39 States Cover Peer Support Services For Behavioral Health – OPEN MINDS Releases Reference Guide On Medicaid Reimbursement For Peer Support Services

Gettysburg, PA, April 26, 2018 -- A new report from OPEN MINDS found that 39 state Medicaid programs cover peer support services for either individuals with mental illness, individuals with addiction disorders, or both groups. This is a rapid increase over the last decade – in 2008, only eight states funded peer services under Medicaid. OPEN MINDS also found that there is a wide variation in Medicaid fee-for-service reimbursement rates for peer support services. A review of selective states’ reimbursement models found that group rates for a 15-minute period ranged from less than $2.00 to over $5.00, and individual rates ranged from $6.50 to $24.36 per 15 minutes. These findings were released by OPEN MINDS in their recent report, State Medicaid Reimbursement For Peer Support Service: An OPEN MINDS Reference Guide.

Medicaid is the main payer for peer support services, although many state departments of behavioral health offer grant funding for these services. If state Medicaid program covers peer support under the fee-for-service benefit, the health plans are also required to cover these services. Some states have special provisions that allow them to only cover peer supports for limited groups of individuals, such as those enrolled in managed care. Some states also allow peer support specialists to act as qualified health care professionals for certain types of behavioral health services, but do not allow for the specific reimbursement of peer support services.

“Research shows the value of peers for individuals with mental illnesses and addictive disorders – participation in peer support groups for addiction recovery promoted higher satisfaction in treatment and lower relapse rates; and peer support has been found to increase social support and social functioning, decrease psychotic symptoms, and reduce hospitalization rates,” said OPEN MINDS Market Intelligence Director, Athena Mandros. “But for the role of peer support specialist to be a sustainable one, provider organizations need a steady source of reimbursement for these services. Our new report provides a state-by-state guide to coverage and reimbursement for organizations considering adding or expanding their peer support service options.”

A free summary (registration required) of the report can be found at: Does Peer Support Pay?. The report, State Medicaid Reimbursement For Peer Support Service: An OPEN MINDS Reference Guide, is available at no charge to Premium and Elite members of The OPEN MINDS Circle and can be purchased in the OPEN MINDS estore for $495. The report explores state Medicaid reimbursement for peer support services, states with proposed reimbursement for peer support, funding authorities for peer support, and reimbursement rates in selected states.

Learn more about becoming an OPEN MINDS Circle member online at www.openminds.com/membership.

For additional questions and inquiries, please contact Sarah Threnhauser, Executive Vice President, OPEN MINDS at 717-334-1329 or [email protected].

ABOUT OPEN MINDS

OPEN MINDS is a national market intelligence and strategic advisory firm focused on the sectors of the health and human service field serving consumers with chronic conditions and complex support needs. Founded in 1987 and based in Gettysburg, Pennsylvania, the 175+ associates provide market insights and innovative management solutions designed to improve operational and strategic performance. Learn more at www.openminds.com.

Tim Snyder
OPEN MINDS
7173341329
[email protected]