Recent research shows the value of peers for individuals with mental illnesses and addictive disorders—that peer support “pays.” Participation in peer support groups for addiction recovery promoted higher satisfaction in treatment and lower relapse rates (see Peer Support Groups In Addiction Treatment Boost Odds Of Long-Term Recovery). And peer support has been found to increase social support and social functioning, decrease psychotic symptoms, and reduce hospitalization rates (see Value of Peers, 2017).
The specialty provider community is responding accordingly. Last June when we conducted our Innovation Survey, we found that 51% of health and human services specialty provider organizations had adopted peer support specialists in their organization (see The 2017 OPEN MINDS National Innovation Survey: Innovation Adoption Among Specialty Provider Organizations).
But for the role of “peer support specialist” to be a sustainable one, provider organizations need a steady source of reimbursement for these services. So, the big question is what payers actually reimburse for peer support specialists?
Medicaid is the main payer for peer support services, although many state departments of behavioral health offer grant funding for these services. Currently, 39 state Medicaid programs cover peer support services for either individuals with mental illness, individuals with addiction disorders, or both groups. 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. 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.
Additionally, a look at Medicaid fee-for-service reimbursement rates for selective states found a wide variation in reimbursement. Group rates for a 15-minute period ranged from less than $2.00, to over $5.00 and individual rates ranged from $6.50 to $24.36 per 15 minutes. Comparatively, average peer specialist compensation was $15.42 in 2015 (see National Survey of Compensation Among Peer Support Specialists).
For the specific state-by-state coverage of Medicaid-reimbursed peer support services, check out our latest report, State Medicaid Reimbursement For Peer Support Services: The 2018 OPEN MINDS Reference Guide. The report includes information on which states that reimburse for peer support (whether for mental illness and/or addictive disorders), the states with proposed reimbursement for peer support, and the reimbursement rates in selected states.
For more, check out these resources:
- Developing Innovative Strategies To Diversify Funding & Revenue Sources (Coffee Break Case Study)
- Diversification & New Service Line Development
- Reinventing Your Organization In A Complex Market: How To Build A Sustainable Strategy
- Diversifying Your Revenue Streams: How To Successfully Launch A New Service Line
- The Changing Role Of Peer Support Services – A Look To The Future
- Los Angeles County To Create Peer Support Network For Veterans
- North Dakota Launches Behavioral Health Treatment Program For Justice-Involved Individuals With Reimbursement Linked To Outcomes
- NYAPRS Peer Bridger Partnership Formed To Improve Health Outcomes For Nassau Queens Performing Provider System
- Virginia Awards Statewide Family Network Services Contract To NAMI Virginia
- Another Disruptor To Business As Usual – Peer Support
And for in-person advice and discussion on service line development, join OPEN MINDS Senior Associate Joseph Naughton-Travers at The 2018 OPEN MINDS Strategy & Innovation Institute for an for an exclusive discussion session, “Are You Developing A New Service Line? A Roundtable Discussion On Service Line Development.” Don’t miss this opportunity to share ideas and learn from the experiences of your peers in this informative, interactive discussion session.