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Peer Support Benefit Addition January 2023-Medicaid Expansion

Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of an added peer support benefit for Medicaid Expansion members effective January 1, 2023.

A peer support specialist is a person who uses his or her lived experience of recovery from mental illness and/or addiction, plus skills learned in formal training, to deliver services to promote mind-body recovery and resiliency. Peer support compliments and is supplemental to clinical services. The role of a peer support is distinct and does not replace the clinician. The addition of peer support specialists will enhance the care options available for behavioral health diagnoses and can assist to improve a member’s health, decrease hospitalizations and inpatient stays, and reduce health care costs.
   
The BCBSND Peer Support medical policy will provide more information regarding peer support criteria https://www.bcbsnd.com/providers/policies-precertification/medical-policy/p/peer-support.

Medicaid Expansion members can receive peer support services as a standalone benefit and receive 1915(i) additional services but cannot duplicate peer support services in both programs.

Precertification is required for Medicaid Expansion members receiving this service. Utilize the Medicaid Expansion precertification tool to search for the service you plan to provide. Precertification requests will be submitted through the Availity Essentials portal.

If you have questions relating to this article or benefits for peer support, contact the phone number on the back of the members ID card.