Various behavioral health providers often have overlapping scopes of practice that easily go overlooked, as they are generally not educated together, nor do they practice in cooperative settings. One policy to address the behavioral health workforce shortage is “task shifting” or delegating non-specialized mental health treatment tasks to professionals not typically considered within the “core licensed behavioral health professions,” including certified addiction counselors, community health workers (CHWs), and peer recovery support specialists (PRS). Another suggestion is to make professional scopes of practice more uniform across the U.S., and to open up these scopes of practice to allow professionals to work to the top of their education and training level.
This project identified similarities and differences in the scopes of practice, education, and training requirements of various levels of addiction counselors, community health workers, and peer recovery support specialists across the country in order to inform future policies that might expand or otherwise modify these elements.
This study analyzed state scopes of practice that govern not only what services these professionals are allowed to provide, but what qualifications they must meet in order to be credentialed. To this end, online state statutes and rules were searched, compiled, extracted to a database, and then compared both across states and across professions for similarities and differences in content. Unique dimensions of addiction counseling were analyzed, including the substitution of academic degrees for supervised practice experience. A secondary component to this project involved billing practices for these three occupations. The research team was interested in how CHWs, psychiatric rehabilitation specialists, and addiction counselors can be reimbursed across the country. Namely, could these occupations bill Medicaid/Medicare, and, if so, how much would they be reimbursed.
Given the opioid epidemic, demand for substance use disorder services in America may rise. In 2018, statutes and administrative rules detailing scopes of practice (SOP) and credential requirements for addiction counselors (ACs), community health workers (CHWs), and peer recovery specialists (PRSs) were extracted from state government, certification board, and/or professional association websites in all fifty states and D.C., as were Medicaid statutes, provider handbooks, and fee schedules. The search revealed 216 AC credentials, 43 CHW credentials, and 63 PRS credentials.
Key findings include:
- Independent, clinical ACs required a graduate degree for practice, and earned an average of $84.03 from Medicaid for an hour of individual therapy.
- No CHW credential required a degree beyond a high school diploma/GED, and CHWs earned an average of $23.54 per 15 minutes of individual health education.
- PRS credentials typically required a GED or high school diploma, 500 practice hours, and 25 supervision hours. A PRS earned an average of $12.98 per 15 minutes of peer support services.
Allowing ACs to be both licensed and certified may increase supply for that occupation. CHWs would most benefit from Medicaid State Plan Amendments that add them as a reimbursable profession. And clarifying PRSs’ roles within SOP documents could reduce interprofessional conflict.