BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 614|
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THIRD READING
Bill No: SB 614
Author: Leno (D)
Amended: 4/6/15
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/15/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SUBJECT: Medi-Cal: mental health services: peer and family
support specialist certification
SOURCE: County Behavioral Health Directors Association of
California
DIGEST: This bill 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.
ANALYSIS:
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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.
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;
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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
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
waivers or other state plan amendments to implement the PFSS
certification program.
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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.
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
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
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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 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.
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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.
Prior Legislation
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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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
One-time costs, likely in the hundreds of thousands per year
for one to three years, to develop program standards and seek
federal approvals by DHCS (Mental Health Services Act funds,
General Fund, and federal funds). This bill requires DHCS to
establish a certifying body for PFSS, to define the
responsibilities of PFSS, specify training requirements, set
other standards, and adopt regulations. This bill also
requires DHCS to amend its State Plan for the Medi-Cal program
to allow PFSS to provide services. It is estimated that DHCS
will incur additional staff costs in the hundreds of thousands
per year for one to three years.
Uncertain ongoing costs to manage the program (Mental Health
Service Act funds, General Fund, federal funds, or special
funds). This bill requires DHCS to establish a certifying body
to provide for the certification of PFSS. However, this bill
also requires DHCS to provide for statewide certification of
PFSS. If DHCS is able to designate one or more third-party
bodies to provide certification to PFSS, then the annual cost
to administer the certification program is likely to be
minimal. However, if DHCS is unable to identify a third-party
organization to certify PFSS, then this bill appears to
require DHCS to fulfill that role. The total cost to actually
provide certification services is unknown, and will depend on
the number of applicants. If DHCS fulfills that
responsibility, the annual costs could be in the hundreds of
thousands to millions per year (although they could be offset
by application fee revenues).
Uncertain impact on county mental health plans that provide
specialty mental health services in the Medi-Cal program
(county funds and federal funds). Under current law, county
mental health plans provide services for Medi-Cal
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beneficiaries with moderate to severe mental health issues.
Creating a new provider type who can provide services to this
population may increase overall service utilization, by
addressing shortages of providers, which would increase costs.
On the other hand, PFSS are likely to be a less costly
provider type than other mental health providers in Medi-Cal
and could potentially reduce expenditures by providing certain
services in a more cost-effective manner. Also, to the extent
that counties are already providing peer support services,
they are currently unable to draw down federal funding for
those costs. Under this bill, they would be able to do so.
Finally, to the extent that PFSS are able to provide support
and assistance to Medi-Cal beneficiaries with mental illness,
it is also possible that the program may reduce the need for
more expensive services such as inpatient hospitalizations.
The extent to which such cost avoidance may occur is unknown.
Uncertain impact on Medi-Cal managed care plans that provide
mental health services to Medi-Cal beneficiaries when the
mental illness is not severe (General Fund and federal funds).
Under current law, Medi-Cal managed care plans provide
coverage for mental health service needs of enrolled
beneficiaries when the mental illness is not severe enough to
warrant specialty mental health services. Creating a new
provider type who can provide services to this population may
increase overall service utilization, by addressing shortages
of providers, which would increase costs. On the other hand,
PFSS are likely to be a less costly provider type than other
mental health providers in Medi-Cal and could potentially
reduce expenditures by providing certain services in a more
cost-effective manner. Finally, to the extent that PFSS are
able to provide support and assistance to Medi-Cal
beneficiaries with mental illness, it is also possible that
the program may reduce the need for more expensive services
such as inpatient hospitalizations. The extent to which such
cost avoidance may occur is unknown.
SUPPORT: (Verified5/28/15)
County Behavioral Health Directors Association of California
(source)
California Association of Alcohol and Drug Program Executives,
Inc.
California Association of Mental Health Peer-Run Organizations
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California Association of Social Rehabilitation Agencies
California Coalition for Mental Health
California Council of Community Mental Health Agencies
California Mental Health Planning Council
California State Association of Counties
Common Sense Kids Action
County of Sacramento
County of Los Angeles
Disability Rights California
Mental Health America of Los Angeles
Mental Health Association of San Francisco
National Alliance on Mental Illness California
Pacific Clinics
Peers Envisioning and Engaging in Recovery Services
SEIU California
Steinberg Institute
Telecare Corporation
OPPOSITION: (Verified5/28/15)
None received
ARGUMENTS IN SUPPORT: Supporters of this 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.
Prepared by:Reyes Diaz / HEALTH /
5/30/15 17:16:17
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