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

• Completed 1500 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 law and ethics. 
• ​CEUs can be in relevant professional competencies obtained via relevant in-state, out-of-state, or national educational forums
• Passed the Medi-Cal Peer Support Specialist 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
• Provided three Letters of Recommendation as outlined:
• ​​One from a supervisor 
• One from a colleague/professional
• One self-recommendation describing their current role and responsibilities as a peer support worker 

What does cultural and structural competence mean (as outlined in the core competencies)?​

Cultural competency is a set of congruent behaviors, attitudes, and policies that come together in a system or agency or among professionals that enables effective interactions in a cross-cultural framework.^{1 2} ​

Structural competency is the trained ability to discern how a host of issues defined clinically as symptoms, attitudes, or diseases (e.g., depression, hypertension, obesity, smoking, medication “non-compliance", trauma, psychosis) also represent the implications of attitudes that are influenced by social determinants of health.

What are the continuing education requirements for a Medi-Cal Peer Support Specialist? 

Medi-Cal Peer Support Specialists must complete 20 hours of continuing education 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.

Can the 20-hour continuing education requirement include hours of training completed in an area of specialization?

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.​

What is the process for renewing a lapsed certification? ​

Certification is considered lapsed immediately following the date of expiration. If a Medi-Cal Peer Support Specialist’s certification lapses but they are within four years from the date that their initial certification expired, the certification program or representing agency must allow renewal of certification if the candidate completes 40 hours of refresher training, passes the state-approved Medi-Cal Peer Support Specialist certification program examination, and agrees, in writing, to adhere to the most recent version of the Code of Ethics for Medi-Cal Peer Support Specialist in California.³ If four years or more have elapsed since initial certification expired, candidates who would like to certify as peers are required to complete the initial certification process to regain certification.

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

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.

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

No. The Medi-Cal Peer Support Specialist certification is only a requirement if the county would like to be reimbursed by Medi-Cal for the provision of covered peer support services to Medi-Cal members. ​

Will the Children and Youth Behavioral Health Initiative and/or Family First Prevention Services Act (FFPSA) aftercare providers need to obtain the Medi-Cal Peer Support Specialist certification?

If the Children and Youth BH Initiative and/or FFPSA aftercare providers are located within counties that have opted-in to provide Medi-Cal Peer Support Services and plan to deliver Medi-Cal Peer Support Services as described in BHIN 22-026, then the providers must comply with all Medi-Cal Peer Support Specialist provider requirements, including obtaining a Medi-Cal Peer Support Specialist certification. Services provided and claimed under other non-Peer Medi-Cal codes or funding sources are not impacted. ​

Areas of Specialization​

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

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

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

Yes. F​ormerly incarcerated individuals may complete the forensic (justice involved) specialization.

Are the hours of training in an area of specialization in addition to the 80 hours of training for initial certification?

Yes. The trainings for areas of specialization must be completed in addition to the 80 hours of training required for initial certification.

Are Medi-Cal Peer Support Specialists who work in a specialization, such as a parent, caregiver, and family member peers, required to complete the area of specialization training?

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 beneficiaries. Training in areas of specialization is optional.

Who is responsible for developing the Medi-Cal Peer Support Services curriculum for each area of specialization?

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

Can certification programs offer areas of specialization in addition to the required specializations specified under BHIN 21-041?

Yes, counties, or county-selected certification programs, may propose additional areas of specialization by submitting the proposed curriculum and core competencies to DHCS for approval.​

Medi-Cal Peer Support Specialist Oversight

Per BHIN 22-026, Medi-Cal Peer Support Specialists must provide services under the direction of a Behavioral Health Professional. A Behavioral Health Professional must be licensed, waivered, or registered in accordance with applicable State of California licensure requirements and be listed in the California Medicaid State Plan as a qualified provider of SMHS, DMC, or DMC-ODS.  ​​​

All SUD and Expanded SUD services, including Medi-Cal Peer Support Services, must be recommended by physicians or other LPHAs acting within their scope of practice and in accord with medical necessity.   ​

All SMHS, including Medi-Cal Peer Support Services, must be recommended by physicians or other LMHPs acting with their scope of practice and in accord with medical necessity.  ​

Therefore, for purposes of directing Medi-Cal Peer Support Specialist services within the SMH, DMC, or DMC-ODS delivery systems, the term “Behavioral Health Professional" encompasses LPHAs and LMHPs, with LPHA being specific to DMC/DMC-ODS and LMHP specific to SMHS. Any provider types not licensed, waivered, or registered in accordance with applicable State of California licensure requirements and listed in the California Medicaid State Plan as a qualified provider of SMHS, DMC, or DMC-ODS, would not be considered a “Behavioral Health Professional".

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

Medi-Cal Peer Support Specialist Supervisors are not required to be Behavioral Health Professionals, as defined in BHIN 22-026. As stated in BHIN 21-041, Medi-Cal Peer Support Specialist Supervisors must meet at least one of the following qualifications:

• Have a Medi-Cal Peer Support Specialist certification program certification; have two years of experience working in the behavioral health system; and have completed a DHCS approved peer support supervisory training curriculum.

