Amended in Assembly July 6, 2015

Amended in Senate April 6, 2015

Senate BillNo. 614


Introduced by Senator Leno

begin insert

(Coauthor: Senator Anderson)

end insert

February 27, 2015


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 Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 614, as amended, Leno. Medi-Cal: mental health services:begin delete peerend deletebegin insert peer, parent,end insert and family support specialist certification.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income persons receive health care benefits. The Medi-Cal program is, in part, governed and funded by federal Medicaid provisions. Existing law provides for 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 for the State Department of Health Care Services, the California Mental 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 23 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, by July 1,begin delete 2016,end deletebegin insert 2017,end insert a statewidebegin delete peerend deletebegin insert peer, parent,end insert and family support specialist certification program, as a part of the state’s comprehensive mental healthbegin insert and substance use disorderend insert delivery system and the Medi-Cal program. The bill would includebegin delete 3end deletebegin insert 4end insert certification categories: adult peer support specialists,begin insert transition-age youth peer support specialists,end insert family peer support specialists, and parent peer support specialists. 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, and establishing a code of ethics and certification revocation processes.begin insert The bill would require an applicant for the certification as a peer, parent, and family support specialist to meet specified requirements, including successful completion of the curriculum and training requirements.end insert

This bill would require the department to collaborate with OSHPD and interested stakeholders in developing the certification program, and to obtain technical assistance pursuant to a specified joint state-county decisionmaking process. The bill would authorize the department to use funding provided through the MHSA and designated funds administered by OSHPD, to develop and administer thebegin delete program.end deletebegin insert program, and would authorize the use of these MHSA funds to serve as the state’s share of funding to develop and administer the program for the purpose of claiming federal financial participation under the Medicaid Program.end insert

This bill would require the department to amend the Medicaid state plan to include a certifiedbegin delete peerend deletebegin insert peer, parent,end insert and family support specialist as a provider type for purposes of the Medi-Cal program, but would implement this provision only if and to the extent that federal financial participation is available and the department obtains all necessary federal approvals. The bill would authorize the department to enter into exclusive or nonexclusive contracts on a bid or nonbid basis, as specified, on a statewide or more limited geographic basis. This bill also would authorize the department to implement, interpret, or make specific its provisions by various informational documents until regulations are adopted.

This bill would declare that it clarifies terms and procedures under the Mental Health Services Act.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no.

The people of the State of California do enact as follows:

P3    1

SECTION 1.  

Article 1.4 (commencing with Section 14045.10)
2is added to Chapter 7 of Part 3 of Division 9 of the Welfare and
3Institutions Code
, to read:

4 

5Article 1.4.  begin deletePeer end deletebegin insertPeer, Parent, end insertand Family Support Specialist
6Certificationbegin insert Programend insert
7

 

8

14045.10.  

This article shall be known, and may be cited, as
9thebegin delete Peerend deletebegin insert Peer, Parent,end insert and Family Support Specialist Certification
10Program Act of 2015.

11

14045.11.  

The Legislature finds and declares all of the
12following:

13(a) With the enactment of the Mental Health Services Act in
142004, support to include peer providers identified as consumers,
15parents, and family members for the provision of services has been
16on the rise.

17(b) There are over 6,000 peerbegin delete support specialistsend deletebegin insert providersend insert in
18California who provide individualized support, coaching,
19facilitation, and education to clients with mental health carebegin delete needs,end delete
20begin insert needs and substance use disorder,end insert in a variety of settings, yet no
21statewide scope of practice, standardized curriculum, training
22standards, supervision standards, or certification protocol is
23available.

24(c) The United States Department of Veterans Affairs and over
2530 states utilize standardized curricula and certification protocols
26for peerbegin delete providerend deletebegin insert supportend insert services.

27(d) The federal Centers for Medicare and Medicaid Services
28(CMS) recognizes peer support services as an evidence-based
29begin delete mental healthend delete model of care and notes it is an important component
30in a state’s delivery of effectivebegin insert mental health and substance use
31disorderend insert
treatment. The CMS encourages states to offer peer
P4    1support services as a component of a comprehensive mental health
2begin insert and substance use disorderend insert delivery system and federal financial
3participation is available for this purpose.

4(e) A substantial number of research studies demonstrate that
5peerbegin delete providersend deletebegin insert supportsend insert improve client functioning, increase client
6satisfaction, reduce family burden, alleviate depression and other
7symptoms, reduce hospitalizations and hospital days, increase
8client activation, and enhance client self-advocacy.

9(f) Certification at the state level can incentivize the public
10mental health system and the Medi-Calbegin delete program,end deletebegin insert program,
11including the Drug Medi-Cal program,end insert
to increase the number,
12diversity, and availability of peer providers and peer-driven
13services.

14

14045.12.  

It is the intent of the Legislature that thebegin delete peerend deletebegin insert peer,
15parent,end insert
and family support specialist certification program,
16established under this article, achieve all of the following:

17(a) Establish the ongoing provision of peer support services for
18beneficiariesbegin delete withend deletebegin insert experiencingend insert mental health carebegin delete needsend deletebegin insert needs,
19substance use disorder needs, or bothend insert
by certified peer support
20begin delete specialists, including adults 18 years of age or older.end deletebegin insert specialists.end insert

begin insert

21(b) Provide support, coaching, facilitation, and education to
22beneficiaries with mental health needs, substance use disorder
23needs, or both, and to families or significant support persons.

end insert
begin delete

24(b)

end delete

25begin insert(c)end insert Provide increased family support, building on the strengths
26of families and helping them achieve desired outcomes.

begin delete

27(c)

end delete

28begin insert(d)end insert Provide a part of a wraparound continuum of services, in
29conjunction with other community mental healthbegin delete services.end deletebegin insert services
30and other substance use disorder services.end insert

begin delete

31(d)

end delete

32begin insert(e)end insert Collaborate with others providing care or support to the
33beneficiary or family.

begin delete

34(e)

end delete

35begin insert(f)end insert Assist parents, when applicable, in developing coping
36mechanisms and problem-solving skills.

begin delete

37(f)

end delete

38begin insert(g)end insert Provide an individualized focus on the beneficiary, the
39family, or both, as needed.

begin insert

P5    1(h) Encourage employment under the peer, parent, and family
2support specialist certification program to reflect the culture,
3ethnicity, sexual orientation, gender identity, mental health service
4experiences, and substance use disorder experiences of the people
5whom they serve.

end insert
begin delete

6(g)

end delete

7begin insert(i)end insert Promote socialization, recovery, self-sufficiency,
8self-advocacy, development of natural supports, and maintenance
9of skills learned in other support services.

begin insert
10

begin insert14045.13.end insert  

For purposes of this article, the following definitions
11shall apply:

12(a) “Adult peer support specialist” means a person who is 18
13years of age or older and who has self-identified as having lived
14experience of recovery from mental illness, substance use disorder,
15or both, and the skills learned in formal trainings to deliver peer
16support services in a behavioral setting to promote mind-body
17recovery and resiliency for adults.

18(b) “Certification” means, as it pertains to the peer, parent,
19and family support specialist certification program, all federal
20and state requirements have been satisfied, federal financial
21participation under Title XIX of the federal Social Security Act
22(42 U.S.C. Sec. 1396 et seq.) is available, and all necessary federal
23approvals have been obtained.

24(c) “Certified” means all federal and state requirements have
25been satisfied by an individual who is seeking designation under
26this article, including completion of curriculum and training
27requirements, testing, and agreement to uphold and abide by the
28code of ethics.

29(d) “Certification examination” means the competency testing
30requirements, as approved by the department, an individual is
31required to successfully complete as a condition of becoming
32certified under this article. Each training program approved by
33the department may develop a unique competency examination
34for each category of peer, parent, and family support specialist
35listed in subdivision (b) of Section 14045.14. Each certification
36examination shall include core curriculum elements.

37(e) “Code of ethics” means professional standards by which
38each certified peer, parent, and family support specialist listed in
39subdivision (b) of Section 14045.14 is required to agree to uphold
40and abide by. These professional standards shall include principles,
P6    1expected behavior and conduct of the certificate holder in an
2agreed-upon statement that is required to be provided to the
3applicant and acknowledged by signing with his or her personal
4signature prior to being granted certification under this article.

5(f) “Core competencies” are the foundational and essential
6competencies required by each category of peer, parent, and family
7support specialists listed in subdivision (b) of Section 14045.14
8who provide peer support services.

9(g) “Cultural competence” means a set of congruent behaviors,
10attitudes, and policies that come together in a system or agency
11that enables that system or agency to work effectively in
12cross-cultural situations. A culturally competent system of care
13acknowledges and incorporates, at all levels, the importance of
14language and culture, intersecting identities, assessment of
15cross-cultural relations, knowledge and acceptance of dynamics
16of cultural differences, expansion of cultural knowledge, and
17adaptation of services to meet culturally unique needs to provide
18services in a culturally competent manner.

19(h) “Family peer support specialist” means a person with lived
20experience as a self-identified family member of an individual
21experiencing mental illness, substance use disorder, or both, and
22the skills learned in formal trainings to assist and empower families
23of individuals experiencing mental illness, substance use disorder,
24or both. For the purposes of this subdivision, “family member”
25includes a sibling or kinship caregiver, and their partners.

26(i) “Parent” means a person who is parenting or has parented
27a child or individual experiencing mental illness, substance use
28disorder, or both, and who can articulate his or her understanding
29of his or her experience with another parent or caregiver. This
30person may be a birth parent, adoptive parent, or family member
31standing in for an absent parent.

32(j) “Parent peer support specialist” means a parent with formal
33training to assist and empower families parenting a child or
34individual experiencing mental illness, substance use disorder, or
35both.

36(k) “Peer support specialist services” means culturally
37competent services that promote engagement, socialization,
38recovery, self-sufficiency, self-advocacy, development of natural
39supports, identification of strengths, and maintenance of skills
40learned in other support services. Peer support specialist services
P7    1shall include, but are not limited to, support, coaching, facilitation,
2and education to Medi-Cal beneficiaries that is individualized to
3the beneficiary and is conducted by a certified adult peer support
4specialist, a certified transition-age youth peer support specialist,
5a certified family peer support specialist, or a certified parent peer
6support specialist.

7(l) “Recovery” means a process of change through which an
8individual improves his or her health and wellness, lives a
9self-directed life, and strives to reach his or her full potential. This
10process of change recognizes cultural diversity and inclusion, and
11honors the different routes to resilience and recovery based on the
12individual and his or her cultural community.

end insert
13

begin delete14045.13.end delete
14begin insert14045.14.end insert  

No later than July 1,begin delete 2016,end deletebegin insert 2017,end insert thebegin delete departmentend delete
15begin insert department, as the sole state Medicaid agency,end insert shall establish a
16begin delete certified peerend deletebegin insert peer, parent,end insert and family support specialist
17begin insert certificationend insert program that, at a minimum, shall do all of the
18following:

19(a) Establish a certifyingbegin delete bodyend deletebegin insert body, either within the
20department, through contract, or through an interagency
21agreement,end insert
to provide for the certification ofbegin delete peerend deletebegin insert peer, parent,end insert
22 and family supportbegin delete specialists.end deletebegin insert specialists as described in this
23article.end insert

24(b) Provide for a statewide certification for each of the following
25 categories of peer supportbegin delete specialist providers,end deletebegin insert specialists,end insert as
26contained in federal guidance issued by the Centers for Medicare
27and Medicaid Services, Statebegin delete Medicalend deletebegin insert Medicaidend insert Director Letter
28(SMDL) #07-011:

29(1) Adult peer supportbegin delete specialists, 18 years of age or older.end delete
30begin insert specialists, who may serve individuals across the lifespan.end insert

begin insert

31(2) Transition-age youth peer support specialists.

end insert
begin delete

32(2)

end delete

33begin insert(3)end insert Family peer support specialists.

begin delete

34(3)

end delete

35begin insert(4)end insert Parent peer support specialists.

