• In July 2021, Department of Health Care Services (DHCS) completed the broad strokes of the state standards and qualifications for the Medi-Cal Peer Support Specialist Certification Programs
• These DHCS Standards for implementation are in the Final Behavioral Health Information Notice (BHIN) #21-041 of July 22, 2021
Difference between Initial & Grandparenting Certification
➢ Take the Medi-Cal PSS Certification Exam
➢ Agree to adhere to the PSS Code of Ethics
Initial Certification Requires
• 80 hours of Peer Employment Training covering the 17 topics
California Mental Health Services Authority (CalMHSA)
Chosen by California Behavioral Health Directors Association to implement Peer Certification
• Joint Powers Authority (JPA), non profit, of member counties & cities. It is funded by member participation. Listed on website are 58 members.
• Partners with CA BH Directors Assn. (CBHDA) & CA Institute for BH Solutions (CIBHS)
• Purpose: to obtain and administer public funds for collaborative partnerships and pooling efforts that support and improve CA Behavioral Health programs, projects & educational programs at the state, regional and local levels
• Re. SB 803 Intention: to act as Certifying Body & PSS Online Training Entity
Best Practices for State Peer Certification
U.S. GAO Report to Congressional Committees Leading Practices for State Programs to Certify Peer Support Specialists (Nov, 2018) https://www.gao.gov/assets/gao-19-41.pdf
1. Systematic screening of applicants to assess their understanding of recovery and the peer role
2. Conduct core training in person by approved training vendors (w/COVID, we suggest hybrid)
3. Incorporate physical health & wellness into training or continuing ed.
4. Prepare agencies and supervisors to effectively use peers
5. Continuing education requirements are specific to peer support
6. Engage peers in leadership & development of certification programs
Best Practices to Avoid Conflicts of Interest for Certifying Body
• It does not train peer support specialists
• It is distinct and independent from training entities (see GAO Report)
• It certifies multiple training entities train to PSS core competencies
• throughout the state to meet the needs of cultural/ethnic and regional differences
• It develops & administers the certification exam based on core competencies
• It certifies individual PSS who have met all requirements
• CA & SAMHSA are investing in peer run agencies to build capacity to train and bill
• Many peer agencies already train PSS and count on that revenue
Senate Bill No. 803 CHAPTER 150
An act to add Article 1.4 (commencing with Section 14045.10) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal.
[ Approved by Governor September 25, 2020. Filed with Secretary of State September 25, 2020. ]
SB 803, Beall. Mental health services: peer support specialist certification.Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a schedule of benefits under the Medi-Cal program and provides for various services, including behavioral and mental health services that are rendered by Medi-Cal enrolled providers.This bill would require the department, by July 1, 2022, subject to any necessary federal waivers or approvals, to establish statewide requirements for counties or their representatives to use in developing certification programs for the certification of peer support specialists, who are individuals who self-identify as having lived experience with the process of recovery from mental illness, substance use disorder, or both. The bill would authorize a county, or an agency that represents a county, to develop a peer support specialist certification program and certification fee schedule, both of which would be subject to department approval. The bill would require the department to seek any federal waivers it deems necessary to establish a demonstration or pilot project for the provision of peer support services in a county that agrees to participate in and fund the project, as specified.
Vote: majority Appropriation: no Fiscal Committee: yes Local Program: no
This act shall be known, and may be cited, as the Peer Support Specialist Certification Program Act of 2020.
