BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 614
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|AUTHOR: |Leno |
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|VERSION: |April 6, 2015 |
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|HEARING DATE: |April 15, 2015 | | |
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|CONSULTANT: |Reyes Diaz |
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SUBJECT : Medi-Cal: mental health services: peer and family
support specialist certification
SUMMARY : Requires the Department of Health Care Services (DHCS) to
establish a program for certifying peer and family support
specialists and to collaborate with interested stakeholders, as
specified; allows DHCS to seek any federal waivers or state plan
amendments to implement the certification program; and allows
DHCS to implement, interpret, and make specific the
certification program through available means, as specified,
until regulations are adopted by July 1, 2018.
Existing law:
1.Establishes the Medi-Cal program, administered by DHCS, under
which qualified low-income individuals receive health care
services.
2.Grants DHCS the sole authority in state government to
determine the qualifications, including the appropriate
skills, education, training, and experience of personnel
working within substance use disorder (SUD) recovery and
treatment programs licensed and/or certified by DHCS.
3.Authorizes DHCS to require an individual providing counseling
services in SUD programs licensed and/or certified by DHCS to
be registered with or certified by a certifying organization
(CO) approved by DHCS to register and certify counselors.
4.Grants DHCS the authority to conduct periodic reviews of COs
to determine compliance with all applicable laws and
regulations and to take actions for non-compliance, including
revocation of DHCS's approval.
SB 614 (Leno) Page 2 of ?
5.Requires, through regulations, the certification of SUD
counselors to be based on specific counseling competencies,
training, and education, including understanding addiction,
knowledge of treatment methods, and professional readiness.
This bill:
1.Requires DHCS, no later than July 1, 2016, to establish a
certified peer and family support specialist (PFSS) program
that, at a minimum:
a. Establishes a certifying body to certify a
PFSS;
b. Provides for statewide certification of the
following PFSS categories: adult peer support
specialists who are 18 years of age or older, family
peer support specialists, and parent peer support
specialists;
c. Defines the range of responsibilities and
practice guidelines for PFSS;
d. Determines curriculum and core competencies,
including areas of specialization, such as veterans,
family support, and forensics;
e. Specifies training requirements, allowing for
multiple training entities and requiring training to
include individuals with practical experience as
consumers of peer support services or their family
members;
f. Specifies required continuing education
requirements for certification;
g. Determines clinical supervision requirements
for a certified PFSS;
h. Establishes a code of ethics and processes for
revocation of certification;
i. Determines a process for certification
renewal; and,
j. Determines a process for allowing existing
PFSS to obtain certification at their option.
2.Requires DHCS to collaborate closely 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 providers and organizations, the
County Behavioral Health Directors Association of California,
health plans participating in the Medi-Cal managed care
SB 614 (Leno) Page 3 of ?
program, the California Mental Health Planning Council, and
others as deemed appropriate by DHCS, in developing,
implementing, and administering the PFSS certification
program.
3.Requires DHCS to amend its Medicaid state plan to include a
certified PFSS as a provider type and include PFSS services as
a distinct service type. Allows DHCS to seek any federal
waiver or other state plan amendments to implement the PFSS
certification program.
4.Allows DHCS to use Mental Health Services Act and OSHPD
Workforce Education and Training Program resources and funding
to develop and administer the certification program.
5.Authorizes DHCS to contract to obtain technical assistance for
development of the PFSS certification program for the purposes
of meeting the mission and goals of DHCS's mental health and
SUD services system.
6.Allows DHCS to enter into exclusive or non-exclusive contracts
on a bid or negotiated basis, including contracts to obtain
subject matter expertise or other technical assistance. Allows
contracts to be statewide or on a more limited geographic
basis.
7.Requires DHCS, by July 1, 2018, to adopt regulations for the
PFSS certification program; allows DHCS to implement,
interpret, or make specific the requirements of the PFSS
certification program through plan letters, plan or provider
bulletins, or similar instructions until the time regulations
are adopted.
8.Requires the PFSS certification program to be implemented only
to the extent that federal financial participation (FFP) is
available and all necessary federal approvals have been
obtained.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, SB 614-the Peer
and Family Support Specialist Certification Act of
2015-provides California the opportunity to receive new
SB 614 (Leno) Page 4 of ?
federal Medicaid funds, expand our behavioral health
workforce, and include evidence-based PFSS services into our
comprehensive health and behavioral health care system. A PFSS
is a person who uses lived experience from mental illness plus
skills learned in formal trainings, coupled with a
certification process, to provide guidance in a behavioral
health care setting to promote mind-body recovery and
resiliency. Quantitative, independently assessed research
findings support the efficacy of a PFSS. Peer support
services help people navigate systems of care, remove barriers
to recovery, stay engaged in the recovery process, and live
full lives.
