GAO refers to the District of Columbia as a state. Officials from the three states GAO reviewed—Colorado, Missouri, and Oregon— reported that their Medicaid
Medicaid
Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Health Insurance As…
Full Answer
Does Medicaid cover peer support services?
If state Medicaid program covers peer support under the fee-for-service benefit, the health plans are also required to cover these services. Some states have special provisions that allow them to only cover peer supports for limited groups of individuals, such as those enrolled in managed care.
Does your state reimburse peer support specialists?
Some states also allow peer support specialists to act as qualified health care professionals for certain types of behavioral health services, but do not allow for the specific reimbursement of peer support services.
Does Medicaid financed peer support reduce crisis stabilization and psychiatric hospitalizations?
Conclusions: While the implementation of Medicaid financed peer support programs may not result in savings from reductions of costly crisis stabilizations and psychiatric hospitalizations, it does support the principles of self-direction and recovery from severe mental illness.
Do peer support programs cost more to public programs?
Background: Peer support programs have proliferated over the past decade, building on recovery oriented programming, yet relationships between peer support services and the costs to public programs have not been well described in literature.
Why should Medicare cover peer support?
Peers Make a Difference: Why Medicare and Other Insurers Should Cover Peer Support. Peer support promotes recovery from mental health conditions and substance use disorders by helping individuals better engage in services, manage physical and mental health conditions, build support systems, and ultimately, live self-directed lives in their ...
What is peer support?
Peer support specialists use their own lived experience, have specialized training, and are certified by their state or national certification body, to assist individuals in achieving recovery goals by furnishing emotional, informational, and other support services to individuals with a mental illness, including dementia, and/or a substance use disorder.
Why is collaborative care important for Medicare?
MHA strongly supports collaborative care because the model promotes screening, early intervention, addressing mental health as part of overall healthcare, and reducing health disparities.
Do Nebraska peer support specialists get paid?
Peer support specialists in Nebraska and elsewhere often work their way off federal/state assistance to be self-sufficient, but in many states peers are not paid a living wage and often are forced to live in poverty or leave the field they love for better wages.
Which states offer peer support services?
Officials from the three states GAO reviewed—Colorado, Missouri, and Oregon —reported that their Medicaid programs offered peer support services as a complement, rather than as an alternative, to clinical treatment for SUD.
Is peer support part of Medicaid?
Similarly, officials in Colorado and Oregon said peer support services were only offered as part of a treatment plan. State officials reported that peer support services could be offered as an alternative to clinical treatment outside of Medicaid using state or grant funding.
Does Medicaid cover peer support?
State Medicaid programs have the option to cover services offered by peer providers—individuals who use their own lived experience recovering from SUD to support others in recovery. GAO's review of Medicaid and CHIP Payment and Access Commission data found that, in 2018, 37 states covered peer support services for adults with SUDs in their Medicaid ...
What does Medicare Part B cover?
Part B also covers durable medical equipment, home health care, and some preventive services.
Does Medicare cover tests?
Medicare coverage for many tests, items, and services depends on where you live . This list includes tests, items, and services (covered and non-covered) if coverage is the same no matter where you live.
What is the training required for a peer support provider in Georgia?
Peer support providers must be trained using a local adaptation of the Georgia Certified Peer Specialist training curriculum or an equivalent. The managed care organization worked with the State and other stakeholders to develop the local training curriculum, including monthly ongoing training.40 The peer support program must submit its proposed curriculum for approval by the managed care organization when applying to provide peer support.41
What is 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.9 Peer support features a one-way relationship where the provider assists the participant using particular expertise that includes but is not limited to his/her experience in recovery.
How often do you need to meet with a mental health professional for peer support?
Like other mental health services, the peer support must be supervised by a mental health professional, who meets each provider at least twice per month for clinical consultation. A mental health professional must be available at all times for telephone consultation. There are no additional requirements specific to the peer support service, such as certification as psychiatric rehabilitation professional.38
What is the Georgia Mental Health Certification Program?
The State and the Georgia Mental Health Consumer Network developed a standard training and certification process. People must apply to the State to participate in the training program. The state selects training participants, giving priority to a) people employed by a provider of Medicaid mental health services; and b) consumers who have demonstrated peer leadership and are sponsored by a Medicaid mental health provider.
What is a certified peer specialist?
As required by CMS, Certified Peer Specialist services must be supervised by a mental health professional. The State prefers supervising professionals be credentialed as a psychiatric rehabilitation professional by the U.S. Psychiatric Rehabilitation Association (formerly IAPSRS). The State also prefers supervising professionals themselves be a Certified Peer Specialist, which is important for consumer-operated service models where most or all staff have a mental illness.34
How many studies have evaluated the effect of services other than peer support provided entirely by peers?
Three studies have evaluated the effect of services other than peer support provided entirely by peers who relate to participants in part based on their personal recovery experience. The three studies focused on different services: case management, a crisis intervention facility, and supported employment.26
What are the positive findings of peer support?
In a 1982 study, a peer specialist program was established for people to use upon discharge from a psychiatric residential treatment facility. The facility was not a hospital, but a community-based facility that provided rehabilitative services after a hospitalization . In a randomized controlled trial, people with access to peer support had fewer hospital admissions and one-third the number of inpatient hospital days in a 10-month period, when compared to people who did not have access to peer support.18