Article 1.4 (commencing with Section 14045.10) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:
The Legislature finds and declares all of the following:(a) Peer providers in California provide individualized support, coaching, facilitation, and education to clients with mental health care needs and substance use disorders in a variety of settings. Yet, no statewide scope of practice, standardized curriculum, training standards, supervision standards, or certification protocol is available.(b) The United States Department of Veterans Affairs and at least 48 states utilize standardized curricula and certification protocols for peer support services.(c) The federal Centers for Medicare and Medicaid Services (CMS) recognizes that the experiences of peer support specialists, as part of an evidence-based model of care, can be an important component in a state’s delivery of effective mental health and substance use disorder treatment. The CMS encourages states to offer comprehensive programs.(d) A substantial number of research studies demonstrate that peer supports improve client functioning, increase client satisfaction, reduce family burden, alleviate depression and other symptoms, reduce homelessness, reduce hospitalizations and hospital days, increase client activation, and enhance client self-advocacy.(e) Certification can increase the diversity and effectiveness of the behavioral health workforce through the use of peers with lived experience.
It is the intent of the Legislature that the peer support specialist certification program, established under this article, achieve all of the following:(a) Support the ongoing provision of services for individuals experiencing mental health care needs, substance use disorder needs, or both, by certified peer support specialists.(b) Support coaching, linkage, and skill building of individuals with mental health needs, substance use disorder needs, or both, and to families or significant support persons.(c) Increase family support by building on the strengths of families and helping them achieve a better understanding of mental illness in order to help individuals achieve desired outcomes.(d) Support collaboration with others providing care or support to the individual or family.(e) Assist parents, families, and individuals in developing coping mechanisms and problem-solving skills in order to help individuals achieve desired outcomes.(f) Promote skill building for individuals in the areas of socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services.(g) Encourage employment under the peer support specialist certification to reflect the culture, ethnicity, sexual orientation, gender identity, mental health service experiences, and substance use disorder experiences of the individuals the peer support specialists serve.
For purposes of this article, the following definitions apply:
(a) “Certification” means the activities related to the verification that an individual has met all of the requirements under this article and that the individual may provide peer support specialist services pursuant to this article.
(b) “Certified” means all federal and state requirements have been satisfied by an individual who is seeking designation under this article, including completion of curriculum and training requirements, testing, and agreement to uphold and abide by the code of ethics.
(c) “Code of ethics” means the standards to which a peer support specialist is required to adhere.(d) “Core competencies” means the foundational and essential knowledge, skills, and abilities required for peer specialists.
e) “Cultural competence” means a set of congruent behaviors, attitudes, and policies that come together in a system or agency that enables that system or agency to work effectively in cross-cultural situations. A culturally competent system of care acknowledges and incorporates, at all levels, the importance of language and culture, intersecting identities, assessment of cross-cultural relations, knowledge and acceptance of dynamics of cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs to provide services in a culturally competent manner.(f) “Department” means the State Department of Health Care Services.
(g) “Peer support specialist” means an individual who is 18 years of age or older, who has self-identified as having lived experience with the process of recovery from mental illness, substance use disorder, or both, either as a consumer of these services or as the parent or family member of the consumer, and who has been granted certification under a county peer support specialist certification program.
(h) “Peer support specialist services” means culturally competent services that promote engagement, socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and identification of strengths. Peer support specialist services include, but are not limited to, prevention services, support, coaching, facilitation, or education that is individualized and is conducted by a certified peer support specialist.(i) “Recovery” means a process of change through which an individual improves their health and wellness, lives a self-directed life, and strives to reach their full potential. This process of change recognizes cultural diversity and inclusion, and honors the different routes to resilience and recovery based on the individual and their cultural community.
