Peer Services

Colorado is reforming its behavioral health system. This transformation is vital to make sure every Coloradan can access the behavioral health care they need when they need it. The Department of Health Care Policy and Financing is working to expand the spectrum of behavioral health services for Health First Colorado (Colorado’s Medicaid program) members. This includes increasing access to peer services for members. These services are supportive and skill-building activities delivered by peer support professionals. 

Peer support professionals are individuals who use their lived experience to help others. Peers can work in a variety of settings and offer support in any area where a member with a diagnosis is receiving care from a Health First Colorado provider. Peers are an addition to the member’s care team. They can offer practical solutions and focused problem solving to help members practice building skills needed to maintain their health and wellbeing.

Frequently Asked Questions

Are Peer services billable?

Many, but not all, peer services are billable. For a peer service to be billable, the member receiving the service must have a covered diagnosis. Then, in accordance with the State Behavioral Health Services Billing Manual (the billing manual), any billable code that indicates a Peer as a service provider may be eligible for reimbursement. The document linked here provides examples of the broad range of services Peers may deliver.

Do Peers delivering Medicaid billable services need to have a certification?

In general, Medicaid does not require that Peer Support Professionals hold a certification.  

The exception to this is in the case of a Recovery Support Service Organization (RSSO) which is a specific type of licensed provider organization. To work in a Recovery Support Service Organization (RSSO), Peers must be certified.  

How do covered Peer services get billed?

Bills for peers services are submitted under the name of the licensed person, who oversees clinical care services for the member and is referred to as the “rendering provider”.

Who do I contact for help with billing and coding questions?

Please reach out to your Managed Care Entity (MCE- RAE or MSO) or you can contact the Department for questions about the billing manual at hcpf_bhcoding@state.co.us

Can Peers supervise other Peers? 

Peer Support Professionals can have two supervisors:  

Clinical Supervisor: The Clinical Supervisor is responsible for ensuring that the services being delivered are clinically indicated. They review the treatment plan goals and progress of the member receiving services, identify any new setbacks, and provide clinical oversight of the Peer Support Professional (who is a non-licensed staff) delivering the services. Any non-licensed professional that delivers Medicaid billable services must receive regular clinical supervision by the licensed individual whose name appears on the claim as the rendering provider. 

Employment Supervisor: The Employment Supervisor is responsible for hiring, training, corrective actions, mentorship and day to day supervisory functions. This supervisor is responsible for setting employee goals and reviews, giving job feedback, completing all HR-related tasks, as well as holding regular check-ins, evaluating work load, problem-solving strategies and providing moral support. The Employment Supervisor does not need to have a clinical license and can provide employment supervision to Peer Support Professionals.

Is transportation a reimbursable activity? 

Code H0038 does cover transportation of professionals serving Health First Colorado members in circumstances where the care provider is traveling with the member in context of a skill building or coping skill building task. As an example, riding with a member on a bus line to help them learn a transit system or become comfortable with using the bus to get groceries would be a covered service. In these cases, the time spent in travel is part of the skill building activity and would be counted as part of the visit.

Recovery Support Services Organizations New to Health First Colorado

Reasons to become a Health First Colorado-enrolled provider:

• Individuals being served are Health First Colorado members
• Health First Colorado members have low to no co-pays, and no deductible, which means providers are paid for their full service amount immediately from the health plan.
• Health First Colorado’s behavioral health payments are often faster than commercial payers, with 98% of claims paid within 10 days of billing.

To become a Health First Colorado Recovery Support Services Organization (RSSO provider type 89) follow these 3 steps:

• Step 1: First, a provider (organization) must apply to become licensed through the BHA to provide recovery support peer services for SUD, mental health and trauma. The following page provides detailed information about the SUD licensure requirements and process.
• Step 2: Next, a provider identifies their Health First Colorado provider type - and enrolls with Medicaid.
• Step 3: Once enrolled as a Health First Colorado, a provider must contract with Managed Care Entities to serve members from one or more regions.

Peer Resources

• State Behavioral Health Services Billing Manual
• Enrollment Page
• Report on Peers in the Workforce
• Fact Sheet on Health-Related Social Needs

Stay Informed

We encourage you to sign up for the Peer Services Bulletin to receive email updates.
 
To ask a question or make a suggestion contact us by email: hcpf_peerservices@state.co.us