Are Behavioral Health Peer Support Services Covered in Kansas, Mississippi, New Mexico, Nebraska, North Dakota for Sober Living homes?
Kansas Peer Support Services Are Billable to Medicaid as of Summer 2023
Kansas announced in a special bulletin on “Expanding Peer Support Providers” released in October 2023 that “any behavioral health services provider who is an enrolled Kansas Medicaid provider” can now bill Medicaid for peer support services retroactively from July 1st 2023. This represents an expansion of Peer Support coverage in Kansas. This bulletin explicitly includes services delivered by Peer Specialists, Peer Mentors, and Parent Peer Specialists in these rules.
The only stipulations placed on Medicaid coverage for Peer Support Services in Kansas are that no services may be provided in acute or residential levels of care. Like most other states, Kansas uses the H0038 and H0038 HQ CPT codes for Medicaid reimbursable Peer Support Services.
You can read more about accreditation for Peer Support Specialists in Kansas here.
For more on behavioral health business and entrepreneurship in Kansas, see: Kansas is a Great State to Open a Sober Living Home and Opening an Addiction Treatment Center in Kansas: Low Fees and a Relatively Easy Process.
New Mexico Medicaid Places Few Restrictions on Peer Support Services Coverage for SUD Patients
New Mexico does cover Peer Support Services, with no copay and no limitations. In New Mexico, Certified Peer Support Workers deliver Peer Support Services in independent provider offices, peer-run wellness centers, and MCOs, or Managed Care Organizations.
Both the New Mexico Credentialing Board of Behavioral Health Professionals and the
Office of Peer Recovery and Engagement offer credentials in Peer Support Services.
For more on operating a sober living facility or addiction treatment center in New Mexico, see:
Nebraska Medicaid Accepts 4 Different CPT Codes for Peer Support Services
Yes, Peer Support Services are Medicaid-reimbursable in Nebraska. The Nebraska Department of Health and Human Services has a handy Medicaid Rate and Fee Schedule for Mental Health and Substance Abuse available on its website updated to reflect 2024 rates and rules.
If you go to the site and download the PDF for addiction treatment, you’ll see that there are three different CPT codes Nebraska Medicaid will accept for Peer Support Services. They are: H0038 HE, H0038 HF, H0038 HE/HQ, and H0038 HF/HQ. H0038 HF and H0038 HF/HQ are specific to people with a diagnosis of Substance Use Disorder. The other two are for those with a mental health diagnosis. Each CPT code represents 15 minutes of service. In Nebraska, Peer Support Services delivered via telehealth are Medicaid-reimbursable, however, for all Peer Support Services CPT codes, providers are required to see the patient face-to-face at least once every 30 days.
In Nebraska, the Nebraska Department of Health and Human Services oversees the certification programs for Peer Support Specialists. You can read more about Peer Support Specialist training and certification here.
For more on behavioral health business in Nebraska, see: Your Questions About Opening a Sober Living Home in Nebraska, Answered and FAQ: Opening and Licensing an Addiction Treatment Center in Nebraska.
Only Medicaid Patients Eligible for 1915(i) May Receive Peer Support Services in North Dakota
North Dakota does cover Peer Support Services under it’s Medicaid program, however, there is a catch.
In North Dakota, only patients who are eligible for 1915(i) state services may access peer support services. In order to be eligible for 1915(i), patients must have a WHODAS (World Health Organization Disability Assessment Schedule) score of 25 or more. If patients score below 25, they are not eligible for Medicaid-reimbursable Peer Support Services.
For those that do qualify, there are no copays or other limitations placed on behavioral health Peer Support Services in North Dakota. The North Dakota Department of Health and Human Services oversees the certification of Peer Support Service workers in the state, and you can find more about their training opportunities here.
Want to learn more about building a behavioral health business in North Dakota? Check out our other posts: 4 Best Kept Secrets About Opening a Sober Living Home in North Dakota and Medicaid Unwinding and State Behavioral Health in South Dakota, North Dakota, Alaska, Vermont, and Wyoming.
Mississippi Limits Medicaid-Reimbursable Peer Support Services to Community Mental Health Centers
According to KFF, Mississippi Medicaid does cover Peer Support Services, however, they are only covered at community mental health centers and there is a limit of 6 15-minute units per day, and an annual cap of 200 in any given fiscal year. Unfortunately, this makes adding Medicaid-reimbursable Peer Support Services to most independent behavioral health businesses, treatment centers, and sober living homes impractical in Mississippi.
For patients at facilities that are qualified to deliver Medicaid-reimbursable Peer Support Services in Mississippi, there are no copays required.
For more on the addiction treatment community in Mississippi, see our other posts: How to Open a Sober Living Home in Mississippi and Pros and Cons of Opening an Addiction Treatment Center in Mississippi.
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