Existing law provides for 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 provisions. Existing law provides for a schedule of benefits under the Medi-Cal program and provides for various services, including various behavioral and mental health services.

Existing law, the Mental Health Services Act (MHSA), an initiative measure enacted by the voters as Proposition 63 at the November 2, 2004, statewide general election, establishes the continuously appropriated Mental Health Services Fund to fund various county mental health programs. The act also requires funds to be reserved for the costs of the State Department of Health Care Services, the California Mental Health Planning Council, the Office of Statewide Health Planning and Development (OSHPD), the Mental Health Services Oversight and Accountability Commission, the State Department of Public Health, and any other state agency to implement all duties pursuant to certain programs provided for by the act, subject to appropriation in the annual Budget Act. The act provides that it may be amended by the Legislature by a ²/₃ vote of each house as long as the amendment is consistent with, and furthers the intent of, the act, and that the Legislature may also clarify procedures and terms of the act by majority vote.

This bill would require the State Department of Health Care Services to establish, no later than July 1, 2020, a statewide peer, parent, transition-age, and family support specialist certification program, as a part of the states comprehensive mental health and substance use disorder delivery system and the Medi-Cal program. The bill would include 4 certification categories: adult peer support specialist, transition-age youth peer support specialist, family peer support specialist, and parent peer support specialist. The certification programs components would include, among others, defining responsibilities and practice guidelines, determining curriculum and core competencies, specifying training and continuing education requirements, establishing a code of ethics, and determining a certification revocation process. The bill would require an applicant for the certification as a peer, parent, transition-age, or family support specialist to meet specified requirements, including successful completion of the curriculum and training requirements.

This bill would require the department to consult with OSHPD and other stakeholders in implementing the certification program, including requiring quarterly stakeholder meetings. The bill would authorize the department to use funding provided through the MHSA, upon appropriation, to develop and administer the certification program, and would authorize the use of these MHSA funds to serve as the states share of funding to claim federal financial participation under the Medicaid Program.

This bill would authorize the department to establish a certification fee schedule and to require remittance of fees as contained in the schedule, for the purpose of supporting the departments activities associated with the ongoing administration of the certification program.

This bill would require Medi-Cal reimbursement for peer support specialist services to be implemented only if, and to the extent that, federal financial participation is available and the department obtains all necessary federal approvals. The bill also would authorize the department to implement, interpret, or make specific its provisions by means of informational notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulations are adopted. The bill would require the department to adopt regulations by July 1, 2022, and, commencing July 1, 2020, would require the department to provide semiannual status reports to the Legislature until regulations have been adopted.

This bill would declare that it clarifies terms and procedures under the Mental Health Services Act.

 VETO  

Bill No: SB 10

Author: Beall (D), et al.

Amended: 6/18/19

Vote: 27

SENATE HEALTH COMMITTEE: 9-0, 3/27/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19

AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski

SENATE FLOOR: 38-0, 5/21/19

AYES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

SENATE FLOOR: 39-0, 9/6/19

AYES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dahle, Dodd, Durazo, Galgiani, Glazer, Lena Gonzalez, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

NO VOTE RECORDED: Jones

ASSEMBLY FLOOR: 79-0, 9/5/19 - See last page for vote

SUBJECT: Mental health services: peer support specialist certification

SOURCE: Los Angeles County Board of Supervisors

Mental Health Services Oversight and Accountability Commission

Steinberg Institute

DIGEST:

This bill requires the Department of Health Care Services (DHCS) to establish a program for certifying peer support specialists; requires DHCS to amend its Medicaid state plan and to seek any federal waivers or state plan amendments to implement the certification program; and permits DHCS to implement, interpret, and make specific the certification program through available means, as specified, until regulations are adopted.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income individuals receive health care services. [WIC §14001.1]
2. Grants DHCS the sole authority in state government to determine the qualifications, including the appropriate skills, education, training, and experience of personnel working within substance use disorder (SUD) recovery and treatment programs licensed and/or certified by DHCS. [HSC §11833]
3. Authorizes DHCS to require an individual providing counseling services in SUD programs licensed and/or certified by DHCS to be registered with or certified by a certifying organization (CO) approved by DHCS to register and certify counselors. [HSC §11833]
4. Grants DHCS the authority to conduct periodic reviews of COs to determine compliance with all applicable laws and regulations and to take actions for non-compliance, including revocation of DHCS’s approval. [HSC §11833]
5. Requires, through regulations, the certification of SUD counselors to be based on specific counseling competencies, training, and education, including understanding addiction and knowledge of treatment methods. [CCR, Title 9, Division 4, Chapter 8]

This bill:

1. Requires DHCS, no later than July 1, 2020, to establish a peer support specialist (or CPSS) certification program, and to do all of the following:
2. Establish a certifying body to certify a CPSS;
3. Provide for statewide certification of CPSS;
4. Define the range of responsibilities, practice guidelines, and supervision standards for CPSS, as specified;
5. Determine curriculum and core competencies, including areas of specialization for CPSS, such as transition-age youth, veterans, gender identity, and sexual orientation, and core competencies that include trauma-informed care, co-occurring mental health and SUDs, preparation for employment opportunities, and navigation of, and referral to, other services;
6. Specify training requirements, allowing for multiple qualified training entities, and requiring training to include individuals with lived experience as consumers and family members, as well as continuing education requirements for certification;
7. Establish a code of ethics and processes for investigations and corrective action, as specified;
8. Determine a process for certification renewal; and,
9. Determine a process for allowing existing personnel employed in the peer support field to obtain certification, as specified.
10. Defines “peers support specialist services” as culturally competent services that promote engagement, socialization, recovery, self-sufficiency, and self-advocacy, and include, but are not limited to, support, coaching, facilitation, or education to Medi-Cal beneficiaries that is individualized to the beneficiary and is conducted by a CPSS, as specified.
11. Prohibits the CPSS certification program to be construed as permitting a CPSS to diagnose an illness, prescribe medication, or provide clinical services. Prohibits the CPSS certification program from altering the scope of practice for a health care professional, or authorize the delivery of health care services in a setting or manner that is not authorized by existing law.
12. Requires DHCS to consult with the Office of Statewide Health Planning and Development (OSHPD), peer support and family organizations, mental health and SUD treatment providers and organizations, the County Behavioral Health Directors Association of California, the California Behavioral Health Planning Council, and other interested parties in developing, implementing, and administering the CPSS certification program, as specified.
13. Requires DHCS to amend its Medicaid state plan to include CPSS as a provider type and include CPSS services as a distinct service type, as specified. Permits DHCS to seek any federal waivers or other state plan amendments as necessary to implement the CPSS certification program.
14. Permits community health workers to partner with CPSS for engagement, outreach, and education in order to facilitate early intervention for mental health services and improve linkage to services.
15. Permits DHCS to use Mental Health Services Act funds to develop and administer the CPSS program, subject to an express appropriation in the annual Budget Act, and for the purposes of claiming Federal financial participation (FFP), as specified.
16. Requires Medi-Cal reimbursement for CPSS services to be implemented only to the extent that FFP is available and all necessary federal approvals have been obtained.
17. Permits DHCS to establish a certification fee schedule to support the activities associated with the ongoing administration of the CPSS certification program. Requires any fees charged be reasonable and reflect the expenditures directly applicable to the ongoing administration of the CPSS certification program.
18. Requires DHCS, by July 1, 2022, to adopt regulations for the CPSS certification program. Permits DHCS to implement, interpret, or make specific the requirements of the CPSS certification program through plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.

Comments

1. Author’s statement. According to the author, California lags behind the nation in implementing a CPSS program. The U.S. Department of Veterans Affairs and 48 states have a certification process in place for mental health CPSS. The federal Centers for Medicare and Medicaid Services (CMS) released guidance in 2007 and clarification in 2013 for establishing a CPSS program to enable the use of FFP with a 50% match. Yet California has not acted. Research is clear that the use of a formal certification program to train CPSS offers enormous benefits, including allowing providers to make use of the federal Medi-Cal match; allowing for standardization of the peer support practice, to ensure the highest quality care; and establishing core competencies that allow CPSS to transfer skills across county lines. Although DHCS anticipates there will be substantial growth in the demand for CPSS, there are no statewide scope of practice, training standards, supervision standards, or certification. This bill creates these standards and establishes a code of ethics and processes for revocation of certification.
2. CPSS. According to the federal Substance Abuse and Mental Health Service Administration, a CPSS is a person who uses lived experience of recovery from mental illness and/or an SUD, plus skills learned in formal training, to deliver services in behavioral health settings to promote recover and resiliency. According to DHCS, a substantial number of studies demonstrate that the CPSS improves patient functioning, increases patient satisfaction, reduces family burden, alleviates depression and other symptoms, reduces hospitalizations and hospital days, increases patient activation, and enhances patient self-advocacy. CPSS are used in more than 40 states and throughout the Veterans Health Administration. CPSS participating in SUD treatment activities are currently a recognized Medicaid service provider in California for SUD services; however, these providers are often limited in the services they are able to provide in traditional health care settings. DHCS states that expanded use of CPSS in mental health and SUD as part of a care team can improve care coordination between behavioral health and physical health care needs of patients. DHCS included CPSS as a component in the most recent Section 1115 Waiver renewal, known as Medi-Cal 2020, by providing financial incentives to managed care plans to support non-physician community providers, promoting both physical and behavioral health care integration, and team-based care. Counties are currently able to seek reimbursement for CPSS services under the “other qualified provider” provider type under the Medicaid state plan.
3. CPSS certification. CMS released guidance in 2007 and further clarification in 2013 for establishing a CPSS certification program to enable FFP in an effort to more fully incorporate and expand the use of peers. CMS requires peer support providers to complete training and certification as defined by each state, and specified that services can be offered for mental illness and/or SUDs. Substantive work has been conducted in California by the Working Well Together Statewide Technical Assistance Center, a collaborative of peer and client-oriented organizations, which culminated in a final report of recommendations to proceed with peer certification. This effort identified key issues for laying the foundation of certification, including training recommendations and core components for a statewide certification program; establishing a standard of practice and core competencies; defining the level of care and services; integrating services across physical health, mental health, and SUD services; and allowing for portability from one county to another.
4. DHCS current certification duties. DHCS ensures that registered and certified SUD counselors provide quality treatment to clients by enforcing counselor certification regulations. DHCS approves COs that register and certify SUD counselors who provide counseling services in an SUD program licensed or certified by DHCS. There are approximately 28,000 SUD counselors, of which roughly half are certified and half are registered while working towards certification. DHCS's oversight authority of COs includes periodic reviews of the COs to monitor adherence to state requirements.

Related/Prior Legislation

SB 906 (Beall, 2018) and SB 614 (Leno, 2015) were identical to this bill. SB 906 was vetoed by the Governor who stated peer support specialists are currently used as providers in Medi-Cal without a state certificate, and SB 906 would have imposed a costly new program, which would have permitted some individuals to continue providing services but shut others out. Governor Brown urged stakeholders and DHCS to improve upon the existing framework while allowing all peer support specialists to continue to work. SB 614 was amended on August 18, 2016, on the Assembly Floor to a new purpose.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Assembly Appropriations Committee, assuming federal approval and availability of FFP:

1. Minor and absorbable costs to OSHPD for their consultative role (Health Data and Planning Fund).
2. Approximately $2 million in administrative staff costs for the first year of implementation, and $3.8 million ongoing for DHCS state staff costs for investigation, discipline and contract oversight (MHSA state administrative dollars or General Fund (GF)/federal).
3. Contract costs to DHCS for administration of the certification program of $3 million annually (MHSA state administrative dollars, GF or fee revenue/federal).

Potentially significant, indeterminate GF costs for provision of peer support services in fee-for-service Medi-Cal, Medi-Cal managed care, and for local specialty mental health services.

SUPPORT: (Verified 10/25/19)

Los Angeles County Board of Supervisors (co-source)

Mental Health Services Oversight and Accountability Commission (co-source)

Steinberg Institute (co-source)

211 California

2020 Mom

ACCESS California

Alameda County District Attorney

American College of Emergency Physicians, California Chapter

American Society of Civil Engineers

Anti-Recidivism Coalition

Arc and United Cerebral Palsy California Collaboration

Association of California Healthcare Districts

Association of Community Human Service Agencies

Association of Regional Center Agencies

Bay Area Community Services

California Academy of Child and Adolescent Psychiatry

California Alliance of Child and Family Services

California Association of Alcohol and Drug Program Executives, Inc.

