​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Medi-Cal Peer Support Services Specialist Program - Frequently Asked Questions

This webpage provides answers to common questions regarding the Medi-Cal Peer Support Specialist Program. Please contact the County Support inbox by emailing CountySupport@dhcs.ca.gov if you are unable to find the answer to your question below.

Questions related to California Mental Health Services Authority's (CalMHSA) role in Medi-Cal Peer Support Specialist certification, including questions about Medi-Cal Peer Support Specialist training, exams, and certification, may be directed to CalMHSA by emailing PeerCertification@calmhsa.org.

The following FAQs are organized into the following categories:

• Medi-Cal Peer Support Specialist Certification Standards
• Areas of Specialization
• Medi-Cal Peer Support Specialist Oversight
• Medi-Cal Peer Support Specialist Certification Programs
• Opting Into the Medi-Cal Peer Support Services Benefit
• Providing Medi-Cal Peer Support Services
• Billing for Medi-Cal Peer Support Services
• Miscellaneous
  

1. How can individuals get certified to become Medi-Cal Peer Support Specialists? 

Reference: BHIN 25-010

Individuals interested in becoming a certified Medi-Cal Peer Support Specialist must apply via an approved certification program. Currently, the only Medi-Cal Peer Support Specialist certification program is available through the California Mental Health Services Authority (CalMHSA). Please visit CalMHSA Peer Certification webpage or contact CalMHSA by emailing PeerCertification@calmhsa.org for information regarding certification. ​

2. What is the cost of Medi-Cal Peer Support Specialist certification? 

Reference: BHIN 25-010

Fees for individuals applying for Medi-Cal Peer Support Specialist certification are set by counties or county-selected certification programs. Currently, California Mental Health Services Authority (CalMHSA) is the sole certification program for all counties opting in to provide Medi-Cal Peer Support Services in California. CalMHSA's fees are posted on the CalMHSA website.  ​

3. Can the Department of Health Care Services (DHCS) waive the Medi-Cal Peer Support Specialist certification exam and/or approve a probationary certification without exam completion for otherwise qualified applicants? 

Reference: BHIN 25-010, W&I Code 14045.15

No. Applicants must pass a certification exam approved by the Department of Health Care Services (DHCS) to receive Medi-Cal Peer Support Specialist certification under the requirements in state law (W&I Code 14045.15).​

4. Can life or work experience be substituted for the GED or equivalent degree requirement? 

Reference: BHIN 25-010, W&I Code14045.15(a)

No. Per W&I Code14045.15(a), applicants must have a General Education Development (GED) or equivalent degree to qualify for Medi-Cal Peer Support Specialist certification.  ​

5. What are the requirements to be certified via the out-of-state reciprocity process?

Reference: BHIN 25-010

Qualified applicants must have:

• ​Completed 1550 hours as a peer support worker in three years or fewer, with 500 hours completed within the last 12 months;
• Completed 20 hours of continuing education units (CEUs), including six hours of law and ethics;
• CEUs can be in relevant professional competencies obtained via relevant in-state, out-of-state, or national educational forums;
• Has peer support worker certification in good standing issued in a state or territory outside of California;
• Passed the certification program exam;
• Agreed to adhere to the Code of Ethics for Medi-Cal Peer Support Specialists in California;
• Provided documentation of completion of at least one peer training; and
• Provided three Letters of Recommendation:
• One from a previous or current supervisor;
• One from a colleague/professional; and
• One self-recommendation describing their current role and responsibilities as a peer support worker

There is no employment deadline or sunset date for peer support workers with out-of-state certification to apply for reciprocity.​

6. When was the deadline to qualify to become a certified Medi-Cal Peer Support Specialist through the grandparenting process? 

Reference: BHIN 25-010

The deadline for grandparenting was June 30, 2023. The grandparenting process is no longer available. ​

7. What are the continuing education requiremen ts for a Medi-Cal Peer Support Specialist? 

Reference: BHIN 25-010

Medi-Cal Peer Support Specialists must complete 20 hours of continuing education, including six hours of continuing education on law and ethics, every two years. The continuing education must include updates on applicable laws and evidence-based best practices. Information on continuing education requirements is available on CAPeerCertification.org. ​

8. Does training completed in an area of specialization count toward the continuing education requirement?

Reference: BHIN 25-010

Yes. Area of specialization training hours completed by certified Medi-Cal Peer Support Specialists within the two years prior to a biennial certification can count towards the 20 hours of continuing education required to complete a biennial certification.​

9. What is the process for renewing a lapsed certification? 

Reference: BHIN 25-010

The certification statuses and procedures for renewal are as follows:

Lapsed: A certification is considered lapsed if it is not renewed by the renewal due date. The certification will remain lapsed for up to one year after the renewal due date if it is not renewed within this period.

