Bill for peer specialist Medicaid reimbursement fails

By Danielle Ray
June 4th, 2023
Rebecca Allen headshot
Rebecca Allen is director of recovery advocacy for Connecticut Community for Addiction Recovery (CCAR).

As a woman in recovery herself, Rebecca Allen put a lot of thought into the written testimony that detailed why she did not support a bill (S.B.  No. 1205) focusing on the push for peer specialists to get reimbursed that ultimately died in committee.

Allen, director of recovery advocacy for Connecticut Community for Addiction Recovery (CCAR), said it has been 25 years since the last time she used heroin.

She explained that CCAR trains, certifies, and employs peer support specialists in the area of substance abuse. Funded by the Department of Mental Health and Addiction Services (DMHAS), CCAR provides non-clinical, community-based, recovery support services out of five Recovery Community Centers in Bridgeport, Hartford, New Haven, Waterbury, and Windham.

“The cost of having to bill Medicaid combined with the low reimbursement rate will make it impossible for recovery coaching to be a stand-alone service.” --Rebecca Allen, director of recovery advocacy, CCAR

In addition, the organization provides recovery coaching to 29 hospital emergency departments, seven correctional facilities, five district parole offices, and three municipal courthouses.

“In 2022, our emergency department recovery coaches responded to over 4,800 calls and have an 82 percent connect to care rate,” Allen wrote. “Our DOC Recovery Coaches have supported over 400 individuals; providing a safety-net and seamless transition for individuals on medication for opioid use disorders during the re-entry process.”

The recovery coach training curriculum developed by CCAR in 2008 has been used to train more than 85,000 coaches nationally and directly employs more than 30 recovery coaches.

Allen believes recovery coaching should be anchored in Recovery Community Organizations (RCOs) and not as adjunct positions at treatment providers or other healthcare entities.

“RCOs are independent, non-profits that can hire, train, and supervise recovery coaches and can best ensure the fidelity of the role,” she stated.

Allen, who declined to comment further than what was in her testimony, wrote that if they move to make recovery coaching a billable service under Medicaid, as the bill proposed, “it will make it extremely difficult for small, community-based organization to provide this service.”

“The cost of having to bill Medicaid combined with the low reimbursement rate will make it impossible for recovery coaching to be a stand-alone service,” she noted. “In addition to the financial burden, the restrictions that Medicaid would impose (education/training requirements, billable units per client, etc.) would place an undue burden on the recovery coach and change the nature of the coaching relationship.”

The bill was one of two that would have allowed certified peer recovery support services to be billed through Medicaid or covered by insurance, a move inspired by the state looking to bolster its mental health system following a large spike in need as a result of the COVID-19 pandemic and years of reduced funding for mental health services.

There are approximately 2,000 peer support specialists currently working in the state who are largely funded by grants awarded to nonprofit organizations. Under the terms of the SB 1205 bill legislation, certified peer recovery support specialists would have been able to bill Medicaid directly for their services or be covered under insurance rather than relying on grant funding.

A task force dedicated to coming up with the best plan for reimbursing peer specialists that was supposed to happen through a 2021 bill was never fully formed and never met. The peer support nonprofit organizations that have been pushing for this change are disappointed.

As of 2018, Connecticut is among 11 states that did not cover peer support specialists under Medicaid, according to an Open Minds analysis of state Medicaid amendments.
The latest Medicaid bill – SB 1205 – was supported by the National Alliance for Mental Illness, the Connecticut Hospital Association, the Connecticut Community Nonprofit Alliance, and the Keep the Promise Coalition. The latter is an organization formed to push back against the state’s defunding of mental health services in the wake of deinstitutionalization.

“Workforce shortages are rampant in behavioral health and throughout the healthcare industry,” wrote Jonathan Craig Allen, medical director at Rushford Behavioral Health Center in Meriden, in testimony. “Incorporating people with lived experience and specialized training into the treatment paradigm addresses this person power deficit while providing treatment teams with members who understand the culture, environment, social and economic factors (and prejudice) often faced by those seeking care.”

However, the legislation was opposed by the Department of Social Services (DSS) and CCAR. DSS Commissioner Andrea Barton Reeves testified that Medicaid reimbursement is already available through some Medicaid waivers, particularly for recovery coaches in substance abuse disorder (SUD) residential treatment programs, and under Medicaid’s Mental Health waiver.

When reached for comment, Connecticut Department of Mental Health and Addiction Services Director of Communications Arthur Mongillo said his organization “did not take a position on the two bills,” SB 1205 and SB 976.

“We value the insights and skills people with lived experience bring to the behavioral health workforce and continue to hire recovery support specialists in our system and fund peer-run organizations to ensure that communities have continued access to these services,” he noted.

In her testimony Allen stated that she has spoken to hundreds of recovery coaches across the country, many of whom are “integrated into the treatment system solely because it’s a billable service in their state.”

“They share that their supervisors and co-workers don’t understand or respect their role and that they’re often relegated to ‘chauffeurs and gophers,’” she wrote. “I don’t want this for Connecticut. I’m asking this committee to ensure that we have a flexible funding stream for recovery coaching services and to not advance this bill out of committee as is.”

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