California Association of Local Behavioral Health Boards and Commissions

California Association of Mental Health Peer Run Organizations

California Association of Public Hospitals and Health Systems

California Association of Social Rehabilitation Agencies

California Association of Veteran Service Agencies

California Behavioral Health Directors Association

California Behavioral Health Planning Council

California Black Health Network

California Children’s Trust

California Coalition for Mental Health

California Council of Community Behavioral Health Agencies

California Down Syndrome Advocacy Coalition

California Health+ Advocates

California Hospital Association

California Mental Health Advocates for Children and Youth

California Society of Addiction Medicine

California State Association of Counties

Children Now

City College of San Francisco

City of San Jose

City of Santa Monica

Community Clinic Association of Los Angeles County

Community Mental Health Certificate Program at City College of San Francisco

Corporation for Supportive Housing

County Behavioral Health Directors Association of California

County of Humboldt

County of Los Angeles

County of Santa Clara

County of Ventura

County Welfare Directors Association

Crestwood Behavioral Health, Inc.

Daniel’s Place

Depression and Bipolar Support Alliance

Didi Hirsch Mental Health Services

Disability Rights California

East Bay Leadership Council

Innovations Health Systems

Juvenile Court Judges of California

Local Health Plans of California

Manzanita Services

Mental Health America of California

Mental Health America of Los Angeles

Mental Health America of Northern California

Mental Health Association of San Francisco

NAMI Amador

NAMI Amador County

NAMI Sacramento

NAMI Yolo County

National Association of Social Workers, California Chapter

Pacific Clinics

Peers Envisioning and Engaging in Recovery Services

Pool of Consumer Champions

Professional Fiduciaries

Project Return Peer Support Network

Psychiatric Occupational Therapy Action Coalition

Roots Community Health Center

Santa Clara Family Health Plan

SEIU California

Seneca Family of Agencies

Telecare Corporation

The Arc and United Cerebral Palsy California Collaboration

University of Southern California Suzanne Dworak Peck School of Social Work

Ventura County Board of Supervisors

Western Center on Law and Poverty

Women’s Wisdom Art

Several individuals

OPPOSITION: (Verified 10/25/19)

None received

ARGUMENTS IN SUPPORT: The Steinberg Institute, Mental Health Services Oversight and Accountability Commission, and the Los Angeles County Board of Supervisors, cosponsors of this bill, and other supporters, largely mental health and youth advocates, argue that peer providers are those who use lived experience with mental health and SUD experience, as well as formal training, to provide measurable benefits to mental health and SUD clients, including reduced hospitalizations, improved functioning, alleviation of depression and other symptoms, and enhanced self-advocacy. Supporters also argue that a peer support program creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. Supporters further state that nearly 6,000 peer specialists in California are already used in many settings, such as community-based organizations, county clinics, schools, and primary care; however, there is currently no statewide standard of practice, consistent curriculum, training or supervision standards, or opportunity for portability across counties. Supporters argue that a certification program is crucial for obtaining FFP for the state and allows for peer services to become a sustainable piece of the state’s mental health care delivery system. The Association of California Healthcare Districts states that workforce development remains a priority for its members, and health care districts support innovative ways to increase the health care workforce in medically underserved communities and increase access to care, such as the use of peer support specialists.

GOVERNOR'S VETO MESSAGE:

I am returning Senate Bill 10 without my signature.

This bill would require DHCS to establish a new state certification program for mental health and SUD peer support specialists.

Peer support services can play an important role in meeting individuals’ behavioral health care needs by pairing those individuals with trained “peers” who offer assistance with navigating local community behavioral health systems and provide needed support. Currently, counties may opt to use peer support services for the delivery of Medicaid specialty mental health services.

As the Administration, in partnership with the Legislature and counties, works to transform the state’s behavioral health care delivery system, we have an opportunity to more comprehensively include peer support services in these transformation plans. I look forward to working with you on these transformations efforts in the budget process and future legislation, as improving the state of the state’s behavioral health system is a critical priority for me.

This proposal comes with significant costs that should be considered in the budget process.

ASSEMBLY FLOOR: 79-0, 9/5/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

10/29/19 10:08:54

**** END ****

 UNFINISHED BUSINESS  

Bill No: SB 10

Author: Beall (D), et al.

Amended: 6/18/19

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 3/27/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19

AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski

SENATE FLOOR: 38-0, 5/21/19

AYES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

ASSEMBLY FLOOR: 79-0, 9/5/19 - See last page for vote

SUBJECT: Mental health services: peer support specialist certification

SOURCE: Los Angeles County Board of Supervisors

Mental Health Services Oversight and Accountability Commission

Steinberg Institute

DIGEST:

This bill requires the Department of Health Care Services (DHCS) to establish a program for certifying peer support specialists; requires DHCS to amend its Medicaid state plan and to seek any federal waivers or state plan amendments to implement the certification program; and permits DHCS to implement, interpret, and make specific the certification program through available means, as specified, until regulations are adopted.

Assembly Amendments

add to DHCS’s responsibilities in developing the certification program to include defining supervision standards for certified peer support specialists (CPSS), and determining core-competencies-based curriculum that includes preparation for employment opportunities, as specified.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income individuals receive health care services. [WIC §14001.1]
2. Grants DHCS the sole authority in state government to determine the qualifications, including the appropriate skills, education, training, and experience of personnel working within substance use disorder (SUD) recovery and treatment programs licensed and/or certified by DHCS. [HSC §11833]
3. Authorizes DHCS to require an individual providing counseling services in SUD programs licensed and/or certified by DHCS to be registered with or certified by a certifying organization (CO) approved by DHCS to register and certify counselors. [HSC §11833]
4. Grants DHCS the authority to conduct periodic reviews of COs to determine compliance with all applicable laws and regulations and to take actions for non-compliance, including revocation of DHCS’s approval. [HSC §11833]
5. Requires, through regulations, the certification of SUD counselors to be based on specific counseling competencies, training, and education, including understanding addiction and knowledge of treatment methods. [CCR, Title 9, Division 4, Chapter 8]

This bill:

1. Requires DHCS, no later than July 1, 2020, to establish a peer support specialist (or CPSS) certification program, and to do all of the following:
2. Establish a certifying body to certify a CPSS;
3. Provide for statewide certification of CPSS;
4. Define the range of responsibilities, practice guidelines, and supervision standards for CPSS, as specified;
5. Determine curriculum and core competencies, including areas of specialization for CPSS, such as transition-age youth, veterans, gender identity, and sexual orientation, and core competencies that include trauma-informed care, co-occurring mental health and SUDs, preparation for employment opportunities, and navigation of, and referral to, other services;
6. Specify training requirements, allowing for multiple qualified training entities, and requiring training to include individuals with lived experience as consumers and family members, as well as continuing education requirements for certification;
7. Establish a code of ethics and processes for investigations and corrective action, as specified;
8. Determine a process for certification renewal; and,
9. Determine a process for allowing existing personnel employed in the peer support field to obtain certification, as specified.
10. Defines “peers support specialist services” as culturally competent services that promote engagement, socialization, recovery, self-sufficiency, and self-advocacy, and include, but are not limited to, support, coaching, facilitation, or education to Medi-Cal beneficiaries that is individualized to the beneficiary and is conducted by a CPSS, as specified.
11. Prohibits the CPSS certification program to be construed as permitting a CPSS to diagnose an illness, prescribe medication, or provide clinical services. Prohibits the CPSS certification program from altering the scope of practice for a health care professional, or authorize the delivery of health care services in a setting or manner that is not authorized by existing law.
12. Requires DHCS to consult with the Office of Statewide Health Planning and Development (OSHPD), peer support and family organizations, mental health and SUD treatment providers and organizations, the County Behavioral Health Directors Association of California, and the California Behavioral Health Planning Council, and other interested parties in developing, implementing, and administering the CPSS certification program, as specified.
13. Requires DHCS to amend its Medicaid state plan to include CPSS as a provider type and include CPSS services as a distinct service type, as specified. Permits DHCS to seek any federal waivers or other state plan amendments as necessary to implement the CPSS certification program.
14. Permits community health workers to partner with CPSS for engagement, outreach, and education in order to facilitate early intervention for mental health services and improve linkage to services.
15. Permits DHCS to use Mental Health Services Act funds to develop and administer the CPSS program, subject to an express appropriation in the annual Budget Act, and for the purposes of claiming Federal financial participation (FFP), as specified.
16. Requires Medi-Cal reimbursement for CPSS services to be implemented only to the extent that FFP is available and all necessary federal approvals have been obtained.
17. Permits DHCS to establish a certification fee schedule to support the activities associated with the ongoing administration of the CPSS certification program. Requires any fees charged be reasonable and reflect the expenditures directly applicable to the ongoing administration of the CPSS certification program.
18. Requires DHCS, by July 1, 2022, to adopt regulations for the CPSS certification program. Permits DHCS to implement, interpret, or make specific the requirements of the CPSS certification program through plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.

Comments

1. Author’s statement. According to the author, California lags behind the nation in implementing a CPSS program. The U.S. Department of Veterans Affairs and 48 states have a certification process in place for mental health CPSS. The federal Centers for Medicare and Medicaid Services (CMS) released guidance in 2007 and clarification in 2013 for establishing a CPSS program to enable the use of FFP with a 50% match. Yet California has not acted. Research is clear that the use of a formal certification program to train CPSS offers enormous benefits, including allowing providers to make use of the federal Medi-Cal match; allowing for standardization of the peer support practice, to ensure the highest quality care; and establishing core competencies that allow CPSS to transfer skills across county lines. Although DHCS anticipates there will be substantial growth in the demand for CPSS, there are no statewide scope of practice, training standards, supervision standards, or certification. This bill creates these standards and establishes a code of ethics and processes for revocation of certification.
2. CPSS. According to the federal Substance Abuse and Mental Health Service Administration, a CPSS is a person who uses lived experience of recovery from mental illness and/or an SUD, plus skills learned in formal training, to deliver services in behavioral health settings to promote recover and resiliency. According to DHCS, a substantial number of studies demonstrate that the CPSS improves patient functioning, increases patient satisfaction, reduces family burden, alleviates depression and other symptoms, reduces hospitalizations and hospital days, increases patient activation, and enhances patient self-advocacy. CPSS are used in more than 40 states and throughout the Veterans Health Administration. CPSS participating in SUD treatment activities are currently a recognized Medicaid service provider in California for SUD services; however, these providers are often limited in the services they are able to provide in traditional health care settings. DHCS states that expanded use of CPSS in mental health and SUD as part of a care team can improve care coordination between behavioral health and physical health care needs of patients. DHCS included CPSS as a component in the most recent Section 1115 Waiver renewal, known as Medi-Cal 2020, by providing financial incentives to managed care plans to support non-physician community providers, promoting both physical and behavioral health care integration, and team-based care. Counties are currently able to seek reimbursement for CPSS services under the “other qualified provider” provider type under the Medicaid state plan.
3. CPSS certification. CMS released guidance in 2007 and further clarification in 2013 for establishing a CPSS certification program to enable FFP in an effort to more fully incorporate and expand the use of peers. CMS requires peer support providers to complete training and certification as defined by each state, and specified that services can be offered for mental illness and/or SUDs. Substantive work has been conducted in California by the Working Well Together Statewide Technical Assistance Center, a collaborative of peer and client-oriented organizations, which culminated in a final report of recommendations to proceed with peer certification. This effort identified key issues for laying the foundation of certification, including training recommendations and core components for a statewide certification program; establishing a standard of practice and core competencies; defining the level of care and services; integrating services across physical health, mental health, and SUD services; and allowing for portability from one county to another.
4. DHCS current certification duties. DHCS ensures that registered and certified SUD counselors provide quality treatment to clients by enforcing counselor certification regulations. DHCS approves COs that register and certify SUD counselors who provide counseling services in an SUD program licensed or certified by DHCS. There are approximately 28,000 SUD counselors, of which roughly half are certified and half are registered while working towards certification. DHCS's oversight authority of COs includes periodic reviews of the COs to monitor adherence to state requirements.

