Medicaid Coverage of Peer Recovery Support Services in Licensed Community-Based SUD Programs

REQUIREMENTS: By September 1, 2023: Providers must ensure all Certified Peer Recovery Specialists are supervised by a Registered Peer Supervisor (RPS) certified by MABPCB. Providers with non-RPS supervisors must submit a supplemental application via ePREP with RPS certification and background check. Before provider enrollment: Billing team must work with providers to verify: (1) CPRS certifications for all peer staff rendering services, (2) RPS or equivalent supervisor credentials, (3) pre-employment background checks for all certified peers and supervisors, (4) provider enrollment status with Maryland Medicaid for Provider Types 32 (OTP) or 50 (Outpatient/IOP/PHP). Immediately: Billing team must update billing software to recognize and bill HCPCS codes H0038 (individual peer recovery support, 15-minute units, $16.87 rate effective 7/1/2023) and H0024 (group peer recovery support, 15-minute units, $4.69 rate effective 7/1/2023). Implement rate change on July 1, 2023 (prior rate: H0038=$16.38, H0024=$4.55). For existing Maryland Medicaid-enrolled providers: Providers must complete supplemental application via ePREP at https://health.maryland.gov/mmcp/provider/Pages/eprepforms.aspx with provider type-specific addenda and required documentation. For new providers: Complete full enrollment application via ePREP including peer recovery support services. Consequences: Claims for peer recovery support services without proper provider enrollment, CPRS certification verification, and correct RPS supervision documentation will be denied. Claims submitted with expired or insufficient CPRS/RPS credentials will be rejected.