• Process to bring certification current:
• Complete 20 hours of continuing education
• Reaffirm Code of Ethics
  
• Pay biennial renewal fee and late fee, if applicable​​
  

• Process to bring certification current:
• Complete 80-hour initial certification refresher course or pass certification exam
• Complete 20 hours of continuing education
• Reaffirm Code of Ethics
• Pay reinstatement fee and late fee, if applicable
  

• Process to bring certification current:
• Reapply for certification
• Complete 80-hour initial certification curriculum
• Pass certification exam
• Pay application fee, training fee, and exam fee​
  

10. Is there a minimum age requirement to become a Medi-Cal Peer Support Specialist​​?

Reference: BHIN 25-010, W&I Code 14045.15

Yes. Per W&I Code 14045.15, applicants must be at least 18 years of age to be certified as a Medi-Cal Peer Support Specialist. This does not preclude Medi-Cal Peer Support Specialists from working with youth or transitional-age youth.

11. Does a peer who does not work with Medi-Cal members need to be certified?

Reference: BHIN 25-010

No. The Medi-Cal Peer Support Specialist certification is only a specific certification requirement if the Medi-Cal behavioral health delivery system would like to be reimbursed by Medi-Cal for the provision of covered Medi-Cal Peer Support Services to Medi-Cal members. ​

Areas of Speciali​​zation

12. Can Medi-Cal Peer Support Specialists complete more than one specialization?

Reference: BHIN 25-010

Yes. Medi-Cal Peer Support Specialists may complete training for multiple specializations. 

13. Can formerly incarcerated individuals complete the forensic (justice involved) specialization?

Reference: BHIN 25-010

Yes. Formerly incarcerated individuals may complete the forensic (justice involved) specialization.

14. Can training in an area of specialization count toward the 80 hours of training for initial certification?

Reference: BHIN 25-010

No. The areas of specialization training hours do not count toward the 80 hours of training required for initial certification.

15. Are Medi-Cal Peer Support Specialists required to complete specialization training to be able to work in a specialization?

Reference: BHIN 25-010

No. DHCS does not require that Medi-Cal Peer Support Specialists complete training in an area of specialization before being able to provide Medi-Cal Peer Support Services to members. Training in areas of specialization is optional.

16. Who develops the curriculum for each area of specialization?

Reference: BHIN 25-010

State-approved Medi-Cal Peer certification programs are responsible for developing and submitting their curriculum for each area of specialization to Department of Health Care Services (DHCS) for approval.

17. Can Certification Programs offer areas of specialization in addition to the required specializations specified under BHIN 25-010?

Reference: BHIN 25-010

Counties, or county-selected Certification Programs, may propose supplemental areas of specialization by submitting a draft curriculum to the Department of Health Care Services (DHCS) at CountySupport@dhcs.ca.gov. Additional areas of specialization proposed by Certification Programs are subject to DHCS' review and approval.​

Medi-Cal Peer Support Specialist Oversight

18. What provider types are authorized to provide direction to Medi-Cal Peer Support Specialists?    

Reference: BHIN 25-010

For Medi-Cal Peer Support Services provided as Specialty Mental Health Services (SMHS), the following Behavioral Health Professionals are authorized to provide direction to a Medi-Cal Peer Support Specialist: a physician; a licensed or waivered psychologist; a licensed, waivered or registered social worker; a licensed, waivered or registered marriage and family therapist; a licensed, waivered or registered professional clinical counselor, a registered nurse (including a certified nurse specialist, or a nurse practitioner), and licensed occupational therapists.

For Medi-Cal Peer Support Services provided as a Drug Medi-Cal (DMC)/ Drug Medi-Cal Organized Delivery System (DMC-ODS) service, the following Behavioral Health Professionals are authorized to provide direction to a Medi-Cal Peer Support Specialist:  a physician; a nurse practitioner; a registered nurse; a licensed clinical psychologist; a licensed or registered clinical social worker; a licensed or registered professional clinical counselor; a licensed or registered marriage and family therapist; and licensed occupational therapists.