Related/Prior Legislation

SB 906 (Beall, 2018) and SB 614 (Leno, 2015) were identical to this bill. SB 906 was vetoed by the Governor who stated peer support specialists are currently used as providers in Medi-Cal without a state certificate, and SB 906 would have imposed a costly new program, which would have permitted some individuals to continue providing services but shut others out. Governor Brown urged stakeholders and DHCS to improve upon the existing framework while allowing all peer support specialists to continue to work. SB 614 was amended on August 18, 2016, on the Assembly Floor to a new purpose.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Assembly Appropriations Committee, assuming federal approval and availability of FFP:

1. Minor and absorbable costs to OSHPD for their consultative role (Health Data and Planning Fund).
2. Approximately $2 million in administrative staff costs for the first year of implementation, and $3.8 million ongoing for DHCS state staff costs for investigation, discipline and contract oversight (MHSA state administrative dollars or General Fund (GF)/federal).
3. Contract costs to DHCS for administration of the certification program of $3 million annually (MHSA state administrative dollars, GF or fee revenue/federal).

Potentially significant, indeterminate GF costs for provision of peer support services in fee-for-service Medi-Cal, Medi-Cal managed care, and for local specialty mental health services.

SUPPORT: (Verified 9/5/19)

Los Angeles County Board of Supervisors (co-source)

Mental Health Services Oversight and Accountability Commission (co-source)

Steinberg Institute (co-source)

2020 Mom

211 California

ACCESS California

Alameda County District Attorney

American College of Emergency Physicians, California Chapter

American Society of Civil Engineers

Anti-Recidivism Coalition

Arc and United Cerebral Palsy California Collaboration

Association of California Healthcare Districts

Association of Community Human Service Agencies

Association of Regional Center Agencies

Bay Area Community Services

California Academy of Child and Adolescent Psychiatry

California Alliance of Child and Family Services

California Association of Alcohol and Drug Program Executives, Inc.

California Association of Local Behavioral Health Boards and Commissions

California Association of Mental Health Peer Run Organizations

California Association of Public Hospitals and Health Systems

California Association of Social Rehabilitation Agencies

California Association of Veteran Service Agencies

California Behavioral Health Directors Association

California Behavioral Health Planning Council

California Black Health Network

California Children’s Trust

California Coalition for Mental Health

California Council of Community Behavioral Health Agencies

California Down Syndrome Advocacy Coalition

California Health+ Advocates

California Hospital Association

California Mental Health Advocates for Children and Youth

California Society of Addiction Medicine

California State Association of Counties

Children Now

City College of San Francisco

City of San Jose

City of Santa Monica

Community Clinic Association of Los Angeles County

Community Mental Health Certificate Program at City College of San Francisco

Corporation for Supportive Housing

County Behavioral Health Directors Association of California

County of Humboldt

County of Los Angeles

County of Santa Clara

County of Ventura

County Welfare Directors Association

Crestwood Behavioral Health, Inc.

Daniel’s Place

Depression and Bipolar Support Alliance

Didi Hirsch Mental Health Services

Disability Rights California

East Bay Leadership Council

Innovations Health Systems

Juvenile Court Judges of California

Local Health Plans of California

Manzanita Services

Mental Health America of California

Mental Health America of Los Angeles

Mental Health America of Northern California

Mental Health Association of San Francisco

NAMI Amador

NAMI Amador County

NAMI Sacramento

NAMI Yolo County

National Association of Social Workers, California Chapter

Pacific Clinics

Peers Envisioning and Engaging in Recovery Services

Pool of Consumer Champions

Professional Fiduciaries

Project Return Peer Support Network

Psychiatric Occupational Therapy Action Coalition

Roots Community Health Center

Santa Clara Family Health Plan

SEIU California

Seneca Family of Agencies

Telecare Corporation

The Arc and United Cerebral Palsy California Collaboration

University of Southern California Suzanne Dworak Peck School of Social Work

Ventura County Board of Supervisors

Western Center on Law and Poverty

Women’s Wisdom Art

Several individuals

OPPOSITION: (Verified 9/5/19)

None received

ARGUMENTS IN SUPPORT: The Steinberg Institute, Mental Health Services Oversight and Accountability Commission, and the Los Angeles County Board of Supervisors, cosponsors of this bill, and other supporters, largely mental health and youth advocates, argue that peer providers are those who use lived experience with mental health and SUD experience, as well as formal training, to provide measurable benefits to mental health and SUD clients, including reduced hospitalizations, improved functioning, alleviation of depression and other symptoms, and enhanced self-advocacy. Supporters also argue that a peer support program creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. Supporters further state that nearly 6,000 peer specialists in California are already used in many settings, such as community-based organizations, county clinics, schools, and primary care; however, there is currently no statewide standard of practice, consistent curriculum, training or supervision standards, or opportunity for portability across counties. Supporters argue that a certification program is crucial for obtaining FFP for the state and allows for peer services to become a sustainable piece of the state’s mental health care delivery system. The Association of California Healthcare Districts states that workforce development remains a priority for its members, and health care districts support innovative ways to increase the health care workforce in medically underserved communities and increase access to care, such as the use of peer support specialists.

ASSEMBLY FLOOR: 79-0, 9/5/19

AYES: Aguiar-Curry, Arambula, Bauer-Kahan, Berman, Bigelow, Bloom, Boerner Horvath, Bonta, Brough, Burke, Calderon, Carrillo, Cervantes, Chau, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Daly, Diep, Eggman, Flora, Fong, Frazier, Friedman, Gabriel, Gallagher, Cristina Garcia, Eduardo Garcia, Gipson, Gloria, Gonzalez, Gray, Grayson, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Obernolte, O'Donnell, Patterson, Petrie-Norris, Quirk, Quirk-Silva, Ramos, Reyes, Luz Rivas, Robert Rivas, Rodriguez, Blanca Rubio, Salas, Santiago, Smith, Mark Stone, Ting, Voepel, Waldron, Weber, Wicks, Wood, Rendon

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

9/5/19 16:20:49

**** END ****

SENATE THIRD READING

STR Bill Id:SB 10

Author:(Beall)

As Amended Ver:June 18, 2019

Majority vote

SUMMARY:

Requires the Department of Health Care Services to amend its Medicaid State Plan (MSP) to include a certified peer support specialist as a provider type for purposes of the Medi-Cal program, and to include peer support specialist services as a distinct service type for purposes of Medi-Cal, which may be provided to eligible Medi-Cal beneficiaries who are enrolled in either a Medi-Cal managed care plan or a mental health plan (MHP). Requires DHCS to establish a certifying body and to establish curriculum and core competencies required for certification, including a process for an individual employed as a peer support specialist on January 1, 2020, to obtain certification under this bill. Establishes requirements for applicants for certification as a peer support specialist, and for continued certification.

COMMENTS:

In 2007 and 2013, CMS provided guidance to states interested in peer support services under the Medicaid program. CMS policy guidance includes requirements for supervision, care-coordination, and minimum training criteria for peer support providers. Peers are currently used in drug treatment and mental health services in some instances. For example, the Drug-Medi-Cal Organized Delivery System (DMC-ODS) Waiver Special Terms and Conditions (STCs) allows coverage of peer-to-peer substance abuse assistance services as a component of recovery services. For Medi-Cal specialty mental health services provided by MHPs, the MSP permits the provision of services by "Other Qualified Providers," defined as, "an individual at least 18 years of age with a high school diploma or equivalent degree determined to be qualified to provide the service by the county mental health department." State law requires these "Other Qualified Providers" to provide services "under the direction of" a licensed mental health professional within their respective scope of practice.

According to the Author:

California lags behind the nation in implementing a peer support specialist certification program. The Veterans Administration and approximately 48 states have a certification process in place for mental health peer support specialists. Thirteen states have a certification process for substance use disorder (SUD) peer recovery coaches. The federal CMS released guidance in 2007 and 2013 for establishing a certification program for peers to enable the use of federal Medicaid financial participation with a 50% match. Yet California has not acted. Studies demonstrate that use of peer support specialists in a comprehensive mental health or SUD treatment program helps reduce client hospitalizations, improve client functioning, increase client satisfaction, alleviate depression and other symptoms, and diversify the mental health workforce. It's time for California to maximize the benefits of peer support with this bill.

Arguments in Support:

This bill is jointly sponsored by the Los Angeles County Board of Supervisors, the Mental Health Services Oversight and Advisory Commission, and the Steinberg Institute, which argue that peer providers who use their life experience with mental illness and recovery, coupled with skills learned through formal training, have proven a valuable addition to service delivery in mental health settings. The sponsors argue research demonstrates that use of qualified peer support specialists has measurable benefits to clients, including reduced hospitalizations, improved functioning, alleviation of depression and other symptoms, and enhanced self-advocacy. A peer support program also creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. The sponsors continue that, across California, peer providers are already utilized in many settings. However, there is no statewide standard of practice, consistent curriculum, training standards, supervision standards, or certification protocol. Establishing a state certification program would enable California providers to bill federal Medicaid (Medi-Cal in California) for 50% of the cost of services provided by certified peers. This is a crucial advantage, as it allows for peer services to become a sustainable piece of the state's mental health care delivery system. Supporters conclude that the time has come for California to embrace peer support as an evidence-based model and put in place a certification program that will standardize best practices, and this bill makes sense from both a policy and fiscal perspective, and will result in a more comprehensive and effective approach to mental health care.

Arguments in Opposition:

Advocates for Responsible Treatment (ART) writes in opposition there is no drug testing for recovering addicts, and an addict for whom recovery has failed can be part of the system, which represents a danger to the population they are supposed to represent. In addition, ART writes that certified peer support specialists do not have to submit to a background check, and there is no restriction that a convicted drug dealer can obtain certification. Finally, ART writes the certification system will likely be a third-party (and not the state) and current state-approved certification are largely pay-to-play.

The California Right to Life Committee, Inc. (CRLC) writes that this measure appears to be more of a workforce development program than one designed to address mental health issues within a community's population. CRLC writes that this bill recognizes the work of 6,000 "peers" active presently in communities without official training and certification, and it questions whether this bill has been well thought out regarding finances, and CRLC writes it foresees financial problems ahead because of the possibility that requiring a training and certification for peer providers will result in substantial cost to the local community, county, and state.

FISCAL COMMENTS:

According to the Assembly Appropriations Committee, assuming federal approval and availability of federal financial participation:

1. Minor and absorbable costs to the Office of Statewide Health Planning and Development for their consultative role (Health Data and Planning Fund).
2. Approximately $2 million in administrative staff costs for the first year of implementation, and $3.8 million ongoing for DHCS state staff costs for investigation, discipline and contract oversight (MHSA state administrative dollars or General Fund (GF)/federal).
3. Contract costs to DHCS for administration of the certification program of $3 million annually (MHSA state administrative dollars, GF or fee revenue/federal).
4. Potentially significant, indeterminate GF costs for provision of peer support services in fee-for-service Medi-Cal, Medi-Cal managed care and for local specialty mental health services.

