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SB-10 Mental health services: peer support specialist certification.(2019-2020)

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Date Published: 05/17/2019 11:34 AM
SB10:v97#DOCUMENT

Amended  IN  Senate  May 17, 2019
Amended  IN  Senate  January 23, 2019

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Senate Bill No. 10


Introduced by Senator Beall
(Principal coauthor: Assembly Member Waldron)
(Coauthor: Senator Nielsen)
(Coauthor: Assembly Member Carrillo)

December 03, 2018


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 mental health.


LEGISLATIVE COUNSEL'S DIGEST


SB 10, as amended, Beall. Mental health services: peer, parent, transition-age, and family peer support specialist certification.
Existing law provides for establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive healthcare health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes 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 of the State Department of Health Care Services, the California Behavioral 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, no later than July 1, 2020, a statewide peer, parent, transition-age, and family peer 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 specialist, transition-age youth peer support specialist, family peer support specialist, and parent peer support specialist. 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, establishing a code of ethics, and determining a certification revocation process. The bill would require an applicant for the certification as a peer, parent, transition-age, or family peer support specialist to meet specified requirements, including successful completion of the curriculum and training requirements.
This bill would require the department to consult with OSHPD and other stakeholders in implementing the certification program, including requiring quarterly stakeholder meetings. The bill would authorize the department to use funding provided through the MHSA, upon appropriation, to develop and administer the certification program, and would authorize the use of these MHSA funds to serve as the state’s share of funding to claim federal financial participation under the Medicaid program.
This bill would authorize the department to establish a certification fee schedule and to require remittance of fees as contained in the schedule, for the purpose of supporting the department’s activities associated with the ongoing administration of the certification program.
This bill would require the department to amend the Medicaid state plan to include a certified peer, parent, transition-age, and family peer support specialist as a provider type for purposes of the Medi-Cal program and to include peer support specialist services as a distinct service type for purposes of the Medi-Cal program. The bill would require Medi-Cal reimbursement for peer support specialist services to be implemented only if, and to the extent that, federal financial participation is available and the department obtains all necessary federal approvals. The bill also would authorize the department to implement, interpret, or make specific its provisions by means of informal notices, plan letters, plan or provider bulletins, or similar instructions, without taking regulatory action, until regulations are adopted. The bill would require the department to adopt regulations by July 1, 2022, and, commencing July 1, 2020, would require the department to provide semiannual status reports to the Legislature until regulations have been adopted.
This bill would declare that it clarifies terms and procedures under the Mental Health Services Act.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   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 Peer Support Specialist Certification Program Act of 2019

14045.10.
 This article shall be known, and may be cited, as the Peer, Parent, Transition-Age, and Family Peer Support Specialist Certification Act of 2019.

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 healthcare health care needs and substance use disorders, 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 that the experiences of peer support specialists, as part of an evidence-based model of care, can be an important component in a state’s delivery of effective mental health and substance use disorder treatment. The CMS encourages states to offer comprehensive programs.
(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 can encourage an increase in the number, diversity, and availability of peer support specialists.

14045.12.
 It is the intent of the Legislature that the peer, parent, transition-age, and family peer support specialist certification program, established under this article, achieve all of the following:
(a) Support the ongoing provision of services for beneficiaries experiencing mental healthcare health care needs, substance use disorder needs, or both by certified peer support specialists.
(b) Support coaching, linkage, and skill building of beneficiaries with mental health needs, substance use disorder needs, or both, and to families or significant support persons.
(c) Increase family support by building on the strengths of families and helping them achieve a better understanding of mental illness in order to help beneficiaries achieve desired outcomes.
(d) Provide part of a continuum of services, in conjunction with other community mental health services and other substance use disorder treatment.
(e) Collaborate with others providing care or support to the beneficiary or family.
(f) Assist parents, families, and beneficiaries in developing coping mechanisms and problem-solving skills in order to help beneficiaries achieve desired outcomes.
(g) Promote skill building for beneficiaries in the areas of socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services.
(h) Encourage employment under the peer, parent, transition-age, and family peer support specialist certification to reflect the culture, ethnicity, sexual orientation, gender identity, mental health service experiences, and substance use disorder experiences of the people whom they serve.

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 training to deliver peer support services in a behavioral setting to promote mind-body recovery and resiliency for adults.

