ModifiedNevada Health AuthorityPolicy N/A

Peer Support Services

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This policy governs Nevada Medicaid coverage, provider eligibility, member eligibility, care planning, covered and non-covered activities, authorization, and billing for adult, family, and youth peer support services.

Policy Summary

PayerNevada Health Authority

PolicyPeer Support Services

Policy CodePolicy N/A

Change TypeModified

Effective DateJuly 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization after 52 hours or 208 units annually, with authorization intervals no longer than 90 days.

SourceLink

POLICY UPDATE CHANGES

The maximum recipient age for family and youth peer support services was updated to under age 26.

Certification language was expanded to recognize the Nevada Certification Board or its successor organization.

Redundant managed care subsections were removed and the managed care section was revised to apply to all peer support services rather than only youth services.

Grammar, punctuation, capitalization, acronyms, section numbering, organization, and duplicative language were standardized throughout the chapter.

52 hours / 208 unitsAnnual services before prior authorization

90 daysMaximum authorization interval

Under 26

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ModifiedNevada Health AuthorityPolicy N/A

Peer Support Services

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Sign up for all Nevada Health Authority policy alerts

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Policy Summary

PayerNevada Health Authority

PolicyPeer Support Services

Policy CodePolicy N/A

Change TypeModified

Effective DateJuly 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization after 52 hours or 208 units annually, with authorization intervals no longer than 90 days.

SourceLink

POLICY UPDATE CHANGES

The maximum recipient age for family and youth peer support services was updated to under age 26.

Certification language was expanded to recognize the Nevada Certification Board or its successor organization.

Redundant managed care subsections were removed and the managed care section was revised to apply to all peer support services rather than only youth services.

Grammar, punctuation, capitalization, acronyms, section numbering, organization, and duplicative language were standardized throughout the chapter.

52 hours / 208 unitsAnnual services before prior authorization

90 daysMaximum authorization interval

Under 26

Family and youth age limit

7Covered billing codes

15 minutesService billing unit

Coverage Criteria

Adult member eligibility

Adult peer support services are covered when all applicable conditions are met.

Adult eligibility and plan of care: The recipient is over age 18; has a diagnosis of a mental health disorder or substance use disorder; has been identified by a professional as having a documented need for Adult Mental Health Peer Support Services or Adult Recovery Peer Support Services; and the services are included in a current plan of care.Recipient over age 18

The plan of care must support recovery, self-sufficiency, or community integration.

Covered adult service types and delivery

Covered adult peer support services include services that meet all applicable delivery requirements.

Covered service delivery: The service is recovery coaching and mentorship; skill-building in self-advocacy and resiliency; symptom management support; crisis de-escalation and support; assistance with navigating behavioral health services; or support for social and community engagement; is documented in the recipient's plan of care; is coordinated with applicable care coordination or interdisciplinary teams; incorporates a trauma-informed approach; and is supervised by a clinical supervisor under MSM Chapter 400 or a certified Peer Recovery and Support Specialist Supervisor.No specific clinical threshold stated

Services may be delivered individually or in groups, face-to-face, by telephone, or through virtual meetings.

Eligible peer support providers

A peer support provider must meet all applicable qualification requirements.

Provider qualifications: The provider self-identifies as having the applicable lived experience; holds certification from the Nevada Certification Board, its successor organization, or an applicable state-approved training program; completes required ongoing training; and has no familial relationship with the recipient.Certification and ongoing training required

Family peer specialists must have lived experience as a parent or caregiver of a child or youth with a behavioral health disorder and applicable training modules.

Family Peer Support eligibility

Family Peer Support Services are covered when all of the following are met.

Family member or caregiver eligibility: The service is provided to the family member or caregiver of an eligible member under age 26.Under age 26

Medical necessity: The service is medically necessary to ameliorate behavioral health conditions and is provided for the direct benefit of the eligible member.

The eligible member does not have to be present during the service.

Current plan of care: The need for Family Peer Support Services is documented in a current plan of care.Current plan of care

Youth Peer Support eligibility

Youth Peer Support Services are covered when all of the following are met.

Age and diagnosis: The eligible member is under age 26 and has a diagnosed mental health or substance use disorder.Under age 26

Documented need: A professional has identified a documented need for Youth Peer Support Services to build self-sufficiency and strengthen community integration.Documented need

Current plan of care: The need for Youth Peer Support Services is documented in a current plan of care.Current plan of care

Service delivery requirements

Covered services must meet all of the following service conditions.

