Karin Lettau, MS, Director of Training & Employment, CAMHPRO [email protected]Please follow us and like us on Face Book https://www.facebook.com/camhpro 870 Market St., Suite 922; San Francisco, CA 94102 ▪ (415) 341-9460 ▪ see our new website:http ://camhpro.org/ CAMHPRO Peer Certification SB 614 Update & Input Meeting August 11, 2016 California
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CAMHPRO Peer Certification SB 614 Update & Input ......2016/08/11 · Senate Bill 614, Peer Certification Not moving forward at this time •The County BH Directors Assoc. (CBHDA),
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Karin Lettau, MS, Director of Training & Employment, CAMHPRO [email protected]
Please follow us and like us on Face Bookhttps://www.facebook.com/camhpro
870 Market St., Suite 922; San Francisco, CA 94102 ▪ (415) 341-9460 ▪
• 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 self-determination and choice.
Poll 1-4
Senate Bill 614, Peer Certification Not moving forward at this time
• The County BH Directors Assoc. (CBHDA), sponsor of bill SB 614, will NOT go with the Dept. of Health Care Services (DHCS) technical amendments that would butcher the bill, but CBHDA has not decided yet.
• Bill author Senator Leno will let the bill expire.
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Bottom Line Since Last Month
• Since DHCS will NOT support new unique billing for peer support, an integral part of the current bill, DHCS would not be needed in a new bill.
• A new State Peer Certification legislative proposal could omit DHCS & omit the new billing to focus on the other key elements of the current bill.
• WE WILL NEED ALL OF YOUR SUPPORT & ACTIVE INVOLVEMENT TO GET A LEGISLATIVE PROPOSAL READY BY JAN, 2017, REFLECTING THE 17 RECOMMENDATIONS MADE BY OVER 700 STAKEHOLDERS.
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Now what? …Peer Support… Then some suggestions
• Research alternatives to a unique billing code needed for a State Plan Amendment that could allow for additional CA credentialing and draw more funding for Peer Support Specialist Services
• Capitated billing that includes peer services?
• Legislative proposals/bills in steps
• Create CA Peer Specialist billing code for Medicaid draw down—LATER
• State Certification with Certifying body—FIRST with above in mind
5Torrey Pine named Esperanza
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Peer Certification Movement in California
• Originally evaluated by California Network (CNMHC)
• Working Well Together (WWT) (2008-2014)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
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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…)
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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
• 42 States & D.C. have State Certified Peer Specialists protocol
• 4 States in process of developing State protocol for certifying peers
• 14 States have State Certified Family or Parent Specialists
• Billing Medicaid for Peer Services is the primary impetus
• U.S. Veterans Administration Certifies Peer Specialists
o Employs over 1,000 Peer Specialists (5 grades)
• The International Association of Peer Specialists (INAPS) develops competencies for international Peer Certification
• SAMHSA drafted 62 Competencies for Peer Support workers in behavioral health (2015)
• CA could be the first state in the nation to adopt certification for peer providers across the life span.
• Over 30 states have unique peer support Medicaid billing codes
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Peer Specialist Training and Certification 2014
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
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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.
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Over 30 States have unique Peer Specialist Service Medicaid Billing Codes
Medicaid Billing for Mental Health Peer Provider Services by State 2014
Example: Georgia Certified Specialists bill
• Structured activities that promote socialization, recovery, wellness, self-advocacy, 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
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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
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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
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SB-614--Where are we now?
Still ‘inactive’, will expire in the legislature
Supporters of Bill as amended Aug., 2015 Include:
• County Behavioral Health Directors Association of California (sponsor)
• Association of California Health Care Districts
• CA Association of Mental Health Peer-Run Organizations
• CA Association of Social Rehabilitation Agencies
• CA Mental Health Oversight & Accountability Commission
• CA Council of Community Mental Health Agencies
• CA State Association of Counties
• Disability Rights California
• National Alliance on Mental Illness California
• Pacific Clinics
• Peers Envisioning and Engaging in Recovery Services (PEERS)
• REMHDCO
• Sacramento County Board of Supervisors
• SEIU California
• Steinberg Institute
• Western Center on Law and Poverty
• United Advocates for Children & Families
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Life Cycle SB 614 (Leno-D)
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• CNMHC & WWT
• Stakeholder Input
• Legislative proposal
• CBHDA sponsors
Stakeholders
• Senator Leno authors SB 614 & intros bill
• Passes Senate unanimously 6/1/15
• Goes to Assembly
Senate • Passes 2 Committees
• Ordered to 3rd
Reading on floor 9/1/15
• Ordered to Assembly Inactive file 9/3/15
Assembly
Governor signs or
dies
CNMHC=CA Network of MH ClientsWWT=Working Well TogetherCBHDA= County BH Directors Association
Our State System
CA BH Directors Association
(CBHDA)
State Legislature:Senate & Assembly
Governor
State Health & Human Svcs
(CHHS)
OSHPD Heath Planning & Dev.
Dept. of Public Health (CDPH)
Office of Health Equity (OHE)
Dept. of Health Care Services
(DHCS)
CA MH Planning Council (CMHPC)
Mental Health & Substance Use
Services
CA Health Facilities Financing Authority
MH Services Oversight &
Accountability Commission (MHSOAC)
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…
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Advocacy Avenues
Individual Agency or Group
County Regional State
Letter, email 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
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How to Track a Legislative Billhttp://leginfo.legislature.ca.gov/
CA Legislative Info.website• Go to Bill Information,
enter bill number or key word
• Click on bill #
• View Tabs
• Click on Track Bill
• Register for email notice of changes to bill• Email address only required
• Using Peers to Support Physical and Mental Health Integration for Adults with Serious Mental Illness Jan 2016, The National Academy for State Health Policy http://www.nashp.org/15220/
• Chapman, S., Blash, L., and Chan, K. (2015). The Peer Provider Workforce in Behavioral Health: A Landscape Analysis. San Francisco, CA: UCSF Health Workforce Research Center on Long-Term Care. http://healthworkforce.ucsf.edu/sites/healthworkforce.ucsf.edu/files/Report-Peer_Provider_Workforce_in_Behavioral_Health-A_Landscape_Analysis.pdf