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 ▪

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CAMHPRO Peer Certification SB 614

Update & Input Meeting August 11, 2016

California

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 1-4

Senate Bill 614, Peer Certification Not moving forward at this time

• The County BH Directors Assoc. (CBHDA), sponsor of bill SB 614, will NOT go with the Dept. of Health Care Services (DHCS) technical amendments that would butcher the bill, but CBHDA has not decided yet.

• Bill author Senator Leno will let the bill expire.

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Bottom Line Since Last Month

• Since DHCS will NOT support new unique billing for peer support, an integral part of the current bill, DHCS would not be needed in a new bill.

• A new State Peer Certification legislative proposal could omit DHCS & omit the new billing to focus on the other key elements of the current bill.

• WE WILL NEED ALL OF YOUR SUPPORT & ACTIVE INVOLVEMENT TO GET A LEGISLATIVE PROPOSAL READY BY JAN, 2017, REFLECTING THE 17 RECOMMENDATIONS MADE BY OVER 700 STAKEHOLDERS.

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Now what? …Peer Support… Then some suggestions

• Research alternatives to a unique billing code needed for a State Plan Amendment that could allow for additional CA credentialing and draw more funding for Peer Support Specialist Services

• Capitated billing that includes peer services?

• Legislative proposals/bills in steps

• Create CA Peer Specialist billing code for Medicaid draw down—LATER

• State Certification with Certifying body—FIRST with above in mind

5Torrey Pine named Esperanza

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Peer Certification Movement in California

• Originally evaluated by California Network (CNMHC)

• Working Well Together (WWT) (2008-2014)Training and Technical Assistance Collaborative:

CNMHC, then in 2012, CAMHPRO-PEERS - California Association of Mental Health Peer Run Organizations – Peers Envisioning and Engaging in Recovery Services

NAMI California - National Alliance on Mental Illness - California

UACF - United Advocates for Children and Families

CiMH - California Institute for Mental Health

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CA 58 Counties = 58 Different Peer Standards

• Many agencies/colleges offer “certificates” for completion of trainings/courses to become MH peer/family providers• These are NOT state recognized

• Most counties employ/contract for peer, parent/family support specialist providers

• But Most Counties… • require no training or require no training standardized to the role of

peer/family/parent support specialist• if training exists it is mostly provided by clinicians/trainers not familiar with

peer practices• have no practice guidelines• have no appropriate supervision requirements• don’t allow peer providers to bill under existing codes (rehab…)

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Stakeholder Process & Involvement

Used multiple methods of gathering input, including four research reports

Written surveys

Focus groups

Comment and question sessions in face-to-face meetings

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

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

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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: Education & 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

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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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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 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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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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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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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

California Medi-Caid (MEDI-CAL) Billing Practices

• Current State Medi-Cal Plan allows billing under rehabilitation, targeted case management and collaterals provided by “Other Qualified Providers”, which includes Peer Specialists.

• Each County Mental Health Director has discretion to use more strict guidelines than required by the State Plan.

• Only a few counties currently allow peer specialists to bill under existing codes.

• Even counties allowing peers to bill under existing codes, lose at least 25% of billing ability because some peer services provided are not billable under current codes

• Free-standing Peer or Family Run agencies cannot bill currently

• SB 614 would have created a distinct peer specialist provider and service type for these unique services, adding Medi-Cal reimbursement to counties for peer services already being provided

• It would have been up to the Dept. Health Care Services (DHCS) to create new billing

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CMS Guidelines Allow Peer Specialist Billing

• In 2007, the Centers for Medi-Care and Medi-Caid Services (CMS) disseminated a set of guidelines for states to establish Peer Providers and Peer Services as a unique Medi-CAL billable services.

• Guidelines minimally require a State Plan to:1. Train and Certify Peer Providers

2. Address the supervision of Peer Providers

3. Ensure care coordination in the context of a comprehensive and individualized plan of care with goals.

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Over 30 States have unique Peer Specialist Service Medicaid Billing Codes

Medicaid Billing for Mental Health Peer Provider Services by State 2014

Example: Georgia Certified Specialists bill

• Structured activities that promote socialization, recovery, wellness, self-advocacy, development of natural supports, and maintenance of community living skills.

• Activities provided between and among individuals who have common issues and needs, are consumer motivated, initiated and/or managed, and assist individuals in living as independently as possible.

• Peer Support (H0038),Psych rehab (H2017), Community support (H2015), ACT (H0039),

• Health and Wellness Supports, (H0025)—Whole Health

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

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Michigan Certified Specialists bill

• “Because of their life experience, Peer Support Specialists provide expertise that professional disciplines cannot replicate.”

