BILL NUMBER: SB 614 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JULY 6, 2015
AMENDED IN SENATE APRIL 6, 2015
INTRODUCED BY Senator Leno
( Coauthor: Senator Anderson
)
FEBRUARY 27, 2015
An act to add Article 1.4 (commencing with Section 14045.10) to
Chapter 7 of Part 3 of Division 9 of, the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 614, as amended, Leno. Medi-Cal: mental health services:
peer peer, parent, and family support
specialist certification.
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 for 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, by July 1, 2016, 2017,
a statewide peer peer, parent,
and family support specialist certification program, as a part of the
state's comprehensive mental health and substance use disorder
delivery system and the Medi-Cal program. The bill would
include 3 4 certification categories:
adult peer support specialists, transition-age youth peer
support specialists, family peer support specialists, and
parent peer support specialists. The certification program's
components would include, among others, defining responsibilities and
practice guidelines, determining curriculum and core competencies,
specifying training and continuing education requirements, and
establishing a code of ethics and certification revocation processes.
The bill would require an applicant for the certification as a
peer, parent, and family support specialist to meet specified
requirem ents, including successful completion of the
curriculum and training requirements.
This bill would require the department to collaborate with OSHPD
and interested stakeholders in developing the certification program,
and to obtain technical assistance pursuant to a specified joint
state-county decisionmaking process. The bill would authorize the
department to use funding provided through the MHSA and designated
funds administered by OSHPD, to develop and administer the
program. program, and would authorize the use of these
MHSA funds to serve as the state's share of funding to develop and
administer the program for the purpose of claiming federal financial
participation under the Medicaid Program.
This bill would require the department to amend the Medicaid state
plan to include a certified peer peer,
parent, and family support specialist as a provider type for
purposes of the Medi-Cal program, but would implement this provision
only if and to the extent that federal financial participation is
available and the department obtains all necessary federal approvals.
The bill would authorize the department to enter into exclusive or
nonexclusive contracts on a bid or nonbid basis, as specified, on a
statewide or more limited geographic basis. This bill also would
authorize the department to implement, interpret, or make specific
its provisions by various informational documents until regulations
are adopted.
This bill would declare that it clarifies terms and procedures
under the Mental Health Services Act.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Article 1.4 (commencing with Section 14045.10) is added
to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 1.4. Peer Peer, Parent,
and Family Support Specialist Certification Program
14045.10. This article shall be known, and may be cited, as the
Peer Peer, Parent, and Family Support
Specialist Certification Program Act of 2015.
14045.11. The Legislature finds and declares all of the
following:
(a) With the enactment of the Mental Health Services Act in 2004,
support to include peer providers identified as consumers, parents,
and family members for the provision of services has been on the
rise.
(b) There are over 6,000 peer support specialists
providers in California who provide
individualized support, coaching, facilitation, and education to
clients with mental health care needs, needs
and substance use disorder, in a variety of settings, yet no
statewide scope of practice, standardized curriculum, training
standards, supervision standards, or certification protocol is
available.
(c) The United States Department of Veterans Affairs and over 30
states utilize standardized curricula and certification protocols for
peer provider support services.
(d) The federal Centers for Medicare and Medicaid Services (CMS)
recognizes peer support services as an evidence-based mental
health model of care and notes it is an important
component in a state's delivery of effective mental health and
substance use disorder treatment. The CMS encourages states to
offer peer support services as a component of a comprehensive mental
health and substance use disorder delivery system and
federal financial participation is available for this purpose.
(e) A substantial number of research studies demonstrate that peer
providers supports improve client
functioning, increase client satisfaction, reduce family burden,
alleviate depression and other symptoms, reduce hospitalizations and
hospital days, increase client activation, and enhance client
self-advocacy.
(f) Certification at the state level can incentivize the public
mental health system and the Medi-Cal program,
program, including the Drug Medi-Cal program, to increase
the number, diversity, and availability of peer providers and
peer-driven services.
14045.12. It is the intent of the Legislature that the
peer peer, parent, and family support specialist
certification program, established under this article, achieve all
of the following:
(a) Establish the ongoing provision of peer support services for
beneficiaries with experiencing mental
health care needs needs, substance use
disorder needs, or both by certified peer support
specialists, including adults 18 years of age or older.
specialists.
(b) Provide support, coaching, facilitation, and education to
beneficiaries with mental health needs, substance use disorder needs,
or both, and to families or significant support persons.
(b)
(c) Provide increased family support, building on the
strengths of families and helping them achieve desired outcomes.
(c)
(d) Provide a part of a wraparound continuum of
services, in conjunction with other community mental health
services. services and other substance use disorder
services.
