Peer Support Services
What is a Certified Peer Specialist?
• Certified through a training and certification
process
• Grounded in their own recovery
• Have a lived experience
• Are a support system
• A role model for recovery and resiliency
• A provider of hope
• A translator between “doctor talk” and the
consumer
• A cheerleader
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Certified Peer Specialist Training
To meet the criteria to be accepted into the training, one
must:
• Have a high school diploma (or equivalent)
• Be self-identified as a current or former consumer of
mental health services
• Be well grounded in their own recovery
• Be at least 18 years or older
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Certified Peer Specialists must:
• Successfully complete 40 hours of training
 Appalachian Consulting Group curriculum
• Pass a written test.
• Receive a written certification.
• Successfully complete 12 hours of continuing
education units each year in order to maintain
certification.
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Peer Specialist Training :
What is Learned and Can Be Shared
• Five Stages in the Recovery Process:
Overview, Dangers, Interventions
• Facing One’s Fears
• Using Your Recovery Story as a
Recovery Tool
• Problem Solving with Individuals
• The Role of Peer Support in the
Recovery Process
• Combating Negative Self-Talk
• Facilitating Recovery Dialogues
• Using Support Groups to Promote
and Sustain Recovery
• Creating Program Environments that
• Peer Specialist Ethics
Promote Recovery
• Power, Conflict and Integrity in the
• Exploring Beliefs that Promote
Workplace – Part 1 , 2
Recovery
• Creating Relationships that Promote • Creating the Life that One Wants
Recovery
• Introduction to Trauma-informed
care
• Effective Listening and the Art of
Asking Questions – Part 1, 2
• Cultural Competency
• Dissatisfaction as an Avenue for
Change
• Introduction to Data Collection and
Documentation
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Responsibilities of Certified Peer Specialist
• Provide peer support services
• Consumer advocate
• Provide information and support
• Assist consumers in regaining control of
their lives
• Assist consumers in learning to utilize
recovery
• Role model recovery and coping skills
• Share own recovery story
• Model mutuality in the relationship
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The Four Performance Domains:
1. Advocacy
• Consumer advocate
• Advocate within system for consumer centered recovery
• Assure consumers choices define and drive their recovery
plan
• Promote consumer-driven recovery plans by serving on
recovery team
Knowledge skills and abilities
• Explain why self-advocacy is the foundation of recovery
• Identify consumers individual support system
• Explain how to advocate within behavioral health system
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Performance Domains Continued
2. Professional Responsibility
• Respond appropriately to risk indicators to assure the
consumers welfare and physical health
• Document services provisions as required by the employer
• Maintain confidentiality
Knowledge skills and abilities
• Define the concept of a wellness-focused approach to
consumer recovery
• Explain the fundamental concepts related to cultural
competency
• Understand the concept of accountability
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Performance Domains Continued
3. Mentoring
• Serve as a role model of a consumer in recovery
• Establish and maintain “peer” relationship rather than a
hierarchical relationship
• Promote social learning through shared experiences
• Assure that consumers know their rights and responsibilities
Knowledge skills and abilities
• Explain the concept of mentoring
• Explain the concept of role-modeling behaviors
• Define social learning
• Define self-advocacy
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Performance Domains Continued
4. Recovery Support
• Serve as an active member of the consumer’s recoveryoriented team
• Assure that all recovery-oriented tasks and activities built on
the consumer’s strengths and resiliencies
• Help the consumer identify their options and participate in all
decisions related to establishing and achieving recovery goals
Knowledge skills and abilities
• Promote self-determination and consumer choice-driven
recovery
• State the stages of recovery
• Help the consumer develop problem-solving skills by working
together to identify and discuss options
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The Work done by Peer Support Specialist
Peer Support Specialists recognize, advocate and
support opportunity for:
• Choice - Individuals ability to make choices are important to
each person’s recovery
• Recognition of each individuals strengths and using those
strengths to accomplish one’s goals ~ FOCUS ON WHAT’S
STRONG NOT WRONG!
• Connection, connection and connection
• Relationship
• Respect
• Honoring each individual’s hopes and dreams
• Supporting them moving toward recovery
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Peer Services
“When consumers begin to
work in the mental health
system as Peer Specialists,
recovery is accelerated in three ways.”
• The Peer Specialists recovery
is strengthened
• Peer Specialists assist others
in recovery
• Peer Specialists help the
agency/system recover
*Recovery Innovations
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Working Together
• Staff members not living
with a mental disorder may
be experts in treating
mental illness.
• Certified Peer Specialists
and their peers are the
experts in living with a
mental health disorder.
Both are important in the
continuum of care.
