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

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870 Market St., Suite 922 San Francisco, CA 94102(415) 341-9460 ▪see our new website: http://camhpro.org/

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.

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Overview

• Peer Support Movement • National Push and Context• California Conditions• Stakeholders Promote California State Certification

• SB 614 • Contents• Major Challenges

• Where Are We Now• What May Be Coming• Support or Oppose SB 614—Deal Breakers

• Holding the Vision

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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 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.

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Peer Specialist vs CPRP Services

• Similar recovery, resiliency, and strengths-based approach, similar Codes of Ethics

• Differences—Peer Specialists…

• use their lived experience to connect with person, to demonstrate the use of one’s strengths, and to encourage and inspire those they support.

• tell strategic stories of their personal recovery in relation to current struggles faced by those who are being supported.

• model recovery behaviors at work and act as ambassadors of recovery in all aspects of their work.

• Views and accepts the whole person, is curious

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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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US Centers for Medicaid (Medi-CAL) (CMS)

• “Peer support providers are a distinct provider type for the delivery of counseling and other support services to Medicaid eligible adults with mental illnesses and/or substance use disorders.”

• “CMS recognizes that the experiences of peer support providers, as consumers of behavioral health care services, can be an important component in a State's delivery of effective treatment.” (2007)

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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 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

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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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Impactful Outcomes

• Certified Peer Specialist Services result in substantial savings by reducing the high-cost of care

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California Conditions

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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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California Medi-Caid (MEDI-CAL) Billing Practices

• Current State 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

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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

• 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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SB 614 Contents

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“It is the intent of the Legislature that the peer, parent, transition-

age, and family support specialist certification program achieve all

of the following…Encourage employment…to reflect the culture,

ethnicity, sexual orientation, gender identity, mental health

service experiences, and substance use disorder experiences of

the people whom they serve.”

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Senate Bill 614 14045.12(h) Intent

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

• Called peer, parent, transition-age, and family support specialist certification programoDHCS would create Certification by July, 2017

o Sponsored by CBHDA

o 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

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

• Be at least 18 years of age.

• 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 of 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 TBD

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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

• 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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SB-614--Where are we now?

Still ‘inactive’

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

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)

Support or Oppose SB-614—Deal Breaker Amendments

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SB 614 Negotiations

• Refuses to open State Plan to create unique Peer Support Service/Provider billing codes.

• Submitted technical amendments to CBHDA

CBHDA makes recommendations in response to DHCS

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DHCS CBHDADHCS CBHDAWant 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

Holding the Vision

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Transformational Advocacy

• Principles of Recovery that we practice ourselves, with each other and the people we serve:• Hope

• Choice

• Empowerment

• Personal Responsibility

• Recovery Environment

• Meaning and Purpose

• Apply to the System too• Meet Agencies where they are

Stages of Change Applied to CA Agencies

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Pre Contemplation (Not Ready)

Contemplation

Preparation (Ready)

Action-Policy planning/implementation

Maintenance

• Pre Contemplation-not knowing things need to change

• Contemplation-challenges, discomfort, but not ready

• Preparation-thinking about change, will hear you

• Action-changes take form, positive outcomes, hope, needs advocates to stay on track

• Maintenance -must be vigilant and flexible to not be static, to continue to grow in a positive way

• 1997 Prochaska, Redding, Evers

• 2008 Recovery Innovations, Lisa St George

CA Agencies Didn’t Follow Along with Us

38Source: offnews.info

Why?

Did understanding of the MHSA & the recovery movement transfer?

Loss of institutional knowledge in transition

from DMH to DHCS

Meet them where they areEducate

CA Government Health Agencies

“Not Ready”

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How Do We Advocate for SB 614?

• Attend State meetings and speak up

• Write letters—we have been called on to write at least 1,000 letters

• Call, Fax

• Letters to editors of publications

• Meet with legislators and government officials• CAMHPRO & or PAAT may set up Mental Health Matters Day Meeting with

5/24 Governor’s aide?

• Organize a local rally or sit-in

• Social Media: Facebook, Twitter…40

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

• Create password to log in

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Who Do We Advocate To?

• Governor Jerry Brown

• CA Health & Human Services, Secretary Diana Dooley

• Dept. of Health Care Services, Director Jennifer Kent

• Your individual CA Representatives and Senators

• Find your representative

• http://findyourrep.legislature.ca.gov

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Contact Governor Jerry Brown

•Phone: 916-445-2841

• Email: https://govnews.ca.gov/gov39mail/mail.php

•Mailing address

c/o State Capitol, Suite 1173, Sacramento, CA 95814

• FAX: 916-558-3160

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Contact CA Health & Human Services

•Secretary Diana S. Dooley•Phone: 916-654-3454• Email: ddooley@chhs.ca.gov•Mailing address: 1600 Ninth St., Room #460,

Sacramento, CA 95814• Fax: 916-654-3343

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Contact Dept. of Health Care Services

•Director Jennifer Kent

• Email: Jennifer.kent@dhcs.ca.gov

•Phone: 916-322-7445

•Mailing Address: PO BOX 997413, Sacramento, CA 95899-7413

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Bill Author Senator Mark Leno Contacts

sd11.senate.ca.gov

www.senate.Ca.Gov/Leno

• 916-651-4011

• Fax 916-651-4911

• Leno’s Aide on SB 614:

• Sunday Balalis: Sunday.balalis@sen.ca.gov

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Advocacy Alert: MHSOAC May Meeting

•MHSOAC Commission Teleconference Meeting• May 26, 2016, 10 am

• Call-In Number: 866-817-6550; Participant Code: 3190377

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Questions & Contributions?

• Thank you for your ongoing commitment to California State Peer Certification!

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Thank you for your commitment and action!

Next Peer Certification Update Webinar2nd Thursday, June 9, 2016 at noon

If you are registered you will be reminded

CAMHPRO Public Policy Committee on Peer Certification Meeting 2nd Wednesday, 4pmhttps://global.gotomeeting.com/join/642389037

Use your microphone and speakers (VoIP) - a headset is recommended. Or, call in using your telephone.

Dial +1 (646) 749-3112, Access Code: 642-389-037

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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/Report-Peer_Provider_Workforce_in_Behavioral_Health-A_Landscape_Analysis.pdf

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