(d)
(e) Collaborate with others providing care or support
to the beneficiary or family.
(e)
(f) Assist parents, when applicable, in developing
coping mechanisms and problem-solving skills.
(f)
(g) Provide an individualized focus on the beneficiary,
the family, or both, as needed.
(h) Encourage employment under the peer, parent, and family
support specialist certification program to reflect the culture,
ethnicity, sexual orientation, gender identity, mental health service
experiences, and substance use disorder experiences of the people
whom they serve.
(g)
(i) Promote socialization, recovery, self-sufficiency,
self-advocacy, development of natural supports, and maintenance of
skills learned in other support services.
14045.13. For purposes of this article, the following definitions
shall apply:
(a) "Adult peer support specialist" means a person who is 18 years
of age or older and who has self-identified as having lived
experience of recovery from mental illness, substance use disorder,
or both, and the skills learned in formal trainings to deliver peer
support services in a behavioral setting to promote mind-body
recovery and resiliency for adults.
(b) "Certification" means, as it pertains to the peer, parent, and
family support specialist certification program, all federal and
state requirements have been satisfied, federal financial
participation under Title XIX of the federal Social Security Act (42
U.S.C. Sec. 1396 et seq.) is available, and all necessary federal
approvals have been obtained.
(c) "Certified" means all federal and state requirements have been
satisfied by an individual who is seeking designation under this
article, including completion of curriculum and training
requirements, testing, and agreement to uphold and abide by the code
of ethics.
(d) "Certification examination" means the competency testing
requirements, as approved by the department, an individual is
required to successfully complete as a condition of becoming
certified under this article. Each training program approved by the
department may develop a unique competency examination for each
category of peer, parent, and family support specialist listed in
subdivision (b) of Section 14045.14. Each certification examination
shall include core curriculum elements.
(e) "Code of ethics" means professional standards by which each
certified peer, parent, and family support specialist listed in
subdivision (b) of Section 14045.14 is required to agree to uphold
and abide by. These professional standards shall include principles,
expected behavior and conduct of the certificate holder in an
agreed-upon statement that is required to be provided to the
applicant and acknowledged by signing with his or her personal
signature prior to being granted certification under this article.
(f) "Core competencies" are the foundational and essential
competencies required by each category of peer, parent, and family
support specialists listed in subdivision (b) of Section 14045.14 who
provide peer support services.
(g) "Cultural competence" means a set of congruent behaviors,
attitudes, and policies that come together in a system or agency that
enables that system or agency to work effectively in cross-cultural
situations. A culturally competent system of care acknowledges and
incorporates, at all levels, the importance of language and culture,
intersecting identities, assessment of cross-cultural relations,
knowledge and acceptance of dynamics of cultural differences,
expansion of cultural knowledge, and adaptation of services to meet
culturally unique needs to provide services in a culturally competent
manner.
(h) "Family peer support specialist" means a person with lived
experience as a self-identified family member of an individual
experiencing mental illness, substance use disorder, or both, and the
skills learned in formal trainings to assist and empower families of
individuals experiencing mental illness, substance use disorder, or
both. For the purposes of this subdivision, "family member" includes
a sibling or kinship caregiver, and their partners.
(i) "Parent" means a person who is parenting or has parented a
child or individual experiencing mental illness, substance use
disorder, or both, and who can articulate his or her understanding of
his or her experience with another parent or caregiver. This person
may be a birth parent, adoptive parent, or family member standing in
for an absent parent.
(j) "Parent peer support specialist" means a parent with formal
training to assist and empower families parenting a child or
individual experiencing mental illness, substance use disorder, or
both.
(k) "Peer support specialist services" means 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. Peer support specialist services shall
include, but are not limited to, support, coaching, facilitation, and
education to Medi-Cal beneficiaries that is individualized to the
beneficiary and is conducted by a certified adult peer support
specialist, a certified transition-age youth peer support specialist,
a certified family peer support specialist, or a certified parent
peer support specialist.
(l) "Recovery" means a process of change through which an
individual improves his or her health and wellness, lives a
self-directed life, and strives to reach his or her full potential.
This process of change recognizes cultural diversity and inclusion,
and honors the different routes to resilience and recovery based on
the individual and his or her cultural community.
14045.13. 14045.14. No later than
July 1, 2016, 2017, the
department department, as the sole state Medicaid
agency, shall establish a certified peer
peer, parent, and family support specialist certification
program that, at a minimum, shall do all of the following:
(a) Establish a certifying body body,
either within the department, through contract, or through an
interagency agreement, to provide for the certification of
peer peer, parent, and family support
specialists. specialists as described in this
article.