19. Are Medi-Cal Peer Support Specialist Supervisors required to be Behavioral Health Professionals? 

Reference: BHIN 25-010

Medi-Cal Peer Support Specialist Supervisors are not required to be Behavioral Health Professionals. As stated in BHIN 25-010, Medi-Cal Peer Support Specialist Supervisors must meet at least one of the following qualifications:

·         Have a Medi-Cal Peer Support Specialist certification; two years of experience providing behavioral health services directly to consumers; and completed a Department of Health Care Services (DHCS) approved Medi-Cal Peer Support Specialist Supervisor training curriculum pursuant to subdivision (b) of Section 7 of BHIN 25-010.

OR

• Be a Behavioral Health Professional pursuant to subdivision (a)(2) of Section 7 of BHIN 25-010; have two years of experience providing behavioral health services directly to consumers; and completed a DHCS approved Medi-Cal Peer Support Specialist Supervisor training curriculum pursuant to subdivision (b) of Section 7 of BHIN 25-010.

OR

• Have a high school diploma or GED, four years of experience providing behavioral health services directly to consumers (which may include providing Medi-Cal Peer Support Services), and completed a DHCS-approved Medi-Cal Peer Support Specialist Supervisor training curriculum pursuant to subdivision (b) of Section 7 of BHIN 25-010.

If a Medi-Cal Peer Support Specialist's supervisor is not also a Behavioral Health Professional as defined in BHIN 25-010, the Medi-Cal Peer Support Specialist must also provide services under the direction of a Behavioral Health Professional who meets the qualifications described in BHIN 25-010, section 6 subdivision (e).

20. Did the Department of Health Care Services (DHCS) establish require ments for a supervisory training curriculum?

Reference: BHIN 25-010

DHCS outlines requirements for Medi-Cal Peer Support Specialist Supervisors in BHIN 25-010. California Mental Health Services Authority (CalMHSA), as the current sole county-selected certification program, developed a DHCS-approved supervisory training curriculum. DHCS encourages counties to support Medi-Cal Peer Support Specialists as supervisors of their peer workforce.

21. How many Medi-Cal Peer Support Specialists can a Medi-Cal Peer Support Specialist Supervisor supervise?

Reference: BHIN 25-010

The Department of Health Care Services (DHCS) has not set standardized staffing ratios for Medi-Cal Peer Support Specialist Supervisors and Medi-Cal Peer Support Specialists. ​

Medi-Cal Peer Support Specialist Certification Programs

22. Who is responsible for administering Medi-Cal Peer Support Specialist certification programs?

Reference: BHIN 25-010

Counties, or an agency representing the county, subject to approval by Department of Health Care Services (DHCS), are responsible for developing, overseeing, and enforcing a Medi-Cal Peer Support Specialist certification program under W&I Code 14045.14 this means that while DHCS is responsible for setting the statewide standards for Medi-Cal Peer Support Specialist certification programs, each county, or entity representing a county, is responsible for developing a program that is aligned with those standards and ensuring it is administered appropriately.

23. What role does California Mental Health Services Authority (CalMHSA) play in the Medi-Cal Pe er Support Specialist certification process?

Reference: BHIN 25-010

Medi-Cal Peer Support Specialist certification programs can be established either by counties or county-selected entities. On behalf of all opt-in counties, the California Behavioral Health Directors' Association identified CalMHSA as the sole Medi-Cal Peer Support Specialist certification program to support consistency statewide. CalMHSA, on behalf of the counties they represent, must adhere to the state standards set forth in BHIN 25-010. ​

Opting Into the Medi-Cal Peer Support Services Benefit

24. If a county opts-in to provide Medi-Cal Peer Support Services, does it have to do so for both delivery systems (Specialty Mental Health and Drug Medi-Cal/Drug Medi-Cal Organized Delivery System)

Reference: BHIN 25-010

No. Under current DHCS policy, counties that chose to opt-in may do so for one or both delivery systems. For example, a county can begin implementing services in the Specialty Mental Health Services (SMHS) delivery system, and then later opt-in to provide the benefit in the Drug Medi-Cal (DMC) or Drug Medi-Cal Organized Delivery System (DMC-ODS), as applicable.

