The Health Care Authority (HCA) certifies peer counselors under its Peer Support Program.  Certification by the HCA is not necessary to provide peer counseling services, however, it is required for reimbursement under Medicaid.  To be certified, a person must:

• self-identify as a consumer, or parent or legal guardian of a consumer, of mental health or substance use disorder services;
• be registered by the Department of Health (DOH) as an agency-affiliated counselor;
• complete an online prerequisite course;
• complete a 40-hour specialized training course on core competencies established by the federal Substance Abuse and Mental Health Services Administration;
• pass an examination administered by the HCA; and
• receive a written notification letter from the HCA recognizing the individual as a counselor.

 
The services that may be provided by certified peer counselors are specified in Washington's Medicaid State Plan (State Plan).  The State Plan specifies that they work with adults, youth, and the parents of children receiving behavioral health services to help them find hope and make progress toward recovery by drawing upon their own life experience.  Since July 1, 2019, behavioral health agencies have been able to provide peer support services for both mental health and substance use disorders and receive Medicaid reimbursement.

Beginning July 1, 2024, certified peer specialists and certified peer specialist trainees are established as new health professions that may engage in the practice of peer support services. Practice of peer support services means the provision of interventions by either a person in recovery from a mental health condition, substance use disorder, or both, or the parent or legal guardian of a youth who is receiving or has received behavioral health services. The person provides the interventions through the use of shared experiences to assist a client in the acquisition and exercise of skills needed to support the client's recovery.

The decision of a person practicing peer support services to become a certified peer specialist is voluntary, unless that person or the person's employer bills a health carrier or medical assistant for those services.

A certificate is not required to practice peer support services but is required to use the title of certified peer specialist or certified peer specialist trainee.

Pathways to Earn a Certificate to Engage in the Practice of Peer Support Services. Educational Course and Examination. Beginning July 1, 2025, the Secretary of Health (secretary) must issue a certificate to engage in the practice of peer support services to anyone who meets the following requirements:

• attests that the applicant self-identifies as a person with one or more years of recovery from a mental health condition, substance use disorder, or both; or, is the parent or legal guardian of a youth who is receiving or has received behavioral health services;
• completes the education course offered by the HCA;
• passes an oral and written examination issued by the HCA;
• completes an experience requirement of at least 1000 supervised hours as a peer specialist trainee; and
• pays any applicable fees which, until July 1, 2030, may not exceed $100.

Prior Experience. The secretary, with the recommendation of the advisory committee, must establish criteria for the issuance of a certificate based on prior experience as a peer specialist attained before July 1, 2025. The criteria must establish equivalency standards necessary to meet the requirements in lieu of coursework and examination. An applicant based on experience as a peer specialist must have until July 1, 2026, to complete any standards the applicant is deficient in.

Apprenticeship. The secretary, with the recommendations of the advisory committee, must adopt criteria for the issuance of a certificate as a peer specialist based on completion of an approved apprenticeship program. 

Certificate to Engage in the Practice of Peer Support Services as a Certified Peer Specialist Trainee. The secretary must also issue certificates for peer specialist trainees to practice peer support services under the supervision of an approved supervisor while completing the experience requirement to obtain a full certificate as a peer specialist. To obtain a certificate as a peer specialist trainee, an applicant must have either:

• met the attestation, education, and oral and written examination requirements for a peer specialist; or
• be enrolled in an approved apprenticeship program.

An applicant seeking to become a certified peer specialist trainee must attest that they are actively pursuing the supervised experience requirement to be certified as a certified peer specialist.

An approved supervisor is either:

• until July 1, 2028, a behavioral health provider with at least two years of experience working in a behavioral health practice that employs peer specialists in treatment teams; or
• a certified peer specialist with at least 1500 hours of work as a certified peer specialist, including at least 500 hours in the joint supervision of peers, and who has completed a peer supervisor training course developed by the HCA.

By December 1, 2027, DOH must submit a study on the adequacy of the supply of certified peer specialists serving as approved supervisors for trainees to meet the supervision needs of trainees as well as recommendations for increasing the supply of certified peer specialists serving as approved supervisors and for establishing alternative methods of providing supervision.

Beginning January 1, 2027, any person who engages in the practice of peer support services must be certified as a certified peer specialist or a trainee if the person or the person's employer bills a health carrier or medical assistance program for those services. Registered agency-affiliated counselors who engage in the practice of peer support services and whose agency bills medical assistance for those services must be certified by January 1, 2027.

Trainings and Examinations. HCA must develop a course of instruction to become a certified peer specialist. The course must be at least 80 hours long and based upon the curriculum offered by HCA in its peer counseling training, as well as the instruction of principles of recovery coaching and suicide prevention. The course must be taught by certified peer specialists and offered with sufficient frequency to meet workforce demands. 

HCA must develop and offer additional trainings, including a training course for peer specialists providing supervision to peer specialist trainees, a 40-hour specialized training course in peer crisis response services, and a course on the benefits of incorporating certified peer specialists and certified peer specialist trainees into clinical staff. Beginning July 1, 2025, peer specialists working as peer crisis responders must have completed HCA's 40-hour peer crisis response training.

HCA is responsible for administration of examinations to earn certification as a certified peer specialist. HCA must approve educational and testing entities to provide educational courses and administer examinations. 

Appropriate Use of Certified Peer Specialists. By July 1, 2026, each carrier shall provide access to services provided by certified peer specialists and certified peer specialist trainees in a manner sufficient to meet the network access standards set forth in rules established by the Office of the Insurance Commissioner.

By July 1, 2024, HCA must contract for a program to link eligible persons in recovery from behavioral health challenges who are seeking employment as peers with potential employers. The contractor must create and maintain a statewide database that is accessible to eligible persons and employers.

Behavioral health agencies must reduce the caseload for approved supervisors who are providing supervision to certified peer specialist trainees according to standards established by the advisory committee.