VOTES:

SENATE FLOOR: 38-0-0

YES: Allen, Archuleta, Atkins, Bates, Beall, Borgeas, Bradford, Caballero, Chang, Dodd, Durazo, Galgiani, Glazer, Grove, Hertzberg, Hill, Hueso, Hurtado, Jackson, Jones, Leyva, McGuire, Mitchell, Monning, Moorlach, Morrell, Nielsen, Pan, Portantino, Roth, Rubio, Skinner, Stern, Stone, Umberg, Wieckowski, Wiener, Wilk

ASM HEALTH: 15-0-0

YES: Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Ramos, Rodriguez, Santiago, Waldron

ASM APPROPRIATIONS: 18-0-0

YES: Gonzalez, Bigelow, Bloom, Bonta, Brough, Calderon, Carrillo, Chau, Diep, Eggman, Fong, Gabriel, Eduardo Garcia, Maienschein, Obernolte, Petrie-Norris, Quirk, Robert Rivas

UPDATED:

VERSION: June 18, 2019

CONSULTANT: Scott Bain / HEALTH / (916) 319-2097 FN: 0001663

Date of Hearing: August 14, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

SBPCA Bill Id:SB 10

Author:(Beall) – As Amended Ver:June 18, 2019

Urgency: No State Mandated Local Program: No Reimbursable: Yes

SUMMARY:

This bill requires the Department of Health Care Services (DHCS) to establish a certification program for peer support specialists (PSS) for purposes of assisting clients with mental health and substance use disorders, and conditions implementation on federal approval and the availability of Medi-Cal federal financial participation (FFP) for Medi-Cal Specialty Mental Health Services provided by peer support specialists. Specifically, this bill:

1. Requires DHCS, not later than July 1, 2020, to establish:
   1. A certifying body, either through contract or interagency agreement, to provide certification activities.
   2. Curriculum and core competencies, training and continuing education (CE) requirements, a code of ethics, processes for complaint investigation and certification revocation and renewal and a process to allow existing personnel employed as a PSS to obtain certification at their option (a process to "grandfather" in individuals already doing this work).
2. Specifies requirements individuals must meet to obtain certification.
3. Requires DHCS to consult with specified entities, including the Office of Statewide Health Planning and Development (OSHPD), in implementing the certification program.
4. Requires DHCS to include peer support specialists certified pursuant to this bill as a Medi-Cal provider type and to include peer support specialist services as a distinct Medi-Cal service type, which may be provided to eligible Medi-Cal beneficiaries who are enrolled in either a Medi-Cal managed care plan or a mental health plan.
5. Authorizes DHCS to seek any federal waivers or state plan amendments necessary to implement the certification program.
6. Contains the following additional funding provisions:
   1. Allows DHCS to use Mental Health Services Act (MHSA) funds to develop and administer the certification program. Specifies MHSA funds shall be available for purposes of claiming FFP contingent on federal approval.
   2. Finds and declares the bill clarifies procedures and terms of the MHSA (a voter-approved initiative that allocates funds for mental health services).
   3. Allows DHCS to establish a certification fee to support ongoing administration, which shall reasonably reflect direct administrative costs.
7. Allows the use of exclusive or nonexclusive contracts on a bid or negotiated basis, and exempts contracts from the Public Contract Code, the state administrative services manual, and the requirement for Department of General Services approval.
8. Allows DHCS to issue guidance to implement this bill without issuing regulations, but requires regulations to be issued by January 1, 2022. Requires semiannual status reports to the Legislature until regulations are adopted.

FISCAL EFFECT:

Assuming federal approval and availability of federal financial participation (FFP):

1. Minor and absorbable costs to OSHPD for their consultative role (Health Data and Planning Fund).
2. Approximately $2 million in administrative staff costs for the first year of implementation, and $3.8 million ongoing for DHCS state staff costs for investigation, discipline and contract oversight (MHSA state administrative dollars or GF /federal).
3. Contract costs to DHCS for administration of the certification program of $3 million annually (MHSA state administrative dollars, GF or fee revenue/federal).
4. Potentially significant, indeterminate GF costs for provision of peer support services in fee-for-service Medi-Cal, Medi-Cal managed care and for local specialty mental health services.

This bill has a mixed impact on local specialty mental health services delivered by counties: a higher volume of peer support services; potentially enhanced ability to claim federal reimbursement for services, which may free up dollars that were allocated to peer support services under current law and practice; and additional state funding required to expand services based on the addition of peer support as a distinct Medi-Cal service type.

Currently, some peer services are funded through existing Medi-Cal service classifications such as targeted case management, but the explicit recognition for peer support services would facilitate reimbursement. If peer support was not added as a Medi-Cal service, the bill would simply allow counties to draw down federal funds for the services, with local funds providing the non-state share of costs. However, the addition of peer support as a distinct Medi-Cal service type is likely to necessitate state funding pursuant to Proposition 30, which specifies legislation enacted after September 30, 2012,

"that has an overall effect of increasing the costs already borne by a local agency for programs or levels of service mandated by the 2011 Realignment Legislation shall apply to local agencies only to the extent that the State provides annual funding for the cost increase."

It is unclear the extent to which peer support services will supplement or supplant other services, like group counseling.

COMMENTS:

1. Purpose. The purpose of this bill is to create a certification program for peer support specialists. The author notes a substantial body of research shows peer support services improve outcomes and quality of life for clients of the mental health and substance abuse (behavioral health) system and their families and save money by reducing acute incidents such as hospitalization. Based on years of discussion and research, stakeholders in the behavioral health community have strongly recommended creating a state certification program to standardize training and core competencies as well as to allow counties that deliver behavioral health services to leverage federal financial participation (FFP) in Medi-Cal.
2. Peer specialists and certification. Peer support specialists are persons who have lived experience from mental illness or substance abuse, plus formal training, to deliver services in a behavioral health setting to promote recovery. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) notes peer services are varied and can in include the following activity types: (a) peer mentoring or coaching, (b) recovery resource connecting, (c) facilitating and leading recovery groups, and (d) building community. A 2007 Center for Medicare and Medicaid Services (CMS) letter to state health officials clarifies states can seek federal approval to receive Medicaid (Medi-Cal in California) reimbursement for peer support services, but notes state-defined training and certification is required in order to receive reimbursement. The U.S. Department of Veterans Affairs and most other states have established programs for certification of peers.

Notably, state law allows for Medi-Cal reimbursement for peer support services under certain conditions. Specifically, most California counties have opted to participate in an effort called the Drug Medi-Cal Organized Delivery System waiver, which allows counties to provide and claim Medi-Cal reimbursement for a robust continuum of substance use services. The waiver allows coverage of peer-to-peer substance abuse services as a component of recovery services. In order to claim FFP for these services, counties must develop a substance use disorder peer support training plan and provide a county designation for staff serving as peers. Counties have been implementing the DMC-ODS waiver in phases starting July 1, 2017, with a number of counties beginning services on July 1 of this year. This bill would centralize personnel certification standards and verification at the state level.

1. DHCS Existing Certification Programs. DHCS currently licenses or certifies drug and alcohol rehabilitation facilities, programs and counselors. With respect to certified counselors, DHCS oversees counselors indirectly via oversight of designated certifying entities.
2. Prior Legislation. SB 614 (Leno), of the 2015-16 Legislative Session, was similar to this bill. After passing this committee, it was amended to a different subject matter with a different author and signed.

SB 906 (Beall), of the 2017-18 Legislative Session, was substantially similar to this bill and was vetoed by Governor Brown, who stated peer support specialists are currently used as providers in Medi-Cal without a state certificate, and that SB 906 imposed a costly new program, which will permit some of these individuals to continue providing services but shut others out. Governor Brown urged the stakeholders and DHCS to improve upon the existing framework while allowing all peer support specialists to continue to work.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing: July 2, 2019

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

SBPCA Bill Id:SB 10

Author:(Beall) – As Amended Ver:June 18, 2019

SENATE VOTE: 38-0

SUBJECT: Mental health services: peer support specialist certification.

SUMMARY: Requires the Department of Health Care Services (DHCS) to amend its Medicaid State Plan (MSP) to include a certified peer support specialist as a provider type for purposes of the Medi-Cal program, and to include peer support specialist services as a distinct service type for purposes of Medi-Cal, which may be provided to eligible Medi-Cal beneficiaries who are enrolled in either a Medi-Cal managed care plan (MCP) or a mental health plan (MHP). Requires DHCS to establish a certifying body and to establish curriculum and core competencies required for certification, including a process for an individual employed as a peer support specialist on January 1, 2020, to obtain certification under this bill. Establishes requirements for applicants for certification as a peer support specialist, and for continued certification. Specifically, this bill:

1. Requires DHCS to amend its MSP to do both of the following:
   
   1. Include a peer support specialist certified pursuant to this bill as a provider type for purposes of the Medi-Cal program; and,
      
   2. Include peer support specialist services as a distinct service type for purposes of Medi-Cal, which may be provided to eligible Medi-Cal beneficiaries who are enrolled in either a MCP or a MHP.
      
2. Defines a “peer support specialist” as a person who is 18 years of age or older and who has self-identified as having lived experience with the process of recovery from mental illness, substance use disorder (SUD), or both, either as a consumer of these services or as the parent or family member of the consumer.
3. Defines “peer support specialist services” as culturally competent services that promote engagement, socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, identification of strengths, and maintenance of skills learned in other support services. Requires peer support specialist services to include, but are not limited to, support, coaching, facilitation, or education to Medi-Cal beneficiaries that is individualized to the beneficiary and is conducted by a certified peer support specialist.
   
4. Permits DHCS to seek any federal waivers or other state plan amendments as necessary to implement the certification program provided for under this bill.
   
5. Requires DHCS, no later than July 1, 2020, to do all of the following:
   
   1. Establish a certifying body, either through contract or through an interagency agreement, to provide for the certification activities described in this bill;
      
   2. Provide for a statewide certification for peer support specialists, as contained in federal guidance issued by the federal Centers for Medicare and Medicaid Services (CMS), State Medicaid Director Letter #07-011;
      
   3. Define the range of responsibilities, practice guidelines and supervision standards for peer support specialists by utilizing best practice materials published by the federal Substance Abuse and Mental Health Services Administration, the federal Department of Veterans Affairs (VA), and related notable experts in the field as a basis for development;
      
   4. 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 DHCS. Requires core competencies-based curriculum to 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. Co-occurring disorders of mental health and substance use;
      10. Conflict resolution;
      11. Professional boundaries and ethics;
      12. Preparation for employment opportunities, which may include 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; and,
      16. Confidentiality.
          
   5. Specify training requirements, including core competencies-based training and specialized training necessary to become certified under this bill, allowing for multiple qualified training entities, and requiring training to include people with lived experience as consumers and family members;
      
   6. Establish a code of ethics;
      
   7. Determine continuing education requirements for biennial certification renewal;
      
   8. Determine the process for biennial certification renewal;
      
   9. Determine a process for investigation of complaints and corrective action, which may include suspension and revocation of certification; and,
      
   10. Determine a process for an individual employed as a peer support specialist on January 1, 2020, to obtain certification under this bill.
       
6. Requires an applicant for certification under this bill to 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 SUD treatment 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. Demonstrate leadership and advocacy skills;
   6. Have a strong dedication to recovery;
   7. Agree, in writing, to adhere to a code of ethics;
   8. Successfully complete the curriculum and training requirements for a peer support specialist; and,
   9. Pass a certification examination approved by DHCS for a peer support specialist.
      
7. Requires, in order for a peer support specialist to maintain certification under this bill, to meet both of the following requirements:
   
   1. Adhere to the code of ethics and biennially sign an affirmation; and,
   2. Complete any required continuing education, training, and recertification requirements.
      
8. Prohibits this bill from being construed to imply that an individual who is certified pursuant to this bill is qualified, or authorized, to diagnose an illness, prescribe medication, or provide clinical services.
   
9. Prohibits this from altering the scope of practice for a health care professional or authorize the delivery of health care services in a setting or manner that is not authorized pursuant to the Business and Professions Code or the Health and Safety Code.
   
10. Requires DHCS to consult with the office of Statewide Health Planning and Development, peer support and family organizations, mental health services and SUD treatment providers and organizations, the County Behavioral Health Directors Association of California, and the California Behavioral Health Planning Council in implementing this bill. Requires consultation to initially include, at a minimum, quarterly stakeholder meetings. Permits DHCS to additionally conduct technical workgroups upon the request of stakeholders.
    
11. Permits community health workers, to facilitate early intervention for mental health services, to partner with peer support specialists to improve linkage to services for the beneficiary.
    
12. Permits DHCS to utilize Mental Health Services Act (MHSA) moneys to fund state administrative costs related to developing and administering this bill, subject to an express appropriation in the annual Budget Act for these purposes, and to the extent authorized under the MHSA. Requires these funds to be available for purposes of claiming federal financial participation (FFP) under Medicaid, contingent upon federal approval.
    
13. Requires Medi-Cal reimbursement for peer support specialist services to be implemented only if, and to the extent that, FFP under Medicaid is available and all necessary federal approvals have been obtained.
    