OR

• Be a non-peer Behavioral Health Professional (including registered & certified SUD counselors) who has worked in the behavioral health system for a minimum of two years, and has completed a DHCS approved peer support supervisory training;

OR

• Have a high school diploma or GED, four years of behavioral health direct service experience that may include Peer Support Services; and have completed an approved peer support supervisory training curriculum.

If a Medi-Cal Peer Support Specialist's supervisor is not also a Behavioral Health Professional as defined in BHIN 22-026, the Medi-Cal Peer Support Specialist must also provide services under the direction of a Behavioral Health Professional who meets the above qualifications.​

Did DHCS establish requirements for a supervisory training curriculum?​

DHCS outlined requirements for Medi-Cal Peer Support Specialist Supervisors in BHIN 21-041. CalMHSA, as the current sole county-selected certification program, developed a supervisory training curriculum that has been approved by DHCS. DHCS encourages counties to support Medi-Cal Peer Support Specialists as supervisors of their peer workforce. 

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

DHCS has not set standardized staffing ratios for Medi-Cal Peer Support Specialist Supervisors and Medi-Cal Peer Support Specialists.

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

Counties, or an agency representing the county, subject to approval by 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.

What role does CalMHSA play in the Medi-Cal Peer Support Specialist certification process?

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 the California Mental Health Services Authority (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 Behavioral Health Information Notice (BHIN) 21-041. 

Are there different certification programs for Medi-Cal Peer Support Specialists providing mental health and substance use disorder services?

While several Peer certification programs exist, the only certification program for Medi-Cal Peer Support Specialists is administered by CalMHSA. For more information, visit the CalMHSA webpage.

How will DHCS monitor Medi-Cal Peer Support Specialist certification programs to ensure compliance?

Medi-Cal Peer Support Specialist certification programs are required to develop a corrective action, complaints, and appeals processes. Certification programs are required to report annually to DHCS and are subject to county Medi-Cal triennial reviews.

​​What steps are required for counties to 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.​​

Do counties have to opt in to provide Medi-Cal Peer Support Services in both the Drug Medi-Cal and Specialty Mental Health Services delivery systems?

No. Counties can opt into Medi-Cal Peer Support Services for one or both delivery systems. For example, a county can begin implementing services in the SMHS delivery system, and then opt-in later to provide the benefit in the DMC or DMC-ODS delivery system.

Will counties opting in to provide Medi-Cal Peer Support Services in DMC-ODS be required to provide the benefit in Opioid Treatment Programs (OTPs)?

No. DHCS does not require Medi-Cal Peer Support Services to be provided by OTPs.​

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

Yes. As described in BHIN 22-026, in accordance with the EPSDT mandate under Section 1905(r) of the Social Security Act, all counties, irrespective of their choice to opt-in to providing Peer Support Services as a Medi-Cal service, must ensure that all beneficiaries under age 21 receive medically necessary services to correct or ameliorate health conditions that are coverable under Section 1905(a) of the Social Security Act, which includes Peer Support Services. DHCS' implementation of Peer Support Services as a distinct DMC, DMC-ODS, and SMHS benefit does not limit or modify the scope of the EPSDT mandate.

Does DHCS require completed background checks for certified Medi-Cal Peer Support Specialists providing Medi-Cal Peer Support Services?

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 requirements regarding suspended and ineligible providers pursuant to W&I Code sections 14043.6 and 14123 and applicable requirements in the Mental Health Plan (MHP) contract.

How can a community-based organization that provides peer services participate in Medi-Cal?

Medi-Cal Peer Support Services are covered behavioral health services administered by county behavioral health agencies that have opted-in to provide Medi-Cal Peer Support Services through DMC/DMS-ODS and/or SMHS. 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 in which they are interested in offering services to discuss contracting requirements.

Does “engagement" as related to Peer Support Services and outlined in BHIN 22-026 include activities related to supporting a beneficiary accessing services?

As indicated in Supplement 3 to Attachment 3.1-A of the California State Plan and BHIN 22-026, “engagement" is described as Medi-Cal Peer Support Specialist-led activities and coaching to encourage and support beneficiaries to participate in behavioral health treatment. Engagement may include supporting beneficiaries in their transitions between levels of care and supporting beneficiaries in developing their own recovery goals and processes.

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

Yes. Medi-Cal Peer Support Services may be provided face-to-face, by telephone, or by telehealth with the beneficiary or significant support person(s) and may be provided anywhere in the community⁴. ⁵Beneficiaries have the right to request and receive in-person services; please see BHIN 23-018 for more information.

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

Per BHIN 22-026, 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). DHCS recommends that group size be limited to no less than two and no more than twelve members at the same time. Providers operating in the SMHS, DMC, and DMC-ODS delivery systems should refer to the appropriate billing manual  for group claiming methodologies.^​6 Formal guidance on group size is forthcoming.

