Amended in Assembly July 16, 2015

Amended in Assembly July 6, 2015

Amended in Senate April 6, 2015

Senate Bill No. 614

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, parent, begin insert transition-age, end insert 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, 2017, a statewide peer, parent, begin insert transition-age, end insert 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 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, begin insert transition-age, end insert and family support specialist to meet specified requirements, 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, 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, parent, begin insert transition-age, end insert 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, Parent, begin insert Transition-Age, end insert and Family Support
Specialist Certification Program

 

14045.10.  

This article shall be known, and may be cited, as
the Peer, Parent, begin insert Transition-Age, end insert 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 providers in California who
provide individualized support, coaching, facilitation, and
education to clients with mental health care 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 support services.

(d) The federal Centers for Medicare and Medicaid Services
(CMS) recognizes peer support services as an evidence-based
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 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, 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, parent,
begin insert transition-age, end insert 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 experiencing mental health care needs, substance use
disorder needs, or both by certified peer support 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.

(c) Provide increased family support, building on the strengths
of families and helping them achieve desired outcomes.

(d) Provide a part of a wraparound continuum of services, in
conjunction with other community mental health services and other
substance use disorder services.

(e) Collaborate with others providing care or support to the
beneficiary or family.

(f) Assist parents, when applicable, in developing coping
mechanisms and problem-solving skills.

(g) Provide an individualized focus on the beneficiary, the
family, or both, as needed.

(h) Encourage employment under the peer, parent,
begin insert transition-age, end insert 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.

(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,
begin insert transition-age, end insert 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, begin insert transition-age, end insert 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 begin insert the end insert professional standards begin delete by which end delete
each certified peer, parent, begin insert transition-age, end insert 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,
begin insert transition-age, end insert 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.

begin insert

(m) “Transition-age youth 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 transition-age
youth, including adolescents and young adults.

end insert

14045.14.  

No later than July 1, 2017, the department, as the
sole state Medicaid agency, shall establish a peer, parent,
begin insert transition-age, end insert and family support specialist certification program
that, at a minimum, shall do all of the following:

(a) Establish a certifying body, either within the department,
through contract, or through an interagency agreement, to provide
for the certification of peer, parent, begin insert transition-age, end insert and family
support specialists as described in this article.

(b) Provide for a statewide certification for each of the following
categories of peer support specialists, as contained in federal
guidance issued by the Centers for Medicare and Medicaid
Services, State Medicaid Director Letter (SMDL) #07-011:

(1) Adult peer support specialists, who may serve individuals
across the lifespan.

(2) Transition-age youth peer support specialists.

(3) Family peer support specialists.

(4) Parent peer support specialists.

(c) Define the range of responsibilities and practice guidelines
for the categories of peer support 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, 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, begin insert transition-age, end insert 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, begin insert and
addiction recovery principles, end insert 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
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 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.

(i) Determine the process for certification renewal.

(j) Determine a process for revocation of certification.

(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.

14045.20.  

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 in developing,
implementing, and administering the peer, parent, begin insert transition-age, end insert
and family support specialist certification program established
pursuant to this article. This consultation shall initially include, at
a minimum, bimonthly stakeholder meetings, which may also
include technical workgroup meetings. The department may seek
private funds from a nonprofit organization or foundation for this
purpose.

14045.21.  

The department may contract to obtain technical
assistance for the development of the peer, parent, begin insert transition-age, end insert
and family support specialist certification program, as provided
in Section 4061.

14045.22.  

(a) The department shall amend its Medicaid state
plan to do both of the following:

(1) Include each category of peer, parent, begin insert transition-age, end insert and
family support begin delete specialists end delete begin insert specialist end insert 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, 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.

begin insert

begin insert 14045.23. end insert   

To facilitate early intervention for mental health
services, community health workers may partner with peer, parent,
transition-age, and family support specialists for engagement,
outreach, and education.

end insert

begin delete 14045.23. end delete
begin insert 14045.24. end insert   

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.

begin delete 14045.24. end delete
begin insert 14045.25. end insert   

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, parent,
begin insert transition-age, end insert 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,
begin insert transition-age, end insert 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.

begin delete 14045.25. end delete
begin insert 14045.26. end insert   

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.

begin delete 14045.26. end delete
begin insert 14045.27. end insert   

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, 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.