Newsletter Vol. 30, No.26

REQUIREMENTS: By July 1, 2021 (HARD DEADLINE FOR CERTIFICATION): - Billing team must update billing system to restrict H0038 HF billing to ONLY certified Peer Recovery Support Specialists (NCPRS by NAADAC or CPRS by NJ Addiction Professionals Certification Board) - Verify all peer staff have obtained required certification; stop billing for uncertified peers after this date - Update claim submission to include peer's individual NPI number under 'servicing provider' field to ensure payment - Audit existing peer staff employment records to confirm 2+ years successful recovery experience documentation Immediately (Before July 1, 2019 if clinic plans to offer service): - Billing team must configure billing system to recognize H0038 HF code with $16.62 per 15-minute reimbursement rate - Providers and clinic admin must complete Independent Clinic Peer Recovery Support Specialist Addendum for each peer on staff (available at www.njmmis.com under 'provider applications') - Both clinic and each PRSS must complete individual Lived Experience Attestations as part of addendum - Submit enrollment addendum to NJ FamilyCare before billing peer services - Update encounter forms and intake process to document that peer staff member is NOT a counselor, and obtain member choice for peer engagement - Establish supervision structure: assign each peer to supervisor meeting qualification standards outlined in policy - Create treatment plans (coordinated by licensed clinician) that include peer services; peer services must be documented in context of overall SUD treatment plan Ongoing: - Ensure progress notes for each peer visit document: specific service rendered, duration, setting, and outcome/progress toward identified goals - Maintain compliance with all federal Medicaid regulations and policy requirements - Do NOT count peer staff toward required staff-to-client ratios per N.J.A.C. 10:161B-1.9 or 10:161B-10.1 - Do NOT substitute peer staff for substance abuse counseling staff Consequences: Claims billed for uncertified peers after July 1, 2021 will be denied. Claims without peer NPI will not be paid. Failure to maintain treatment plan coordination will result in service disallowance.