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? 

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. 

*Note that the rate for H0050 will not be deployed in SD/MC claim processing system until November 2023; therefore, DHCS recommends counties hold claims with H0050 until then.​

Are there separate billing codes to distinguish Medi-Cal Peer Support Services provided to beneficiaries from Medi-Cal Peer Support Services provided to family members or other caregivers?

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

Can Medi-Cal Peer Support Services be offered across all DMC-ODS American Society of Addiction Medicine (ASAM) levels of care?

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.

What mode and service function codes will the Medi-Cal Peer Support Services (i.e., “Behavioral Health Prevention Education Service" and “Self-Help/Peer Services") fall under on the Mental Health Cost Report?

When reporting units of service and costs for Medi-Cal Peer Support Services on the SMHS Cost Report, use Mode 15, Service Function 20.

How is “collateral services" defined in the context of Medi-Cal Peer Support Services?

As described in Supplement 3 to Attachment 3.1-A of the California State Plan and BHIN 22-026, Medi-Cal Peer Support Services can include contact with family members or other collaterals (family members or other people supporting the beneficiary), if the purpose of the collateral's participation is to focus on the treatment needs of the beneficiary by supporting the achievement of the beneficiary's goals. There may be times when, based on clinical judgment, the beneficiary is not present during the delivery of the service, but remains the focus of the service.

In BHIN 22-026, DH​CS references Medi-Cal Peer Support Specialists as "supporting beneficiaries in their transitions between levels of care". Would this function performed by Medi-Cal Peer Support Specialists qualify as Care Coordination in DMC-ODS or Targeted Case Management (TCM) in SMHS?​

No. Medi-Cal Peer Support Specialists providing Medi-Cal Peer Support Services to support beneficiaries in their transitions between levels of care is separate from Care Coordination and/or TCM and should be claimed as Medi-Cal Peer Support Services as described in BHIN 22-026.​

​​Can Medi-Cal Peer Support Services be delivered and claimed as a standalone service or provided in conjunction with other SMHS, DMC, or DMC-ODS services, including inpatient and residential services?

Medi-Cal Peer Support Services can be delivered and claimed as a standalone service – a beneficiary may receive Medi-Cal Peer Support Services even if they are not currently engaged in other outpatient services. A beneficiary 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 22-026. As specified in BHIN 22-026, for claims to be adjudicated, DMC, DMC-ODS, and/or SMHS counties must submit claims that include the Healthcare Common Procedure Coding System (HCPCS) and modifier combinations. Only DMC-ODS counties must specify the level of care in the claim, even if the beneficiary chose not to take up the services.

Do Medi-Cal Peer Support Specialists need to be enrolled in Provider Application and Validation for Enrollment (PAVE)?

Medi-Cal Peer Support Specialists operating within the Specialty Mental Health, DMC, or DMC-ODS delivery systems need to be employed by or contracted with an organizational provider. Medi-Cal Peer Support Specialists do not need to be enrolled in PAVE as long as the organizational provider that they are employed by or contracted with meets applicable PIMS and/or SMART6i enrollment requirements. In the Specialty Mental Health delivery system, organizational providers must be enrolled in the Provider Information Management System (PIMS). Organizational providers in the DMC and DMC-ODS delivery systems need to be enrolled in the Short-Doyle Medi-Cal Remediation Technology System (SMART6i).  

With the addition of Medi-Cal Peer Support Services, can providers who historically billed under “Other Qualified Providers" continue billing under service codes available to “Other Qualified Providers"?

DHCS is not removing any existing billing codes, services, or provider types in the SMHS, DMC, or DMC-ODS programs, including the “Other Qualified Provider" type. 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.

*Note that the rate for H0050 will not be deployed in SD/MC claim processing system until November 2023; therefore, DHCS recommends counties hold claims with H0050 until then.​

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

Medi-Cal rates claimed by the County Behavioral Health P​lan are published on the DHCS website and on the MEDCCC Library page under the “Service Rates" header and “Supplemental Rates Table" bullet. 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. ​

Miscellaneous​

If a Medi-Cal Peer Support Specialist relapses in their recovery and/or engages in treatment services, do they have to wait before providing Medi-Cal Peer Support 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.

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

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. Consequently, compensation for individual Medi-Cal Peer Support Specialists may vary across counties and other organizations that employ Peers.

¹W&I 14045.12(e)

²Cross et al. 1998. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington DC: CASSP Technical Assistance Center, Georgetown University Child Development Center.

³BHIN 21-041 at page 6. Per BHIN 21-041, the 40-hour refresher training must cover the core competencies but would be a condensed version of the full 80-hour curriculum. This refresher curriculum must also be approved by DHCS.

⁴Specialty Mental Health Medi-Cal Billing Manual (Revised 4/2023) 

⁵DMC-ODS Recovery Services FAQs

^​6See the DHCS MedCCC Library for up-to-date billing manuals for SMHS, DMC, and DMC-ODS.​​​​​