25. How do counties certify sites providing Medi-Cal Peer Support Services?

Counties must submit completed Provider File Update (PFU) forms and Medi-Cal Certification and Transmittal forms (Transmittal forms) adding Medi-Cal Peer Support Services for all organizational providers offering Medi-Cal Peer Support Services. Until updates are made to the Transmittal form, counties may handwrite the Peer Support Services Mode of Service 15/Service Function 20 combination on Transmittal form submissions.

26. Do counties that opt to provide Medi-Cal Peer Support Services in Drug Medi-Cal Organized Delivery System (DMC-ODS) have to provide it in Opioid Treatment Programs (OTPs)?

Reference: BHIN 25-010

No. Counties are not required to provide Medi-Cal Peer Support Services through OTPs.

27. How can community-based and peer-run organizations provide and bill for Medi-Cal Peer Support Services?

Reference: BHIN 25-010

Each opt-in county manages its own network of Medi-Cal Peer Support Specialists. Organizations interested in providing Medi-Cal Peer Support Services should contact the county or counties in which they are interested in offering services to discuss contracting opportunities and requirements. ​

Providing Medi-Cal Peer Support Services

28. Are counties required to provide medically necessary Medi-Cal Peer Support Services to members under age 21 in order to meet the counties' obligation under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) mandate?

Reference: BHIN 25-010

Yes. As described in BHIN 25-010 in accordance with the EPSDT mandate under Section 1905(r) of the Social Security Act, because Medi-Cal Peer Support Services are coverable under Section 1905(a) of the Social Security Act, all counties, irrespective of their choice to opt-in to providing Medi-Cal Peer Support Services, must ensure that all members under age 21 receive Medi-Cal Peer Support Services to correct or ameliorate discovered health conditions. DHCS' implementation of Medi-Cal Peer Support Services as a distinct Drug Medi-Cal (DMC), Drug Medi-Cal Organized Delivery System (DMC-ODS), and Specialty Mental Health Services (SMHS) benefit does not limit or modify the scope of the EPSDT mandate.

29. Does the Department of Health Care Services (DH CS) require completed background checks for certified Medi-Cal Peer Support Specialists providing Medi-Cal Peer Support Services?

Reference: BHIN 25-010

No. DHCS does not require criminal background checks for Medi-Cal Peer Support Specialists because they do not have a Fee-for-Service (FFS) Pathway in DHCS' provider enrollment system. Counties, or an agency representing the county, may institute background check requirements for Medi-Cal Peer Support Specialists. Medi-Cal Peer Support Specialists shall be subject to applicable requirements regarding suspended and ineligible providers pursuant to 14043.6 and 14123, and to applicable requirements in the Mental Health Plan (MHP) contract.14123, and to applicable requirements in the Mental Health Plan (MHP) contract.

30. Can Medi-Cal Peer Support Specialists deliver services via telehealth?

Reference: BHIN 23-018, SMHS, DMC, DMC-ODS Billing Manuals

Yes. Medi-Cal Peer Support Services may be provided face-to-face, by telephone, or by telehealth with the member or significant support person(s) and may be provided anywhere in the community. Members have the right to request and receive in-person services. For more information, see BHIN 23-018 and the MedCCC Library for up-to-date billing manuals for Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal-Organized Delivery System (DMC-ODS).

31. Are Medi-Cal Peer Support Specialists able to also work as Community Health Workers (CHWs)?

Reference: Community Health Worker Provider Manual

Medi-Cal Peer Support Specialists who meet the eligibility criteria for Community Health Workers (CHWs) may work as CHWs. Please see the CHW Provider Manual for information on the minimum qualifications for CHWs and CHW billing codes. Services provided by Medi-Cal Peer Support Specialist as a CHW, must utilize CHW taxonomy code. CHW services do not include Medi-Cal Peer Support Services as covered under the Drug Medi-Cal, Drug Medi-Cal Organized Delivery System, and Specialty Mental Health Services programs. CHW services are distinct and separate from Medi-Cal Peer Support Services.

32. What is considered an “approved plan of care" for Medi-Cal Peer Support Services?

Reference: BHIN 23-068, CMS State Medicaid Directors Letter 07-011

Per CMS State Medicaid Directors Letter 07-011, Peer Support Services, “must be coordinated within the context of a comprehensive, individualized plan of care that includes specific individualized goals." A plan of care for Medi-Cal Peer Support Services must include engaging the member to ensure it reflects the needs and preferences of the member.

An approved plan of care must be documented within the member's clinical record and approved by a treating provider who can render reimbursable Medi-Cal services. Please see BHIN 23-068 (or superseding guidance) for additional details regarding progress note documentation requirements for all Specialty Mental Health (SMH), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) services.

