CAMHPRO State Peer Certification SB 614 Update & Input Meeting September 8, 2016

Transcription

1 CAMHPRO State Peer Certification SB 614 Update & Input Meeting September 8, 2016 California Funded by the U.S. Substance Abuse & Mental Health Services Administration (SAMHSA) State Consumer Network Grant 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 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 1-4 2

3 Agenda Bottom Line Regroup & Refocus Identify options What leverage do we have? Honor Stakeholders 17 Recommendations 3

4 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. 4

5 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 5

6 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. 6

7 Now what? Peer Support and 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? 7

8 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. 8

9 What Leverage Do We Have? DHCS is applying for Section 223 Demonstration Project Hillary s* proposed MH policy on peer support Updated 2016 Peer Specialist Training & Certification Programs: National Overview What funding leverage do we have? *CAMHPRO does not endorse any political candidates. 9

10 Section 223 Demonstration Project A 2014 law established a demonstration program in eight states, under which new benefits would be available to health centers certified by the federal government as Certified Community Behavioral Health Clinics (CCBHCs). To be a CCBHC, a clinic must provide a range of physical and mental health services, including emergency psychiatric care, treatment for mental health and substance use disorders, and peer support. In return, the clinic can receive reimbursement at rates similar to those received by federally-qualified health centers. 10

11 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

12 223: Improving Quality and Access Federally defined criteria for certifying clinics that require coordinated, comprehensive, and quality care Common data collection and reporting on quality measures on screening, integration, treatment, and outcomes Payment systems that reimburse providers for the prospective cost of delivering services Slide 12

13 Certified Community Behavioral Health Clinics (CCBHCs) Criteria 1. Staffing: staffing linguistic, culture and numbers based on community needs assessments 2. Availability & accessibility: maximum waiting times for services, expanding operating hours 3. Care coordination: required agreements with community agencies 4. Scope of services: comprehensive, integrated, across the life-span 5. Quality measures: 21 measures collected at the clinic and state levels 6. Organizational authority: Requires consumer and family voice Slide 13

14 223 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 14 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

15 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 15

16 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 16

17 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 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? 17

18 Hillary s* Agenda for Mental Health Services Promote the use of peer support specialists. Peer support specialists have been shown to provide needed, cost-effective services Hillary will support initiatives to include peers in clinical care teams in primary care settings, mental health specialty care settings, hospitals, and Accountable Care Organizations. She will encourage all 50 states to reimburse peer services in state Medicaid programs, which 30 states do currently, and continue providing the Consumer and Consumer Supporter Technical Assistance Center grants. *CAMHPRO does not endorse any political candidates. 18

19 Hillary* for Expansion of 223 Demonstration Project Support the creation of high-quality, comprehensive community health centers in every state. Hillary will invest $5 billion over the next ten years to scale up this 223 demonstration project and help bring it to every state in America. This will vastly expand community-based treatment, by enabling thousands of health centers across the country (i.e., FQHCs, CMHCs, etc.) to upgrade to an integrated center. *CAMHPRO does not endorse any political candidates. 19

20 Funding Options OSHPD Remaining Workforce Education & Training (WET) Funds $7 million remains slotted for Consumer/Family WET programming Advisory Committees have not met in at least 9 months SAMHSA Grants? Other grant opportunities? Other billing mechanisms? What else? 20

21 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 21

22 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 SB

23 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 ) 23

24 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 24

25 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 25

26 Stakeholder Recommendation: Education & 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 26

27 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 27

28 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 28

29 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. 29

30 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 30

31 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 31

32 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. 32

33 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 33

34 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 34

35 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 35

36 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. 36

37 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 37

38 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

39 How Can We Advocate for State Peer Certification? Budget for, or ask your agency to budget discretionary funds and time for advocacy activities Attend State and County meetings and speak up Participate on workgroups to support activities/legislation Letters to editors of publications Meet with legislators and government officials Attend CAMHPRO Day at the Capitol in May Organize a local rally or sit-in Form a Coalition; Educate continuously Social Media: Facebook, Twitter 39

40 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 40

41 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 41

42 CAMHPRO Trainings & Technical Assistance ABC s of Advocacy Webinar Series Web A: Advocacy Basics aired on August 24, 10:30 AM Recording and materials at: Web B: Best Community Planning Practices aired on August 31, 10:30 AM Recording and materials at: Web C: Community Planning; How to Work it on September 14, 10:30 AM Register here: Other Advocacy Webinars; State Advocacy: Where'd the Bills Go? October 12, 2016 Register here: Local Onsite Advocacy Workshop "Practicing the ABC s of Advocacy in Mental Health" (5 hours including Lunch) per request Finding Your Voice Onsite Workshops (3 hrs) per request or appointment Follow-Up Support Technical Assistance 42

43 Advocacy Alerts: Upcoming Meetings Mental Health Services Oversight & Accountability Commission (MHSOAC) Criminal Justice/Mental Health Subcommittee Meeting Wednesday September 21, 2016, 9:00AM - 12:00PM LA Area Chamber of Commerce, 350 South Bixel Street Los Angeles, CA MHSOAC Commission Meeting Thursday, September 22, 2016, 9:00am-3:30pm CA African American Museum, 600 State Drive Los Angeles, CA CA Mental Health Planning Council (CMHPC) Oct , 2016 Lake Natoma Inn, 702 Gold Lake Drive, Folsom CA

44 Thank you for your commitment and action! Next Peer Certification Update Webinar 2 nd Thursday, October 13, 2016 at noon If you are registered you will be reminded. If you are not registered please do so at link below Registration URL: