Amended in Assembly August 31, 2015

Amended in Assembly July 16, 2015

Amended in Assembly July 6, 2015

Amended in Senate April 6, 2015

Senate BillNo. 614


Introduced by Senator Leno

(Coauthor: Senator Anderson)

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: peer, parent, transition-age, 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, 2017, a statewide peer, parent, transition-age, and family 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 specialists, transition-age youth peer support specialists, 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. The bill would require an applicant for the certification as a peer, parent, transition-age, and family support specialist to meet specified requirements, including successful completion of the curriculum and training requirements.

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 the 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.

begin insert

This bill would authorize the department to establish a certification fee schedule and require remittance of fees as contained in the schedule, for the purpose of supporting the department’s activities associated with the ongoing state administration of the peer, parent, transition-age, and family support specialist certification program. The bill would require the department to utilize the other funding resources made available under the bill before determining the need for the certification fee schedule and requiring the remittance of fees. The bill would declare legislative intent that the certification fees be reasonable and reflect the expenditures directly applicable to the ongoing state administration of the program.

end insert

This bill would require the department to amend the Medicaid state plan to include a certified peer, parent, transition-age, 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.  Peer, Parent, Transition-Age, and Family Support
6Specialist Certification Program
7

 

8

14045.10.  

This article shall be known, and may be cited, as
9the Peer, Parent, Transition-Age, and Family Support Specialist
10Certification Program 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 peer providers in California who
18provide individualized support, coaching, facilitation, and
P4    1education to clients with mental health care needs and substance
2use disorder, in a variety of settings, yet no statewide scope of
3practice, standardized curriculum, training standards, supervision
4standards, or certification protocol is available.

5(c) The United States Department of Veterans Affairs and over
630 states utilize standardized curricula and certification protocols
7for peer support services.

8(d) The federal Centers for Medicare and Medicaid Services
9(CMS) recognizes peer support services as an evidence-based
10model of care and notes it is an important component in a state’s
11delivery of effective mental health and substance use disorder
12treatment. The CMS encourages states to offer peer support
13services as a component of a comprehensive mental health and
14substance use disorder delivery system and federal financial
15participation is available for this purpose.

16(e) A substantial number of research studies demonstrate that
17peer supports improve client functioning, increase client
18satisfaction, reduce family burden, alleviate depression and other
19symptoms, reduce hospitalizations and hospital days, increase
20client activation, and enhance client self-advocacy.

21(f) Certification at the state level can incentivize the public
22mental health system and the Medi-Cal program, including the
23Drug Medi-Cal program, to increase the number, diversity, and
24availability of peer providers and peer-driven services.

25

14045.12.  

It is the intent of the Legislature that the peer, parent,
26transition-age, and family support specialist certification program,
27established under this article, achieve all of the following:

28(a) Establish the ongoing provision of peer support services for
29beneficiaries experiencing mental health care needs, substance use
30disorder needs, or both by certified peer support specialists.

31(b) Provide support, coaching, facilitation, and education to
32beneficiaries with mental health needs, substance use disorder
33needs, or both, and to families or significant support persons.

34(c) Provide increased family support, building on the strengths
35of families and helping them achieve desired outcomes.

36(d) Provide a part of a wraparound continuum of services, in
37conjunction with other community mental health services and other
38substance use disorder services.

39(e) Collaborate with others providing care or support to the
40beneficiary or family.

P5    1(f) Assist parents, when applicable, in developing coping
2mechanisms and problem-solving skills.

3(g) Provide an individualized focus on the beneficiary, the
4family, or both, as needed.

5(h) Encourage employment under the peer, parent, transition-age,
6and family support specialist certification program to reflect the
7culture, ethnicity, sexual orientation, gender identity, mental health
8service experiences, and substance use disorder experiences of the
9people whom they serve.

10(i) Promote socialization, recovery, self-sufficiency,
11self-advocacy, development of natural supports, and maintenance
12of skills learned in other support services.

13

14045.13.  

For purposes of this article, the following definitions
14shall apply:

15(a) “Adult peer support specialist” means a person who is 18
16years of age or older and who has self-identified as having lived
17experience of recovery from mental illness, substance use disorder,
18or both, and the skills learned in formal trainings to deliver peer
19support services in a behavioral setting to promote mind-body
20recovery and resiliency for adults.

21(b) “Certification” means, as it pertains to the peer, parent,
22transition-age, and family support specialist certification program,
23all federal and state requirements have been satisfied, federal
24financial participation under Title XIX of the federal Social
25Security Act (42 U.S.C. Sec. 1396 et seq.) is available, and all
26necessary federal approvals have been obtained.

27(c) “Certified” means all federal and state requirements have
28been satisfied by an individual who is seeking designation under
29this article, including completion of curriculum and training
30requirements, testing, and agreement to uphold and abide by the
31code of ethics.

32(d) “Certification examination” means the competency testing
33requirements, as approved by the department, an individual is
34required to successfully complete as a condition of becoming
35certified under this article. Each training program approved by the
36department may develop a unique competency examination for
37each category of peer, parent, transition-age, and family support
38specialist listed in subdivision (b) of Section 14045.14. Each
39certification examination shall include core curriculum elements.

P6    1(e) “Code of ethics” means the professional standards each
2certified peer, parent, transition-age, and family support specialist
3listed in subdivision (b) of Section 14045.14 is required to agree
4to uphold and abide by. These professional standards shall include
5principles, expected behavior and conduct of the certificate holder
6in an agreed-upon statement that is required to be provided to the
7applicant and acknowledged by signing with his or her personal
8signature prior to being granted certification under this article.

9(f) “Core competencies” are the foundational and essential
10competencies required by each category of peer, parent,
11transition-age, and family support specialists listed in subdivision
12(b) of Section 14045.14 who provide peer support services.

13(g) “Cultural competence” means a set of congruent behaviors,
14attitudes, and policies that come together in a system or agency
15that enables that system or agency to work effectively in
16cross-cultural situations. A culturally competent system of care
17acknowledges and incorporates, at all levels, the importance of
18language and culture, intersecting identities, assessment of
19cross-cultural relations, knowledge and acceptance of dynamics
20of cultural differences, expansion of cultural knowledge, and
21adaptation of services to meet culturally unique needs to provide
22services in a culturally competent manner.

23(h) “Family peer support specialist” means a person with lived
24experience as a self-identified family member of an individual
25experiencing mental illness, substance use disorder, or both, and
26the skills learned in formal trainings to assist and empower families
27of individuals experiencing mental illness, substance use disorder,
28or both. For the purposes of this subdivision, “family member”
29 includes a sibling or kinship caregiver, and their partners.

30(i) “Parent” means a person who is parenting or has parented a
31child or individual experiencing mental illness, substance use
32disorder, or both, and who can articulate his or her understanding
33of his or her experience with another parent or caregiver. This
34person may be a birth parent, adoptive parent, or family member
35standing in for an absent parent.

36(j) “Parent peer support specialist” means a parent with formal
37training to assist and empower families parenting a child or
38individual experiencing mental illness, substance use disorder, or
39both.

P7    1(k) “Peer support specialist services” means culturally competent
2services that promote engagement, socialization, recovery,
3self-sufficiency, self-advocacy, development of natural supports,
4identification of strengths, and maintenance of skills learned in
5other support services. Peer support specialist services shall
6include, but are not limited to, support, coaching, facilitation, and
7education to Medi-Cal beneficiaries that is individualized to the
8beneficiary and is conducted by a certified adult peer support
9specialist, a certified transition-age youth peer support specialist,
10a certified family peer support specialist, or a certified parent peer
11support specialist.

12(l) “Recovery” means a process of change through which an
13individual improves his or her health and wellness, lives a
14self-directed life, and strives to reach his or her full potential. This
15process of change recognizes cultural diversity and inclusion, and
16honors the different routes to resilience and recovery based on the
17individual and his or her cultural community.