14. Permits DHCS to establish a certification fee schedule, and to require remittance as contained in the certification fee schedule for the purpose of supporting the activities associated with the ongoing administration of the peer support specialist certification program.
    
15. Requires certification fees charged by DHCS to reasonably reflect the expenditures directly applicable to the ongoing administration of the peer support specialist certification program.
    
16. Permits DHCS, for the purpose of implementing this bill, to 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.
    
17. Permits DHCS to implement, interpret, or make specific this bill by means of informal notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until the time regulations are adopted. Requires DHCS to adopt regulations by July 1, 2022, in accordance with the requirements of Administrative Procedure Act. Requires DHCS, commencing July 1, 2020, to provide semiannual status reports to the Legislature until regulations have been adopted.
    
18. Makes legislative findings and declarations and states legislative intent related to the provisions of this bill.

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income individuals receive health care services.
2. Establishes a schedule of benefits under the Medi-Cal program, which includes mental health and SUD services.
   
3. Requires DHCS to have the sole authority in state government to determine the qualifications, including the appropriate skills, education, training, and experience of personnel working within alcoholism or drug abuse recovery and treatment programs licensed, certified, or funded by DHCS.
4. Requires DHCS, except for licensed professionals, as defined by DHCS, to require that an individual providing counseling services working within alcohol or drug abuse recovery and treatment programs licensed, certified or funded by DHCS to be registered with or certified by a certifying organization approved by the DHCS to register and certify counselors.

FISCAL EFFECT: According to the Senate Appropriations Committee, staff notes the author’s amendments may reduce costs as it reduces the number of peer support categories; however, it is anticipated DHCS would incur unknown implementation costs to develop program standards and to seek necessary federal approvals. The impact to county MHPs and MCPs remains unknown.

1. One-time costs, likely in the hundreds of thousands per year for one to three years, to develop program standards and seek federal approvals by DHCS (MHSA funds, General Fund [GF], and federal funds [FF]).
2. Unknown ongoing costs (that could range from minimal to hundreds of thousands to millions per year) to manage the certification of the program (MHSA funds, GF, FF, or special funds).
3. Uncertain impact on county mental health plans that provide specialty mental health services in the Medi-Cal program (county funds and FF). Plans may see an overall increase service utilization; however, depending on the provider type, could reduce expenditures by providing certain services in a more cost-effective manner.
4. Uncertain impact on MCPs that provide mental health services to Medi-Cal beneficiaries when the mental illness is not severe (GF and FF).

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California lags behind the nation in implementing a peer support specialist certification program. The VA and approximately 48 states have a certification process in place for mental health peer support specialists. Thirteen states have a certification process for SUD peer recovery coaches. The federal CMS released guidance in 2007 and 2013 for establishing a certification program for peers to enable the use of federal Medicaid financial participation with a 50% match. Yet California has not acted. Studies demonstrate that use of peer support specialists in a comprehensive mental health or SUD treatment program helps reduce client hospitalizations, improve client functioning, increase client satisfaction, alleviate depression and other symptoms, and diversify the mental health workforce. It’s time for California to maximize the benefits of peer support with this bill.
2. BACKGROUND. In 2007 and 2013, CMS provided guidance to states interested in peer support services under the Medicaid program. CMS wrote that states are increasingly interested in covering peer support providers as a distinct provider type for the delivery of counseling and other support services to Medicaid eligible adults with mental illnesses and/or SUDs. CMS stated peer support services are an evidence-based mental health model of care which consists of a qualified peer support provider who assist individuals with their recovery from mental illness and SUDs. CMS continued that it recognized that the experiences of peer support providers, as consumers of mental health and substance use services, can be an important component in a state’s delivery of effective treatment. CMS reaffirmed its commitment to state flexibility, increased innovation, consumer choice, self-direction, recovery, and consumer protection through approval of these services. CMS policy guidance includes requirements for supervision, care-coordination, and minimum training criteria for peer support providers.
   
   CMS indicated that, in order to be considered for federal reimbursement, states must identify the Medicaid authority to be used for coverage and payment, describe the service, the provider of the service, and their qualifications in full detail. States must describe utilization review and reimbursement methodologies. CMS stated Medicaid reimburses for peer support services delivered directly to Medicaid beneficiaries with mental health and/or SUDs. Additionally, reimbursement must be based on an identified unit of service and be provided by one peer support provider, based on an approved plan of care. States must provide an assurance that there are mechanisms in place to prevent over-billing for services, such as prior authorization and other utilization management methods.

CMS established the minimum requirements that should be addressed for supervision, care coordination, and training when electing to provide peer support services, including:

• 1. Supervision: supervision must be provided by a competent mental health professional (as defined by the State). CMS stated the amount, duration, and scope of supervision will vary depending on State Practice Acts, the demonstrated competency and experience of the peer support provider, as well as the service mix, and may range from direct oversight to periodic care consultation;
  2. Care-coordination: Peer support services must be coordinated within the context of a comprehensive, individualized plan of care that includes specific individualized goals; and,
  3. Training and credentialing: Peer support providers must complete training and certification as defined by the State. Training must provide peer support providers with a basic set of competencies necessary to perform the peer support function. The peer must demonstrate the ability to support the recovery of others from mental illness and/or SUDs. Similar to other provider types, ongoing continuing educational requirements for peer support providers must be in place.

1. CURRENT USE OF PEERS FOR SUD AND MENTAL HEALTH SERVICES. Peers are used in drug treatment and mental health services in some instances. For example, the Drug-Medi-Cal Organized Delivery System (DMC-ODS) Waiver Special Terms and Conditions (STCs) allows coverage of peer-to-peer substance abuse assistance services as a component of recovery services. DHCS guidance states that, as a component of recovery services, SUD peer support services cannot be reimbursed for any other service modality in the DMC-ODS. Counties utilizing SUD peer support services must comply with all federal Medicaid regulations and policy guidance. Counties are responsible for the development of a SUD Peer Support Training Plan and are to provide a county SUD designation for SUD peer support staff consistent with the requirements outlined in the STCs of the Waiver and in state guidance.

For Medi-Cal specialty mental health services provided by county MHPs, the MSP permits the provision of services by “Other Qualified Providers,” defined as, “an individual at least 18 years of age with a high school diploma or equivalent degree determined to be qualified to provide the service by the county mental health department.” Mental Health Services (excluding Therapy), Targeted Case Management, Day Rehabilitative Services, Day Treatment Intensive Services, Crisis Intervention, Crisis Stabilization, Adult Residential and Crisis Residential Treatment services may be provided by “any person” determined by the MHP to be qualified to provide the service, consistent with state law. State law requires these “Other Qualified Providers” to provide services “under the direction of” a licensed mental health professional within their respective scope of practice. The MHP may designate certain other qualified providers to contribute to the assessment, including gathering the beneficiary’s mental health and medical history, substance exposure and use, and identifying strengths, risks, and barriers to achieving goals.

1. SUPPORT. This bill is jointly sponsored by the Los Angeles County Board of Supervisors, the Mental Health Services Oversight and Advisory Commission, and the Steinberg Institute, which argue that peer providers who use their life experience with mental illness and recovery, coupled with skills learned through formal training, have proven a valuable addition to service delivery in mental health settings. The sponsors argue research demonstrates that use of qualified peer support specialists has measurable benefits to clients, including reduced hospitalizations, improved functioning, alleviation of depression and other symptoms, and enhanced self-advocacy. A peer support program also creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. The sponsors continue that, across California, peer providers are already utilized in many settings. However, there is no statewide standard of practice, consistent curriculum, training standards, supervision standards, or certification protocol. Establishing a state certification program would enable California providers to bill federal Medicaid (Medi-Cal in California) for 50% of the cost of services provided by certified peers. This is a crucial advantage, as it allows for peer services to become a sustainable piece of the state’s mental health care delivery system. Currently, 48 states plus the District of Columbia and the VA have implemented protocols to certify peer specialists, and four additional states are in the process of creating certification programs, enabling the majority of states to leverage Medicaid funds. Supporters conclude that the time has come for California to embrace peer support as an evidence-based model and put in place a certification program that will standardize best practices, and this bill makes sense from both a policy and fiscal perspective, and will result in a more comprehensive and effective approach to mental health care.
2. SUPPORT IF AMENDED. The California Society of Addiction Medicine (CSAM) requests an amendment to ensure that the certification program works in conjunction with, and does not disrupt, the existing certification system for SUD counselors, as CSAM writes that many of those individuals are peer counselors.

The Board of Behavioral Sciences writes requesting amendments, including that the bill specify allowable supervisors of peer support specialists (including but not limited to marriage and family therapists [MFTs], clinical social workers [LCSWs], and licensed professional clinical counselors), and that the bill contain more specific protection of current mental health provider practice acts by prohibiting a peer support specialist from providing any service that falls under the scope of practice of specified mental health providers (such as MFTs and LCSWs).

1. OPPOSITION. Advocates for Responsible Treatment (ART, which describes itself as an all-volunteer citizens’ advocacy group representing Southern California which wishes to ensure recovery businesses operate in a safe, human and legal manner) writes in opposition there is no drug testing for recovering addicts, and an addict for whom recovery has failed can be part of the system, which represents a danger to the population they are supposed to represent. In addition, ART writes that certified peer support specialists do not have to submit to a background check, and there is no restriction that a convicted drug dealer can obtain certification. Finally, ART writes the certification system will likely be a third-party (and not the state) and current state-approved certification are largely pay-to-play.

The California Right to Life Committee, Inc. (CRLC) writes that this measure appears to be more of a workforce development program than one designed to address mental health issues within a community’s population. CRLC writes that this bill recognizes the work of 6,000 “peers” active presently in communities without official training and certification, and it questions whether this bill has been well thought out regarding finances, and CRLC writes it foresees financial problems ahead because of the possibility that requiring a training and certification for peer providers will result in substantial cost to the local community, county, and state. Finally, CRLC writes expressing concern of the probability of the State of California requiring certification in the future for all types of counselors, peer or otherwise, who volunteer for non-profit agencies.

1. RELATED LEGISLATION. AB 704 (Patterson) would have required a person, hired by an alcoholism or drug abuse recovery or treatment facility on or after January 1, 2020, who has frequent contact with clients of that alcoholism or drug abuse recovery or treatment facility to be subject to a criminal record review prior to that person’s involvement in the provision of services. A person hired by an alcoholism or drug abuse recovery or treatment facility before January 1, 2020, who has frequent contact with clients of that alcoholism or drug abuse recovery or treatment facility must complete a criminal record review on or before December 31, 2021. AB 704 was held on the Assembly Appropriations Committee suspense file.
2. PREVIOUS LEGISLATION.
   1. SB 614 (Leno) of 2015 was substantially similar to this bill, but it was gutted and amended and used for an unrelated purpose.
   2. SB 906 (Beall) of 2018 was substantially similar to this bill. SB 906 was vetoed by Governor Brown. In his veto message, Governor Brown wrote that peer support specialists are currently used as providers in Medi-Cal without a state certificate, and that SB 906 imposed a costly new program which will permit some of these individuals to continue providing services but shut others out. Governor Brown urged the stakeholders and DHCS to improve upon the existing framework while allowing all peer support specialists to continue to work.
      

