By Caren Howard, National Advocacy Manager at Mental Health America
Mental Health America and partner organizations helped usher the introduction of recent key legislation in the U.S. House of Representatives: H.R. 8206, the Promoting Effective and Empowering Recovery Services (PEERS) in Medicare Act of 2020. This bipartisan bill, introduced by Representatives Judy Chu (D-CA) and Adrian Smith (R-NE), would recognize for the first time in Medicare history certified peer specialists and would allow reimbursement of peer support services when they are offered as part of coordinated physical and mental health care provided by therapists, case managers, and physicians in holistic treatment. The National Association of State Mental Health Program Directors, the Depression and Bipolar Support Alliance, the National Association of Peer Supporters, and the Association for Behavioral Health and Wellness, were partners with MHA in this effort.
MHA strongly supports Rep. Chu’s and Rep. Smith’s bill to provide Medicare coverage for peer support services for individuals within integrated physical and mental health care. Take action today and let Congress know why they should pass H.R. 8206.
Medicare is the federal health insurance program for which people qualify once they reach a certain age or have a disability when they also have a work history. Most private commercial insurance plans set their policies and benefits packages based on Medicare policy and benefits. Thus, because of its influence on the broader market, H.R. 8206 is more than just a stepping-stone bill. It will likely allow all adults with health insurance to enjoy the benefits of peer support within integrated care, once seniors and people with disabilities begin to enjoy its benefits.
As we see a growing surge in distress and demand for mental health services, increasing access to peer support is essential to meet people’s mental health needs and to empower individuals to live healthy lives in their communities.
Peer-Run Affiliate Solidifies Bill Sponsor
Peer support specialists use their own lived experience, have specialized training, and are certified by their state or national certification body, to assist individuals in achieving recovery goals by furnishing emotional, informational, and other support services to individuals with a mental illness, including dementia, and/or a substance use disorder.
The COVID-19 crisis is exacerbating a pre-existing behavioral health workforce shortage that is particularly acute in rural areas and for communities of color. MHA of Nebraska’s Executive Director Kasey Moyer and Wellbeing Initiative’s Executive Director Danielle Smith saw this and met with staff for Congressman Adrian Smith (D-NE) and discussed the important work of peers in the state. They requested that the Congressman co-sponsor H.R. 8206 with Congresswoman Judy Chu (D-CA).
Wellbeing Initiative, the state’s largest peer training entity counting over 500 peers trained, explained how the bill would help grow the reach of peers who are needed in remote areas of the state. These areas are experiencing extreme shortages of mental health providers, limited ability of residents to travel for in-person care, and limited opportunity to use telehealth platforms – all while people are experiencing increased isolation, fear, and anxiety. In the virtual meeting with Rep. Smith’s office, peers also noted their ability to provide technical assistance in setting up telehealth to help their clients engage in care.
MHA Nebraska reported seeing a dramatic increase to its emotional support warmline, staffed by peer specialists, at the beginning of the pandemic. At the time, Nebraska residents were facing disaster recovery from flooding. The Governor had also declared a state emergency on top of the COVID public health crisis. Other MHA affiliates and other providers across the country were also reporting an uptick of calls to their warmlines, support groups, and other peer programs, without receiving additional grant funding. Peers, alongside frontline health workers, are being asked to do more with less. Peer support specialists in Nebraska and elsewhere often work their way off federal/state assistance to be self-sufficient, but in many states peers are not paid a living wage and often are forced to live in poverty or leave the field they love for better wages. H.R. 8206 would help take care of that, by allowing for fair compensation for peers providing integrated care.
Peers Make a Difference: Why Medicare and Other Insurers Should Cover Peer Support
Peer support promotes recovery from mental health conditions and substance use disorders by helping individuals better engage in services, manage physical and mental health conditions, build support systems, and ultimately, live self-directed lives in their communities. The Substance Abuse and Mental Health Services Administration (SAMHSA) recognizes peer support as an effective, evidence-based practice. And, as of January 2019, over 43 states allowed Medicaid – the state program for individuals with disabilities, are low income, and for pregnant women and their children – to be billed for peer support services.
- According to SAMHSA, the proven benefits of peer support include reduced hospital admission rates, increased social support and social functioning, and decreased substance use and depression.
- A 2018 analysis showed that providers with peer services had 2.9 fewer hospitalizations per year and saved an average of $2,138 per Medicaid-enrolled month in Medicaid expenditures.
- The Veterans’ Administration has recognized the value of peer support specialists to serve Veterans with mental health and substance use conditions. For example, a 2012 White House Executive Order to improve mental health access for Veterans included a directive to hire additional peer support specialists.
- A peer support program in Pierce County, Washington reduced involuntary hospitalizations by 32 percent leading to a savings of $1,990,000 in one year.
- A Federally Qualified Health Center in Denver found that using peers saved $2.28 for every dollar spent.
- A New York-based peer support program for individuals transitioning from inpatient services back to the community resulted in a 47.1 percent decrease in total behavioral health costs.
Under H.R. 8206, co-sponsored by Reps. Judy Chu (D-CA) and Adrian Smith (R-NE), peer support would be covered by Medicare as part of integrated physical and mental healthcare and billed through the respective codes for integrated care. For example, under collaborative care models, a primary care doctor, care coordinator and other team members provide behavioral health services and coordinate mental and physical health care. Medicare has specific collaborative care billing codes to support this model. MHA strongly supports collaborative care because the model promotes screening, early intervention, addressing mental health as part of overall healthcare, and reducing health disparities. Adding peers will increase the emphasis on recovery, as well as strengths-based and person-centered care. This legislation specifies that peer support specialists can be members of the integrated care team and their services can be billed as part of that overall model of care under these codes.
A Call to Action
