This webpage provides answers to common questions regarding the Medi-Cal Peer Support Specialist Program. If you don't find the answer to your question below, please contact the Peers inbox:
peers@dhcs.ca.gov
Any additional information or questions related to California Mental Health Services Authority's (CalMHSA) role in the Peer Support Specialist Program can be sent to CalMHSA's inbox:
PeerCertification@calmhsa.org
Can life or work experience be substituted for the GED or equivalent degree requirement?
No, a peer must have a GED or equivalent degree to qualify for Medi-Cal Peer Support Specialist certification.
What are the qualifications and training requirements for Peer Support Specialist Supervisors?
The requirements for Peer Support Specialist Supervisors are outlined in BHIN 22-018.
Are there DHCS-specified requirements, or best practice recommendations, for the supervision of peer progress notes and how a supervisor should document supervision of the work of peer support?
Per W&I Code § 14045.13, documentation skills and standards are a required core competency for Peer Support Specialist certification programs to include in their curriculum. DHCS encourages counties to defer to CalMHSA's guidance on documentation skills and standards for best practice recommendations. DHCS has not issued guidance on how supervisors should document the supervision of Peer Support Specialists, but recommends counties mirror standard procedure for documentation of clinical supervision.
Can youth be Peer Support Specialists?
The law includes several qualification requirements for an applicant to be certified as a Peer Support Specialist in W&I 14045.15. One such requirement is that an applicant must be at least 18 years of age. This does not preclude Peer Support Specialists from working with youth or transitional-age youth.
If I am currently a Peer Support Specialist but do not work with Medi-Cal beneficiaries, do I need to be certified by this program?
No. This certification is only a requirement if Peer Support Services are provided to a Medi-Cal beneficiary and the county submits a claim to be reimbursed by Medi-Cal for the federal share of the cost.
Will there be different certification programs for substance use disorder peers and mental health peers?
No. The law does not make a distinction as separate certifications and states a Peer Support Specialist is an individual “having lived experience with the process of recovery from mental illness, substance use disorder, or both, either as a consumer of these services or as the parent or family member of the consumer."
What are the oversight requirements for Medi-Cal Peer Support Specialists?
Under California Medicaid State Plan Amendments, Medi-Cal Peer Support Specialists shall provide services under the direction of a Behavioral Health Professional2. Per Behavioral Health Information Notice 22-026, a Behavioral Health Professional must be licensed, waivered, or registered in accordance with applicable State of California licensure requirements and listed in the California Medicaid State Plan as a qualified provider of DMC, DMC-ODS, or SMHS. Qualified providers who may direct or recommend services within the SMH, DMC, and DMC-ODS delivery systems include: physicians; licensed or waivered psychologists; licensed, waivered, or registered social workers, marriage and family therapists, and professional clinical counselors; registered nurses (including certified nurse specialists within SMH only); and nurse practitioners.3
Individuals who directly supervise Medi-Cal Peer Support Specialists must meet all applicable California state requirements for Peer Support Specialist Supervisors as outlined in BHIN 22-018. If the Peer Support Specialist's direct supervisor is not a licensed, waivered, or registered Behavioral Health Professional who is qualified to provide and direct services in DMC, DMC-ODS, or SMHS (e.g., a non-clinician program administrator, manager, or supervisor), the Peer Support Specialist Supervisor needs to also meet the requirement of providing services under the direction of a licensed, waivered, or registered Behavioral Health Professional who is qualified to provide and direct services in DMC, DMC-ODS, and/or SMHS.
Are Medi-Cal Peer Support Specialist Supervisors required to be licensed Behavioral Health Professionals?
Peer Support Specialist Supervisors are not required to be licensed Behavioral Health Professionals. As stated in BHIN 21-041, Peer Support Specialist Supervisors must meet at least one of the following qualifications:
- Have a Medi-Cal Peer Support Specialist Certification Program certification; have two years of experience working in the behavioral health system; and have completed a DHCS approved peer support supervisory training curriculum.
OR
- Be a non-peer Behavioral Health Professional (including registered & certified SUD counselors) who has worked in the behavioral health system for a minimum of two years, and has completed a DHCS approved peer support supervisory training;
OR
- Have a high school diploma or GED, four years of behavioral health direct service experience that may include Peer Support Services; and have completed an approved peer support supervisory training curriculum.