REGISTERED SUPPORT / OPPOSITION:

Support

Los Angeles County Board of Supervisors (cosponsor)

Mental Health Services Oversight and Accountability Commission (cosponsor)

Steinberg Institute (cosponsor)

211 California
211 LA County
The Arc of California
Association of California Healthcare Districts, And Affiliated Entity Alpha Fund
Association of Community Human Service Agencies
Association of Community Human Service Agencies
Association of Regional Center Agencies
California Behavioral Health Planning Council
California Council of Community Behavioral Health Agencies
California Academy of Child And Adolescent Psychiatry
California Alliance of Child And Family Services
California Assoc. of Mental Health Peer Run Organizations

California Association of Alcohol And Drug Program Executives, Inc.
California Association of Mental Health Peer Run Organizations
California Association of Public Hospitals & Health Systems
California Association of Veteran Service Agencies
California Black Health Network
California Chapter of The American College of Emergency Physicians
California Down Syndrome Advocacy Coalition
California Hospital Association/California Association of Hospitals And Health Systems
California Judges Association
California State Association of Counties
California State Council of Service Employees
CaliforniaHealth+ Advocates
Children Now
City of Santa Monica
Community Clinic Association of Los Angeles County
Corporation For Supportive Housing
County Behavioral Health Directors Association
County of Los Angeles Board of Supervisors
County of Santa Clara
County Welfare Directors Association of California (Cwda)
Depression And Bipolar Support Alliance
Disability Rights California
Having Our Say Coalition
County of Humboldt
Innovations Health Systems
Los Angeles County Chief Executive office
Los Angeles County Department of Mental Health
Mental Health America of Los Angeles
Mental Health America of Northern California
Mental Health Association In California
Mental Health Services Oversight And Accountability Commission
NAMI California
NAMI Los Angeles County Council
NAMI Sonoma County
National Alliance On Mental Illness
National Alliance On Mental Illness Yolo County
National Association of Social Workers, California Chapter
Pacific Clinics
Peers Envisioning And Engaging In Recovery Services
Private Essential Access Community Hospitals
Project Return Peer Support Network
Psychiatric Occupational Therapy Action Coalition
Roots Community Health Center
City of San Jose
City of Santa Clara
Self
Seneca Family of Agencies
Steinberg Institute
United Parents
USC Suzanne Dworak-Peck School of Social Work
Ventura; County of
Western Center On Law & Poverty, Inc.

Opposition

Advocates for Responsible Treatment
California Right to Life Committee, Inc.

Analysis Prepared by: Scott Bain / HEALTH / (916) 319-2097

 THIRD READING  

Bill No: SB 10

Author: Beall (D), et al.

Amended: 5/17/19

Vote: 21

SENATE HEALTH COMMITTEE: 9-0, 3/27/19

AYES: Pan, Stone, Durazo, Grove, Hurtado, Leyva, Mitchell, Monning, Rubio

SENATE APPROPRIATIONS COMMITTEE: 6-0, 5/16/19

AYES: Portantino, Bates, Bradford, Hill, Jones, Wieckowski

SUBJECT: Mental health services: peer support specialist certification

SOURCE: Los Angeles County Board of Supervisors

Mental Health Services Oversight and Accountability Commission

Steinberg Institute

DIGEST:

This bill requires the Department of Health Care Services (DHCS) to establish a program for certifying peer support specialists; requires DHCS to amend its Medicaid state plan and to seek any federal waivers or state plan amendments to implement the certification program; and permits DHCS to implement, interpret, and make specific the certification program through available means, as specified, until regulations are adopted.

ANALYSIS:

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income individuals receive health care services. [WIC §14001.1]
2. Grants DHCS the sole authority in state government to determine the qualifications, including the appropriate skills, education, training, and experience of personnel working within substance use disorder (SUD) recovery and treatment programs licensed and/or certified by DHCS. [HSC §11833]
3. Authorizes DHCS to require an individual providing counseling services in SUD programs licensed and/or certified by DHCS to be registered with or certified by a certifying organization (CO) approved by DHCS to register and certify counselors. [HSC §11833]
4. Grants DHCS the authority to conduct periodic reviews of COs to determine compliance with all applicable laws and regulations and to take actions for non-compliance, including revocation of DHCS’s approval. [HSC §11833]
5. Requires, through regulations, the certification of SUD counselors to be based on specific counseling competencies, training, and education, including understanding addiction and knowledge of treatment methods. [CCR, Title 9, Division 4, Chapter 8]

This bill:

1. Requires DHCS, no later than July 1, 2020, to establish a peer support specialist (or certified peer support specialist [CPSS]) certification program, and to do all of the following:
2. Establish a certifying body to certify a CPSS;
3. Provide for statewide certification of CPSS;
4. Define the range of responsibilities and practice guidelines for CPSS, as specified;
5. Determine curriculum and core competencies, including areas of specialization for CPSS, such as transition-age youth, veterans, gender identity, and sexual orientation, and core competencies that include trauma-informed care, co-occurring mental health and SUDs, and navigation of, and referral to, other services;
6. Specify training requirements, allowing for multiple qualified training entities, and requiring training to include individuals with lived experience as consumers and family members, as well as continuing education requirements for certification;
7. Establish a code of ethics and processes for investigations and corrective action, as specified;
8. Determine a process for certification renewal; and,
9. Determine a process for allowing existing personnel employed in the peer support field to obtain certification, as specified.
10. Defines “peers support specialist services” as culturally competent services that promote engagement, socialization, recovery, self-sufficiency, and self-advocacy, and include, but are not limited to, support, coaching, facilitation, or education to Medi-Cal beneficiaries that is individualized to the beneficiary and is conducted by a CPSS, as specified.
11. Prohibits the CPSS certification program to be construed as permitting a CPSS to diagnose an illness, prescribe medication, or provide clinical services. Prohibits the CPSS certification program from altering the scope of practice for a health care professional, or authorize the delivery of health care services in a setting or manner that is not authorized by existing law.
12. Requires DHCS to consult with the Office of Statewide Health Planning and Development, peer support and family organizations, mental health and SUD treatment providers and organizations, the County Behavioral Health Directors Association of California, and the California Behavioral Health Planning Council, and other interested parties in developing, implementing, and administering the CPSS certification program, as specified.
13. Requires DHCS to amend its Medicaid state plan to include CPSS as a provider type and include CPSS services as a distinct service type, as specified. Permits DHCS to seek any federal waivers or other state plan amendments as necessary to implement the CPSS certification program.
14. Permits community health workers to partner with CPSS for engagement, outreach, and education in order to facilitate early intervention for mental health services and improve linkage to services.
15. Permits DHCS to use Mental Health Services Act funds to develop and administer the CPSS program, subject to an express appropriation in the annual Budget Act, and for the purposes of claiming Federal financial participation (FFP), as specified.
16. Requires Medi-Cal reimbursement for CPSS services to be implemented only to the extent that FFP is available and all necessary federal approvals have been obtained.
17. Permits DHCS to establish a certification fee schedule to support the activities associated with the ongoing administration of the CPSS certification program. Requires any fees charged be reasonable and reflect the expenditures directly applicable to the ongoing administration of the CPSS certification program.
18. Requires DHCS, by July 1, 2022, to adopt regulations for the CPSS certification program. Permits DHCS to implement, interpret, or make specific the requirements of the CPSS certification program through plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.

Comments

1. Author’s statement. According to the author, California lags behind the nation in implementing a CPSS program. The U.S. Department of Veterans Affairs and 48 states have a certification process in place for mental health CPSS. The federal Centers for Medicare and Medicaid Services (CMS) released guidance in 2007 and clarification in 2013 for establishing a CPSS program to enable the use of FFP with a 50% match. Yet California has not acted. Research is clear that the use of a formal certification program to train CPSS offers enormous benefits, including allowing providers to make use of the federal Medi-Cal match; allowing for standardization of the peer support practice, to ensure the highest quality care; and establishing core competencies that allow CPSS to transfer skills across county lines. Although DHCS anticipates there will be substantial growth in the demand for CPSS, there are no statewide scope of practice, training standards, supervision standards, or certification. This bill creates these standards and establishes a code of ethics and processes for revocation of certification.
2. CPSS. According to the federal Substance Abuse and Mental Health Service Administration, a CPSS is a person who uses lived experience of recovery from mental illness and/or an SUD, plus skills learned in formal training, to deliver services in behavioral health settings to promote recover and resiliency. According to DHCS, a substantial number of studies demonstrate that the CPSS improves patient functioning, increases patient satisfaction, reduces family burden, alleviates depression and other symptoms, reduces hospitalizations and hospital days, increases patient activation, and enhances patient self-advocacy. CPSS are used in more than 40 states and throughout the Veterans Health Administration. CPSS participating in SUD treatment activities are currently a recognized Medicaid service provider in California for SUD services; however, these providers are often limited in the services they are able to provide in traditional health care settings. DHCS states that expanded use of CPSS in mental health and SUD as part of a care team can improve care coordination between behavioral health and physical health care needs of patients. DHCS included CPSS as a component in the most recent Section 1115 Waiver renewal, known as Medi-Cal 2020, by providing financial incentives to managed care plans to support non-physician community providers, promoting both physical and behavioral health care integration, and team-based care. Counties are currently able to seek reimbursement for CPSS services under the “other qualified provider” provider type under the Medicaid state plan.
3. CPSS certification. CMS released guidance in 2007 and further clarification in 2013 for establishing a CPSS certification program to enable FFP in an effort to more fully incorporate and expand the use of peers. CMS requires peer support providers to complete training and certification as defined by each state, and specified that services can be offered for mental illness and/or SUDs. Substantive work has been conducted in California by the Working Well Together Statewide Technical Assistance Center, a collaborative of peer and client-oriented organizations, which culminated in a final report of recommendations to proceed with peer certification. This effort identified key issues for laying the foundation of certification, including training recommendations and core components for a statewide certification program; establishing a standard of practice and core competencies; defining the level of care and services; integrating services across physical health, mental health, and SUD services; and allowing for portability from one county to another.
4. DHCS current certification duties. DHCS ensures that registered and certified SUD counselors provide quality treatment to clients by enforcing counselor certification regulations. DHCS approves COs that register and certify SUD counselors who provide counseling services in an SUD program licensed or certified by DHCS. There are approximately 28,000 SUD counselors, of which roughly half are certified and half are registered while working towards certification. DHCS's oversight authority of COs includes periodic reviews of the COs to monitor adherence to state requirements.

Related/Prior Legislation

SB 906 (Beall, 2018) and SB 614 (Leno, 2015) were identical to this bill. SB 906 was vetoed by the Governor who stated peer support specialists are currently used as providers in Medi-Cal without a state certificate, and SB 906 would have imposed a costly new program, which would have permitted some individuals to continue providing services but shut others out. Governor Brown urged stakeholders and DHCS to improve upon the existing framework while allowing all peer support specialists to continue to work. SB 614 was amended on August 18, 2016, on the Assembly Floor to a new purpose.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to the Senate Appropriations Committee, staff notes the author’s amendments may reduce costs as it reduces the number of peer support categories; however, it is anticipated DHCS would incur unknown implementation costs to develop program standards and to seek necessary federal approvals. The impact to county mental health plans and managed care plans remains unknown.

• One-time costs, likely in the hundreds of thousands per year for one to three years, to develop program standards and seek federal approvals by DHCS (Mental Health Services Act funds, General Fund, and federal funds).
• Unknown ongoing costs (that could range from minimal to hundreds of thousands to millions per year) to manage the certification of the program (Mental Health Service Act funds, General Fund, federal funds, or special funds).
• Uncertain impact on county mental health plans that provide specialty mental health services in the Medi-Cal program (county funds and federal funds). Plans may see an overall increase service utilization; however, depending on the provider type, could reduce expenditures by providing certain services in a more cost-effective manner.
• Uncertain impact on Medi-Cal managed care plans that provide mental health services to Medi-Cal beneficiaries when the mental illness is not severe (General Fund and federal funds).

SUPPORT: (Verified 5/17/19)

Los Angeles County Board of Supervisors (co-source)

Mental Health Services Oversight and Accountability Commission (co-source)

Steinberg Institute (co-source)

American College of Emergency Physicians

Anti-Recidivism Coalition

Association of California Healthcare Districts

Association of Community Human Service Agencies

Association of Regional Center Agencies

Bay Area Community Services

California Academy of Child and Adolescent Psychiatry

California Alliance of Child and Family Services

California Association of Alcohol and Drug Program Executives, Inc.

California Association of Local Behavioral Health Boards and Commissions

California Association of Mental Health Peer Run Organizations

California Association of Public Hospitals and Health Systems

California Association of Social Rehabilitation Agencies

California Association of Veteran Service Agencies

California Behavioral Health Directors Association

California Behavioral Health Planning Council

California Children’s Trust

California Coalition for Mental Health

California Council of Community Behavioral Health Agencies

California Down Syndrome Advocacy Coalition

California Hospital Association

California State Association of Counties

California State Council of the Service Employees International Union

Children Now

City College of San Francisco

City of San Jose

City of Santa Monica

Community Clinic Association of Los Angeles County

Community Mental Health Certificate Program at City College of San Francisco

Corporation for Supportive Housing

County Behavioral Health Directors Association of California

County of Santa Clara

County of Ventura

County Welfare Directors Association

Crestwood Behavioral Health, Inc.

