HCPF: Billing for Peer Support Services

Time and again at Tough as a Mother, we hear powerful stories of mothers in recovery. But more importantly, we also hear amazing stories of transformation – where moms turn their lived experience into a “pay-it-forward” moment. Moms like Megan, Glory, Dominique and Tessa are just some of our moms who now take the time to help others on their recovery journey because they know first-hand what moms need most.

“We have to be available to those individuals when they are ready to reach out for help. People can and do recover. I work in an agency where I see so many faces of hope and hear so many voices of recovery. And as long as we aren’t judgmental and unkind to one another, moms remain open to peer conversations and discover the possibility that somebody can live a purposeful life without drugs and alcohol.”

– Dominique Knowles CPFS, Springs Recovery Connection, Programs Director, Colorado Springs

With a shortage of care providers across the state, peer support is an important integration into your services to expand support and care. You should know that there is fiscal support for this component of care and the integration of peers into your work can be incredibly additive and rewarding.

Providers: As Colorado continues to build statewide support for peer specialists – an evidence-based approach to the continuum of care for people in recovery – it is important you have information on how to integrate this essential component to your system of care.

Did you know that you don’t have to be a Community Mental Health Center or Recovery Support Services Organization to bill for peer support services?

This month, we sat down with Colorado’s Department of Health Care Policy and Financing (HCPF) to learn more about how they have expanded the many peer specialist services covered under many provider types to include services peer specialists may deliver under a new provider type organization developed in partnership with the Behavioral Health Administration (BHA) called a Recovery Support Services Organization (RSSO). We also learned that the behavioral health billing manual (USCS Manual) lists a plethora of provider types that can bill for peer support services in a wide array of places of service.

Peer support can be coded and covered by Medicaid. Here is what you need to know and how to capitalize on this great benefit if your organization provides peer support services to Medicaid members
Peer services can be provided to address any diagnosis covered by the RAEs (not just SUD) when provided in line with the other coding requirements.
The member has been assessed using ASAM Criteria
The current substance use disorder benefit, as defined by The American Society of Addiction Medicine (ASAM), includes peer support and establishes the guidelines for every level of care in the recovery process. The ASAM criteria is a nationally recognized, evidence-based system that guides clinicians with matching patient needs to specific levels of care. The State of Colorado uses this criteria to determine level of care.
Your organization is enrolled with Medicaid and contracted with a Regional Accountable Entities (RAE). To bill for peer supports, reach out and work with your RAE. Peer services are submitted under the name of the licensed provider (“rendering provider”) who oversees the clinical care of the peer support provider. Many peer services are covered, but not all, so working with your RAE is an important step as the provider. Peers do not need to be licensed if they are working with you as a licensed provider. One of the most important criteria to ensure is that the member receiving services has a covered diagnosis.
Check out the peer services support page from HCPF. HCPF has developed a suite of resources for providers to fully understand peer support coverage.
Understand the specific codes and coverage. Here is a quick reference (refer to page 95) for some of the codes and options for peer support services to help you familiarize with options for care.

MOMS SHARING THEIR STORIES AND OFFERING PEER SUPPORT IS A POWERFUL PART OF RECOVERY. LEARN MORE ABOUT HOW YOU CAN TAP INTO COLORADO’S PEER SUPPORT CHANNELS AND ADD THIS CRITICAL ELEMENT TO YOUR CARE.

Issue 8