By July 1, 2022, subject to Section 14045.19, the department shall do all of the following:(a) Establish statewide requirements for counties, or an agency representing counties, to use in developing certification programs for the certification of peer support specialists.(b) Define the qualifications, range of responsibilities, practice guidelines, and supervision standards for peer support specialists. The department may utilize best practice materials published by the federal Substance Abuse and Mental Health Services Administration, the United States Department of Veterans Affairs, and related notable experts in the field as a basis for development of these definitions.(c) Determine curriculum and core competencies required for certification of an individual as a peer support specialist, including curriculum that may be offered in areas of specialization, including, but not limited to, transition-age youth, veterans, gender identity, sexual orientation, and any other areas of specialization identified by the department. Core-competencies-based curriculum shall include, at a minimum, training related to all of the following elements:(1) The concepts of hope, recovery, and wellness.(2) The role of advocacy.(3) The role of consumers and family members.(4) Psychiatric rehabilitation skills and service delivery, and addiction recovery principles, including defined practices.(5) Cultural competence training.(6) Trauma-informed care.(7) Group facilitation skills.(8) Self-awareness and self-care.(9) Cooccurring disorders of mental health and substance use.(10) Conflict resolution.(11) Professional boundaries and ethics.(12) Preparation for employment opportunities, including study and test-taking skills, application and résumé preparation, interviewing, and other potential requirements for employment.(13) Safety and crisis planning.(14) Navigation of, and referral to, other services.(15) Documentation skills and standards.(16) Confidentiality.(d) Specify peer support specialist employment training requirements, including core-competencies-based training and specialized training necessary to become certified under this article, and require training to include people with lived experience as consumers and family members.(e) Establish a code of ethics.(f) Determine continuing education requirements for biennial certification renewal.(g) Determine the process for initial certification issuance and biennial certification renewal.(h) Determine a process for investigation of complaints and corrective action, including suspension and revocation of certification and appeals.(i) Determine a process for an individual employed as a peer support specialist on January 1, 2022, to obtain certification under this article.(j) Determine requirements for peer support specialist certification reciprocity between counties, and for peer support specialists from out of state.(k) Seek any federal approvals, related to the statewide certification standards, that it deems necessary to implement this article. For any federal approvals that the department deems necessary related to the statewide certification standards, this article shall be implemented only if and to the extent that the department obtains those federal approvals.
(a) Subject to department approval, a county, or an agency representing the county, may develop a peer support specialist certification program in accordance with this article and any standards established by the department. That county, or an agency representing that county, shall oversee and enforce the certification requirements developed pursuant to this article. To request department approval of the county peer support specialist program, a county, or an agency representing the county, shall do all of the following:(1) Submit to the department a peer support specialist program plan describing how the peer support specialist program will meet all of the federal and state requirements for the certification and oversight of peer support specialists.(2) Submit to periodic reviews conducted by the department to ensure adherence to all federal and state requirements.(3) Submit annual peer support specialist program reports to the department.(b) If a county chooses not to develop peer support specialist certification programs in accordance with this article, the county may fund peer programs to the extent those programs meet all requirements of the applicable funding source.(c) The Legislature finds that peer support specialist certification is conducted at the state level in other states, but this section passes this responsibility to counties. Subject to an appropriation by the Legislature, the state shall fund the startup costs to implement this section.
(a) To receive a certification under this article, an applicant shall meet all of the following requirements:(1) Be at least 18 years of age.(2) Possess a high school diploma or equivalent degree.(3) Be self-identified as having experience with the process of recovery from mental illness or substance use disorder either as a consumer of these services or as the parent or family member of the consumer.(4) Be willing to share their experience.(5) Have a strong dedication to recovery.(6) Agree, in writing, to adhere to a code of ethics.(7) Successfully complete the curriculum and training requirements for a peer support specialist.(8) Pass a certification examination approved by the department for a peer support specialist.(b) To maintain certification under this article, a certified peer support specialist shall meet both of the following requirements:(1) Adhere to the code of ethics and biennially sign an affirmation.(2) Complete any required continuing education, training, and recertification requirements.
This article does not authorize an individual who is certified pursuant to this article to diagnose an illness, prescribe medication, or provide clinical services.
The department shall solicit stakeholder input that may include input from the Office of Statewide Health Planning and Development, peer support and family organizations, mental health services and substance use disorder treatment providers and organizations, the County Behavioral Health Directors Association of California, and the California Behavioral Health Planning Council in implementing this article. Consultation shall include regular stakeholder meetings. The department may additionally conduct technical workgroups upon the request of stakeholders.