Plan-of-care inclusion: The service is documented in the recipient's plan of care.

Care coordination: The service is coordinated with applicable care coordination or interdisciplinary teams.

Trauma-informed delivery: The service incorporates a trauma-informed approach that seeks to enhance safety, trust, collaboration, and partnership between providers and recipients.

Supervision: The service is supervised by a clinical supervisor under MSM Chapter 400 or an appropriately certified Family or Youth Peer Support Specialist Supervisor approved by Nevada Medicaid.Active certification where applicable

Adult Peer Support Specialists may not provide direct medical services, care coordination, or therapy services. These activities are outside the scope of the adult peer support benefit and are not reimbursable under this benefit.

Services are not covered when delivered to recipients who are institutionalized or residing in an institution for mental diseases (IMD).

Family Peer Support Services must directly support the eligible member and be included in the plan of care. Non-covered activities include direct medical, care coordination, therapy, clinical, supervision, transportation, documentation, tutoring, room and board, and services provided by relatives, unpaid interns, or volunteers. Caregiver or household services, such as babysitting, laundering clothes, moving, housekeeping, and grocery shopping, are also excluded.

Youth Peer Support Services must directly support the eligible youth and be included in the plan of care. Non-covered activities include direct medical, care coordination, therapy, clinical, supervision, transportation, documentation, tutoring, room and board, and services provided by relatives, unpaid interns, or volunteers. Caregiver or household services for the youth or the youth's family, such as babysitting, laundering clothes, moving, housekeeping, and grocery shopping, are also excluded.

Services that do not directly support recovery or are not included in the recipient's plan of care are not eligible for Medicaid reimbursement under this benefit.

Billing and Coding

Covered Adult Peer Support Services HCPCS CodesHCPCSCovered

H0038	Self-help/Peer Services (Adult Peer Support Services); per 15 minutes; 208 units annually before Prior Authorization
H0038-HQ	Self-help/Peer Services group (Adult Peer Support Services); per 15 minutes; 208 units annually before Prior Authorization

Covered Family Peer Support Services HCPCS CodesHCPCSCovered

H0038 (HR)	Family Peer Support Services (with client present); per 15 minutes; 208 units annually before Prior Authorization
H0038 (HS)	Family Peer Support Services (without client present); per 15 minutes; 208 units annually before Prior Authorization
H0038 (HQ + HR)	Group Family Peer Support Services; per 15 minutes; 208 units annually before Prior Authorization

Covered Youth Peer Support Services HCPCS CodesHCPCSCovered

H0038-HA	Self-help/Peer Services (Youth Peer Support Services); per 15 minutes; 208 units annually before Prior Authorization
H0038-HQ + HA	Self-help/Peer Services group (Youth Peer Support Services); per 15 minutes; 208 units annually before Prior Authorization

Adult Peer Support Services

Annual thresholdUp to 52 hours annually before prior authorization is required

Unit equivalent208 units annually

Applies toAdult Peer Support Services

Adult Prior Authorization

Maximum intervalPrior authorization may not exceed 90-day intervals

Approval authorityMedicaid's Quality Improvement Organization (QIO)-like vendor

Provider Requirements and Actions

Prior Authorization

Adult Prior Authorization After Annual Threshold

Adult Peer Support Services may be used for up to 52 hours/208 units annually before prior authorization is required. Authorization must be approved by Medicaid’s QIO-like vendor, may not exceed 90-day intervals, and must be based on the recipient’s needs documented in the plan of care.

Prior authorization is required after 52 hours or 208 units in a calendar year.
Authorization must not exceed 90-day intervals and must be supported by the plan of care.

Prior Authorization

Family Services Prior Authorization Threshold

Family Peer Support Services may be used for up to 52 hours/208 units annually before prior authorization is required. Authorization must be approved by Medicaid’s QIO-like vendor, may not exceed 90-day intervals, and must be based on the expected benefit to the eligible member as documented in the plan of care.

Prior authorization is required after 52 hours or 208 units annually.
Authorization must not exceed 90-day intervals and must be supported by the plan of care.

Policy Background

Adult peer support services provide structured, recovery-oriented interventions for individuals with mental health disorders or substance use disorders. These services support recovery, self-advocacy, symptom management, community integration, and access to behavioral health resources. Services are person-centered, may be delivered individually or in groups, and may occur face-to-face, by telephone, or through virtual meetings.