36(c) Define the range of responsibilities and practice guidelines
37forbegin insert the categories ofend insert peer supportbegin delete specialists.end deletebegin insert specialists listed in
38subdivision (b).end insert

39(d) Determine curriculum and core competencies, including
40begin insert curriculum that may be offered inend insert areas of specialization, such as
P8    1begin insert older adults,end insert veterans, family support,begin delete and forensics.end deletebegin insert forensics,
2whole health, juvenile justice, youth in foster care, sexual
3orientation, gender identity, and any other areas of specialization
4identified by the department. Specialized curriculum shall be
5determined for each of the categories of peer, parent, and family
6support specialists listed in subdivision (b). Core
7competencies-based curriculum shall include, at a minimum, all
8of the following elements:end insert

begin insert

9(1) The concepts of hope, recovery, and wellness.

end insert
begin insert

10(2) The role of advocacy.

end insert
begin insert

11(3) The role of consumers and family members.

end insert
begin insert

12(4) Psychiatric rehabilitation skills and service delivery,
13including defined practices.

end insert
begin insert

14(5) Cultural competence training.

end insert
begin insert

15(6) Trauma-informed care.

end insert
begin insert

16(7) Group facilitation skills.

end insert
begin insert

17(8) Self-awareness and self-care.

end insert
begin insert

18(9) Cooccurring disorders of mental health and substance use.

end insert
begin insert

19(10) Conflict resolution.

end insert
begin insert

20(11) Professional boundaries and ethics.

end insert
begin insert

21(12) Safety and crisis planning.

end insert
begin insert

22(13) Navigation of, and referral to, other services.

end insert
begin insert

23(14) Documentation skills and standards.

end insert
begin insert

24(15) Study and test-taking skills.

end insert

25(e) Specify training requirements,begin insert including
26core-competencies-based training and specialized training
27necessary to become certified under this article,end insert
allowing for
28multiple qualified training entities, and requiring training tobegin delete include
29individuals with practical experience as consumers of peer support
30services, or their family members.end delete
begin insert include people with lived
31experience as consumers and family members.end insert

32(f) Specify required continuing education requirements for
33certification.

34(g) Determine clinical supervision requirements for personnel
35certified under thisbegin delete section.end deletebegin insert article, that shall require, at a
36minimum, personnel certified pursuant to this article to work under
37the direction of a mental health rehabilitation specialist or
38substance use disorder professional.end insert

39(h) Establish a code ofbegin delete ethics and processes for revocation of
40certification.end delete
begin insert ethics.end insert

P9    1(i) Determine the process for certification renewal.

begin insert

2(j) Determine a process for revocation of certification.

end insert
begin delete

3(j)

end delete

4begin insert(k)end insert Determine a process for allowing existing personnel
5employed in the peer support field to obtain certification under
6this article, at their option.

begin insert
7

begin insert14045.15.end insert  

In order to be certified as an adult peer support
8specialist, an individual shall, at a minimum, satisfy all of the
9following requirements:

10(a) Be at least 18 years of age.

11(b) Have or have had a primary diagnosis of mental illness,
12substance use disorder, or both, which is self-disclosed.

13(c) Have received or is receiving mental health services,
14substance use disorder services, or both.

15(d) Be willing to share his or her experience of recovery.

16(e) Demonstrate leadership and advocacy skills.

17(f) Have a strong dedication to recovery.

18(g) Agree to uphold and abide by a code of ethics. A copy of the
19code of ethics shall be signed by the applicant.

