Medicaid Coverage of Peer Support for People with Mental ...

1 HEALTHCARE. Medicaid Coverage of peer Support for People with Mental Illness: Available Research and State Examples November 6, 2008. To Shawn Terrell Center for Medicaid and State Operations Centers for Medicare & Medicaid Services Baltimore, Maryland By Steve Eiken, Thomson Reuters Jean Campbell, , Missouri Institute of Mental Health Healthcare Thomson Reuters TABLE OF CONTENTS. INTRODUCTION .. 1. OVERVIEW OF peer Support .. 2. peer Support 3. peer Support as a Distinct Service .. 4. Services Delivered by a Team of Peers and 6.

2 peer -Delivered Services Other Than peer Support .. 6. STATE EXAMPLES OF Medicaid peer Support SERVICES .. 7. Georgia State Plan Rehabilitative Service .. 8. Iowa Additional Services Authorized Under 1915(b)(3) .. 9. Wisconsin Home and Community-Based Services 9. CONCLUSION .. 10. BIBLIOGRAPHY .. 12. The analyses upon which this publication is based were performed under Contract Number 500-00-0021, Task Order Number 1, entitled ADA and Quality Initiatives, sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services.

3 The opinions expressed in this report are those of the authors and do not reflect the views of the Centers for Medicare & Medicaid Services, Thomson Reuters, or University of Missouri-Columbia, Missouri Institute of Mental Health. Medicaid Coverage of peer Support for People with Mental Illness: Available Research and State Examples State Mental health systems across the country are changing their Mental health systems to emphasize recovery. 1 This transition is informed by the experiences of People with serious Mental illness who live, work, and learn in the community.

4 These individuals have increased awareness among policy makers that individuals can recover from even the most serious Mental illnesses to live fulfilling and productive lives. 2 In addition to these life changes, recovery may also involve a reduction or remission of symptoms, depending on the individual. 3 The National Consensus Statement on Mental Health Recovery, developed by a panel of over 110. experts, defines recovery as follows: Mental health recovery is a journey of healing and transformation enabling a person with a Mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

5 4. The President's New Freedom Initiative Commission on Mental Health identified two principles for a system focused on recovery, rather than symptom management. First, People must have meaningful choices about their treatment options and providers so services are centered on the person's needs and preferences. Second, services must focus on increasing resiliency, the ability cope with the challenges inherent in life. 5. As part of pursuing a recovery-based system, states have increasingly expressed interest in covering peer Support as a specific type of service and/or provider in the Medicaid program.

6 peer Support services from staff who have experienced a serious Mental illness and who relate to participants based on their experience in the recovery process can play an important role in recovery. peer providers teach social and coping skills essential to increasing resiliency and provide a model of recovery. In a 2007 letter to State Medicaid Directors, the Centers for Medicare & Medicaid Services (CMS) declared peer Support an evidence-based Mental health model of care and specified requirements for Medicaid -funded peer Support , including: 1.

7 Supervision by a Mental health professional (as defined by the State). 2. care -coordination within a comprehensive, individualized plan of care with specific, individualized goals 3. Training and credentialing, including continuing education requirements, that ensure providers have a basic set of competences necessary to Support the recovery of others 6. states also must meet requirements that apply to any Medicaid service. For example, states must describe the service and provider qualifications in detail and must establish utilization review and reimbursement methodologies.

8 Also, states must meet the requirements of the particular Medicaid authority used for covering peer Support ( , the Medicaid State Plan 1. For examples of transformation efforts supported by Federal grants, see Research Triangle Institute, 2008 and Substance Abuse and Mental Health Services Administration, 2006a. 2. Campbell, 1996. 3. Public Health Service, 1999. 4. Substance Abuse and Mental Health Services Administration, 2006b 5. President's New Freedom Commission on Mental Health, 2003. 6. Centers for Medicare & Medicaid Services, 2007.)

9 2008 Thomson Reuters. All rights reserved. 1. Medicaid Coverage of peer Support for People with Mental Illness: Available Research and State Examples rehabilitative service or a waiver authorized by Section 1915(b) or Section 1915(c) of the Social Security Act). 7. This report provides information to assist State Medicaid Agencies and their partner Mental health agencies in efforts to incorporate peer Support into the Medicaid program. First, the report provides an overview of peer Support , including a definition of peer Support and examples of services furnished by peer providers.

10 Second, it summarizes the available research to date regarding the effectiveness of peer Support . Finally, the report presents State examples of peer Support within three different Medicaid authorities. Information for this report was gathered through reviews of journal articles; 8 technical reports on Medicaid services; State policy documents such as waiver applications and regulations; and interviews with state Medicaid and Mental health agency personnel. Overview of peer Support peer Support is provided by specially trained individuals with a Mental illness who are focused on extending services to others and who relate to participants in part based on their personal recovery experience.