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 December, 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•Poll 1

2

3

Poll 2

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.

• Organizational membership and individual member applications are on our website https://camhpro.org/

Poll 3

Agenda

• Bottom Line

• Regroup & Refocus

• Identify options

• Workforce Education & Training (WET) $8 million

• Honor Stakeholders’ 17 Recommendations—poll for agreement

• Advocacy Alerts

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

• Previously known as California State Peer, Transition Age, Parent & Family Support Certification Program, Senate Bill 614 (Leno-D) died in the last legislative cycle.

• 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.

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

10

Regrouping

Tomorrow, Dec. 9, there will be an initial meeting in Sacramento with the key State stakeholder agencies that originally signed on in support of the Leno State peer certification billAfter that there will be meetings that will be open to

more agency leaders and others.You may request to attend subsequent meetings by

contacting Heidi Strunk, CAMHPRO Advocacy Coordinator, advocacycamhpro@gmail.com

11

What Leverage Do We Have?

• DHCS is applied for Section 223 Demonstration Project• Updated 2016 Peer Specialist Training & Certification

Programs: National Overview• What funding leverage do we have?

• Office of Statewide Health Planning & Development (OSHPD) Remaining Workforce Education & Training (WET) Funds

• $8 million designated for Consumer/Family Employment• All WET funds revert to State if not used by April, 2019

12

“Protecting Access to Medicare Act (PAMA) of 2014”Background: US HR 4302 Section 223 Demo Project Requires Peer Support

• 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• 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• Certified BH Community Clinics

(CCBH) with required Peer Support Services.

• Establish PPS (prospective payment system)

• Solicit input from consumers, providers and stakeholders

• Submitted 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:

• Increased 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

14

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 SpecialistsoEmploys 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 15

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

16

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]

17

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 applied for the 223 Demonstration Project

18

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

• Office of Statewide Health Planning & Development (OSHPD) Remaining Workforce Education & Training (WET) Funds

• $8 million remains slotted for Consumer/Family WET programming for next 2+ years

• Advisory Committees have not met in 11-12 months!• SAMHSA Grants?• Other grant opportunities?• Other billing mechanisms?• What else?

19

WET FIVE-YEAR PLAN BUDGET (2014-2019)

20

$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 $23,936,0231 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 $1,800,000Clinical 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 $3,100,000Social 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 $10,000,0003 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 $2,250,000Psych 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 $05 Regional Partnership $9,000,000 $3,000,000 $3,000,000 $3,000,000 $06 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 $250,000CalSEARCH $1,000,000 $250,000 $250,000 $250,000 $250,000

Retention $1,000,000 $250,000 $250,000 $250,000 $250,0007 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

21

WET Budget Reassessment 2015

22

23

24

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

Dec, 2015

26

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

Consumer/Family WET Funds

• A year ago members of 2 Office of Statewide Health Planning & Development (OSHPD) WET Advisory Committees recommended more than proposed $7 million

• At Jan, 2016 California Mental Health Planning Council (CMHPC)• OSHPD presented the final proposal after re-assessment, which added another

million to the $7 million already proposed for a total of $8 million for Consumer/Family member WET funds. It was approved by CMHPC.

• No records of this proposal & approval can be found online

Last week, at CMHPC WET Ad Hoc Committee meeting, it was announced that OSHPD will resume the WET Advisory Committee meetings, and

• Between now and June, 2017, OSHPD Requests for Applications (RFAs) will be released monthly to spend remaining Consumer/Family WET $$

27

Background & Stakeholder Recommendations for California Certification of Peer Specialists

28

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 ServicesNAMI California - National Alliance on Mental Illness - CaliforniaUACF - United Advocates for Children and Families

CiMH - California Institute for Mental Health

29

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

30

Resulted in 17 Stakeholder Recommendations for CA Peer/Family Specialist Certification, mostly reflected in the former SB 614- see handout Poll 4

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…)

31

Stakeholder Recommendation—Certifying Body Composition

• Establish Certifying Body• was to be Dept. of Health Care Services (DHCS)• Agency plus collaborative cluster of state

organizations representing youth, consumer, family of adult, parents of child, etc.

• Completely separate from training entities

32

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

33

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 5

34

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

• Poll 635

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

• Poll 7

36

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.

• Poll 837

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

38

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 SpecialistsoEmploys 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

39

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 Providers2. Address the supervision of Peer Providers3. Ensure care coordination in the context of a comprehensive and

individualized plan of care with goals.

40

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

41

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

42

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

43

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.

44

Supporters of old Bill as amended Aug., 2015 Included:• County Behavioral Health Directors

Association of California (sponsored)• 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 &

Families45

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

ServicesCA 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…

47

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

48

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

49

CAMHPRO Trainings & Technical Assistance

50

♦Onsite Workshops (Target: Rural/Frontier/Latino/Youth) “Finding Your Voice” Informal Small Group Workshops

♦ 3 Hours, per request or appointment [Superior; Central; Southern]

“Delivering the ABC’s of Advocacy Workshop”♦ San Mateo Nov. 15, 2016; San Joaquin [TBD]

♦ Client Culture with Continuing Education Credits (Coming in 2017)♦ Regional Policy Forums on Current Issues

♦ Los Angeles, October; Shasta County [TBD]; Central [TBD]

♦ Regional Networking Forums ♦ Southern Region, San Diego [February]♦ Superior Region [TBD]

Advocacy Alerts: Upcoming Meetings • Mental Health Services Oversight and Accountability Commission (MHSOAC)

• Client and Family Leadership Committee & Cultural and Linguistic Competence Committee Joint Teleconference Meeting

TODAY: Thursday, December 8, 2016 10:00 AM – 3:00 PM1325 J Street, Suite 1700, Sacramento, CA 95814Call-In Number 1-866-508-0938; Participation Code 1765491Agenda: http://www.mhsoac.ca.gov/sites/default/files/documents/2016-11/12-08-16_CFLC-CLCC_Agenda_12-08-2016_FINAL.pdfOAC Handout on Community Planning Best Practices

• 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 CA 92108

51

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, January 12, 2017 at noonIf 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

52