More than 30 states have implemented a certification process
under their Medicaid programs. California would benefit from
enactment, for we presently have no standard definition of
training or certification process and could be obtaining a 50
percent federal match for services, which are currently
supported by local funds. DHCS has included the PFSS as a
workforce expansion strategy in the recent 1115 Waiver Renewal
"Medi-Cal 2020", which it submitted to the Centers for
Medicare and Medicaid Services (CMS) on March 27, 2015. SB
614 can be the vehicle for this specific purpose.
2.PFSS. According to DHCS, a substantial number of studies
demonstrate that the PFSS improves patient functioning,
increases patient satisfaction, reduces family burden,
alleviates depression and other symptoms, reduces
hospitalizations and hospital days, increases patient
activation, and enhances patient self-advocacy. PFSS are used
in at least 36 states and throughout the Veterans Health
Administration. PFSS participating in SUD treatment activities
are currently a recognized Medicaid service provider in
California for SUD services; however, these providers are
often limited in the services they are able to provide in
traditional health care settings. DHCS states that expanded
use of PFSS in mental health and SUD as part of a care team
can improve care coordination between behavioral health and
physical health care needs of patients. DHCS included PFSS as
a component to the recent 1115 Waiver Renewal.
3.Certification of PFSS. CMS released guidance for establishing a
PFSS certification program to enable FFP in an effort to more
fully incorporate and expand the use of peers. CMS requires peer
support providers to complete training and certification as
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defined by each state. Substantive work has been conducted in
California by the Working Well Together Statewide Technical
Assistance Center, a collaborative of peer and client-oriented
organizations, which culminated in a final report of
recommendations to proceed with peer certification. This effort
identified key issues for laying the foundation of certification,
including training recommendations and core components for a
statewide certification program; establishing a standard of
practice and core competencies; defining the level of care and
services; integrating services across physical health, mental
health, and SUD services; and allowing for portability from one
county to another.
4.DHCS's current certification duties. The Department of Alcohol
and Drug Programs (ADP) was established to develop and
implement a statewide plan to alleviate problems related to
inappropriate alcohol and drug use and abuse. Following a
25-year effort, ADP adopted counselor certification
regulations in April 2005. ADP's programs and duties were
transferred to DHCS on July 1, 2013, pursuant to AB 75
(Committee on Budget), Chapter 22, Statutes of 2013. Current
counselor certification regulations apply to all individuals
providing counseling services in an SUD program licensed or
certified by DHCS.
Prior to the enactment of AB 2374 (Mansoor), Chapter 815,
Statutes of 2014, DHCS only had the authority to ensure that
COs maintained a business office in California and remained
accredited with the National Commission for Certifying
Agencies (NCCA). Once approved, DHCS had no authority to
monitor, suspend, or revoke approval of a CO unless they lost
their NCCA accreditation. Ten COs were originally approved in
regulations to register and certify individuals providing SUD
counseling in programs licensed and/or certified by DHCS. DHCS
currently recognizes four approved counselor COs. The other
six COs lost their accreditation with the NCCA, thereby losing
approval from DHCS. The four COs have approximately 28,000 SUD
counselors, of which roughly half are certified and half are
registered while working towards certification. AB 2374
established new requirements for DHCS's oversight of COs. This
new oversight authority includes periodic reviews of the COs
and administrative tasks related to periodic reviews to
monitor the approved COs' adherence to state requirements.
SB 614 (Leno) Page 6 of ?
5.Prior legislation. AB 2374 (Mansoor), Chapter 815, Statutes of
2014, requires DHCS to, among other things, conduct periodic
reviews of COs and require COs to contact other COs before
registering or certifying a person as an SUD counselor to
determine if the person's registration or certification had
ever been revoked.
6.Support. Supporters of the bill cite the state's
underutilization of the PFSS at a time when the Medi-Cal
program has been expanded and the health care system needs to
ensure that the appropriate workforce meets demand, including
culturally and linguistically appropriate care. They cite
research that the PFSS helps clients hone life functioning
skills, alleviate depression and other symptoms, enhance
clients' advocacy and navigation abilities, reduce
hospitalizations, and improve client satisfaction. Supporters
further cite the lack of statewide training and supervision
standards for the PFSS and state that CMS, the U.S. Department
of Veteran's Affairs, and more than 30 states have already
recognized the importance and value of PFSS certification.
SUPPORT AND OPPOSITION :
Support: County Behavioral Health Directors Association of
California (sponsor)
Association of California Health Care Districts
California Association of Mental Health Peer-Run
Organizations
California Association of Social Rehabilitation
Agencies
California Council of Community Mental Health Agencies
California State Association of Counties
Disability Rights California
National Alliance on Mental Illness California
Pacific Clinics
Peers Envisioning and Engaging in Recovery Services
(PEERS)
Sacramento County Board of Supervisors
SEIU California
Steinberg Institute
Western Center on Law and Poverty
Oppose: None received.
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