The Health Care Authority (Authority) certifies peer counselors under its Peer Support Program. Certification by the Authority is not necessary to provide peer counseling services, however, it is required for reimbursement under Medicaid. The services that may be provided by certified peer counselors are specified in Washington's Medicaid State Plan (State Plan). The State Plan authorizes them to provide peer support services which are defined as scheduled activities that promote socialization, recovery, self-advocacy, development of natural supports, and maintenance of community living skills.
In 2023 legislation established peer specialists as a health profession to be certified by the Department of Health beginning July 1, 2025. Applicants for certification must submit an attestation that they self-identify as: (1) a person with one or more years of recovery from a mental health condition, substance use disorder, or both; or (2) a parent or legal guardian of a youth who is receiving or has received behavioral health services. In addition, they must complete an education course offered by the Authority, pass written and oral examinations, and complete a 1,000 hour supervised experience requirement.
Beginning January 1, 2027, any person who provides peer support services must be certified as a certified peer specialist or a trainee if the person or the person's employer bills a health carrier or medical assistance program for those services. "Practice of peer support services" means the provision of interventions by either: (1) a person in recovery from a mental health condition, substance use disorder, or both; or (2) the parent or legal guardian of a youth who is receiving or has received behavioral health services. The interventions are provided to a client through the use of shared experiences to assist a client in the acquisition and exercise of shared skills to support the client's recovery.
Naming of Certified Peer Support Specialists.
The profession of certified peer specialists is changed to "certified peer support specialists."
Certified Peer Support Specialist Training in Domestic Violence, Sexual Assault, and Human Trafficking.
The Health Care Authority, in collaboration with the Office of Crime Victims Advocacy at the Department of Commerce, must contract for the development of three courses to supplement the training of certified peer support specialists in the provision of peer support services to persons who have experienced domestic violence, sexual assault, or human trafficking. The courses must cover topics relevant to victim advocacy, including: (1) safety planning; (2) an understanding of domestic violence, sexual assault, or human trafficking; and (3) advocacy in legal, medical, social services, and other systems. Beginning October 1, 2026, a victim services agency may only bill for peer support services if the certified peer support specialist providing the services has completed a course relevant to the client's experience. The term "victim services agency" is defined as a program or organization that provides assistance and advocacy for persons who have experienced domestic violence, sexual assault, or human trafficking through services such as crisis intervention, individual and group support, information, referrals, and safety planning.
Expanded Access to Peer Support Services.
The Health Care Authority (Authority) must contract with at least one external entity to expand access to peer support services. The contracts begin December 31, 2025, and require the entity to:
The contracted entities must submit a report to the Authority by November 1, 2026. The report must describe the technical assistance provided, the proposals developed, the trends in health carriers providing payment for peer support services, and any recommendations to encourage health carriers to reimburse providers for peer support services.
Peer Support Specialists in Managed Care Organization Networks.
Among the factors that the Authority must give significant weight to when procuring Medicaid managed care services is the accessibility of peer services. The level of accessibility will be demonstrated in the managed care organization's (MCO's) application through a comprehensive analysis of access to peer services in the MCO's network. The analysis must evaluate the availability of peer support specialists who are adults in recovery from a mental health condition or a substance use disorder, youth or young adults who are in recovery from a mental health condition or a substance use disorder, and parents and legal guardians of youth who are receiving behavioral health services.
The substitute bill eliminates the Department of Health endorsements to the certifications of peer support specialists. The Health Care Authority (Authority) must collaborate with the Office of Crime Victims Advocacy to contract with at least one training entity to develop courses for the provision of peer support services to persons who have experienced domestic violence, sexual assault, or human trafficking. The courses are to include competencies in safety planning; a foundational understanding of domestic violence, sexual assault, or human trafficking; and advocacy across legal, medical, social services, and other systems. Victim services agencies may bill for peer support services only if the certified peer support specialist providing the service has completed a course relevant to the client's experience, beginning October 1, 2026.
The substitute bill delays the activities of the external entity providing options to expand access to peer support services from October 1, 2025, to December 31, 2025. In addition to its other duties, the external entity must develop opportunities for tribes, tribal health providers, and urban Indian health programs to bill for peer support services provided by tribal elders.
(In support) This bill is about transitioning peer-based programs supported by the state general fund to having private insurance cover the costs. This bill creates opportunities for professional peers to obtain endorsements and training to have the biggest impact on supporting victims of domestic violence, sexual assault and trafficking, so the work is being done by those who best understand the experience of it. This bill makes sure that peers are infused into clinical care settings that know what peers are and how to integrate them into the workforce. There has been confusion related to the acronym of certified peer specialists that could have a detrimental effect on a person's desire to access peer services. Through the access to billing for peers, this bill will support the development of peers and access to subclinical services. This bill will address the root causes of violence, domestic violence, and substance use by increasing access to peer support specialists.
(Opposed) None.
(Other) It is unclear how the bill's Medicaid billing provisions will work and how a peer's background information will be kept confidential. The bill raises questions about whether the peer support specialist credential is intended to be voluntary regardless of whether the peer support services are billed under Medicaid. The bill raises concerns about the consequences of allowing entities to bill for peer support services if they are not licensed as behavioral health agencies. Having peers only supervised by other peers could silo them from the rest of the treatment team.
(In support) Representative Lauren Davis, prime sponsor; Joshua Wallace, Peer Washington; Jason Clark, Northwest Credible Messenger; Turner Yarbrough, Northwest Credible Messenger; Stephaine Courtney, The Shades of Motherhood Network; Khalia Williams-O'Neal, Northwest Credible Messenger; Young Cho; and Natalia Cipriano.
The Appropriations Committee recommended removing the requirement that, in order for a victim services agency to bill for peer support services provided to a client who has experienced domestic violence, sexual assault, or human trafficking, the certified peer support specialist providing the services must have completed training in topics relevant to the client's experience. A technical error was corrected, and a clause was added making sections and 3of the bill null and void if not referenced in the operating budget.
(In support) Peer support services have traditionally been covered by federal grants along with state funding. Peers provide culturally responsive services to communities throughout the state. Changes being made at the federal level along with the budget shortfalls raise concerns about the ability to continue providing peer support services.
This legislation provides the opportunity for recovery organizations to contract directly with Medicaid insurance carriers on a per member per month basis to provide community peer support to individuals living with behavioral health challenges. This funding opportunity would provide a more sustainable model for the provision of services while minimizing the cost to the state through leveraging Medicaid funding.
(Opposed) None.
Josh Wallace, Peer Washington; and Jason Clark, Northwest Credible Messenger.