CAMHPRO Peer Certification SB 614 Update & Input Meeting July - - PowerPoint PPT Presentation

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CAMHPRO Peer Certification SB 614 Update & Input Meeting

July 14, 2016

California Association of Mental Health Peer Run Organizations (CAMHPRO)

• Non profit statewide organization of consumer run

programs and individuals…to empower, support, and ensure the rights of consumers, eliminate stigma, and advance self-determination for all those affected by MH issues…

• Promotes involvement of consumers at all levels of

planning, policy, and programming for MH and related systems.

• Poll 1-4

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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

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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
• ther 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
• ther mental health services such

as: rehabilitation, targeted case management or collateral.

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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.

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CMS Guidelines to States Allowing Peer Specialist Billing

• In 2007, the Centers for Medi-Care and Medi-Caid Services (CMS)

disseminated a set of guidelines for states to establish Peer Providers and Peer Services as a unique Medi-CAL billable services.

• Guidelines minimally require a State Plan to:
• 1. Train and Certify Peer Providers
• 2. Address the supervision of Peer Providers
• 3. Ensure care coordination in the context of a comprehensive and

individualized plan of care with goals.

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Official National & State Certifications

• 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
• r Parent Specialists
• Billing Medicaid for Peer Services is

the primary impetus

• U.S. Veterans Administration

Certifies Peer Specialists

• 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

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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
• 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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Impactful Outcomes

• Certified Peer Specialist Services result in

substantial savings by reducing the high-cost of care

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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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California Practices WWT 2012 Research:

• Survey sent to 58 CA counties
• Of 32 Counties responding to stakeholder survey
• 31 reported Consumer, Family Members &/or Parent/Caregiver Peer

Support Specialists are employed in their county.

• Learned there is no statewide standard in job tasks, job training, job title
• Only standard was that someone had “lived experience”.
• Required training hours ranged from 12-480 hours.
• Only 5 of the 31 Counties required training prior to hire.

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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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WWT 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, 2013.

• Vetted the recommendations at this

meeting utilizing a modified consensus model.

• On-going monthly teleconferences
• Member list has over 700 people

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Resulted in 17 Stakeholder Recommendations for CA Peer/Family Specialist Certification, mostly reflected in SB 614

Key CA Peer Specialist Vetted Documents

• Four Research & Stakeholder Recommendations Reports, links:
• https://camhpro.org/peer-certification-sb614/
• 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

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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 create a distinct peer

specialist provider and service type for these unique services, adding Medi-Cal reimbursement to counties for peer services already being provided

• It would be up to the Dept. Health Care

Services (DHCS) to create new billing

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SB-614--Where are we now? Still ‘inactive’

SB 614 Negotiations

• Refuses to create

unique Peer Support Service/Provider billing codes.

• Submitted technical

amendments to CBHDA

• Considered CBHDA

and submits final changes with minor concessions CBHDA makes recommendations in response to DHCS CBHDA had Stakeholder meeting held 5/31/16 to review changes. CBHDA met with Stakeholder leaders on DHCS version in late June Stakeholders voted to NOT support DHCS’ amendments

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DHCS CBHDA

Want progress without compromising the integrity of genuine peer support services and specialists

• Accurate definitions of peer

support specialist and others

• Stakeholder involvement
• Multiple trainers
• Grandfathering in
• Requirements for Cert.
• Use of best practices
• Tied to the MHSA & funding

Stakeholders

Bottom Line Since Last Month

• Indicators are 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.

• If so, the author Senator Leno could push the bill through anyway, as it

currently reads but face a veto from Governor Brown, since DHCS will not support this.

• If vetoed, it would make it very difficult to pass a new version or

rendition of the bill in future legislative sessions.

• It may be best to pull the bill this session and start over for a chance to

pass a new version of the bill.

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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 &
• mit the new billing to focus on the other key elements of the current

bill.

• If so, 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. VIEW

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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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Senate Bill 614 introduced in 2015 by Senator Mark Leno (D) as Amended 8/31/15

• Called peer, parent, transition-age, and family support specialist

certification program

• DHCS would create Certification by July, 2017, Sponsored by CBHDA
• Statewide certification for:
• Adult peer specialists, 18 years of age or older
• Parent peer support specialists
• Transition-age Youth Peer Support Specialists (18 or older)
• Family Peer support specialists
• Department of Health Care Services (DHCS) would administer
• Amendments pending: Removal of categories?—to be placed under specialties
• Removal of substance use references?

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SB 614 Certification Requirements as of 8/31/15 Amendments

• Be at least 18 years of age. (will add HS

Diploma or GED?)

• Have/had a primary diagnosis of mental

illness, substance use disorder, or both, which is self-disclosed. (or to be family member of adult or parent of child/youth)

• Have received/is receiving MH services,

substance use disorder services, or both.

• Be willing to share his or her experience of

recovery.

• Demonstrate leadership & advocacy skills.
• Have a strong dedication to recovery.
• Agree to uphold and abide by a code
• f ethics.
• Successful completion of the

curriculum and training requirements for peer/family support specialist.

• Pass a certification exam approved by

DHCS for peer/family support specialist.

• Successful completion of required

continuing education, training, & recertification

• Grandfathering-in process

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SB 614 (Leno-D) Continued

• Would amend Medicaid state plan allowing Medi-Cal billing to include peer

and family support specialist as Provider TYPE and as Provider Service— Will be amended out. May emphasize the ability for peer providers to bill under EXISTING billing codes, already allowable if County BH Director of each county permits.

• Could use Mental Health Services Act funds, and WET resources to develop

and administer Program?

• Could enter into exclusive or nonexclusive contracts on a bid or negotiated

basis, including contracts for the purpose of obtaining subject matter expertise or other technical assistance. Contracts may be statewide or on a more limited geographic basis?

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Life Cycle SB 614 (L (Leno-D) 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 Clients WWT=Working Well Together CBHDA= County BH Directors Association

Major Challenges & Roadblocks

The Division of Government & Legislation--Lines Blurred

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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)

• Last month’s polling results
• 37 Attendees polled

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POLLING YOUR PRIORITIES

• What are your priorities:

36 Poll 5-8

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
• Educate continuously
• Social Media: Facebook, Twitter…

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Advocacy Avenues

Individual Agency or Group County Regional State Letter, email to,

• r meeting with

lawmaker, gov’t

• fficial, or to

Editor

  Unless

contracts prohibits Often prohibited CBHDA Rally, Sit-in

   

Info & input webinars

    

Media, social media

 

Poll 9-10

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How to Track a Legislative Bill

http://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
• Create password to log in

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Advocacy Alert: MHSOAC July Meeting

• MHSOAC Commission Meeting
• July 28, 2016 10:00 am

1325 J St, Suite 1700 Sacramento, CA 95814 Call-In Number: 866-817-6550 Participant Code: 3190377

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Thank you for your commitment and action!

Next Peer Certification Update Webinar

2nd Thursday, August 11, 2016 at noon If you are registered you will be reminded

• Registration

URL: https://attendee.gotowebinar.com/register/65 29515036756175362

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References

• http://sites.utexas.edu/mental-health-institute/files/2014/07/Peer-

Specialist-Training-and-Certification-Programs-A-National-Overview-2014- Update.pdf

• Using Peers to Support Physical and Mental Health Integration for Adults

with Serious Mental Illness Jan 2016, The National Academy for State Health Policy 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/Repo rt-Peer_Provider_Workforce_in_Behavioral_Health- A_Landscape_Analysis.pdf

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