A participating county, or an agency representing a participating county, is authorized to establish a certification fee schedule for the purpose of supporting the activities associated with the ongoing administration of the peer support specialist certification program. Before the fee schedule may be implemented, the department shall review and either approve or disapprove the fee schedule of the participating county or an agency representing the participating county.
(a) The department shall seek any federal waivers it deems necessary to establish a demonstration or pilot project for the provision of peer support services in counties that agree to participate and provide the necessary nonfederal share funding for the demonstration or pilot project. The demonstration or pilot project shall do all of the following:(1) Include a peer support specialist certified pursuant to this article as a Medi-Cal provider type for purposes of the demonstration or pilot project.(2) Include peer support specialist services as a distinct service type in counties that opt in to the demonstration or pilot project.(3) Develop and implement one or more billing codes, reimbursement rates, and claiming requirements for peer support specialist services.(b) (1) This section does not require a county to participate in a demonstration or pilot project pursuant to this section. A county that opts to participate in a demonstration or pilot project and provide the necessary nonfederal share funding shall be considered to do so voluntarily for purposes of all state and federal laws.(2) A county that opts to participate in a demonstration or pilot project pursuant to this section agrees to fund the nonfederal share of any applicable expenditures through certified public expenditures or intergovernmental transfers in accordance with Section 433.51 of Title 42 of the Code of Federal Regulations. Each participating county shall certify that the local funds it uses to fund the nonfederal share of expenditures pursuant to this section qualify for federal financial participation pursuant to applicable federal Medicaid laws and any terms of federal approval, in the form and manner as required by the department.(3) Demonstration or pilot projects developed and implemented pursuant to this section shall not constitute a mandate of a new program or higher level of service that has an overall effect of increasing the costs mandated by the 2011 realignment legislation for the counties that opt in to a demonstration or pilot project.(4) General Fund moneys shall not be used to fund the nonfederal share of any expenditures made pursuant to a demonstration or pilot project under this section.(c) This section shall be implemented only if and to the extent that the department obtains any necessary federal approvals, and federal financial participation is available and is not otherwise jeopardized.
For the purpose of implementing this article, the department may 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 entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and the State Administrative Manual, and shall be exempt from the review or approval of any division of the Department of General Services or the Department of Technology.
Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this article, in whole or in part, by means of plan or county letters, information notices, plan or provider bulletins, or other similar instructions, without taking any further regulatory action.
In September of 2020, Senate Bill (SB) 803 (Beall, Chapter 150, Statues of 2020) was chaptered, requiring DHCS to seek federal approval to establish Peer Specialist as a provider type and to provide distinct peer support services under the SMHS and DMC-ODS programs. While services provided by peers can currently be claimed under the provider type "other qualified provider" within the SMHS program, and recovery services provided by peers can be claimed within the DMC-ODS programs, DHCS is proposing to add peers as a unique provider type within specific reimbursable services and to allow counties to opt-in to provide this valuable resource. By July 1, 2021, DHCS will determine the peer certification standards in alignment with the provisions SB 803 (Beall, Chapter 150, Statutes of 2020), and in accordance within CMS' guidance, have the new benefit in place by January 1, 2022.
This document contains a preliminary approach to Peer Support Specialists in the SMHS and DMC-ODS programs. Comments on the preliminary approach will be accepted through Friday, January 29, 2020. Feedback may be submitted to the DHCS inbox: Peers@dhcs.ca.gov.
Peer Support Specialist Listening Session #1 - Friday, January 22, 2021, 10 a.m. - noon
Peer Support Specialist Listening Session #2 - Tuesday, March 2, 2021, 1 - 3 p.m.
DRAFT - Medi-Cal Code of Ethics for Peer Support Specialists in CaliforniaResources
Questions and comments may be submitted by email to Peers@dhcs.ca.gov.
This inbox is targeted to questions and comments related to the implementation of SB 803. For general inquiries regarding existing peer support services, trainings, or other resources please contact your local county mental health plan.