(b)

(a) “Certification” means the activities of the certifying body related to the verification that an individual has met all of the requirements under this article and that the individual may provide mental health services and substance use disorder treatment pursuant to this article.

(c)

(b) “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)

(c) “Code of ethics” means the standards to which a peer support specialist is required to adhere.

(e)

(d) “Core competencies” are the foundational and essential knowledge, skills, and abilities required for peer specialists.

(f)

(e) “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.

(g)

(f) “Department” means the State Department of Health Care Services.

(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 training to assist and empower families of individuals experiencing mental illness, substance use disorder, or both. For the purpose of this subdivision, “family member” includes a sibling or kinship caregiver, and a partner of that family member.

(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 the parent’s understanding of their 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.

(g) “Peer support specialist” means a person who is 18 years of age or older and who is a person who has self-identified as having lived experience with the process of recovery from mental illness, substance use disorder, or both, either as a consumer of these services or as the parent or family member of the consumer.

(k)

(h) “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, or 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)

(i) “Recovery” means a process of change through which an individual improves their health and wellness, lives a self-directed life, and strives to reach their 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 their 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 training 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, 2020, the department shall do all of the following:
(a) Establish a certifying body, either through contract or through an interagency agreement, to provide for the certification activities 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 federal Centers for Medicare and Medicaid Services, State Medicaid Director Letter (SMDL) #07-011: #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), peer support specialists 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 required for certification of an individual as a peer support specialist, including curriculum that may be offered in areas of specialization, including, but not limited to, transition-age youth, veterans, gender identity, sexual orientation, and any other areas of specialization identified by the department. Core competencies-based curriculum shall include, at a minimum, training related to 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.
(16) Confidentiality.
(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) Establish a code of ethics.
(g) Determine continuing education requirements for biennial certification renewal.
(h) Determine the process for biennial certification renewal.
(i) Determine a process for investigation of complaints and corrective action, which may include suspension and revocation of certification.
(j) Determine a process for an individual employed as a peer support specialist on January 1, 2020, to obtain certification under this article.

14045.15.

(a)In order to be certified as an adult peer support specialist, an individual shall, at a minimum, satisfy all of the following requirements:

(1)Be at least 18 years of age.

(2)Have or have had a primary diagnosis of mental illness, substance use disorder, or both, that is self-disclosed.

(3)Have received, or be receiving, mental health services, substance use disorder services, or both.

(4)Be willing to share the individual’s experience of recovery.

(5)Demonstrate leadership and advocacy skills.

(6)Have a strong dedication to recovery.

(7)Agree, in writing, to abide by a code of ethics. A copy of the code of ethics shall be signed by the applicant.

(8)Successfully complete the curriculum and training requirements for an adult peer support specialist.

(9)Pass a certification examination approved by the department for an adult peer support specialist.

(10)Successfully complete any required continuing education, training, and recertification requirements.

(11)Meet all applicable federal requirements.

(b)To maintain certification pursuant to this section, an adult peer support specialist shall do both of the following:

(1)Abide by the code of ethics and biennially sign an affirmation.

(2)Complete any required continuing education, training, and recertification requirements.

14045.16.

(a)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:

(1)Be at least 18 years of age.

(2)Have or have had a primary diagnosis of mental illness, substance use disorder, or both, that is self-disclosed.

(3)Have received, or be receiving, mental health services, substance use disorder addiction services, or both.

(4)Be willing to share the individual’s experience of recovery.

(5)Demonstrate leadership and advocacy skills.

(6)Have a strong dedication to recovery.

(7)Agree, in writing, to abide by a code of ethics. A copy of the code of ethics shall be signed by the applicant.

(8)Successfully complete the curriculum and training requirements for a transition-age youth peer support specialist.

(9)Meet all applicable federal requirements.

(b)To maintain certification pursuant to this section, a transition-age youth peer support specialist shall do both of the following:

(1)Abide by the code of ethics and biennially sign an affirmation.

(2)Complete any required continuing education, training, and recertification requirements.

14045.17.

(a)In order to be certified as a family peer support specialist, an individual shall, at a minimum, satisfy all of the following requirements:

(1)Be at least 18 years of age.

(2)Be self-identified as a family member of a person experiencing mental illness, substance use disorder, or both.