Definitions

Family Peer Support Services

DefinitionStructured support provided to parents and caregivers of children and youth with behavioral health disorders

Eligible support populationParents and caregivers of children and youth with behavioral health disorders

Certified provider contextCertified Family Peer Support Specialists are adults with lived experience as parents or caregivers of children or youth with behavioral health disorders

Youth Peer Support Services

DefinitionStructured support provided to youth with behavioral health disorders

Certified provider contextCertified Youth Peer Support Specialists are young adults 18 to 30 years old with lived experience as a youth with a behavioral health disorder

Covered Treatment Modalities

Adult mental health and substance use recovery peer support

Adult peer support is available through either of the following modalities.

Adult peer support modality: Adult Mental Health Peer Support Services support individuals with mental health disorders, or Adult Recovery Peer Support Services support individuals with substance use disorders.Adult recipient over age 18

Both modalities are structured, recovery-oriented peer interventions.

Trauma-informed Family and Youth Peer Support Services

Family and Youth Peer Support Services must meet the following modality requirement.

Trauma-informed peer support: Family and Youth Peer Support Services must incorporate a trauma-informed approach to care that seeks to enhance safety, trust, collaboration, and partnership between providers and recipients.

Service Limits

Adult Peer Support Services Visit Limit

Annual limit before prior authorizationUp to 52 hours

Unit limit208 units annually

Authorization triggerPrior authorization is required after the annual limit is reached

Family and Youth Peer Support Services Visit Limit

Annual limit before prior authorizationUp to 52 hours

Unit limit208 units annually

Covered servicesFamily Peer Support Services and Youth Peer Support Services

Policy Summary

PayerNevada Health Authority

PolicyPeer Support Services

Policy CodePolicy N/A

Change TypeModified

Effective DateJuly 1, 2026

Next Review DateN/A

Key ActionObtain prior authorization after 52 hours or 208 units annually, with authorization intervals no longer than 90 days.

SourceLink

On This Page

Basis for authorization

Recipient's needs documented in the plan of care

Family and Youth Peer Support Services

Annual thresholdUp to 52 hours annually before prior authorization is required

Unit equivalent208 units annually

Applies toFamily Peer Support Services and Youth Peer Support Services

Family and Youth Prior Authorization

Maximum intervalPrior authorization may not exceed 90 days

Approval authorityMedicaid's QIO-like vendor

Authorization basisFamily services: expected benefit to the eligible member documented in the plan of care; Youth services: recipient's needs documented in the plan of care

Prior Authorization

Youth Services Prior Authorization Threshold

Youth Peer Support Services may be used for up to 52 hours/208 units annually before prior authorization is required. Authorization must be approved by Medicaid’s QIO-like vendor, may not exceed 90-day intervals, and must be based on the recipient’s needs documented in the plan of care.

Prior authorization is required after 52 hours or 208 units annually.
Authorization must not exceed 90-day intervals and must be supported by the plan of care.

Documentation Required

Adult Plan of Care Documentation

Maintain a current, comprehensive, individualized adult plan of care (POC) describing the recipient’s documented need for Adult Mental Health Peer Support or Adult Recovery Peer Support Services, the service goals, and how those goals will be achieved. Integrate applicable goals from the therapeutic treatment plan; when the recipient is not receiving therapeutic services, establish peer service goals in the POC.

Document the need for services in a current POC.
Include detailed service plans, needs, outcomes, strategies, and peer service goals.
A separate POC is not required when an existing therapeutic treatment plan incorporates the required peer-service information.

Documentation Required

Adult Service and Coordination Documentation

Document Adult Mental Health Peer Support and Adult Recovery Peer Support Services in the recipient’s POC and coordinate them with applicable care-coordination or interdisciplinary teams.

Ensure the service record supports the POC and required coordination.
Do not treat peer support as a substitute for direct medical, therapy, or care-coordination services.

Documentation Required

Current Family and Youth Plan of Care

For Family and Youth Peer Support, maintain a current POC documenting the eligible member’s service need, peer-service goals, expected outcomes, strategies, and detailed service plans. Family services must benefit the eligible member under age 26, even when the member is not present; Youth services must address the eligible youth’s documented need.

Family Peer Support is provided to a family member or caregiver for the direct benefit of an eligible member under age 26.
Youth Peer Support requires an eligible member under age 26 with a documented need for the service.
A separate POC is not required when an existing therapeutic treatment plan incorporates the required peer-service information.