If a Peer Support Specialist's supervisor is not a licensed, waivered, or registered Behavioral Health Professional who is qualified to provide and direct services for DMC, DMC-ODS, and/or SMHS, the Peer Support Specialist must also provide services under the direction of a Behavioral Health Professional who meets the above qualifications.
Can Medi-Cal Peer Support Specialists approve a plan of care?
BHIN 22-019 states that Medi-Cal Peer Support Specialists cannot approve a plan of care. Medi-Cal Peer Support Specialists can contribute to the documentation in a beneficiary's progress notes and clinical record. Under DHCS's current policy as stated in BHIN 22-019, documentation, including the plan of care, must be approved by a treating provider who can render reimbursable Medi-Cal Services. A treating provider is a Behavioral Health Professional who is licensed, waivered, or registered in accordance with applicable State of California licensure requirements and listed in the California Medicaid State Plan as a qualified provider of DMC, DMC-ODS, or SMH services.
Telehealth
Can Medi-Cal Peer Support Specialists deliver services via telehealth?
Yes. Medi-Cal Peer Support Services may be provided face-to-face, by telephone, or by telehealth with the beneficiary or significant support person(s) and may be provided anywhere in the community.4 5Beneficiaries have the right to request and receive in-person services; please see DHCS' Telehealth Policy Paper for more information.6
Where can I find more information about providing services via telehealth?
Information regarding telehealth is available on the DHCS Medi-Cal & Telehealth page and the DHCS Telehealth Resources page. DHCS is updating its telehealth guidance for Specialty Mental Health Services and Substance Use Disorder Treatment Services in Medi-Cal, and more information is forthcoming. Please see the DHCS Telehealth Policy Paper for additional information on policies that apply to all Medi-Cal delivery systems.
How does someone apply to become a Medi-Cal Peer Support Specialist? An applicant for Medi-Cal Peer Support Specialist certification must apply via the Certification Entity. For Fiscal Year 2022/23, the only certifying entity is CalMHSA. Please visit the CalMHSA Peer Certification webpage or contact CalMHSA at PeerCertification@calmhsa.org for additional information regarding certification. Counties may select different entities for each fiscal year.
How much is the certification fee for an individual to become a Medi-Cal Peer Support Specialist?
Certification fees for peers applying for Medi-Cal Peer Support Specialist certification via CalMHSA are posted on the CalMHSA website.
Are there scholarships available for peers who are seeking to become certified as a Medi-Cal Peer Support Specialist?
DHCS has made limited funding available in the form of scholarships for peers seeking certification as Medi-Cal Peer Support Specialists in California. The scholarships and funding are time limited. A total of 5,000 scholarships are available: 2,500 for peers under the grandparenting process and 2,500 for “initial" peers, not under the grandparenting process. Please refer to CalMHSA's summary of the scholarship process for additional information.
Are peers required to complete a minimum of 1,550 hours of work experience as a peer prior to submitting an application for grandparenting in accordance with BHIN 21-041?
Yes. Applicants for Medi-Cal Peer Support Specialist certification must have completed the required hours of work experience at the time of application submission.
What are the Continuing Education requirements for a Medi-Cal Peer Support Specialist?
Peer Support Specialists must complete 20 hours of continuing education every two years. The continuing education must include updates on applicable laws and evidence-based best practices. CalMHSA will provide a list of approved Continuing Education training vendors.
What is the timeframe for the development of Peer Support Specialist Certification Program standards?
DHCS released BHIN 21-041 to County Behavioral Health Agencies and associations with these certification standards on July 22, 2021. For more information and updated timelines, please check the
DHCS Peer Support Services website.
Is there a statewide timeframe requirement for a Peer Support Specialist to complete initial certification?
While each approved certification program may include a timeframe requirement, DHCS is not requiring certification programs to have timeframes for the initial certification process for individuals.
What does cultural and structural competence mean (as outlined in the core competencies)?
Cultural competency: A set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals that enables effective interactions in a cross-cultural framework.7
A culturally competent Peer Support Specialist can provide high-quality care to diverse individuals, and tailor this care to meet their social, cultural, and linguistic needs.
Structural competency: The trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance," trauma, psychosis) also represent the implications of attitudes that are influenced by social determinants of health.
Can the 20 hours of continuing education required for biennial renewal include any hours of training done for an area of specialization?
Yes. Area of specialization training hours completed by Medi-Cal certified Peer Support Specialists within the two years prior to a biennial certification can count towards the 20 hours of continuing education required to complete a biennial certification.