18(m) “Transition-age youth peer support specialist” means a
19person who is 18 years of age or older and who has self-identified
20as having lived experience of recovery from mental illness,
21substance use disorder, or both, and the skills learned in formal
22trainings to deliver peer support services in a behavioral setting to
23promote mind-body recovery and resiliency for transition-age
24youth, including adolescents and young adults.

25

14045.14.  

No later than July 1, 2017, the department, as the
26sole state Medicaid agency, shall establish a peer, parent,
27transition-age, and family support specialist certification program
28that, at a minimum, shall do all of the following:

29(a) Establish a certifying body, either within the department,
30through contract, or through an interagency agreement, to provide
31for the certification of peer, parent, transition-age, and family
32support specialists as described in this article.

33(b) Provide for a statewide certification for each of the following
34categories of peer support specialists, as contained in federal
35guidance issued by the Centers for Medicare and Medicaid
36Services, State Medicaid Director Letter (SMDL) #07-011:

37(1) Adult peer support specialists, who may serve individuals
38across the lifespan.

39(2) Transition-age youth peer support specialists.

40(3) Family peer support specialists.

P8    1(4) Parent peer support specialists.

2(c) Define the range of responsibilities and practice guidelines
3for the categories of peer support specialists listed in subdivision
4begin delete (b).end deletebegin insert (b), by utilizing best practice materials published by the federal
5Substance Abuse and Mental Health Services Administration, the
6federal Department of Veterans Affairs, and related notable experts
7in the field as a basis for development.end insert

8(d) Determine curriculum and core competencies, including
9curriculum that may be offered in areas of specialization, such as
10older adults, veterans, family support, forensics, whole health,
11juvenile justice, youth in foster care, sexual orientation, gender
12identity, and any other areas of specialization identified by the
13department. Specialized curriculum shall be determined for each
14of the categories of peer, parent, transition-age, and family support
15specialists listed in subdivision (b). Core competencies-based
16curriculum shall include, at a minimum, all of the following
17elements:

18(1) The concepts of hope, recovery, and wellness.

19(2) The role of advocacy.

20(3) The role of consumers and family members.

21(4) Psychiatric rehabilitation skills and service delivery, and
22addiction recovery principles, including defined practices.

23(5) Cultural competence training.

24(6) Trauma-informed care.

25(7) Group facilitation skills.

26(8) Self-awareness and self-care.

27(9) Cooccurring disorders of mental health and substance use.

28(10) Conflict resolution.

29(11) Professional boundaries and ethics.

30(12) Safety and crisis planning.

31(13) Navigation of, and referral to, other services.

32(14) Documentation skills and standards.

33(15) Study and test-taking skills.

34(e) Specify training requirements, including
35core-competencies-based training and specialized training
36necessary to become certified under this article, allowing for
37multiple qualified training entities, and requiring training to include
38people with lived experience as consumers and family members.

39(f) Specify required continuing education requirements for
40certification.

P9    1(g) Determine clinical supervision requirements for personnel
2certified under this article, that shall require, at a minimum,
3personnel certified pursuant to this article to work under the
4direction of a mental health rehabilitationbegin delete specialistend deletebegin insert specialist, as
5defined in Section 782.35 of Title 9 of the California Code of
6Regulations,end insert
or substance use disorder professional.begin insert A licensed
7mental health professional, as defined in Section 782.26 of Title
89 of the California Code of Regulations, may also provide
9supervision.end insert

10(h) Establish a code of ethics.

11(i) Determine the process for certification renewal.

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

13(k) Determine a process for allowing existing personnel
14employed in the peer support field to obtain certification under
15this article, at their option.

16

14045.15.  

In order to be certified as an adult peer support
17specialist, an individual shall, at a minimum, satisfy all of the
18following requirements:

19(a) Be at least 18 years of age.

20(b) Have or have had a primary diagnosis of mental illness,
21substance use disorder, or both, which is self-disclosed.