33. What are the requirements for Medi-Cal Peer Support Services documentation?

Reference: BHIN 23-068, W& Code §14045.13

Per W&I Code §14045.13, documentation skills and standards are a required core competency for Medi-Cal Peer Support Specialist certification programs to include in their curriculum. Please refer to BHIN 23-068 (or superseding guidance) for additional information for documentation requirements for Medi-Cal Behavioral Health services, including Medi-Cal Peer Support Services.

34. Are the care planning requirements for Targeted Case Management (TCM) and Intensive Care Coordination (ICC) the same as those for Medi-Cal Peer Support Services?

Reference: 42 CFR § 440.169(d)(2)

Medi-Cal Peer Support Services are distinct from Targeted Case Management and Intensive Care Coordination, which have their own care planning requirements. For additional information, see 42 CFR § 440.169(d)(2).

35. How are “collaterals" defined in the context of Medi-Cal Peer Support Services?

Reference: BHIN 25-010, Supplement 3 to Attachment 3.1-A of the California State Plan

As described in Supplement 3 to Attachment 3.1-A of the California State Plan and BHIN 25-010, Medi-Cal Peer Support Services can include contact with family members or other collaterals (family members or other people supporting the beneficiary). These services are typically directed at aiding significant support person(s) in the member's life, such as family members or close support networks, to better assist the member in achieving their mental health or substance use recovery goals. Collateral services may include consultations, education, and other forms of engagement that focus on equipping the member's support system with the knowledge or tools necessary to foster the individual's recovery and resilience. There may be times when, based on clinical judgment, the member is not present during the delivery of the service, but remains the focus of the service. ​

Billing for Medi-Cal Peer Support Services

36. Which procedure code should be used for Medi-Cal Peer Support Specialist group services and what are the group size parameters? 

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

Per BHIN 25-010, Medi-Cal Peer Support Specialist group services are covered under “Educational Skill Building Groups" and should be claimed under the “Behavioral Health Prevention Education Service" code (H0025). Group size is limited to no less than two and no more than twelve members at the same time. Providers operating in the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), and Drug Medi-Cal Organized Delivery System (DMC-ODS) should refer to the appropriate Medi-Cal billing manual for group claiming methodologies. (See the DHCS MedCCC Library for up-to-date billing manuals for SMHS, DMC, and DMC-ODS.)

37. In a group setting where both a Medi-Cal Peer Support Specialist and another provider are delivering services, is each provider type allowed to bill separately for the distinct services they provided?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

Per BHIN 25-010, Peer Support Services can be delivered and claimed as a standalone service or provided in conjunction with other SMHS, DMC, or DMC-ODS services. Medi-Cal Peer Support Services must be coordinated to avoid duplicative services. Therefore, when multiple practitioners render services to the same member at the same time, each practitioner must submit a separate claim for the distinct service each practitioner rendered to be eligible for Medi-Cal reimbursement when appropriately documented and billed. Note that Medi-Cal Peer Support Specialists are the only provider type eligible to bill codes H0038 and H0025 codes, and co-practitioners are not allowed in the DMC and DMC-ODS delivery systems.

Guidance related to Peer Support Specialist billing for the delivery of Peer Support Services is outlined in BHIN 25-010. Additional guidance for billing SMHS, DMC, and DMC-ODS services can be found in the DHCS MedCCC Library.

38. Can Medi-Cal Peer Support Specialists claim for non-Medi-Cal Peer Support Services provided to Medi-Cal members using service codes other than H0025, H0038, and H0050? 

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

Certified Medi-Cal Peer Support Specialists may only submit claims to Short Doyle Medi-Cal (SD/MC) for Medi-Cal Peer Support Services (H0038 and H0025) and Contingency Management (H0050) under the Peer taxonomy. If a Medi-Cal Peer Support Specialist meets the qualifications for another practitioner type (e.g., Other Qualified Provider), the Medi-Cal Peer Support Specialist may submit a separate claim under a different taxonomy code for any non-Medi-Cal Peer Support Services that are non-duplicative of Peer Support Services claimed. Medi-Cal Peer Support Specialists should refer to BHIN 25-010, section 11 for detailed guidance on claiming for services. 