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Peer Support Providers’ Services are
Evidence Based
August, 2007 letter from the Administrator of Center on Medicare
and Medicaid Services stated:
• Peer support services are an evidence-based mental health model of care
which consists of a qualified peer support provider who assists individuals with
their recovery from mental illness and substance use disorders.
Larry Davidson, Professor of Psychiatry and Director of the
Program for Recovery and Community Health Yale University
School of Medicine and Institution for Social and Policy Studies
(Pillars of Peer Support Summit 2012)
• First generation studies showed that it was feasible to hire people in recovery to
serve as mental health staff
• Second generation studies showed that peer staff could generate equivalent
outcomes to non-peer staff in similar roles
• Third generation studies are investigating whether or not there are unique
contributions that peer support can make
• Evidence base is growing along with expansion of peer workforce
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Optum Idaho Peer Services :
Peer Services CPT Codes
•
Peer Support Services (H0038)- services initiated/offered in the community by a network
provider that is credentialed to provide peer support services.
 Certified Peer Support Specialist, per Optum Idaho standards
 Initial authorization of 16 units
 Medical Necessity required for authorization of additional units
•
Community Transition Support Services (H2015)- services provided by a Certified Peer
Support Specialist and Licensed Clinician to assist the Member in the transition from inpatient
services to community-based services. This service is not provider-initiated.
 Optum Idaho Discharge Coordinators will initiate service authorizations upon approval
by the Member
 Services will be authorized for up to 32 total units within authorization time span
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Network Participation Requirements for Peer Support Services
– Credentialing Specific to Peer Support Services/ Peer Run Agency:
• Network Agency Request Form (NRF) and Agency Credentialing
Application attesting to adherence to the applicable criteria
• Peer Support Specialist Addendum
• Network Manager requests an audit of the peer support services program
– Required audits
• Existing In Network Agencies may be reviewed by desk top audit
• Site audits required for unaccredited agencies pursuing group contracts
• Compliance with the criteria for specialists, the organization’s detailed
plan for supervision, and record keeping protocols (e.g., contact notes)
for peer support specialist will be reviewed during the audit.
– Approval by Optum Credentialing Committee
• Credentialing committee meets 1 time/ month
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Peer Support Staff Requirements
• Network providers are required to:
– Ensure you are employing only certified staff
• Certified Peer Support Specialists with certification issued by
Mountain States training program
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Peer Support Service Claims:
 CATEGORY THREE SERVICES REQUIRE PRIOR AUTHORIZATION
• Claims will be denied unless you are an approved Peer Support Service Provider
Related CPT Codes from the Idaho Fee Schedule:
Assessment and Treatment Plan
•H0031 Behavioral Health Assessment, by a qualified paraprofessional for peer support, family
support or CBRS
•H0032 Individualized Behavioral Health Treatment Plan, by a qualified paraprofessional for peer
support, family support or CBRS
Peer Services
•H0038 Peer Support by a qualified Peer Support Specialist
•H2015 Community Transition Support Services by a licensed clinician and a qualified Peer
Support Specialist (initiated by an Optum Idaho network provider at the request of an Optum
Idaho Discharge Coordinator or Intensive Care Manager)
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Submitting Prior Authorization Requests for Peer Support Services
First Month of Service:
• Like all category 3 services, service is attached to the member.
• Provider faxes/emails authorization request form to Optum.
• Optum authorizes 16 units of Peer Support Services for up to 30 days upon
receipt of complete and accurate request.
•
Incomplete or inaccurate forms will be returned to provider.
• After receiving complete and accurate request, Optum has two business days to
create authorization for services.
• Provider will receive confirmation of authorized services.
• Notice of authorizations are automatically sent out and are available on Provider
Express within 24 hours.
After Initial Authorization:
• Once initial authorizations for Peer Support Services are exhausted, additional
units will require a full clinical review by an Optum Idaho Care Manager.
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Links
This is a link in Provider Express:
https://www.ubhonline.com/
Clinical tab > bottom of page Recovery & Resiliency Toolkit
This is a link to the Office Of Consumer and Family Affairs:
http://www.consumerandfamilyaffairs.org/
Training tab
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Additional Tools For Peer Support Specialists
Supporting and creating evidence based, best
practice opportunities and initiatives:
• WRAP - Wellness Recovery Action Planning
®
• WHAM- Whole Health Action Management
• Trauma Education and Trauma-informed peer support
• Shared Decision Making Education and Practices
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Thank You
Martha Ekhoff
Amanda Lehto
Amy Wernsing
Certified Peer Specialist
Family Support Specialist
Member & Family Affairs
amanda.lehto@optum.com
amy.m.wernsing@optum.com
martha.a.ekhoff@optum.com
208-914-2013
208-914-2236
Director of
208-914-2234