Are the hours of training in an area of specialization in addition to the 80 hours of training for initial certification?
Yes. The training for areas of specialization is in addition to the 80 hours of training for initial certification.
Are Peer Support Specialists who work in a specialization, such as a parent, caregiver, and family peers, required to complete the area of specialization training to provide Medi-Cal peer support services?
No. A county opting into developing a program, either through a designated entity or their own approved program, must make training in the areas of specialization available to certified Medi-Cal Peer Support Specialists within the county, but the state does not require that Peer Support Specialists complete this training before being able to provide Medi-Cal reimbursable services to beneficiaries. Receiving Peer Support Specialist Medi-Cal certification, e.g. taking the eighty-hour training, passing the Medi-Cal Peer Support Specialist Certification Exam, and signing the Code of Ethics, are sufficient to be able to be reimbursed for Medi-Cal services in a county that has opted-in to the benefit. A county may elect to require specialized training pertinent to their beneficiary population or workforce requirements, and a Peer Support Specialist who has received the training in the area of specialization would be able to demonstrate competency for positions within that specialization statewide.
What kind of training will be considered for Peers that are applying for certification through the grandparenting process or out-of-state reciprocity process?
All Peer training will be considered, however part of the grandparenting process also requires a Peer must pass a state-approved exam. Exams must be based on the core competencies set forth in W&I
14045.13.
For a Peer Support Specialist seeking certification via the out-of-state reciprocity policy, is there any requirement regarding how recent the employment experience needs to be?No. If the Peer Support Specialist has at least one year of employment and meets all the other requirements and qualifications set forth in
BHIN 21-041, they are eligible for certification.
Will DHCS be establishing requirements for a supervisory training curriculum?
DHCS will not be establishing a supervisory training curriculum, however, the requirements for peer supervisors are outlined in
BHIN 21-041. CalMHSA is developing a supervisory training curriculum that will be available for counties to use to meet this requirement. DHCS encourages counties to support Peers as supervisors of their peer workforce but understands that not all counties may have a viable workforce and resources to do so upon implementation of their Medi-Cal Peer Support Services program.
Where should I send recommendations for topics that should be included in the training?
DHCS has forwarded specific recommendations regarding further development of the certification program curriculum to CalMHSA for their use. We encourage feedback to be provided directly to CalMHSA at
PeerCertification@calmhsa.org. What is the deadline to qualify to be certified as a Medi-Cal Peer Support Specialist through the grandparenting process?
BHIN 23-003 (superseded BHIN 22-066) extended the deadline for individuals to apply for Medi-Cal Peer Support Specialist certification through the grandparenting process. The new deadline is June 30, 2023.
Based on the extension, an individual is eligible for grandparenting if they meet all eligibility criteria8 AND were employed as a Peer on January 1, 20229 AND are employed as a Peer at the time of the submission of their grandparenting application between January 1, 2022 and June 30, 2023. An individual who was employed as a Peer prior to January 1, 2022 but not employed as a Peer on January 1, 2022 would not be eligible for certification through the grandparenting process but can apply for certification through the standard initial certification process.10
Examples of Eligibility:
Example
| Eligible for Grandparenting?
| Reasoning |
Individual started work as a Peer on January 1, 2022 and
applied for grandparenting on December 12, 2022 while
still employed as a Peer.
| Yes*
| Employed as a Peer on January 1, 2022 and submitted application while still employed between January 1, 2022 and June 30, 2023.
|
Individual employed as a Peer from November 1, 2021 - April 1, 2023 and applies for grandparenting on March 1, 2023.
| Yes*
| Employed as a Peer on January 1, 2022 and submitted application while still employed between January 1, 2022 and June 30, 2023.
|
Individual was employed as a Peer from
August 1, 2018 to
November 11, 2021, was re-hired as a Peer on February 20, 2022 and applied for grandparenting on February 22, 2022.
| No
| Individual was not employed as a Peer on January 1, 2022.
|
* Assumes
individual meets all other grandparenting requirements as outlined in BHIN 21-041
Opting-in and Claiming Requirements
Are there separate billing codes to distinguish services provided to beneficiaries from services provided to family members or other collaterals?
There is no distinct procedure code or modifier to distinguish Peer Support Specialist services provided to beneficiaries from services provided to family members or other collaterals. For claims to be adjudicated, Peer Support Services must be claimed in accordance with Short-Doyle/Medi-Cal (SD/MC) claiming procedures outlined within
BHIN 22-026.
