September 16, 2019

Community Support Team Service Changes Lead to Whole Person Care

Community Support Team is both a Medicaid and State-funded service definition that offers adults with mental illness and/or substance use disorders a structured team approach to increase and restore the individual’s ability to live successfully in the community.  The service definition is undergoing a rework that will fold in parts of another service definition, Transition Management Services (TMS), and strengthen the integration of behavioral and physical healthcare as well as Social Determinants of Health (SDOH).  NC DHHS is making the shift in the definition for a few reasons.  One is to better serve the consumers who are a part of the US DOJ Settlement to divert individuals with Severe Mental Illness from Adult Care Homes to the community.  Another is a part of the larger vision to achieve whole person care in the public system. 

TMS is a rehabilitative service intended to increase and restore an individual’s ability to live successfully in the community by maintaining their tenancy in housing.  The new CST service adds the housing interventions and activities that are a part of the stand-alone TMS service.  CST will also have a psychiatric rehabilitation component and require the addition of a Substance Use Professional to the team.  The new definition will become effective on October 1, 2019 for State funded services, and the slightly revised TMS service definition will also go into effect that same day.  NC DHHS submitted a State Plan Amendment to the federal government for the Medicaid service definition and requested that it become effective on October 1, 2019.  The new CST service definition will include a rate increase due to its expanded scope and increased expectations for staff.    

Peer Support Services Stand-Alone Service Definition

In the past, Peer Support Services (PSS) have been embedded in many service definitions.  Now it looks like there will be a stand-alone service definition for Certified Peer Support Specialists to provide services to adult consumers with mental illness or a substance use disorder.  According to the new service definition, Peer Support Services are “structured, scheduled services that promote recovery, self-determination, self-advocacy, engagement in self-care and wellness and enhancement of community living skills of beneficiaries. PSS services are directly provided by Certified Peer Support Specialists (CPSS) who have self-identified as a person(s) in recovery from a mental health or substance use disorder.”  Structured services can include:  peer mentoring or coaching; recovery resource connecting; skill building recovery groups; and, building community (social connections).  A Qualified Professional will supervise the CPSS and there are limitations on ratios of CPSS to consumers. 

Peer Support Services will be available to Medicaid beneficiaries regardless of whether the individual is in the Standard Plan or the BH/IDD Tailored Plan. 

NC DHHS has set forth a number of expected outcomes for Peer Support Services including:  increased engagement in self-directed recovery process;  increased natural and social support networks; increased ability to engage in community activities;  increased ability to live independently as possible and use recovery skills to maintain a stable living arrangement;  higher levels of empowerment and hopefulness in recovery; improved emotional, behavioral and physical health;  improved quality of life; improved vocational skills;  decreased substance use; decreased frequency or intensity of crisis episodes; or decreased use of crisis services or hospitalizations.  Clinical assessments and whether identified goals in the Person-Centered Plan will determine if these expected outcomes have been met. 

The new service definition went into effect for State-funded services on August 1, 2019.  A State Plan Amendment to the NC Medicaid program was submitted to the federal government on August 16, 2019 with a retroactive start date of July 1, 2019.