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Best Practices: Level-of-Care Criteria for Peer Support Services: A Best-Practice Guide
Allen S. Daniels, Ed.D.; Rebecca Cate, Ph.D.; Susan Bergeson; Sandra Forquer, Ph.D.; Gerard Niewenhous, M.S.W.; Beth Epps, M.Ed.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201300277
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Dr. Daniels is a health care consultant based in Cincinnati, Ohio (e-mail: allensdaniels@gmail.com). The other authors are with Optum, Golden Valley, Minnesota. The late William M. Glazer, M.D., served as editor of this column.

Copyright © 2013 by the American Psychiatric Association

Abstract

Peer support services (PSS) are an expanding part of the continuum of care provided for behavioral health conditions. These services have been deemed an evidence-based reimbursable model of care by the Centers for Medicare and Medicaid Services. States, counties, employers, and health plans are increasingly covering PSS in benefit plans. Controlled and experimental studies are building the evidence base for these services. Medicaid and the states have not developed level-of-care or medical necessity criteria for PSS, even though these criteria are standards for determining coverage and reimbursement. This review of emerging level-of-care criteria for PSS provides a framework for the further development of these resources.

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