22(c) Have received or is receiving mental health services,
23substance use disorder services, or both.

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

25(e) Demonstrate leadership and advocacy skills.

26(f) Have a strong dedication to recovery.

27(g) Agree to uphold and abide by a code of ethics. A copy of
28the code of ethics shall be signed by the applicant.

29(h) Successful completion of the curriculum and training
30requirements for an adult peer support specialist.

31(i) Pass a certification examination approved by the department
32for an adult peer support specialist.

33(j) Successful completion of any required continuing education,
34training, and recertification requirements.

35

14045.16.  

In order to be certified as a transition-age youth peer
36support specialist, an individual shall, at a minimum, satisfy all of
37the following requirements:

38(a) Be at least 18 years of age.

39(b) Have or have had a primary diagnosis of mental illness,
40substance use disorder, or both, which is self-disclosed.

P10   1(c) Have received or is receiving mental health services,
2substance use disorder addiction services, or both.

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

4(e) Demonstrate leadership and advocacy skills.

5(f) Have a strong dedication to recovery.

6(g) Agree to uphold and abide by a code of ethics. A copy of
7the code of ethics shall be signed by the applicant.

8(h) Successful completion of the curriculum and training
9requirements for a transition-age youth peer support specialist.

10(i) Pass a certification examination approved by the department
11for a transition-age youth peer support specialist.

12(j) Successful completion of any required continuing education,
13training, and recertification requirements.

14

14045.17.  

In order to be certified as a family peer support
15specialist, an individual shall, at a minimum, satisfy all of the
16following requirements:

17(a) Be at least 18 years of age.

18(b) Be self-identified as a family member of an individual
19experiencing mental illness, substance use disorder, or both.

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

21(d) Demonstrate leadership and advocacy skills.

22(e) Have a strong dedication to recovery.

23(f) Agree to uphold and abide by a code of ethics. A copy of
24the code of ethics shall be signed by the applicant.

25(g) Successful completion of the curriculum and training
26requirements for a family peer support specialist.

27(h) Pass a certification examination approved by the department
28for a family peer support specialist.

29(i) Successful completion of any required continuing education,
30training, and recertification requirements.

31

14045.18.  

In order to be certified as a parent peer support
32specialist, an individual shall, at a minimum, satisfy all of the
33following requirements:

34(a) Be at least 18 years of age.

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

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

37(d) Demonstrate leadership and advocacy skills.

38(e) Have a strong dedication to recovery.

39(f) Agree to uphold and abide by a code of ethics. A copy of
40the code of ethics shall be signed by the applicant.

P11   1(g) Successful completion of the curriculum and training
2requirements for a parent peer support specialist.

3(h) Pass a certification examination approved by the department
4for a parent peer support specialist.

5(i) Successful completion of any required continuing education,
6training, and recertification requirements.

7

14045.19.  

This article shall not be construed to imply that an
8individual who is certified pursuant to this article is qualified to,
9or authorize that individual to, diagnose an illness, prescribe
10medication, or provide clinical services.

11

14045.20.  

The department shall closely collaborate with the
12Office of Statewide Health Planning and Development (OSHPD)
13and its associated workforce collaborative, and regularly consult
14with interested stakeholders, including peer support and family
15organizations, mental health and substance use disorder services
16providers and organizations, the County Behavioral Health
17Directors Association of California, health plans participating in
18the Medi-Cal managed care program, the California Mental Health
19Planning Council, and other interested parties in developing,
20implementing, and administering the peer, parent, transition-age,
21and family support specialist certification program established
22pursuant to this article. This consultation shall initially include, at
23a minimum, bimonthly stakeholder meetings, which may also
24include technical workgroup meetings. The department may seek
25private funds from a nonprofit organization or foundation for this
26purpose.

27

14045.21.  

The department may contract to obtain technical
28assistance for the development of the peer, parent, transition-age,
29and family support specialist certification program, as provided
30in Section 4061.

31

14045.22.  