How should a DMC, DMC-ODS, or SMHS county claim for standalone Peer Support Services? Do we need to specify the level of care in the claim?
As specified in
BHIN 22-026, for claims to be adjudicated, DMC, DMC-ODS, and/or SMHS counties must submit claims that include the Healthcare Common Procedure Coding System (HCPCS) and modifier combinations. Only DMC-ODS counties must specify the level of care in the claim, even if they choose not to take up the services.
Which procedure code should be utilized for group services?
Per
BHIN 22-026, group services would qualify under “Educational Skill Building Groups" and would thus be claimed under the “Behavioral Health Prevention Education Service" Code (H0025).
What mode and service function codes will the New Peer Support Services (i.e., “Behavioral Health Prevention Education Service" and “Self-Help/Peer Services") fall under on the Mental Health Cost Report?
When reporting units of service and costs for Peer Support Services on the SMHS Cost Report, use Mode 15, Service Function 01.
Where can we find the published rates for the new Peer Support Services for mental health?
In general, county rates are published on the DHCS website, and on the
MEDCCC Library page. For Specialty Mental Health Peer Support Services, the rate is equal to the county's Targeted Case Management rate.
What is the definition of “engagement" as related to Peer Support Services outlined in BHIN 22-026? Does this definition include engagement activities related to supporting a beneficiary accessing services?
As indicated in Supplement 3 to Attachment 3.1-A of the California State Plan and
BHIN 22-026, “engagement" is described as Peer Support Specialist-led activities and coaching to encourage and support beneficiaries to participate in behavioral health treatment. Engagement may include supporting beneficiaries in their transitions between levels of care and supporting beneficiaries in developing their own recovery goals and processes.
For counties opting in to provide Peer Support Services in DMC-ODS, will it be required to provide the benefit in Opioid Treatment Programs (OTPs)?
No, DHCS does not require Peer Support Services to be provided by OTPs.
Are counties required to provide medically necessary Peer Support Services to beneficiaries under 21 in order to meet the counties' obligation under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandate?
Yes. As described in
BHIN 22-026, in accordance with the EPSDT mandate under Section 1905(r) of the Social Security Act, all Counties, irrespective of their choice to opt-in to providing Peer Support Services as a Medi-Cal service, must ensure that all beneficiaries under age 21 receive medically necessary services to correct or ameliorate health conditions that are coverable under Section 1905(a) of the Social Security Act, which includes Peer Support Services. DHCS' implementation of Peer Support Services as a new, distinct DMC, DMC-ODS, and SMHS benefit does not limit or modify the scope of the EPSDT mandate.
How is “collateral services" defined in the context of Peer Support Services?
As described in Supplement 3 to Attachment 3.1-A of the California State Plan and
BHIN 22-026, Peer Support Services can include contact with family members or other collaterals (family members or other people supporting the beneficiary), if the purpose of the collateral's participation is to focus on the treatment needs of the beneficiary by supporting the achievement of the beneficiary's goals. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service.
In BHIN 22-026, DHCS references Peer Support Specialists as "supporting beneficiaries in their transitions between levels of care". Would this function performed by Peer Support Specialists qualify as Care Coordination in DMC-ODS or Targeted Case Management (TCM) in SMHS?
No. Peer Support Specialists providing Peer Support Services to support beneficiaries in their transitions between levels of care is separate from Care Coordination and/or TCM and should be claimed as Peer Support Services as described in
BHIN 22-026.
Can Peer Support Services be delivered and claimed as a standalone service or provided in conjunction with other SMHS, DMC, or DMC-ODS services, including inpatient and residential services?
Peer Support Services can be delivered and claimed as a standalone service – a beneficiary may receive Peer Support Services even if they are not currently engaged in other outpatient services. A beneficiary may also receive Peer Support Services provided in conjunction with other SMHS, DMC, or DMC-ODS services, including, for example, Narcotic Treatment Program services – in these cases, Peer Support Services should be claimed in addition to these services. For inpatient and residential levels of care, peer support services may be claimed in addition to, or concurrently with, residential or inpatient services that are claimed at per diem rates, as described in
BHIN 22-026. However, ETS is still working on the Short Doyle system change to allow Peer Support Services to be claimed on the same day as inpatient or residential services. (DHCS will notify counties when the change goes into effect in the Short Doyle system).
Does DHCS require completed background checks for Certified Peer Support Specialists providing Peer Support Services?
