Peer Support Specialists: Roles and Responsibilities in Medi-Cal
Medi-Cal is preparing for the end of the COVID-19 Public Health Emergency and urging beneficiaries to update their contact information to maintain coverage. DHCS is introducing peer support specialist services as an optional behavioral health benefit in California from July 1, 2022, onwards. Become a DHCS Coverage Ambassador to help in this transition and ensure continuity of care for beneficiaries.
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Medi-Cal Peer Support Specialists: Roles and Responsibilities Tuesday, June 7, 2022 3:00 p.m. 4:00 p.m.
Public Health Emergency (PHE) Unwinding The COVID-19 PHE will end soon and millions of Medi-Cal beneficiaries may lose their coverage. Top Goal of DHCS: Minimize beneficiary burden and promote continuity of coverage for our beneficiaries. How you can help: Become a DHCS Coverage Ambassador Download the Outreach Toolkit on the DHCS Coverage Ambassador webpage Join the DHCS Coverage Ambassador mailing list to receive updated toolkits as they become available 2
DHCS PHE Unwind Communications Strategy Phase One: Encourage Beneficiaries to Update Contact Information Launch immediately. Multi-channel communication campaign to encourage beneficiaries to update contact information with county offices. Flyers in provider/clinic offices, social media, call scripts, website banners. Phase Two: Watch for Renewal Packets in the mail. Remember to update your contact information! Launch 60 days prior to COVID-19 PHE termination. Remind beneficiaries to watch for renewal packets in the mail and update contact information with county office if they have not done so yet. 3
Featured Presenters Ali Marzolf, Senior Policy Consultant, Integrated Care, Aurrera Health Group Kristen Mungcal, Program Manager, Department of Behavioral Health, San Bernardino County Lucero Robles, LCSW, Quality Assurance Director, California Mental Health Services Authority (CalMHSA) Alexandria Simpson, Program Implementation Section Manager, Department of Health Care Services (DHCS)
Agenda Department of Health Care Services (DHCS) County Certification Entity (CalMHSA) Questions
Department of Health Care Services (DHCS) Alexandria Simpson, Program Implementation Section Manager Department of Health Care Services (DHCS)
Senate Bill 803 Senate Bill 803 (SB 803) (Beall, Chapter 150, Statutes of 2020) authorized DHCS to request federal approvals to add peer support specialists as a Medi-Cal provider type and peer support services as a distinct Medi-Cal benefit in counties opting to implement the service Accordingly, DHCS requested federal approvals through the State Plan Amendment (SPA) process and received approvals from CMS in December 2021 SPA 20-0006-A SPA 21-0058 SPA 21-0051 Effective July 1, 2022, peer support specialist services will be an optional behavioral health Medi-Cal benefit in California that can be implemented within DMC, DMC-ODS, and/or the SMHS delivery systems
Peer Support Specialist Certification Review and approve certification, supervision, and continuing education curriculum submitted by counties or designated entity. Review and approve implementation plan for Medi-Cal Peer Support Specialist Certification Program.
Peer Support Services Benefit Ensure that appropriate federal authorities are in place for reimbursement of Medi-Cal Peer Support Services Determine rates for DMC Review and approve DMC-ODS rates
Program Integrity and Reporting Provide data to federal partners as specified in the 1115 Demonstration Waiver Evaluation Design Plan (42 CFR 431.424) Monitor the Peer Support Services Benefit through regular reviews
County Kristen Mungcal, Program Manager Department of Behavioral Health, San Bernardino County Clubhouse and Community Connections
Benefit: Peer Support Services Collaboration with all parts of the system as early as possible. Inclusion of Quality Management, Compliance, Information Technology, Workforce Education and Training, Human Resources, and any other divisions applicable to your system. Address topics such as: Determine DMC-ODS rates for DHCS approval Administer utilization controls to ensure program integrity of reimbursed Peer Support Services Verify Medi-Cal eligibility of each beneficiary for each month of service prior to billing for services Report any overpayments made for Peer Support Services Maintain and report billing and employment data to the state as appropriate
Provider: Peer Support Specialists Provide implementation assistance for existing peer workforce Complete hiring and training of additional Medi-Cal Peer Support Specialists in order to participate in the new benefit Determine appropriate staffing levels for supervision of Medi-Cal Peer Support Specialists Set peer workforce expectations for all staff upon integration of Peer Support Specialists into the workforce Establish formal ongoing support structure to avoid peer drift
Contractors: Peer Support Services Communicate certification timelines with contract providers Update contracts with contracted providers that provide Peer Support Services to include: Peer Support Specialists as a new Medi-Cal provider type and Medi-Cal Peer Support Services as a new benefit The rate of reimbursement for State Plan DMC, DMC-ODS, and/or SMHS services Requirements for data reporting Quality Assurance, Quality Improvement, Utilization Management, and/or Utilization Review standards if applicable Provide implementation support for those new to Peer Support Services
External Stakeholders: Peer Support Services Communicate certification requirements, process, and future efforts Incorporate into existing community program planning efforts and/or create a dedicated plan Ensure that external stakeholders have technical assistance on navigating the contract process, if desired SB-803 is the result of decades of advocacy by peers and grass-roots peer run organizations. It is important to continue to partner with them throughout implementation
Beneficiaries: Peer Support Services Inform clients of the new benefit Educate clients on the purpose and utility of Peer Support Services Involve clients in the implementation and roles of Peer Support Services Advise interested beneficiaries on the various pathways to employment in the Peer Support Services field
Contact Information Kristen Mungcal, Program Manager Email: DBH-PeerCertification@dbh.sbcounty.gov Phone Number: (909) 458-1527
Certification Entity Lucero Robles, LCSW Quality Assurance Director, California Mental Health Services Authority (CalMHSA)
CalMHSA California Mental Health Services Authority Experience in the development and implementation of local, regional, and state-wide mental health services and programs.