Daniel’s Place

Depression and Bipolar Support Alliance

Didi Hirsch Mental Health Services

Disability Rights California

Innovations Health Systems

Juvenile Court Judges of California

Manzanita Services

Mental Health America of California

Mental Health America of Los Angeles

Mental Health America of Northern California

Mental Health Association of San Francisco

NAMI Amador

NAMI Sacramento

National Association of Social Workers, California Chapter

Pacific Clinics

Peers Envisioning and Engaging in Recovery Services

Pool of Consumer Champions

Project Return Peer Support Network

Seneca Family of Agencies

Telecare Corporation

The Arc and United Cerebral Palsy California Collaboration

Ventura County Board of Supervisors

Western Center on Law and Poverty

Several individuals

OPPOSITION: (Verified 5/17/19)

None received

ARGUMENTS IN SUPPORT: The Steinberg Institute, Mental Health Services Oversight and Accountability Commission, and the Los Angeles County Board of Supervisors, cosponsors of this bill, and other supporters, largely mental health and youth advocates, argue that peer providers are those who use lived experience with mental health and SUD experience, as well as formal training, to provide measurable benefits to mental health and SUD clients, including reduced hospitalizations, improved functioning, alleviation of depression and other symptoms, and enhanced self-advocacy. Supporters also argue that a peer support program creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. Supporters further state that nearly 6,000 peer specialists in California are already used in many settings, such as community-based organizations, county clinics, schools, and primary care; however, there is currently no statewide standard of practice, consistent curriculum, training or supervision standards, or opportunity for portability across counties. Supporters argue that a certification program is crucial for obtaining FFP for the state and allows for peer services to become a sustainable piece of the state’s mental health care delivery system. The Association of California Healthcare Districts states that workforce development remains a priority for its members, and health care districts support innovative ways to increase the health care workforce in medically underserved communities and increase access to care, such as the use of peer support specialists.

Prepared by: Reyes Diaz / HEALTH / (916) 651-4111

5/20/19 19:28:53

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 10 (Beall) - Mental health services: peer, parent, transition-age, and family support specialist certification

Bill Summary:

Senate Bill 10 would establishes the Peer, Parent, Transition-Age, and Family Support Specialist Certification Program within the Department of Health Care Services (DHCS), and requires DHCS, no later than July 1, 2020, to establish a statewide certification program and practice guidelines for specified categories of peer support specialists. Would require DHCS to amend its Medicaid state plan and to seek any federal waivers or state plan amendments to implement the certification program; and permits DHCS to implement, interpret, and make specific the certification program through available means, as specified, until regulations are adopted.

*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********

The following information is revised to reflect amendments

adopted by the committee on May 16, 2019

Fiscal Impact:

Staff notes the author’s amendments may reduce costs as it reduces the number of peer support categories, however, it is anticipated the department would incur unknown implementation costs to develop program standards and to seek necessary federal approvals. The impact to county mental health plans and managed care plans remains unknown.

• One-time costs, likely in the hundreds of thousands per year for one to three years, to develop program standards and seek federal approvals by DHCS (Mental Health Services Act funds, General Fund, and federal funds).
• Unknown ongoing costs (that could range from minimal to hundreds of thousands to millions per year) to manage the certification of the program (Mental Health Service Act funds, General Fund, federal funds, or special funds).
• Uncertain impact on county mental health plans that provide specialty mental health services in the Medi-Cal program (county funds and federal funds). Plans may see an overall increase service utilization, however, depending on the provider type, could reduce expenditures by providing certain services in a more cost-effective manner.
• Uncertain impact on Medi-Cal managed care plans that provide mental health services to Medi-Cal beneficiaries when the mental illness is not severe (General Fund and federal funds).

Author Amendments:

The amendments consolidate four peer categories and their requirements (adult peer support specialists, transition-age youth peer support specialists, family peer support specialists, and parent peer support specialists) into one peer support specialist category, with conforming changes. Specifically, the amendments:

• Define “peer support specialist” as a person who is 18 years or older with qualifying lived experiences, as specified.
• Provide criteria for a person to be certified as a peer support specialist.

-- END --

SENATE COMMITTEE ON APPROPRIATIONS

Senator Anthony Portantino, Chair

2019 - 2020 Regular Session

SB 10 (Beall) - Mental health services: peer, parent, transition-age, and family support specialist certification.

Bill Summary:

Establishes the Peer, Parent, Transition-Age, and Family Support Specialist Certification Program within the Department of Health Care Services (DHCS), and requires DHCS, no later than July 1, 2020, to establish a statewide certification program and practice guidelines for specified categories of peer support specialists. Requires DHCS to amend its Medicaid state plan and to seek any federal waivers or state plan amendments to implement the certification program; and permits DHCS to implement, interpret, and make specific the certification program through available means, as specified, until regulations are adopted.

Fiscal Impact:

The committee considered an identical bill (Senate Bill 906, Beall, 2018) last year; this estimate remains consistent. SB 906 was narrowed, and the Department of Finance provided a public analysis on the narrower version. For that fiscal detail, please see Staff Comments.

• One-time costs, likely in the hundreds of thousands per year for one to three years, to develop program standards and seek federal approvals by DHCS (Mental Health Services Act funds, General Fund, and federal funds).
• Unknown ongoing costs (that could range from minimal to hundreds of thousands to millions per year) to manage the certification of the program (Mental Health Service Act funds, General Fund, federal funds, or special funds), depending on which entity will certify the Peer/Parent Family Support Specialist (PFSS).
• Uncertain impact on county mental health plans that provide specialty mental health services in the Medi-Cal program (county funds and federal funds). Plans may see an overall increase service utilization, however, depending on the provider type, could reduce expenditures by providing certain services in a more cost-effective manner.
• Uncertain impact on Medi-Cal managed care plans that provide mental health services to Medi-Cal beneficiaries when the mental illness is not severe (General Fund and federal funds).

Background:

The DHCS operates the Medi-Cal program, which provides health care coverage to income-eligible individuals, families, and children. Medi-Cal also provides coverage to childless adults and parents with household incomes up to 138 percent of the federal poverty level (FPL), and to children with household incomes up to 266 percent of the FPL. The federal government provides matching funds that vary from 50 percent to 90 percent of expenditures depending on the category of beneficiary. Medi-Cal managed care plans provide services to beneficiaries with mild mental illness; county mental health plans serve beneficiaries with moderate to severe mental illness.

Federal law allows states to include peer and family support specialists to provide services in state Medicaid programs, provided that PFSS are certified in that state. In California, PFSS are an eligible service provider for substance use disorder services, but not for mental health services.

DHCS ensures that registered and certified substance use disorder (SUD) counselors provide quality treatment to clients by enforcing counselor certification regulations. DHCS approves certifying organizations (CO) that register and certify SUD counselors who provide counseling services in an SUD program licensed or certified by DHCS. There are approximately 28,000 SUD counselors, of which roughly half are certified and half are registered while working towards certification.

Proposed Law: Senate Bill 10 establishes the Peer, Parent, Transition-Age, and Family Support Specialist Certification Act of 2019, and includes the following provisions.

Certification Program. The bill requires the Department of Health Care Services (DHCS), no later than, July 1, 2020, to do all of the following:

• • Establish a certifying body, either through contract or interagency agreement.
  • Provide a statewide certification for each of the following categories of peer support specialists, as specified in federal guidance:
    • Adult peer support specialists, who may serve individuals across the lifespan;
    • Transition-age youth support specialists;
    • Family peer support specialists;
    • Parent peer support specialists.
  • Define range of responsibilities and practice guidelines for the categories of peer support specialists by utilizing specified best practices. Determine continuing education requirements for biennial certification renewal.
  • Determine a process for complaint investigation and corrective action, which may include suspension and certification revocation.
  • Determine a process for an individual employed as a peer support specialist on January 1, 2020, to obtain certification.

Minimum Qualifications. The bill establishes minimum requirements for an individual to be certified as an adult peer support specialist, a transition-age youth peer support specialist, a family peer support specialist, or a parent peer support specialist.

Certification Fee. The bill authorizes DHCS to establish a certification fee schedule and may require remittance as contained in the certification fee schedule for the purpose of supporting the activities associated with the ongoing administration of the peer, parent, transition-age, and family support specialist certification program. Certification fees must reasonably reflect the administration expenditures of the certification program.

Medicaid State Plan. The bill requires DHCS to amend its state plan to include each category of peer, parent, transition-age, and family support specialist as a provider type, as specified; and, to include peer support specialist services as a distinct services, which may be provided to eligible Medi-Cal beneficiaries enrolled in a managed care plan or a mental health plan.

The bill authorizes DHCS to seek any federal waivers or other state plan amendments to implement the certification program, as proposed by this bill.

Federal Financial Participation. The bill provides that Medi-Cal reimbursement for peer support specialist services must be implemented only if federal financial participation is available and all necessary federal approvals have been obtained.

Consultation with Office of Statewide Health Planning and Development. The bill requires DHCS to consult with the Office of Statewide Health Planning and Development (OSHPD), peer support and family organizations, mental health services and substance use disorder treatment providers and organizations, the County Behavioral Health Directors Association of California, the California Behavioral Health Planning Council in implementing this article. Consultation must initially include, at a minimum, quarterly stakeholder meetings. DHCS may additionally conduct technical workgroups upon the request of stakeholders.

Other. The bill provides that the statute is not intended to be construed to imply that an individual who is certified is qualified to, or authorized to diagnose an illness, prescribe medication, or provide clinic services. The bill also provides that it does not alter scope of practice for a healthcare professional or delivery of healthcare services in a setting or unauthorized manner.

Definitions. The bill defines terms, including but not limited to: “adult peer support specialist”, “certification”, “code of ethics”, “family peer support specialist”, “parent support specialist”, “peer support services”, and “transition-age youth peer support specialist.”

Findings and declarations. The bill makes legislative findings and declarations, and clarifies procedures and terms of the Mental Health Services Act within the meaning of Section 18 of the Mental Health Services Act.

Related Legislation:

• SB 906 (Beall of 2018) was similar to this bill and included only the peer support specialist certification program. Governor Brown vetoed the bill, stating:

Peer support specialists are currently used as providers in Medi-Cal without a state certificate. The bill imposes a costly new program which will permit some of these individuals to continue providing services but shut others out. I urge stakeholders to improve the existing framework while allowing all peer support specialists to continue to work.

• SB 614 (Leno of 2015) was identical to this bill. SB 614 was amended on August 18, 2016, on the Assembly Floor to a new purpose.
• AB 2374 (Mansoor, Chapter 815, Statutes of 2014) requires DHCS to, among other things, conduct periodic reviews of COs and requires COs to contact other COs before registering or certifying a person as an SUD counselor to determine if the person’s registration or certification has ever been revoked.

Staff Comments:

The Legislature considered SB 906 (Beall, 2018) last year. The Department of Finance’s August 8, 2018, analysis estimated costs of the narrower version to be $3.8 million in 2018-19 and $6.8 million in 2019-20 and ongoing (split between General Fund and federal fund) to develop certification standards and seek necessary program approvals. In addition, the DOF analysis noted “the addition of peer support services as a distinct service under the State Plan would result in Proposition 30 costs to counties. These costs are indeterminate, but would be borne by the GF.”