(3)Be willing to share the individual’s experience.

(4)Demonstrate leadership and advocacy skills.

(5)Have a strong dedication to recovery.

(6)Agree, in writing, to abide by a code of ethics. A copy of the code of ethics shall be signed by the applicant.

(7)Successfully complete the curriculum and training requirements for a family peer support specialist.

(8)Pass a certification examination approved by the department for a family peer support specialist.

(9)Meet all applicable federal requirements.

(b)To maintain certification pursuant to this section, a family peer support specialist shall do both of the following:

(1)Abide by the code of ethics and biennially sign an affirmation.

(2)Complete any required continuing education, training, and recertification requirements.

14045.18.

(a)In order to be certified as a parent peer support specialist, an individual shall, at a minimum, satisfy all of the following requirements:

(1)Be at least 18 years of age.

(2)Be self-identified as a parent.

(3)Be willing to share the individual’s experience.

(4)Demonstrate leadership and advocacy skills.

(5)Have a strong dedication to recovery.

(6)Agree, in writing, to abide by a code of ethics. A copy of the code of ethics shall be signed by the applicant.

(7)Successfully complete the curriculum and training requirements for a parent peer support specialist.

(8)Meet all applicable federal requirements.

(b)To maintain certification pursuant to this section, a parent peer support specialist shall do both of the following:

(1)Abide by the code of ethics and biennially sign an affirmation.

(2)Complete any required continuing education, training, and recertification requirements.

14045.15.
 (a) An applicant for certification under this article shall meet all of the following requirements:
(1) Be at least 18 years of age.
(2) Possess a high school diploma or equivalent degree.
(3) Be self-identified as having experience with the process of recovery from mental illness or substance use disorder treatment either as a consumer of these services or as the parent or family member of the consumer.
(4) Be willing to share their experience.
(5) Demonstrate leadership and advocacy skills.
(6) Have a strong dedication to recovery.
(7) Agree, in writing, to adhere to a code of ethics.
(8) Successfully complete the curriculum and training requirements for a peer support specialist.
(9) Pass a certification examination approved by the department for a peer support specialist.
(b) To maintain certification under this article, a peer support specialist shall meet both of the following requirements:
(1) Adhere to the code of ethics and biennially sign an affirmation.
(2) Complete any required continuing education, training, and recertification requirements.

14045.19. 14045.16.
 (a) This article shall not be construed to imply that an individual who is certified pursuant to this article is qualified to, or authorized to, diagnose an illness, prescribe medication, or provide clinical services.
(b) This article does not alter the scope of practice for a healthcare health care professional or authorize the delivery of healthcare health care services in a setting or manner that is not authorized pursuant to the Business and Professions Code or the Health and Safety Code.

14045.20. 14045.17.
 The department shall consult with the Office of Statewide Health Planning and Development (OSHPD), peer support and family organizations, mental health services and substance use disorder treatment providers and organizations, the County Behavioral Health Directors Association of California, and the California Behavioral Health Planning Council in implementing this article. Consultation shall initially include, at a minimum, quarterly stakeholder meetings. The department may additionally conduct technical workgroups upon the request of stakeholders.

14045.21. 14045.18.
 To facilitate early intervention for mental health services, community health workers may partner with peer, parent, transition-age, and family peer support specialists to improve linkage to services for the beneficiary.

14045.22. 14045.19.
 (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 and a peer support specialist 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 care plan or a mental 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.

14045.23. 14045.20.
 The department may utilize Mental Health Services Act moneys to fund state administrative costs related to developing and administering this article, subject to an express appropriation in the annual Budget Act for these purposes, and to the extent authorized under the Mental Health Services Act. These funds 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.), contingent upon federal approval.

14045.24. 14045.21.
 Medi-Cal reimbursement for peer support specialist 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.

14045.25. 14045.22.
 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 activities associated with the ongoing administration of the peer, parent, transition-age, and family peer support specialist certification program. Certification fees charged by the department shall reasonably reflect the expenditures directly applicable to the ongoing administration of the peer, parent, transition-age, and family peer support specialist certification program.

14045.26. 14045.23.
 For the purpose 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.

14045.27. 14045.24.
 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 informal notices, 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, 2022, 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. Commencing July 1, 2020, 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.