploys 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 41

42 CMS Guidelines Allow 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. 42

43 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 have created 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 have been up to the Dept. Health Care Services (DHCS) to create new billing 43

44 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) Additional Certification: Health and Wellness Supports, (H0025) Whole Health o Supporting the individual in building skills that enable whole health improvements 44

45 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 Used 1915 b(3) waiver Administered by Michigan Department of Community Health, Behavioral Health Has Parent Specialists too 45

46 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 Peer Specialists are a PROVIDER type in Oregon Use lottery funds, have Block grants and SAMHSA Access to Recovery Grant Credentialing: Oregon Health Authority (OHA) through the Office of Equity and Inclusion with the collaboration of the Addictions and Mental Health Division. 46

47 Supporters of Bill as amended Aug., 2015 Included: 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 47

48 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

49 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 Organize a local rally or sit-in Form a Coalition; Educate continuously Social Media: Facebook, Twitter 49

50 Advocacy Toolbox Public comment, written comment online, committee/board membership Link to How-tos on CAMHPRO website How to Write Op-Eds and Letters to the Editor How to write fact sheets and action alerts How to Visit a Policymaker How to Organize a Rally Action Plan Template Sample 50

51 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 media 51

52 CAMHPRO Trainings & Technical Assistance Onsite Workshops (Target: Rural/Frontier/Latino/Youth) Finding Your Voice Informal Small Group Workshops 3 Hours, per request or appointment [Superior; Southern; Central] Delivering the ABC s of Advocacy Workshop San Mateo Nov. 15, 2016; San Joaquin [TBD] Client Culture (Coming in 2017) Regional Policy Forums on Current Issues Los Angeles, October; Shasta County [TBD]; Central or Southern Region [TBD] Regional Networking Forums Superior Region [TBD] Central Region [TBD] 52

53 Advocacy Alerts: Upcoming Meetings MHSOAC Commission Meeting Thurs., November 17, 2016, 9 A.M. 3 P.M J St., Suite 1700, Sacramento, CA Call-In Number: ; Participant Code: Agenda: CA Mental Health Planning Council (CMHPC) January 18-20, 2017: Courtyard San Diego Mission Valley/Hotel Circle, 595 Hotel Circle South San Diego California USA 53

54 Thank you for your commitment and action! If you want to attend a State Meeting and could use some technical assistance or coaching, please contact Advocacy Coordinator, Heidi Strunk, AdvocacyCAMHPRO@gmail.com Next Peer Certification Update Webinar 2 nd Thursday, December 8, 2016 at noon If you are registered you will be reminded. If you are not registered please do so at link below Registration URL: 54