39. Are there separate billing codes to distinguish Medi-Cal Peer Support Services provided to individuals and Medi-Cal Peer Support Services provided to family members or other caregivers?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

No. There is no distinct procedure code or modifier to distinguish Medi-Cal Peer Support Specialist services provided to individuals from services provided to family members or caregivers.

40. Can Medi-Cal Peer Support Services be delivered and claimed across all Drug Medi-Cal Organized Delivery System (DMC-ODS) American Society of Addiction Medicine (ASAM) levels of care?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

Yes. Medi-Cal Peer Support Services may be delivered and claimed as a standalone service, or a service delivered as part of an ASAM level of care under a covered DMC-ODS service.

41. What are the mode and service function codes for Medi-Cal Peer Support Services (i.e. ​“Behavioral Health Prevention Education Service" and “Self-Help/Peer Services")?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

Use Mode 15, Service Function 20 when reporting units of service and costs for Medi-Cal Peer Support Services on the Specialty Mental Health Services Cost Report.

42. Can Medi-Cal Peer Support Services be delivered and claimed as a standalone service or provided in conjunction with other Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), or Drug Medi-Cal Organized Delivery System (DMC-ODS) services, including inpatient and residential services?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals, 42 CFR § 438.208(b)(4)

Medi-Cal Peer Support Services may be delivered and claimed as a standalone service by a Medi-Cal Peer Support Specialist – a member may receive Medi-Cal Peer Support Services even if they are not currently engaged in other outpatient services. A member may also receive Medi-Cal Peer Support Services provided in conjunction with other SMHS, DMC, or DMC-ODS services, including, for example, Narcotic Treatment Program services – in these cases, Medi-Cal Peer Support Services should be claimed in addition to these services. For inpatient and residential levels of care, Medi-Cal Peer Support Services may be claimed in addition to, or concurrently with, residential or inpatient services that are claimed at per diem rates, as described in BHIN 25-010. As specified in BHIN 25-010, for claims to be adjudicated, SMHS counties, DMC counties, and/or DMC-ODS plans must submit claims that include the Healthcare Common Procedure Coding System (HCPCS) and modifier combinations. Only DMC-ODS plans must specify the level of care in the claim, even if the member chose not to take up the services. Medi-Cal Peer Support Specialist Services are not subject to prior authorization by Medi-Cal behavioral health delivery systems. In accordance with the SMHS, DMC, and DMC-ODS billing manuals, there are no lockouts for Medi-Cal Peer Support Services. (See the DHCS MedCCC Library for up-to-date billing manuals for SMHS, DMC, and DMC-ODS.)

Medi-Cal Peer Support Services may be delivered by any Medi-Cal Peer Support Specialist affiliated with an organizational provider that is contracted with a Medi-Cal behavioral health delivery system to provide Medi-Cal Peer Support Services. As described in 42 CFR § 438.208(b)(4), Medi-Cal Peer Support Services must be coordinated to avoid duplicative services.

43. Can Medi-Cal Peer Support Specialists provide rehabilitative mental health services described in the State Plan, including assessment, psychosocial rehabilitation, referral and linkages, therapy, and/or treatment planning?   

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals, Supplement 3 to Attachment 3.1-A of the California State Plan

Components of all the following services are consistent with the Medi-Cal Peer Support Specialist scope of services: Assessment, psychosocial rehabilitation, referral and linkages, and treatment planning. Medi-Cal Peer Support Specialists may use Medi-Cal Peer Support Procedure Codes (H0025 and H0038), as appropriate, for providing in-scope services. Medi-Cal Peer Support Specialists must not duplicate services and must follow all applicable billing and documentation guidance.

For example: It is within the scope of Medi-Cal Peer Support Services to provide components of the referral and linkages service, including identifying appropriate resources, making appointments, and assisting a beneficiary with a warm hand-off to obtain ongoing services. The Medi-Cal Peer Support Specialist would bill either H0025 or H0038, as appropriate, for providing these services.

Medi-Cal Peer Support Specialists are not able to conduct a SMHS or SUD clinical assessment. However, it is within the scope of Medi-Cal Peer Support Services to contribute information to a SMHS or SUD assessment. In this case, the Medi-Cal Peer Support Specialist would bill H0038, if appropriate.