SAMHSA Working Definition of Recovery
(11 pages Last updated in 2011).
"Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. "
~~SAMHSA Working Definition of Recovery (Last updated in 2011)
The belief that recovery is possible for all who experience psychiatric, traumatic, or substance use challenges is fundamental to the practice of peer support. The likelihood of long-term recovery is increased with effective support. Peer support has been demonstrated through research and practical application to be highly effective.
2012: The National Association of Peer Specialists in collaboration with SAMHSA convened an inclusive process to establish standards for practice.
1000 peer specialists participated via: website solicitations, newsletter and email, focus groups, surveys, informalgatherings and literature review.
In addition to a value-based product, the guidelines will be framed in a human rights context. Next is a passage from the World Health Organization’s (WHO) Quality Rights tool kit.
"In many countries, the quality of care in both inpatient and outpatient facilities is poor or even harmful and can actively hinder recovery. The treatment provided is often intended to keep people and their
conditions ‘under control’ rather than to enhance their autonomy and improve their quality of life. People are seen as ‘objects of treatment’ rather than human beings with the same rights and entitlements as everybody else. They are not consulted on their care or recovery plans, in many cases receiving treatment against their wishes."
In addition to the SAMHSA Working Definition and Guiding Principles of Recovery, the following core values have been ratified by peer supporters across the country as the core ethical guidelines for peer support practice:
1. Peer support is voluntary
2. Peer supporters are hopeful
3. Peer supports are open minded
4. Peer supporters are empathetic
5. Peer supports are respectful
6. Peer supporters facilitate change
7. Peer supporters are honest and direct
8. Peer support is mutual and reciprocal
9. Peer support is equally shared power
10. Peer support is strengths-focused
11. Peer support is transparent
12. Peer support is person-driven
California Behavioral Health Directors (CBHDA) September 3, 2020 Supporting peer certification
to Join Mental Health Leaders in Calling for Governor Newsom to Sign SB 803
Youtube - https://youtu.be/0PKy-KTyNhs
CAMHPRO: LEAD Webinar - SB803 Passes: What Now?!
What is Covered & Next Steps for Peer Certification in California Web Meeting
10:30 a.m. to 12:30 p.m.
Oct. 26, 2020
Get answers to your questions, and learn what the next steps are going to be, from policymakers and advocates who contributed to the establishment of California's first Peer Certification program.
Sally Zinman of CAMHPRO
Elia Gallardo, CBHDA
Keris Myrick, L.A. County DMH
Steinberg Institute (invited)
Public Policy Committee Chair
CAMHPRO SB 803 Implementation Workgroups
CAMHPRO Workgroups have been meeting to discuss in depth each of the tasks allocated to DHCS. Each workgroup has met 5-6 times and have written reports summitted to DHCS with the peer perspective, insights and concerns. If you would like to know more group facilitators are listed below.
CAMHPRO LEAD Contact: Andrea Wagner firstname.lastname@example.org
Group 0: Curriculum and Core Competencies and Code of Ethics: Contact: Karin Lettau/PAL, email@example.com
Group 1: Define qualifications, responsibilities, practice guidelines and supervision standards Contact: Robyn.firstname.lastname@example.org
Group 2: Statewide Requirements for Certification for Counties Contact:TBD
Group 3 Training Requirements: Contact : Carol West email@example.com
Group 4 State and Federal Waiver Process Contact: TBD
Group 5 Reciprocity transferring across county and state lines Ronald Shaw, firstname.lastname@example.org
Group 6 Process for initial certification and renewal Kellie Jack, email@example.com
Group 7 Code of ethics Contact: Karin Lettau/PAL, firstname.lastname@example.org
Group 8 Process for oversight and accountability Jason Robison, Jason@shareselfhelp.org
Group 9 Continuing education requirements for biennial renewal Kellie Jack, email@example.com
Group 10 Grandfathering In Contact :Sally Zinman, firstname.lastname@example.org