(b) Provide for a statewide certification for each of the
following categories of peer support specialist providers,
specialists, as contained in federal guidance
issued by the Centers for Medicare and Medicaid Services, State
Medical Medicaid Director Letter (SMDL)
#07-011:
(1) Adult peer support specialists, 18 years of age or
older. specialists, who may serve individuals across
the lifespan.
(2) Transition-age youth peer support specialists.
(2)
(3) Family peer support specialists.
(3)
(4) Parent peer support specialists.
(c) Define the range of responsibilities and practice guidelines
for the categories of peer support specialists.
specialists listed in subdivision (b).
(d) Determine curriculum and core competencies, including
curriculum that may be offered in areas of specialization, such
as older adults, veterans, family support, and
forensics. forensics, whole health, juvenile justice,
youth in foster care, sexual orientation, gender identity, and any
other areas of specialization identified by the department.
Specialized curriculum shall be determined for each of the categories
of peer, parent, and family support specialists listed in
subdivision (b). Core competencies-based curriculum shall include, at
a minimum, 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,
including defined practices.
(5) Cultural competence training.
(6) Trauma-informed care.
(7) Group facilitation skills.
(8) Self-awareness and self-care.
(9) Cooccurring disorders of mental health and substance use.
(10) Conflict resolution.
(11) Professional boundaries and ethics.
(12) Safety and crisis planning.
(13) Navigation of, and referral to, other services.
(14) Documentation skills and standards.
(15) Study and test-taking skills.
(e) Specify training requirements, including
core-competencies-based training and specialized training necessary
to become certified under this article, allowing for multiple
qualified training entities, and requiring training to
include individuals with practical experience as consumers of peer
support services, or their family members. include
people with lived experience as consumers and family members.
(f) Specify required continuing education requirements for
certification.
(g) Determine clinical supervision requirements for personnel
certified under this section. article, that
shall require, at a minimum, personnel certified pursuant to this
article to work under the direction of a mental health rehabilitation
specialist or substance use disorder professional.
(h) Establish a code of ethics and processes for
revocation of certification. ethics.
(i) Determine the process for certification renewal.
(j) Determine a process for revocation of certification.
(j)
(k) Determine a process for allowing existing personnel
employed in the peer support field to obtain certification under
this article, at their option.
14045.15. In order to be certified as an adult peer support
specialist, an individual shall, at a minimum, satisfy all of the
following requirements:
(a) Be at least 18 years of age.
(b) Have or have had a primary diagnosis of mental illness,
substance use disorder, or both, which is self-disclosed.
(c) Have received or is receiving mental health services,
substance use disorder services, or both.
(d) Be willing to share his or her experience of recovery.
(e) Demonstrate leadership and advocacy skills.
(f) Have a strong dedication to recovery.
(g) Agree to uphold and abide by a code of ethics. A copy of the
code of ethics shall be signed by the applicant.
(h) Successful completion of the curriculum and training
requirements for an adult peer support specialist.
(i) Pass a certification examination approved by the department
for an adult peer support specialist.
(j) Successful completion of any required continuing education,
training, and recertification requirements.
14045.16. In order to be certified as a transition-age youth peer
support specialist, an individual shall, at a minimum, satisfy all
of the following requirements:
(a) Be at least 18 years of age.
(b) Have or have had a primary diagnosis of mental illness,
substance use disorder, or both, which is self-disclosed.
(c) Have received or is receiving mental health services,
substance use disorder addiction services, or both.
(d) Be willing to share his or her experience of recovery.
(e) Demonstrate leadership and advocacy skills.
(f) Have a strong dedication to recovery.
(g) Agree to uphold and abide by a code of ethics. A copy of the
code of ethics shall be signed by the applicant.
(h) Successful completion of the curriculum and training
requirements for a transition-age youth peer support specialist.
(i) Pass a certification examination approved by the department
for a transition-age youth peer support specialist.
(j) Successful completion of any required continuing education,
training, and recertification requirements.
14045.17. In order to be certified as a family peer support
specialist, an individual shall, at a minimum, satisfy all of the
following requirements:
(a) Be at least 18 years of age.
(b) Be self-identified as a family member of an individual
experiencing mental illness, substance use disorder, or both.
(c) Be willing to share his or her experience.
(d) Demonstrate leadership and advocacy skills.
(e) Have a strong dedication to recovery.
(f) Agree to uphold and abide by a code of ethics. A copy of the
code of ethics shall be signed by the applicant.
(g) Successful completion of the curriculum and training
requirements for a family peer support specialist.