Staff notes the additional fiscal considerations:

• Uncertain ongoing costs to manage the program (Mental Health Service Act funds, General Fund, federal funds, or special funds). The bill requires the Department to establish a certifying body to provide for the certification of PFSS. However, the bill also requires DHCS to provide for statewide certification of PFSS. If DHCS fulfills that responsibility, the annual costs may be in the hundreds of thousands to millions per year, with application fee revenues to offset costs.
• Uncertain impact on county mental health plans that provide specialty mental health services in the Medi-Cal program (county funds and federal funds). County mental health plans provide services for Medi-Cal beneficiaries with moderate to severe mental health issues. PFSS are likely to be a less costly provider type than other mental health providers in Medi-Cal. Also, to the extent counties are already providing peer support services, they are currently unable to draw down federal funding. Under this bill, they would be able to do so. Finally, to the extent that PFSS are able to provide support and assistance to Medi-Cal beneficiaries with mental illness, it is also possible that the program may reduce the need for more expensive services such as inpatient hospitalizations. The extent of cost avoidance is unknown.
• To the extent that PFSS are able to provide support and assistance to Medi-Cal beneficiaries with mental illness, the program may reduce the need for more expensive services such as inpatient hospitalizations. The extent of cost avoidance is unknown.

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SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: SB 10

SUBJECT: Mental health services: peer, parent, transition-age, and family support specialist certification.

SUMMARY:

Requires the Department of Health Care Services (DHCS) to establish a program for certifying peer, parent, transition-age youth, and family support specialists; requires DHCS to amend its Medicaid state plan and to seek any federal waivers or state plan amendments to implement the certification program; and permits DHCS to implement, interpret, and make specific the certification program through available means, as specified, until regulations are adopted.

Existing law:

1. Establishes the Medi-Cal program, administered by DHCS, under which qualified low-income individuals receive health care services. [WIC §14001.1]

1. Grants DHCS the sole authority in state government to determine the qualifications, including the appropriate skills, education, training, and experience of personnel working within substance use disorder (SUD) recovery and treatment programs licensed and/or certified by DHCS. [HSC §11833]
2. Authorizes DHCS to require an individual providing counseling services in SUD programs licensed and/or certified by DHCS to be registered with or certified by a certifying organization (CO) approved by DHCS to register and certify counselors. [HSC §11833]
3. Grants DHCS the authority to conduct periodic reviews of COs to determine compliance with all applicable laws and regulations and to take actions for non-compliance, including revocation of DHCS’s approval. [HSC §11833]
4. Requires, through regulations, the certification of SUD counselors to be based on specific counseling competencies, training, and education, including understanding addiction and knowledge of treatment methods. [CCR, Title 9, Division 4, Chapter 8]

This bill:

1. Requires DHCS, no later than July 1, 2020, to establish a peer, parent, transition-age youth, and family support specialist (or certified support specialist [CSS]) certification program, and to do all of the following:
2. Establish a certifying body to certify a CSS;
3. Provide for statewide certification of adult peer support specialist; transition-age youth peer support specialist, family peer support specialist, and parent peer support specialist;
4. Define the range of responsibilities and practice guidelines for the CSS categories, as specified;
5. Determine curriculum and core competencies, including areas of specialization for each CSS category, such as transition-age youth, veterans, gender identity, and sexual orientation, and core competencies that include trauma-informed care, co-occurring mental health and SUDs, and navigation of, and referral to, other services;
6. Specify training requirements, allowing for multiple qualified training entities, and requiring training to include individuals with lived experience as consumers and family members, as well as continuing education requirements for certification;
7. Establish a code of ethics and processes for investigations and corrective action, as specified;
8. Determine a process for certification renewal; and,
9. Determine a process for allowing existing personnel employed in the peer support field to obtain certification, as specified.
10. Defines “peers support specialist services” as culturally competent services that promote engagement, socialization, recovery, self-sufficiency, and self-advocacy, and include, but are not limited to, support, coaching, facilitation, or education to Medi-Cal beneficiaries that is individualized to the beneficiary and is conducted by a CSS, as specified.
11. Prohibits the CSS certification program to be construed as permitting a CSS to diagnose an illness, prescribe medication, or provide clinical services. Prohibits the CSS certification program from altering the scope of practice for a health care professional, or authorize the delivery of health care services in a setting or manner that is not authorized by existing law.
12. Requires DHCS to consult with the Office of Statewide Health Planning and Development (OSHPD), peer support and family organizations, mental health and SUD treatment providers and organizations, the County Behavioral Health Directors Association of California, and the California Behavioral Health Planning Council, and other interested parties in developing, implementing, and administering the CSS certification program, as specified.

1. Requires DHCS to amend its Medicaid state plan to include each CSS category as a provider type and include CSS services as a distinct service type, as specified. Permits DHCS to seek any federal waivers or other state plan amendments as necessary to implement the CSS certification program.
2. Permits community health workers to partner with each CSS category for engagement, outreach, and education in order to facilitate early intervention for mental health services and improve linkage to services.
3. Permits DHCS to use Mental Health Services Act funds to develop and administer the CSS program, subject to an express appropriation in the annual Budget Act, and for the purposes of claiming Federal financial participation (FFP), as specified.
4. Requires Medi-Cal reimbursement for CSS services to be implemented only to the extent that FFP is available and all necessary federal approvals have been obtained.
5. Permits DHCS to establish a certification fee schedule to support the activities associated with the ongoing administration of the CSS certification program. Requires any fees charged be reasonable and reflect the expenditures directly applicable to the ongoing administration of the CSS certification program.
6. Requires DHCS, by July 1, 2022, to adopt regulations for the CSS certification program. Permits DHCS to implement, interpret, or make specific the requirements of the CSS certification program through plan letters, plan or provider bulletins, or similar instructions until the time regulations are adopted.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, California lags behind the nation in implementing a CSS program. The U.S. Department of Veterans Affairs and 48 states have a certification process in place for mental health CSS. The federal Centers for Medicare and Medicaid Services (CMS) released guidance in 2007 and clarification in 2013 for establishing a CSS program to enable the use of FFP with a 50% match. Yet California has not acted. Research is clear that the use of a formal certification program to train CSS offers enormous benefits, including allowing providers to make use of the federal Medi-Cal match; allowing for standardization of the peer support practice, to ensure the highest quality care; and establishing core competencies that allow CSS to transfer skills across county lines. Although DHCS anticipates there will be substantial growth in the demand for CSS, there are no statewide scope of practice, training standards, supervision standards, or certification. This bill creates these standards and establishes a code of ethics and processes for revocation of certification.
2. CSS. According to the federal Substance Abuse and Mental Health Service Administration, a CSS is a person who uses lived experience of recovery from mental illness and/or an SUD, plus skills learned in formal training, to deliver services in behavioral health settings to promote recover and resiliency. According to DHCS, a substantial number of studies demonstrate that the CSS improves patient functioning, increases patient satisfaction, reduces family burden, alleviates depression and other symptoms, reduces hospitalizations and hospital days, increases patient activation, and enhances patient self-advocacy. CSS are used in more than 40 states and throughout the Veterans Health Administration. CSS participating in SUD treatment activities are currently a recognized Medicaid service provider in California for SUD services; however, these providers are often limited in the services they are able to provide in traditional health care settings. DHCS states that expanded use of CSS in mental health and SUD as part of a care team can improve care coordination between behavioral health and physical health care needs of patients. DHCS included CSS as a component in the most recent Section 1115 Waiver renewal, known as Medi-Cal 2020, by providing financial incentives to managed care plans to support non-physician community providers, promoting both physical and behavioral health care integration, and team-based care. Counties are currently able to seek reimbursement for CSS services under the “other qualified provider” provider type under the Medicaid state plan.
3. CSS certification. CMS released guidance in 2007 and further clarification in 2013 for establishing a CSS certification program to enable FFP in an effort to more fully incorporate and expand the use of peers. CMS requires peer support providers to complete training and certification as defined by each state, and specified that services can be offered for mental illness and/or SUDs. Substantive work has been conducted in California by the Working Well Together Statewide Technical Assistance Center, a collaborative of peer and client-oriented organizations, which culminated in a final report of recommendations to proceed with peer certification. This effort identified key issues for laying the foundation of certification, including training recommendations and core components for a statewide certification program; establishing a standard of practice and core competencies; defining the level of care and services; integrating services across physical health, mental health, and SUD services; and allowing for portability from one county to another.
4. DHCS current certification duties. DHCS ensures that registered and certified SUD counselors provide quality treatment to clients by enforcing counselor certification regulations. DHCS approves COs that register and certify SUD counselors who provide counseling services in an SUD program licensed or certified by DHCS. There are approximately 28,000 SUD counselors, of which roughly half are certified and half are registered while working towards certification. DHCS's oversight authority of COs includes periodic reviews of the COs to monitor adherence to state requirements.
5. Prior legislation. SB 906 (Beall of 2018) was identical to this bill. SB 906 was vetoed by the Governor who stated peer support specialists are currently used as providers in Medi-Cal without a state certificate, and SB 906 imposed a costly new program, which would permit some individuals to continue providing services but shut others out. The Governor urged stakeholders and DHCS to improve upon the existing framework while allowing all peer support specialists to continue to work.

SB 614 (Leno of 2015) was identical to this bill. SB 614 was amended on August 18, 2016, on the Assembly Floor to a new purpose.

AB 2374 (Mansoor, Chapter 815, Statutes of 2014) requires DHCS to, among other things, conduct periodic reviews of COs and requires COs to contact other COs before registering or certifying a person as an SUD counselor to determine if the person’s registration or certification has ever been revoked.

1. Support. The Steinberg Institute, Mental Health Services Oversight and Accountability Commission, and the Los Angeles County Board of Supervisors, cosponsors of this bill, and other supporters, largely mental health and youth advocates, argue that peer providers are those who use lived experience with mental health and SUD experience, as well as formal training, to provide measurable benefits to mental health and SUD clients, including reduced hospitalizations, improved functioning, alleviation of depression and other symptoms, and enhanced self-advocacy. Supporters also argue that a peer support program creates a career ladder so that consumers and family members working in mental health care have the opportunity to fully contribute, translating their experience into meaningful employment. Supporters further state that nearly 6,000 peer specialists in California are already used in many settings, such as community-based organizations, county clinics, schools, and primary care; however, there is currently no statewide standard of practice, consistent curriculum, training or supervision standards, or opportunity for portability across counties. Supporters argue that a certification program is crucial for obtaining FFP for the state and allows for peer services to become a sustainable piece of the state’s mental health care delivery system. The Association of California Healthcare Districts states that workforce development remains a priority for its members, and health care districts support innovative ways to increase the health care workforce in medically underserved communities and increase access to care, such as the use of peer support specialists.
2. Support if amended. The California Society of Addiction Medicine supports this bill if it is amended to ensure that the CSS program works in conjunction with, and does not disrupt, the existing certification system for SUD counselors, many of whom are peer counselors.

SUPPORT AND OPPOSITION:

Support: Mental Health Services Oversight and Accountability Commission (co-sponsor)

Los Angeles County Board of Supervisors (co-sponsor)

Steinberg Institute (co-sponsor)

Anti-Recidivism Coalition

Association of California Healthcare Districts

Association of Community Human Service Agencies

Association of Regional Center Agencies

Bay Area Community Services

California Academy of Child and Adolescent Psychiatry

California Alliance of Child and Family Services

California Association of Alcohol and Drug Program Executives, Inc.

California Association of Local Behavioral Health Boards and Commissions

California Association of Mental Health Peer Run Organizations

California Association of Social Rehabilitation Agencies

California Association of Veteran Service Agencies

California Behavioral Health Planning Council

California Coalition for Mental Health

California Council of Community Behavioral Health Agencies

California Hospital Association

California Society of Addiction Medicine

California State Association of Counties

California State Council of the Service Employees International Union

City College of San Francisco

City of San Jose

City of Santa Monica

Community Clinic Association of Los Angeles County

Community Mental Health Certificate Program at City College of San Francisco

Corporation for Supportive Housing

County Behavioral Health Directors Association of California

County of Santa Clara

County Welfare Directors Association

Crestwood Behavioral Health, Inc.

Depression and Bipolar Support Alliance

Didi Hirsch Mental Health Services

Disability Rights California

Juvenile Court Judges of California

Mental Health America of California

Mental Health America of Los Angeles

Mental Health America of Northern California

Mental Health Association of San Francisco

National Association of Social Workers, California Chapter

Pacific Clinics

Project Return Peer Support Network

Seneca Family of Agencies

The Arc and United Cerebral Palsy California Collaboration

Ventura County Board of Supervisors

Western Center on Law and Poverty

Several individuals

Oppose: None received