20(h) Successful completion of the curriculum and training
21requirements for an adult peer support specialist.

22(i) Pass a certification examination approved by the department
23for an adult peer support specialist.

24(j) Successful completion of any required continuing education,
25training, and recertification requirements.

end insert
begin insert
26

begin insert14045.16.end insert  

In order to be certified as a transition-age youth
27peer support specialist, an individual shall, at a minimum, satisfy
28all of the following requirements:

29(a) Be at least 18 years of age.

30(b) Have or have had a primary diagnosis of mental illness,
31substance use disorder, or both, which is self-disclosed.

32(c) Have received or is receiving mental health services,
33substance use disorder addiction services, or both.

34(d) Be willing to share his or her experience of recovery.

35(e) Demonstrate leadership and advocacy skills.

36(f) Have a strong dedication to recovery.

37(g) Agree to uphold and abide by a code of ethics. A copy of the
38code of ethics shall be signed by the applicant.

39(h) Successful completion of the curriculum and training
40requirements for a transition-age youth peer support specialist.

P10   1(i) Pass a certification examination approved by the department
2for a transition-age youth peer support specialist.

3(j) Successful completion of any required continuing education,
4training, and recertification requirements.

end insert
begin insert
5

begin insert14045.17.end insert  

In order to be certified as a family peer support
6specialist, an individual shall, at a minimum, satisfy all of the
7following requirements:

8(a) Be at least 18 years of age.

9(b) Be self-identified as a family member of an individual
10experiencing mental illness, substance use disorder, or both.

11(c) Be willing to share his or her experience.

12(d) Demonstrate leadership and advocacy skills.

13(e) Have a strong dedication to recovery.

14(f) Agree to uphold and abide by a code of ethics. A copy of the
15code of ethics shall be signed by the applicant.

16(g) Successful completion of the curriculum and training
17requirements for a family peer support specialist.

18(h) Pass a certification examination approved by the department
19for a family peer support specialist.

20(i) Successful completion of any required continuing education,
21training, and recertification requirements.

end insert
begin insert
22

begin insert14045.18.end insert  

In order to be certified as a parent peer support
23specialist, an individual shall, at a minimum, satisfy all of the
24following requirements:

25(a) Be at least 18 years of age.

26(b) Be self-identified as a parent, as defined in Section 14045.13.

27(c) Be willing to share his or her experience.

28(d) Demonstrate leadership and advocacy skills.

29(e) Have a strong dedication to recovery.

30(f) Agree to uphold and abide by a code of ethics. A copy of the
31 code of ethics shall be signed by the applicant.

32(g) Successful completion of the curriculum and training
33requirements for a parent peer support specialist.

34(h) Pass a certification examination approved by the department
35for a parent peer support specialist.

36(i) Successful completion of any required continuing education,
37training, and recertification requirements.

end insert
begin insert
38

begin insert14045.19.end insert  

This article shall not be construed to imply that an
39individual who is certified pursuant to this article is qualified to,
P11   1or authorize that individual to, diagnose an illness, prescribe
2medication, or provide clinical services.

end insert
3

begin delete14045.14.end delete
4begin insert14045.20.end insert  

The department shall closely collaborate with the
5Office of Statewide Health Planning and Development (OSHPD)
6and its associated workforce collaborative, and regularly consult
7with interested stakeholders, including peer support and family
8organizations, mental healthbegin insert and substance use disorder servicesend insert
9 providers and organizations, the County Behavioral Health
10Directors Association of California, health plans participating in
11the Medi-Cal managed care program, the California Mental Health
12Planning Council, and other interestedbegin delete parties, as deemed
13appropriate by the department,end delete
begin insert partiesend insert in developing,
14implementing, and administering thebegin delete peerend deletebegin insert peer, parent,end insert and family
15support specialist certificationbegin delete program.end deletebegin insert program established
16pursuant to this article. This consultation shall initially include,
17at a minimum, biend insert
begin insertmonthly stakeholder meetings, which may also
18include technical workgroup meetings. The department may seek
19private funds from a nonprofit organization or foundation for this
20purpose.end insert

21

begin delete14045.15.end delete
22begin insert14045.21.end insert  

The department may contract to obtain technical
23assistance for the development of thebegin delete peerend deletebegin insert peer, parent,end insert and family
24support specialist certification program, as provided in Section
254061.