DHCS does not require criminal background checks for Peer Support Specialists because they do not have a Fee-for-Service (FFS) Pathway in DHCS' provider enrollment system. Contractors may institute background check requirements for Peer Support Specialists. Peer Support Specialists shall be subject to requirements regarding suspended and ineligible providers pursuant to W&I Code sections
14043.6 and
14123
and applicable requirements in the Mental Health Plan (MHP) contract.
Can Peer Support Services be offered across all DMC-ODS ASAM levels of care?
Yes, Medi-Cal Peer Support Services may be delivered and claimed as a standalone service, or a service delivered as part of a level of care under a covered DMC-ODS service.
BHIN 22-026 states that “Peer Support Services are based on an approved plan of care." Will the problem list required under BHIN 22-019 meet this requirement?
The plan of care for Peer Support Services must align with the requirements in CMS State Medicaid Directors letter #07-011 and must be contained within a progress note as outlined in BHIN 22-019 and BHIN 22-026.
Will DHCS require CalMHSA to offer additional areas of specialization in addition to the required specializations specified under BHIN 21-041?
Areas of specialization approved by DHCS may be added in the future via forthcoming guidance.
Can a Peer Support Specialist complete more than one specialization?
Yes, Peer Support Specialists may complete training for multiple specializations.
Can an individual who was formerly incarcerated complete the forensic (justice involved) specialization?
Yes, formerly incarcerated individuals may complete the forensic (justice involved) specialization.
How many peers can a Peer Support Specialist Supervisor supervise?
DHCS has not set standardized staffing ratios for Peer Support Specialist Supervisors and Peer Support Specialists.
If a county wants to opt-in to the Peer Support Services benefit, do they have to opt-in for Peer Support Services both in Drug Medi-Cal and Specialty Mental Health Services delivery systems?
No, a county can opt-in to one or both delivery systems. For example, a county can begin implementing services in the Mental Health delivery system, and then opt-in later to provide the benefit in the Substance Use Disorder delivery system.
If a Peer Support Specialist relapses in their recovery, do they have to wait 90 days before providing Peer services?
There is no state requirement, in statute, regulation, waiver, or Interagency Agreement, that individuals working as Peer Support Specialists cannot provide services for 90 days after a relapse.
Does an individual need to wait 90 days after finishing treatment services to become a Peer Support Specialist?
There is no state requirement, in statute, regulation, waiver, or Interagency Agreement, that individuals working as a Peer Support Specialist must wait any length of time prior to providing Peer Support Specialist services.
Will the hourly wage for Peer Support Specialists increase?
DHCS is not authorized under law to set a pay scale for Peer Support Specialists. Counties are responsible for setting rates of pay for county-employed Peer Support Specialists. Some Medi-Cal Peer Support Specialists may be employed by independent organizations or facilities that may or may not be comparable to county pay scales. The rates of pay may vary across different counties and other organizations that employ Peer Support Specialists.
How will DHCS review Peer certification programs to identify problematic issues and ensure compliance?
Counties that opt-in to developing a Medi-Cal Peer Support Specialist Certification Program, whether on their own or through a designated entity, are required to develop corrective action, complaints, and appeals processes. Programs will be required to report annually to DHCS and will be subject to a county's Medi-Cal triennial reviews.
With the addition of Peer Support Services as a new/standalone service type, are providers who historically billed under “other qualified providers" prior to the addition of Peer Support Specialist type able to continue billing under the historic service codes available to be delivered by a variety of staff categories?
DHCS is not removing any existing billing codes, services, or provider types in the SMHS, DMC, or DMC-ODS programs, including the “Other Qualified Provider" type. Peer Support Specialists providing and claiming Peer Support Services as specified in
BHIN 22-026 must comply with all Medi-Cal certification requirements as outlined in
BHIN 21-041 and meet all other applicable California State requirements.
Will California Health and Human Services (CalHHS) Children and Youth Behavioral Health Initiative and/or Family First Prevention Services Act (FFPSA) Aftercare providers need to obtain the Peer Support Specialist Certification?
If the CalHHS Children and Youth BH Initiative and/or FFPSA Aftercare programs are located within counties that have opted-in to provide Peer Support Services and the programs' providers deliver Peer Support Services as described in
BHIN 22-026, then the programs' providers must comply with all Peer Support Specialist provider requirements, including obtaining a Peer Support Specialist certification. Other services provided and billed under other Medi-Cal codes or funding sources are not impacted. 