Documentation Required

Plan Development, Review, and Signatures

Develop, monitor, and update the POC with the required participants. Review and update it at least annually, sooner when the recipient’s circumstances or needs significantly change, or upon the applicable recipient, family member, or caregiver’s request. Obtain all required signatures before relying on the POC for billing.

Family POC: obtain signatures from the Family Peer Support Specialist, supervisor, and recipient’s family member or caregiver.
Youth POC: obtain signatures from the Youth Peer Support Specialist, supervisor, recipient, and—when the recipient is a legal minor—the family member or caregiver.
Youth POC development must include the recipient or, for a legal minor, the recipient’s family member or caregiver.

Documentation Required

Service Documentation and Coordination

Document Family and Youth Peer Support Services in the recipient’s POC and coordinate the services with the applicable care coordinator, care-coordination team, or interdisciplinary team.

Service documentation must demonstrate that the service is included in the current POC.
Maintain evidence of required interdisciplinary or care-coordination collaboration.

Documentation Required

Measurable and Achievable Goals

POC needs, outcomes, and strategies must be specific, measurable, and achievable. Goals must be clearly identified, outcomes must be behaviorally based and written in clear, understandable language when practicable, and the identified needs must be attainable within a designated time period using accessible and available resources.

Specific: clearly identify the goals.
Measurable: define how the recipient’s or caregiver’s needs will be recognized as met.
Achievable: align the needs and timeframe with available resources and supports.

Denial Risk

Services Outside the Plan of Care Are Not Covered

Services that do not directly support the eligible recipient, or that are not included in the applicable POC, are not eligible for Medicaid reimbursement. Peer Support Specialists may not provide direct medical, care-coordination, or therapy services under this benefit.

Do not bill services outside the current POC.
Documentation itself, supervision, clinical services, transportation (other than connection to transportation resources), and caregiver or household services are non-covered examples.

Denial Risk

Ineligible or Improperly Certified Provider

Bill only through providers and specialists who satisfy the applicable qualification and enrollment requirements. Adult specialists must have lived experience, current Nevada Certification Board (NCB) or successor certification, required ongoing training, and no familial relationship with the recipient. Family specialists must be certified through the NCB, its successor, or an approved state training program covering adult and youth behavioral health needs, complete required training, and have no familial relationship with the recipient.

Use an appropriately affiliated individual provider or a Nevada-based, peer-led Medicaid-enrolled Peer Support Services agency.
Verify Medicaid enrollment and provider status requirements.
Do not use a provider who lacks required certification, training, enrollment, or independence from the recipient.

Documentation Required

Eligibility and Plan-of-Care Requirement

Family and Youth Peer Support require an eligible member under age 26 and a current POC documenting the need for services. Family services must be medically necessary to ameliorate the eligible member’s behavioral health condition and directly benefit that member; Youth services require a diagnosed mental health or SUD condition and a professionally identified need.

The eligible member need not be present when Family Peer Support is provided to a family member or caregiver.
Document eligibility, medical necessity or identified need, and the applicable service goals in the current POC.

Denial Risk

Family Peer Support Non-Covered Services

Family Peer Support services are not covered when they do not directly support the eligible member or are not included in the POC. Do not bill services delivered by a relative, unpaid intern, or volunteer, or tutoring, supervision, clinical services, transportation (except connection to transportation resources), or household and caregiver tasks.

Services cannot be provided by an individual with a familial relationship to the individual receiving support.
Examples of non-covered household tasks include babysitting, laundering, moving, housekeeping, and grocery shopping.

Denial Risk

Youth Peer Support Non-Covered Services

Youth Peer Support services are not covered when they do not directly support the eligible youth or are not included in the POC. Do not bill services delivered by a relative, unpaid intern, or volunteer, or tutoring, supervision, clinical services, transportation (except connection to transportation resources), or household and caregiver tasks.

Services cannot be provided by an individual with a familial relationship to the individual receiving support.
Examples of non-covered household tasks include babysitting, laundering, moving, housekeeping, and grocery shopping.

Provider roleAssist youth in building self-advocacy skills, developing wellness goals, navigating youth-serving systems, and transitioning to adult-serving systems

Trauma-Informed Approach

DefinitionAn approach to care that seeks to enhance safety, trust, collaboration, and partnership between providers and recipients

Required applicationFamily and Youth Peer Support Services must incorporate a trauma-informed approach to care

Care principlesSafety, trust, collaboration, and partnership between providers and recipients