Karin Lettau, MS, Director of Training & Employment, CAMHPRO klettau7@gmail.com

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 ▪

see our new website:http://camhpro.org/

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 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

3

CAMHPRO’s Mission

4

• 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

5

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

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

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

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

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?

10

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

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

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

13

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 of Demonstration

• 8 States to be selected to be part of the project by Dec. 31, 2016.

• Demonstration runs Jan. 2017 to Jan. 2019

• Evaluate-Final report to Congress Dec. 2021

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.”

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

DCOTargeted

Case

Management

DCO

Peer,

Family

Support &

Counselor

Services

DCO

R

Slide 15

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

16

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 protocol 17

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

18

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]

19

https://camphro.files.wordpress.com/2016/07/peer-specialist-training-and-certification-programs-national-overview-2016-update.pdf

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

20

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?

21

WET FIVE-YEAR PLAN BUDGET (2014-2019)

22

$234,500,000

$119,755,910

$114,744,090

Item

Number

State Administered WET

Program

State WET Funding

for 4 Year BudgetFiscal 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

23

WET Budget Reassessment 2015

24

25

26

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

Dec, 2015

28

http://www.oshpd.ca.gov/documents/HWDD/WET/2015/Presentation-on-WET-Budget-Re-Assessment-Proposed-Modifications.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

29

Background & Stakeholder Recommendations for California Certification of Peer Specialists

30

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

31

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

32

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…)

33

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

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

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

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

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

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

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

40

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

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

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

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

o Supporting the individual in building skills that enable whole health improvements

44

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

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

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

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…

49

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

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

51

CAMHPRO Trainings & Technical Assistance

52

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

53

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 916-212-3685

Next Peer Certification Update Webinar2nd 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

54