26

begin delete14045.16.end delete
27begin insert14045.22.end insert  

(a) The department shall amend its Medicaid state
28plan to do both of the following:

29(1) Includebegin delete a peerend deletebegin insert each category of peer, parent,end insert and family
30supportbegin delete specialistend deletebegin insert specialists listed in subdivision (b) of Section
3114045.14end insert
certified pursuant to this article as a provider type for
32purposes of this chapter.

33(2) Include peer support specialist services as a distinct service
34type for purposes of thisbegin delete chapter.end deletebegin insert chapter, which may be provided
35to eligible Medi-Cal beneficiaries who are enrolled in either a
36Medi-Cal managed mental health care plan or a Medi-Cal
37managed care health plan.end insert

38(b) The department may seek any federal waivers or other state
39plan amendments as necessary to implement the certification
40program provided for under this article.

P12   1(c) This article shall be implemented only if and to the extent
2that federal financial participation under Title XIX of the federal
3Social Security Act (42 U.S.C. Sec. 1396 et seq.) is available and
4all necessary federal approvals have been obtained.

5

begin delete14045.17.end delete
6begin insert14045.23.end insert  

It is not the intent of the Legislature in enacting this
7article to modify the Medicaid state plan in any manner that would
8otherwise change or nullify the requirements, billing, or
9reimbursement of the “other qualified provider” provider type, as
10currently authorized by the Medicaid state plan.

11

begin delete14045.18.end delete
12begin insert14045.24.end insert  

The department may utilize Mental Health Services
13Act funds, as authorized in subdivision (d) of Section 5892, and
14any designated Workforce Education and Training Program
15resources, including funding, as administered by OSHPD pursuant
16to Section 5820, to develop and administer thebegin delete peerend deletebegin insert peer, parent,end insert
17 and family support specialist certification program.begin insert These Mental
18Health Service Act funds may serve as the state’s share of funding
19to develop and administer the peer, parent, and family support
20specialist certification program and shall be available for purposes
21of claiming federal financial participation under Title XIX of the
22federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) once all
23necessary federal approvals have been obtained.end insert

24

begin delete14045.19.end delete
25begin insert14045.25.end insert  

For the purposes of implementing this article, the
26department may enter into exclusive or nonexclusive contracts on
27a bid or negotiated basis, including contracts for the purpose of
28obtaining subject matter expertise or other technical assistance.
29Contracts may be statewide or on a more limited geographic basis.

30

begin delete14045.20.end delete
31begin insert14045.26.end insert  

Notwithstanding Chapter 3.5 (commencing with
32Section 11340) of Part 1 of Division 3 of Title 2 of the Government
33Code, the department may implement, interpret, or make specific
34this article by means of plan letters, plan or provider bulletins, or
35similar instructions, without taking regulatory action, until the
36time regulations are adopted. The department shall adopt
37regulations by July 1,begin delete 2018,end deletebegin insert 2019,end insert in accordance with the
38requirements of Chapter 3.5 (commencing with Section 11340) of
39Part 1 of Division 3 of Title 2 of the Government Code.
40Notwithstanding Section 10231.5 of the Government Code,
P13   1beginning six months after the effective date of this article, the
2department shall provide semiannual status reports to the
3Legislature, in compliance with Section 9795 of the Government
4Code, until regulations have been adopted.

5

SEC. 2.  

The Legislature finds and declares that this act clarifies
6procedures and terms of the Mental Health Services Act within
7the meaning of Section 18 of the Mental Health Services Act.



O

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