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

Karin Lettau, MS, Director of Training & Employment, CAMHPRO klettau7@gmail.com Please follow us and like us on Face Book

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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

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

• r 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

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CAMHPRO’s Mission

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• 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 1-3

Agenda

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

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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

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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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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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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.

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Now what? Regroup

• Collectively craft new proposal for the next

legislative session in Jan. 2017.

• 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?

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How Can We Gain Formal State Validation and Billing for Peer Specialist Services?

We have to ask

• urselves the right

questions to bring forth creative answers.

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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?

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Background: US Section 223 Demo Project Requires Peer Support

US Congress passed H.R. 4302 “Protecting Access to Medicare Act (PAMA) of 2014” and President signed into law April, 2014.

• 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

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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.30

2016 to be reviewed to be part

• f Demonstration
• 8 States to be selected to be part
• f the project by Dec. 31, 2016.
• Demonstration runs Jan. 2017 to
• Jan. 2019
• Evaluate-Final report to

Congress Dec. 2021

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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

• utside 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.”

Services are provided by CCBHCs directly and through formal relationships with DCOs Treatment Planning Psychiatric Rehab Services DCO Crisis Services*** Screening, Assessment, Diagnosis & Risk Assessment Outpatient Mental Health & Substance Use Services Outpatient Primary Care Screening & Monitoring DCO Community- Based Mental Health Care for Veterans DCO Targeted Case Management DCO Peer, Family Support & Counselor Services DCO R

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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. 2016 to

be part of Demonstration

• 8 States to be selected to be part of

the project by Dec. 31, 2016.

• Demonstration runs Jan. 2017 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. 2021

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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

• Employs 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 protocol

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2016 Updated Report on National Peer Specialist Certification

• Peer Specialist Training & Certification Programs: National Overview 2016
• Kaufman, L., Kuhn, W., & Stevens Manser, S. 2016. 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.

• https://camphro.files.wordpress.com/2016/07/peer-specialist-training-and-certification-programs-

national-overview-2016-update.pdf

• Also a handout
• Identify from other states
• their certifying bodies
• other mechanisms to allow for billing

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Report & Map of Peer Specialist Training and Certification Programs by State

• As of July 2016, 41

states and the District

• f 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]

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https://camphro.files.wordpress.com/20 16/07/peer-specialist-training-and- certification-programs-national-

• verview-2016-update.pdf

CA is the only State without a State Certification Program applying for the 223 Demonstration Project

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Peer Specialist Training & Certification Programs: National Overview 2016Kaufman, L.,

Kuhn, W., & Stevens Manser, S. 2016. 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?

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 11-12 months!
• SAMHSA Grants?
• Other grant opportunities?
• Other billing mechanisms?
• What else?

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WET FIVE-YEAR PLAN BUDGET (2014-2019)

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$234,500,000 $119,755,910 $114,744,090 Item Number State Administered WET Program State WET Funding for 4 Year Budget Fiscal Year 14/15 Fiscal Year 15/16 Fiscal Year 16/17 Fiscal Year 17/18 $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 $250,000 7 Evaluation $2,744,090 $686,023 $686,023 $686,023 $686,023 Total

Mental Health Workforce Education and Training (WET) Five-Year Plan Budget

WET Funding Allocated for State Administered Programs in 2008 WET Funding Spent via State Administered Programs in 2008-2013 WET Five-Year Plan WET Funding Remaining for State Administered Programs for 2014-2019 WET Five-Year Plan

Original Plan Jan, 2014

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WET Budget Reassessment 2015

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25

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http://www.oshpd.ca.gov/HWDD/2015/WET/WET-Budget-Re-Assessment-Presentation-20150929.pdf

Dec, 2015

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http://www.

• shpd.ca.go

v/document s/HWDD/W ET/2015/Pre sentation-

• n-WET-

Budget-Re- Assessment- Proposed- Modificatio ns.pdf

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 re-

assessment, 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

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Background & Stakeholder Recommendations for California Certification of Peer Specialists

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Original 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 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 the former SB 614

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 Recommendation—Certifying Body Composition

• Establish Certifying Body
• NOT Dept. of Health Care Services
• Agency plus collaborative cluster of state
• rganizations representing youth, consumer, family
• f adult, parents of child, etc.
• Completely separate from training entities

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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

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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

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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

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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

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Defi fining 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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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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Offic icial 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

• 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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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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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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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)

• Additional Certification: 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
• Used 1915 b(3) waiver
• Administered by Michigan Department of Community Health,

Behavioral Health

• Has Parent Specialists too

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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
• 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.

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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

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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)

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…

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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

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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

 

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CAMHPRO Trainings & Technical Assistance

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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]

Advocacy Alerts: Upcoming Meetings

• MHSOAC Commission Meeting
• Thurs., November 17, 2016, 9 A.M. – 3 P.M.
• 1325 J St., Suite 1700, Sacramento, CA 95814
• Call-In Number: 866-817-6550; Participant Code: 3190377
• Agenda: http://mhsoac.ca.gov/sites/default/files/documents/2016-

11/111716_OAC_0_Agenda_Final.pdf

• CA Mental Health Planning Council (CMHPC)

http://www.dhcs.ca.gov/services/MH/Pages/CMHPC-PlanningCouncilWelcome.aspx

• January 18-20, 2017: Courtyard San Diego Mission Valley/Hotel Circle, 595

Hotel Circle South San Diego California 92108 USA

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Thank you for your commitment and actio ion!

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 916-212-3685 Next Peer Certification Update Webinar

2nd 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: https://attendee.gotowebinar.com/register/5972164910449781505

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