BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 614| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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: SB 614 Page 2 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; SB 614 Page 3 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. SB 614 Page 4 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 SB 614 Page 5 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. SB 614 Page 6 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 SB 614 Page 7 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 SB 614 Page 8 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 SB 614 Page 9 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 SB 614 Page 10 **** END ****