(a) The department shall amend its Medicaid state
32plan to do both of the following:

33(1) Include each category of peer, parent, transition-age, and
34family support specialist listed in subdivision (b) of Section
3514045.14 certified pursuant to this article as a provider type for
36purposes of this chapter.

37(2) Include peer support specialist services as a distinct service
38type for purposes of this chapter, which may be provided to eligible
39Medi-Cal beneficiaries who are enrolled in either a Medi-Cal
P12   1managed mental health care plan or a Medi-Cal managed care
2health plan.

3(b) The department may seek any federal waivers or other state
4plan amendments as necessary to implement the certification
5program provided for under this article.

6(c) begin deleteThis article end deletebegin insertMedi-Cal reimbursement for peer support
7services end insert
shall be implemented only if and to the extent that federal
8financial participation under Title XIX of the federal Social
9Security Act (42 U.S.C. Sec. 1396 et seq.) is available and all
10necessary federal approvals have been obtained.

11

14045.23.  

To facilitate early intervention for mental health
12services, community health workers may partner with peer, parent,
13transition-age, and family support specialists for engagement,
14outreach, and education.

15

14045.24.  

It is not the intent of the Legislature in enacting this
16article to modify the Medicaid state plan in any manner that would
17otherwise change or nullify the requirements, billing, or
18reimbursement of the “other qualified provider” provider type, as
19currently authorized by the Medicaid state plan.

20

14045.25.  

The department may utilize Mental Health Services
21Act funds, as authorized in subdivision (d) of Section 5892, and
22any designated Workforce Education and Training Program
23resources, including funding, as administered by OSHPD pursuant
24to Section 5820, to develop and administer the peer, parent,
25transition-age, and family support specialist certification program.
26begin delete Theseend deletebegin insert Further, theseend insert Mental Health Service Act funds maybegin insert thenend insert
27 serve as the state’s share of funding to develop and administer the
28peer, parent, transition-age, and family support specialist
29certification program and shall be available for purposes of
30claiming federal financial participation under Title XIX of the
31federal Social Security Act (42 U.S.C. Sec. 1396 et seq.) once all
32necessary federal approvals have been obtained.

begin insert
33

begin insert14045.251.end insert  

The department may establish a certification fee
34schedule and may require remittance as contained in the
35certification fee schedule for the purpose of supporting the
36department’s activities associated with the ongoing state
37administration of the peer, parent, transition-age, and family
38support specialist certification program. The department shall
39utilize all funding resources as made available in Section 14045.25
40first, prior to determining the need for the certification fee schedule
P13   1and requiring the remittance of fees. It is the intent of the
2Legislature that any certification fees charged by the department
3be reasonable and reflect the expenditures directly applicable to
4the ongoing state administration of the peer, parent, transition-age
5and family support specialist certification program.

end insert
6

14045.26.  

For the purposes of implementing this article, the
7department may enter into exclusive or nonexclusive contracts on
8a bid or negotiated basis, including contracts for the purpose of
9obtaining subject matter expertise or other technical assistance.
10Contracts may be statewide or on a more limited geographic basis.

11

14045.27.  

Notwithstanding Chapter 3.5 (commencing with
12Section 11340) of Part 1 of Division 3 of Title 2 of the Government
13Code, the department may implement, interpret, or make specific
14this article by means of plan letters, plan or provider bulletins, or
15similar instructions, without taking regulatory action, until the
16time regulations are adopted. The department shall adopt
17regulations by July 1, 2019, in accordance with the requirements
18of Chapter 3.5 (commencing with Section 11340) of Part 1 of
19Division 3 of Title 2 of the Government Code. Notwithstanding
20Section 10231.5 of the Government Code, beginning six months
21after the effective date of this article, the department shall provide
22semiannual status reports to the Legislature, in compliance with
23Section 9795 of the Government Code, until regulations have been
24 adopted.

25

SEC. 2.  

The Legislature finds and declares that this act clarifies
26procedures and terms of the Mental Health Services Act within
27the meaning of Section 18 of the Mental Health Services Act.



O

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