Part 5: Current State of Peers in the United States - Demographics and Economic Impact

As peer support has become central to the treatment philosophy of the seriously mentally ill in the United States, it has gradually gained acceptance as a true intervention methodology and its practitioners recognized as integral members of the treatment teams. SAMHSA has designated it as an evidence-based practice, (Benefits of Peer Services, n.d.). Guidelines and core competencies have been elaborated by SAMHSA (Core Competencies for Peer Workers, 2018) and the National Association for Peer Support (NAPS) (Foglesong et al 2021). However, the scope of peer services varies widely by state. According to Videka et al (2019), only about 25% of mental health facilities in the United States offer peer services. There is a wide variance of mental health center concentration, substance use disorder treatment facility and peer usage in the United States as shown in Table 1.  

As of 2018, 45 states and the District of Columbia have established or will establish training and credentialing criteria for peer workers. Here too, there are large variances from state-to-state regarding credentialing requirements as seen in Table 2.

To address this, in 2017 Mental Health America (National Certified Peer Specialist (NCPS) Certification-- Get Certified!, n.d.) launched the first national certification process for peer workers.

The value of peers has been recognized as more states develop payment methodologies for peer-related services. Georgia was the first state to do so in 1999. In 2008 there were 9 states billing for peer services. As of 2017, 41 states do so. Initial reserve about billing for “nonprofessional” services has given way to widespread adoption of peer services. Typical Current Procedural Terminology (CPT) codes used for peer support include: H0038, H0046, H2015, H2017, H2019 and T1012, (State Medicaid Reimbursement for Peer Support Service: An OPEN MINDS Reference Guide. 2018). While it is encouraging that billing is possible, the reimbursement rate for the CPT codes is still quite low.

The criteria for both credentialing and billing vary considerably from state to state. This is understandable since the predominant payer source for peer support is Medicaid which is administered at the state level.

For detailed information about credentialing and reimbursement for peer workers see:

• Benefits of Peer Services by the Mental Health Alliance
• State Medicaid Reimbursement for Peer Support Service: An OPEN MINDS Reference Guide
• Beck et al., (2018) Scopes of Practice and Reimbursement Patterns of Addiction Counselors, Community Health Workers, and Peer Recovery Specialists in the Behavioral Health Workforce

Central to the identity of peer workers is the concept of “lived experience.” The fact that peer workers have experienced mental health challenges is what sets them apart from other care providers and what makes them uniquely effective in helping others. But what exactly is “lived experience”? As summarized in Table 3, a survey of nearly 600 peer workers conducted by Cronise et al (2016) found a wide range of overlapping issues that described lived experience.    

In the same study, the authors identified a variety of job titles for people doing peer work. Peer specialist/peer support specialist was the clear favorite, but others are frequently used as well as shown in Table 4.

In our next and final blog of this series, we will discuss the clinical success of peer support, the challenges peers face in the workforce and how the future of peers will evolve and grow.  

A look back on the rest of the peer support series:

Part 1: Origins of Peer Support in Mental Health

Part 2: Development of Peer Support in the United States and Other Regions of the World

Part 3: Public Policy and the Professionalization of Peers

Part 4: Role of Peers and Mutual Support in Alcoholics Anonymous

References Part 5

• Beck, AJ., Page, C., Buche, J., Rittman, D. and Gaiser, M. (2018) Scopes of Practice and Reimbursement Patterns of Addiction Counselors, Community Health Workers, and Peer Recovery Specialists in the Behavioral Health Workforce. University of Michigan. https://www.behavioralhealthworkforce.org/publications/
• Benefits of Peer Services. (n.d.) Mental Health Association.  https://www.mhanational.org/peer-support-research-and-reports
• Core Competencies for Peer Workers in Behavioral Health Services. (2015) SAMHSA. https://www.samhsa.gov/sites/default/files/programs_campaigns/brss_tacs/core-competencies_508_12_13_18.pdfCronise, R., Teixeira, C., Rogers, S. and Harrington, S. (2016) The Peer Support Workforce: Results of a National Survey. Psychiatric Rehabilitation Journal. https://pubmed.ncbi.nlm.nih.gov/27618458/
• Foglesong, F., Knowles, K., Cronise, R., Wolf, J. and Edwards, JP, (2021) National Practice Guidelines for Peer Support Specialists and Supervisors. Psychiatric Services. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000901
• National Certified Peer Specialist (NCPS) Certification-- Get Certified! (n.d.). Mental Health America. https://www.mhanational.org/national-certified-peer-specialist-ncps-certification-get-certified
• State Medicaid Reimbursement for Peer Support Service: An OPEN MINDS Reference Guide. March 14, 2018. https://openminds.com/market-intelligence/reference-guide/state-medicaid-reimbursement-for-peer-support-service/
• Videka, L., Neale, J., Page, C., Buche, J., Beck, AJ, Wayment, C. and Gaiser, M. (2019) National Analysis of Peer Support Providers: Practice Settings, Requirements, Roles, and Reimbursement. University of Michigan. https://www.behavioralhealthworkforce.org/publication/national-analysis-of-peer-support-providers-practice-settings-requirements-roles-and-reimbursement/