(h) Pass a certification examination approved by the department
for a family peer support specialist.
(i) Successful completion of any required continuing education,
training, and recertification requirements.
14045.18. In order to be certified as a parent peer support
specialist, an individual shall, at a minimum, satisfy all of the
following requirements:
(a) Be at least 18 years of age.
(b) Be self-identified as a parent, as defined in Section
14045.13.
(c) Be willing to share his or her experience.
(d) Demonstrate leadership and advocacy skills.
(e) Have a strong dedication to recovery.
(f) Agree to uphold and abide by a code of ethics. A copy of the
code of ethics shall be signed by the applicant.
(g) Successful completion of the curriculum and training
requirements for a parent peer support specialist.
(h) Pass a certification examination approved by the department
for a parent peer support specialist.
(i) Successful completion of any required continuing education,
training, and recertification requirements.
14045.19. This article shall not be construed to imply that an
individual who is certified pursuant to this article is qualified to,
or authorize that individual to, diagnose an illness, prescribe
medication, or provide clinical services.
14045.14. 14045.20. The department
shall closely collaborate with the Office of Statewide Health
Planning and Development (OSHPD) and its associated workforce
collaborative, and regularly consult with interested stakeholders,
including peer support and family organizations, mental health
and substance use disorder services providers and
organizations, the County Behavioral Health Directors Association of
California, health plans participating in the Medi-Cal managed care
program, the California Mental Health Planning Council, and other
interested parties, as deemed appropriate by the department,
parties in developing, implementing, and
administering the peer peer, parent,
and family support specialist certification program.
program established pursuant to this article. This
consultation shall initially include, at a minimum, bi
monthly stakeholder meetings, which may also include
technical workgroup meetings. The department may seek private funds
from a nonprofit organization or foundation for this purpose.
14045.15. 14045.21. The department
may contract to obtain technical assistance for the development of
the peer peer, parent, and family
support specialist certification program, as provided in Section
4061.
14045.16. 14045.22. (a) The
department shall amend its Medicaid state plan to do both of the
following:
(1) Include a peer each category of peer,
parent, and family support specialist
specialists listed in subdivision (b) of Section 14045.14
certified pursuant to this article as a provider type for purposes of
this chapter.
(2) Include peer support specialist services as a distinct service
type for purposes of this chapter. chapter,
which may be provided to eligible Medi-Cal beneficiaries who are
enrolled in either a Medi-Cal managed mental health care plan or a
Medi-Cal managed care health plan.
(b) The department may seek any federal waivers or other state
plan amendments as necessary to implement the certification program
provided for under this article.
(c) This article shall be implemented only if and to the extent
that federal financial participation under Title XIX of the federal
Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and
all necessary federal approvals have been obtained.
14045.17. 14045.23. It is not the
intent of the Legislature in enacting this article to modify the
Medicaid state plan in any manner that would otherwise change or
nullify the requirements, billing, or reimbursement of the "other
qualified provider" provider type, as currently authorized by the
Medicaid state plan.
14045.18. 14045.24. The department
may utilize Mental Health Services Act funds, as authorized in
subdivision (d) of Section 5892, and any designated Workforce
Education and Training Program resources, including funding, as
administered by OSHPD pursuant to Section 5820, to develop and
administer the peer peer, parent, and
family support specialist certification program. These Mental
Health Service Act funds may serve as the state's share of funding to
develop and administer the peer, parent, and family support
specialist certification program and shall be available for purposes
of claiming federal financial participation under Title XIX of the
federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) once all
necessary federal approvals have been obtained.
14045.19. 14045.25. For the
purposes of implementing this article, the department may enter into
exclusive or nonexclusive contracts on a bid or negotiated basis,
including contracts for the purpose of obtaining subject matter
expertise or other technical assistance. Contracts may be statewide
or on a more limited geographic basis.
14045.20. 14045.26. Notwithstanding
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code, the department may implement,
interpret, or make specific this article by means of plan letters,
plan or provider bulletins, or similar instructions, without taking
regulatory action, until the time regulations are adopted. The
department shall adopt regulations by July 1, 2018,
2019, in accordance with the requirements of
Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3
of Title 2 of the Government Code. Notwithstanding Section 10231.5 of
the Government Code, beginning six months after the effective date
of this article, the department shall provide semiannual status
reports to the Legislature, in compliance with Section 9795 of the
Government Code, until regulations have been adopted.
SEC. 2. The Legislature finds and declares that this act clarifies
procedures and terms of the Mental Health Services Act within the
meaning of Section 18 of the Mental Health Services Act.