As New York expands its Recovery Oriented System of Care (ROSC), the utilization of peers within hospital emergency rooms, addiction treatment, and recovery support providers, has demonstrated tremendous value, and opportunities to achieve enhanced engagement and retention of individuals in need of addiction services and supports. The Centers for Medicare & Medicaid Services (CMS) provided guidance to state Medicaid directors in April 2007 on peers as an evidence-based model of care.
The New York State Office of Addiction Services and Supports (OASAS) identified a Certification Board to develop and administer a process for individuals with lived experience to become Certified Recovery Peer Advocates (CRPAs) to work within its ROSC. Simultaneously, the state received approval from CMS for Medicaid reimbursement for peer services provided by CRPAs working within the OASAS outpatient system of addiction treatment. Today there are now more than 1,300 CRPAs providing peer services throughout the state!
OASAS has developed several innovative, locally based programs that utilize peers within clinical teams to better meet the needs of New Yorkers, wherever they are in their path to recovery. These programs increase access to assessments and referrals; and provide family support while reducing barriers to receiving help. Capitalizing on federal funding related to the nationwide opioid crisis, OASAS developed 20 Centers of Treatment Innovation (COTIs) that provide mobile treatment, telehealth and transportation to bring services directly to individuals that need them.
The COTI providers utilize peer outreach and engagement within communities to help link individuals with appropriate levels of care and support. The data OASAS has received to date indicates that more than half of the individuals engaged by peers are subsequently admitted to an OASAS certified treatment.
The anchors for the COTIs are the certified outpatient treatment programs. Many of these COTI providers have also joined with hospital emergency departments to provide CRPAs to engage individuals after an opioid overdose and to provide a warm hand-off to an appropriate level of care. In 2019 OASAS developed a demonstration with 5 hospital emergency departments to provide buprenorphine induction while partnering with outpatient providers for peer services delivered by CRPAs. One of our outpatient COTI providers, CN Guidance & Counseling (CNG) stated that peer services have been a “game changer” for engagement as the peers put a face on early recovery. A participating hospital systems partner, Northwell Health in Long Island, commented:
In 2017 OASAS initiated the development of 21 Peer Engagement Specialists (PES) programs, in response to community feedback received during the Heroin and Opiate Task Force listening tours conducted throughout the state in 2016. The Task Force, co-chaired by me and Lieutenant Governor Kathy Hochul, identified a series of recommendations, one of which was the development of services to engage individuals that have experienced an opioid overdose. The PES providers link CRPAs with hospital emergency departments to engage individuals and their families and make referrals to appropriate levels of care. The data is striking (see data charts on page 37).
To support the implementation of the peer program agenda OASAS initiated policy and regulatory modifications. In addition to seeking and obtaining Medicaid reimbursement for peer services delivered by CRPAs within outpatient programs, OASAS now authorizes outpatient providers to conduct and bill for pre-admission outreach and engagement; and to conduct and bill for, these services in-community, or outside of the clinic’s four walls.
OASAS issued guidance documents on the following topics: scope of practice for peer services; pre-admission and in-community service provision; and documentation and billing guidance. OASAS also developed a bureau focused solely on peer services integration to provide technical assistance with certified outpatient and opioid treatment program (OTP) providers. The availability of technical assistance to help clinical treatment outpatient providers to integrate non-clinical peers or CRPAs is critical given that OASAS modified its outpatient regulations effective March 29, 2019, to require all such outpatient treatment programs and OTPs to provide peer services as part of their menu of services by January 1, 2020.
An organizational readiness self-assessment tool was disseminated to all outpatient and OTP programs. The tool features embedded links to peer resources, including a Peer Integration Toolkit, as well as links to all of the above referenced guidance documents.
New York is committed to continuing the integration of peer services. To accomplish this objective OASAS is partnering with the following organizations to train more CRPAs for employment within our ROSC: 1) CRPA Certification Board, the New York Certification Board (NYCB); 2) a statewide organization dedicated to developing local recovery community organizations, Friends of Recovery-New York; and 3) the Alliance for Careers in Healthcare (ACH). ACH is partnered with some City University of New York (CUNY) community colleges to develop new CRPA curriculums that provide CRPA training.
The totality of our shared efforts has already demonstrated the power of a peer to engage more individuals in need of addiction and recovery services, and thereby help more families and individuals to achieve wellness on their path to recovery.