BILL NUMBER: SB 614 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY AUGUST 31, 2015
AMENDED IN ASSEMBLY JULY 16, 2015
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,
parent, transition-age, 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,
transition-age, 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, transition-age, 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 authorize the department to establish a
certification fee schedule and require remittance of fees as
contained in the schedule, for the purpose of supporting the
department's activities associated with the ongoing state
administration of the peer, parent, transition-age, and family
support specialist certification program. The bill would require the
department to utilize the other funding resources made available
under the bill before determining the need for the certification fee
schedule and requiring the remittance of fees. The bill would declare
legislative intent that the certification fees be reasonable and
reflect the expenditures directly applicable to the ongoing state
administration of the program.
This bill would require the department to amend the Medicaid state
plan to include a certified peer, parent, transition-age, 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, Transition-Age, and Family Support
Specialist Certification Program
14045.10. This article shall be known, and may be cited, as the
Peer, Parent, Transition-Age, 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, transition-age, 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, transition-age,
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,
transition-age, 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, transition-age, 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 the professional standards each
certified peer, parent, transition-age, 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,
transition-age, 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.
(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.
14045.14. No later than July 1, 2017, the department, as the sole
state Medicaid agency, shall establish a peer, parent,
transition-age, 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, transition-age, 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). (b), by utilizing best practice
materials published by the federal Substance Abuse and Mental Health
Services Administration, the federal Department of Veterans Affairs,
and related notable experts in the field as a basis for development.
(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, transition-age, 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, 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) 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
specialist, as defined in Section 782.35 of Title 9 of
the California Code of Re gulations, or substance
use disorder professional. A licensed mental health
professional, as defined in Section 782.26 of Title 9 of the
California Code of Regulations, may also provide supervision.
(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, transition-age, 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, transition-age,
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, transition-age, and
family support specialist 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 Medi-Cal reimbursement
for peer support services 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.
14045.23. 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.
14045.24. 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.
14045.25. 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, transition-age, and
family support specialist certification program. These
Further, these Mental Health Service Act funds
may then serve as the state's share of funding to develop
and administer the peer, parent, transition-age, 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.
14045.251. The department may establish a certification fee
schedule and may require remittance as contained in the certification
fee schedule for the purpose of supporting the department's
activities associated with the ongoing state administration of the
peer, parent, transition-age, and family support specialist
certification program. The department shall utilize all funding
resources as made available in Section 14045.25 first, prior to
determining the need for the certification fee schedule and requiring
the remittance of fees. It is the intent of the Legislature that any
certification fees charged by the department be reasonable and
reflect the expenditures directly applicable to the ongoing state
administration of the peer, parent, transition-age and family support
specialist certification program.
14045.26. 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.
14045.27. 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.