• Service Codes:

• Assertive Community Treatment (ACT) H0039

• Peer-Directed and -Operated Support Services, H0023, H0038, H0046

• H0023: Drop-in center

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Oregon Certified Peer Specialists bill

• “Peer Delivered Services” means an array of agency or community-based services and supports provided by peers, and peer support specialists, to individuals or family members with similar lived experience, that are designed to support the needs of individuals and families as applicable.

• H2021 Community-Based Wraparound

• H2027 Psycho-educational Services

• H0038 Self-Help/Peer Support

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SB-614--Where are we now?

Still ‘inactive’, will expire in the legislature

Supporters of Bill as amended Aug., 2015 Include:

• County Behavioral Health Directors Association of California (sponsor)

• Association of California Health Care Districts

• CA Association of Mental Health Peer-Run Organizations

• CA Association of Social Rehabilitation Agencies

• CA Mental Health Oversight & Accountability Commission

• CA Council of Community Mental Health Agencies

• CA State Association of Counties

• Disability Rights California

• National Alliance on Mental Illness California

• Pacific Clinics

• Peers Envisioning and Engaging in Recovery Services (PEERS)

• REMHDCO

• Sacramento County Board of Supervisors

• SEIU California

• Steinberg Institute

• Western Center on Law and Poverty

• United Advocates for Children & Families

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Life Cycle SB 614 (Leno-D)

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• CNMHC & WWT

• Stakeholder Input

• Legislative proposal

• CBHDA sponsors

Stakeholders

• Senator Leno authors SB 614 & intros bill

• Passes Senate unanimously 6/1/15

• Goes to Assembly

Senate • Passes 2 Committees

• Ordered to 3rd

Reading on floor 9/1/15

• Ordered to Assembly Inactive file 9/3/15

Assembly

Governor signs or

dies

CNMHC=CA Network of MH ClientsWWT=Working Well TogetherCBHDA= County BH Directors Association

Our State System

CA BH Directors Association

(CBHDA)

State Legislature:Senate & Assembly

Governor

State Health & Human Svcs

(CHHS)

OSHPD Heath Planning & Dev.

Dept. of Public Health (CDPH)

Office of Health Equity (OHE)

Dept. of Health Care Services

(DHCS)

CA MH Planning Council (CMHPC)

Mental Health & Substance Use

Services

CA Health Facilities Financing Authority

MH Services Oversight &

Accountability Commission (MHSOAC)

How Can We Advocate for State Peer Certification?

• Budget for, or ask your agency to budget discretionary funds and time for advocacy activities

• Attend State and County meetings and speak up

• Participate on workgroups to support activities/legislation

• Letters to editors of publications

• Meet with legislators and government officials

• Attend CAMHPRO Day at the Capitol in May

• Organize a local rally or sit-in

• Form a Coalition; Educate continuously

• Social Media: Facebook, Twitter…

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Advocacy Avenues

Individual Agency or Group

County Regional State

Letter, email to, or meeting with lawmaker, gov’t official, or to Editor

Unless

contracts prohibits

Often prohibited

CBHDA

Rally, Sit-in

Info & input webinars

Media, social media

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How to Track a Legislative Billhttp://leginfo.legislature.ca.gov/

CA Legislative Info.website• Go to Bill Information,

enter bill number or key word

• Click on bill #

• View Tabs

• Click on Track Bill

• Register for email notice of changes to bill• Email address only required

• Create password to log in

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CAMHPRO Trainings & Technical Assistance

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ABC’s of Advocacy Webinar Series• Web A: Advocacy Basics on August 24, 10:30 AM

• Register here: https://attendee.gotowebinar.com/register/8532067671389922819

• Web B: Best Community Planning Practices on August 31, 10:30 AM• Register here: https://attendee.gotowebinar.com/register/845422563540292865

• Web C: Community Planning; How to Work it on September 14, 10:30 AM • Register here: https://attendee.gotowebinar.com/register/4812485805325354754

Local Onsite Advocacy Workshop• "Practicing the ABC’s of Advocacy in Mental Health" (5 hours including Lunch) per request

• “Finding Your Voice” Onsite Workshops (3 hrs) per request or appointment

Follow-Up Support Technical Assistance

Advocacy Alert: MHSOAC August Meetings

• MHSOAC Client and Family Leadership Committee• August 18, 2016; 9:30am-12:00pm

• 1325 J St, Suite 1700, Sacramento, CA 95814• Call-In Number: 866-817-6533; Participant Code: 1189021

• MHSOAC Cultural and Linguistic Competence Committee• August 18, 2016; 1:00—3:30 pm

• Same address as above• Call-in Number: 866-508-0938; Participation Code: 1765491

• MHSOAC Commission Meeting http://www.mhsoac.ca.gov/

• August 25, 2016 9:00 am

same address as above

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

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Thank you for your commitment and action!

Next Peer Certification Update Webinar2nd Thursday, September 8, 2016 at noon

If you are registered you will be reminded

• Registration URL: https://attendee.gotowebinar.com/register/6529515036756175362

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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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