We’ve seen some confusion about new requirements for providers who bill Medicaid. So we’ll break it down for you!
If you employ peers and bill for their services, HCPF will require your peers to be certified by January 1, OR are in the process to their certification.¹ But does this mean peers need to have a specific certification to do their job? Is the CPFS certification the only one that counts, or vice versa?
The answer is: You can have either a CPFS or NCPRSS certification. Here’s why.
In the Process is defined as peers who have already completed 60 hours of training.
This means, starting January 1, peers who have not completed their core trainings are not eligible to have their services reimbursed by Medicaid.
Peers have six months following the completion of core trainings to obtain their certification.
How It Works
The Behavioral Health Administration (BHA) oversees behavioral health services in Colorado, and establishes rules for licensed organizations to follow. To bill Medicaid for peer services, an organization must be licensed by the BHA. The BHA says when peer support professionals provide peer recovery support services, they must hold a professional credential, or have completed trainings that cover all of the core competencies as outlined by the Substance Abuse and Mental Health Administration (SAMHSA).²
These competencies are considered best practices for peer work, and SAMHSA considers peer certification to be the highest standard for delivering peer services.
HCPF, the Department of Healthcare and Policy Financing, oversees Medicaid for the state of Colorado, and makes the rules on what organizations need to do before they can bill. Because peer certification is a rigorous process, it’s proof that peers will perform to the highest standards.
So HCPF says peers must have a credential for their services to be billed to Medicaid, and they use the BHA’s rules to define what a credential is.
So What's The Definition?
Here’s how the BHA defines requirements for a peer credential:
- At least sixty (60) hours of training, which must include SAMHSA’s core competencies,
- At least 200 hours of experience as a peer support professional, and
3. Passing a certification exam.
That’s it! The BHA and HCPF do not specify which certification you need. The certification you choose depends on the best fit for your career – so if you already have the CPFS or NCPRSS certification (or if you’re currently working on it), you’re good to go.
And if you’re new to certifications, check out these resources to learn more about each one!
Sources
- HCPF – Peer Services.
- BHA Rules – Chapter 3, Section 3.3 A.