44. Can Medi-Cal Peer Support Specialists provide substance use disorder and/or expanded substance use disorder services described in the State Plan, including assessment, individual counseling, group counseling, patient education, SUD crisis intervention services, care coordination, observation, and/or recovery services?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals, Supplement 3 to Attachment 3.1-A of the California State Plan

Components of the following services are consistent with the Medi-Cal Peer Support Specialist scope of services: Patient education, SUD crisis intervention services, care coordination, and recovery services. Medi-Cal Peer Support Specialists may use Medi-Cal Peer Support Procedure Codes (H0025 and H0038), as appropriate, for providing in-scope services. Medi-Cal Peer Support Specialists must not duplicate services and must follow all applicable billing and documentation guidance.

Examples include:

• Recovery services: The existing scope of Medi-Cal Peer Support Services is consistent with components of recovery services described in the State Plan, including care coordination, recovery monitoring, and relapse prevention. In this case, the Medi-Cal Peer Support Specialist may bill either H0025 or H0038, as appropriate.
• Care coordination: Medi-Cal Peer Support Specialists may use engagement services to support connections with practitioner and therapeutic activities to advocate for client's referrals, consistent with components of care coordination, as defined in the State Plan. In this case, a Medi-Cal Peer Support Specialist may bill H0038, as appropriate.​
  

45. Can providers who billed under “Other Qualified Providers" prior to Medi-Cal Peer Support Services continue billing under service codes available to “Other Qualified Providers"?

Reference: BHIN 25-010, SMHS, DMC, DMC-ODS Billing Manuals

The Department of Health Care Services (DHCS) is not removing any existing billing codes, services, or provider types in the Specialty Mental Health Services (SMHS), Drug Medi-Cal (DMC), or Drug Medi-Cal Organized Delivery System (DMC-ODS) programs, including the “Other Qualified Provider" type. “Other Qualified Providers" may continue claiming for tother services using the “Other Qualified Provider" taxonomy code. Medi-Cal Peer Support Specialists may only submit claims to Short Doyle Medi-Cal for Medi-Cal Peer Support Services and Contingency Management (H0038, H0025 and H0050) under the Peer taxonomy.

46. Where are rates for Medi-Cal Peer Support Services published?​

Reference: SMHS, DMC, DMC-ODS Billing Manuals

Medi-Cal rates claimed by the county behavioral health plan are published on the Department of Health Care Services (DHCS) website, specifically on Medical Behavioral Health Fee Schedules page. The county's Medi-Cal rates listed are not the rates paid to individual Medi-Cal Peer Support Specialists. Compensation for Medi-Cal Peer Support Specialists is determined by the organization that employs the Medi-Cal Peer Support Specialist.

47. Can certified Medi-Cal Peer Support Specialists use Medi-Cal Peer Support Services billing codes (e.g., H0038 & H0025) when providing mobile crisis or contingency management services?

Reference: BHIN 25-010, BHIN 23-025, BHIN 24-031

No. Medi-Cal Peer Support Specialists may not use Medi-Cal Peer Support Services billing codes while delivering services under the mobile crisis or contingency management benefits. See BHIN 25-010 for guidance related to Medi-Cal Peer Support Services, BHIN 23-025 for guidance related to Mobile Crisis Services, and BHIN 24-031 for guidance related to Contingency Management Services.​

Miscellaneous​

48. Can Medi-Cal Pe er Support Specialists who relapse in their recovery and/or engages in treatment services continue to provide services?

There is no state requirement in statute, regulation, waiver, or Interagency Agreement that individuals working as Medi-Cal Peer Support Specialists cannot provide services for any length of time after a relapse or engaging in treatment services.

49. How are Medi-Cal Peer Support Specialists' salaries or hourly rates developed?

Reference: BHIN 25-010

The Department of Health Care Services (DHCS) is not authorized under law to establish a pay scale for Medi-Cal Peer Support Specialists. Counties set rates of pay for county-employed Medi-Cal Peer Support Specialists. Counties also negotiate payment and contract terms with community-based organizations that employ Medi-Cal Peer Support Specialists and contract with the county to provide Medi-Cal behavioral health services. As a result, compensation for individual Medi-Cal Peer Support Specialists may vary across counties and other organizations that employ peers.

50. What opportunities for professional advancement exist for Medi-Cal Peer Support Specialists?

Reference: BHIN 25-010

Medi-Cal Peer Support Specialists may become Medi-Cal Peer Support Specialist Supervisors if they meet the eligibility and training requirements outlined in BHIN 25-010 and are assigned that role by their employer.

Counties and contracted organizations providing Medi-Cal Peer Support Services may develop additional career pathways, job roles, and titles for employees.​​