Issued: February 19, 2020

Authorizations and Documentation: Partners will align the authorization requirements for both State and Medicaid funded Peer Support services.

There will be 64 unmanaged units for Peer Support regardless of funding source. When the provider wants to request more units beyond the unmanaged units, the provider must submit a service order, a person centered plan (PCP) and comprehensive clinical assessment (CCA).   It is important to note that the Service Order must be signed on the first day of service. The PCP and CCA should be completed during the unmanaged visits and ready to submit with the first authorization request beyond the unmanaged allowance.

This change is effective February 17, 2020*.

* We recognize that State-funded Peer Support units have been unmanaged. Providers delivering State-funded Peer Support have until April 1, 2020 to submit a service authorization request with all required documentation.

Service Orders: There have been questions about what should be included with a standalone Service Order.  The following elements must be captured:

  • Full Name of Member
  • Date of Birth
  • Service Ordered
  • Diagnosis Code
  • Signature of Ordering Practitioner
  • Credential of Ordering Practitioner

Training: Providers have asked questions about the training requirements for Peer Support. Training can be face to face, webinar or by internal staff who have their certification from a Train the Trainer session. There must be a certificate for each peer support employee signed by the trainer and kept in each personnel file.

If you have additional questions, please contact the Mental Health/Substance Use (MHSU) Utilization Management Workgroup at 704-842-6436.