Law that makes billing for Peer services a new Medi-Cal benefit for counties that opt-in Peers Certification Implementation SB803 Oversees Peer Services benefit Updates state waivers Sets reimbursement rates Set standards for certification DHCS Peers Individuals that meet requirement for certification Counties Opt-In to this benefit CalMHSA Certifying Entity Once certified, individuals can move across counites as part of certified workforce Opt-In to Peer Benefit Select Certifying Entity Update contracts/billing system for reimbursement Has employer & contract oversight role Certifies Individuals Approves Training Entities Develops all Board functions, Exam, registration lookup, investigations, etc. Evaluates outcomes
Certifying Entity CalMHSA was selected by county Behavioral Health Plans as the Certifying Entity for Medi-Cal Peer Support Specialists Responsible for certification, examination, and enforcement of professional standards for Medi-Cal Peer Support Specialists in California. All applicants seeking certification are required to successfully pass an exam ensuring any individual holding a certification has met the minimum educational requirements. CalMHSA investigates consumer complaints and imposes disciplinary actions against a Certificant who violates the Code of Ethics.
Certifying Entity Supporting the standardization of Medi-Cal Peer Support Specialist certification across counties, based on DHCS standards. Single DHCS- approved examination for certification to best enhance the workforce. Held 13 community listening session in October 2021 Peer Certification program Stakeholder Advisory Council We have 1 full time manager, 1 Supervisor, and 3 full-time Peer Specialists Single exam under development; input from subject matter experts. Implemented an all-inclusive certification website www.CAPeerCertification.org
Peer Voice Stakeholder Advisory Council 18 members across counties Input into the development of certification program Input on policy Input on the identification of curriculum competencies for specializations Meeting is open with opportunity for community input/feedback Meeting notes and agendas posted on website https://www.calmhsa.org/peer- certification/ Subject Matter Experts Examination Development Identification of curricula for specializations Support with informing material Program staff
Certification and Specializations CERTIFICATION One general certification for Medi-Cal Peer support Specialists Encompasses working with individuals in mental health and/or substance use disorders programs Self identify as a person having personal lived experience or lived experience as a parent, caregiver, family member in mental health and/or substance use disorders. Medi-Cal Peer support services are geared towards supporting the peer in care. SPECIALIZATIONS 1. Parent, Caregiver, Family Member 2. Working with persons who are unhoused 3. Working with persons who are involved in the criminal justice system 4. Working with person who are in crisis Specialization are additional training in area of expertise. These are not additional certifications. Trainings provided by approved training entities.
Specializations CalMHSA will identify curriculum and requirements Parent, Caregiver, Family Member Peer competencies have been identified via third party facilitator with subject matter experts participating in focus group The other three specializations will follow the same format
Training Entities Approve training entities meet minimum training requirements Maintain list of approved training entities on Certification website Perform quality assurance activities of training entities
Supervisor Training Develop e-learning course with best practice guidelines from the Substance Abuse and Mental Health Services Administration, Supervision of Peer Workers
Exam Development Through a competitive bid process, CalMHSA contracted with the Human Resources Research Organization (HumRRO) for the development of a fair, reliable, and defensible exam Development of single exam for certification CalMHSA identified subject matter experts for the development of exam items/questions Exam blueprint containing categories of focus on the exam will be publicly available June 2022
Issue Certifications Review all applicants seeking certification meet requirement Issue certification for Medi-Cal Peer Support Specialists Review applications for biennial renewal
Data Collection Collect and maintain records of Certificants Collect and maintain records of persons taking Supervisor training Submit yearly reports to DHCS
Certificant Registry Develop and Maintain Certificant Registry Public-facing Searchable Information on status of certification
Complaints, Investigations, Actions, & Appeals In accordance with Code of Ethics for Medi-Cal Peer Support Specialists Review all complaints made against a certified Medi-Cal Peer Support Specialist Take actions against an individual s certification
Program Evaluation Evaluate outcomes for persons who received Peer support services by a certified Medi-Cal Peer Support Specialist Evaluate outcomes and impact on workforce
How to Apply Go to www.CAPeerCertification.org for information and registration Fees are currently under development Anticipated fees, include: 1) application, 2) examination & reexamination, 3) training for certification, 4) renewal of certification
Contact CalMHSA Email: PeerCertification@calmhsa.org Thank you
Questions Please submit your questions through the GoToWebinar portal. Questions after the presentation regarding the peers benefit may be submitted to your County Support Liaison.
