Utah Covers Peer Support Services for Addiction Treatment and Recovery Residences
Does Utah Medicaid cover peer support services for addiction treatment and recovery services? Although the KFF database lists Utah as “not recorded” or “NR” for its 2022 database entry, the answer is: yes. Peer support services have been a billable service for Utah’s Medicaid program since 2011.
According to Utah’s Medicaid Provider Manual for Rehabilitative Mental Health and Substance Use Disorder Services, peer support services are billable to Medicaid in Utah. They are required to be “medically necessary,” of course, and they must be prescribed by a licensed mental health therapist as part of an overall treatment plan.
Utah Medicaid uses the typically H0038 CPT code for individual peer support services. Each H0038 claim represents 15 minutes of service. For group peer support services, the HQ modifier must be added to the end of the H0038 CPT code.
Utah has a certification program for peer support specialists, as well as Behavioral Health Technicians and Behavioral Health Coaches.
For more on behavioral health business management, planning, and strategy in Utah, see:
Nevada Medicaid Covers Peer Support Services, With Some Limitations
Nevada’s Medicaid program does cover peer support services, with no copay for the patient. However, prior authorization is required for all peer support services that go beyond 18 hours (or 72 units) in a single calendar year. In other words, the first 18 hours does not require prior authorization.
For more about sober living home management in Nevada, see: Answering Your Questions About How to Open a Sober Living Home in Nevada.
Iowa’s Medicaid-Reimbursable Peer Support Services Require No Copay
Good news: Iowa’s Medicaid program covers peer support services with no copay and no limitations! This makes peer support services an attractive value-add for any behavioral health business in Iowa that should provide evidence-based benefits to residents as well as additional income for operators.
For more on the behavioral health business in Iowa, see: Opening an Addiction Treatment Center in Iowa? The State’s Long-Standing SUD Problem Is Getting Worse, Not Better.
Arkansas has Several Different Peer Support Services Programs, All Covered Under Medicaid
Although the billing codes for peer support do not appear on either the Counseling and Crisis Services nor the Counseling Substance Abuse Codes for LADAC procedure code tables on the Arkansas Human Services website, Arkansas Medicaid does, indeed, cover peer support services. Not only that, but the state actually has three similar peer support roles: peer support specialist, family support partner, and youth support specialist.
In fact, Arkansas recently named a handful of peer support supervisors from a pool of peer support specialists to oversee the state’s peer support workforce.
For more on Arkansas addiction treatment and sober living, see: Opening an Addiction Treatment Center in Arkansas? Here’s How to Get Started and Get Licensed and The Fastest Way to Open a Sober Living Home in Arkansas.
South Dakota Does Not Cover Peer Support Support Services for Medicaid Patients
South Dakota is one of the few states that does not cover peer support services under its Medicaid program. You can’t bill Medicaid for peer support services in South Dakota, which is a deal breaker for more sober living home organizations. If you navigate to peer support services on the South Dakota Department of Social Services website, it links you to NAMI, a national peer support services nonprofit. This may change in the future, but there are currently no major attempts to make changes to this policy in the state.
South Dakota did add Community Health Workers to its Medicaid coverage under physician direction in 2022, but, unfortunately, peer support services remain incompatible with South Dakota Medicaid.
For more on Medicaid and sober living homes in South Dakota, see: Medicaid Unwinding and State Behavioral Health in South Dakota, North Dakota, Alaska, Vermont, and Wyoming and What You Need to Know About Opening a Sober Living Home in South Dakota.
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