Peer support core competency and billing crosswalk
Oregon Erratics LLC · Sources: SAMHSA Core Competencies for Peer Workers (2015) + TIP 64 (SAMHSA, 2023) · OHP BH Fee Schedule (Feb 2026)
H0038 — Peer support ($26.49/15 min base)
H0023 — Outreach/pre-diagnostic ($62.97/service)
T1016 — Case mgmt boundary ref ($34.49/15 min)
H2011 — Crisis intervention ($41.70/15 min)
2015 SAMHSA 2015 Core Competencies
TIP 64 TIP 64 addition/elaboration
12 competency categories
1
Engages peers in collaborative and caring relationships
H0038 2015
- Initiates contact with peers
- Listens with careful attention to content and emotion being communicated
- Reaches out to engage peers across the whole continuum of the recovery process
- Demonstrates genuine acceptance and respect
- Demonstrates understanding of peers' experiences and feelings
TIP 64 adds: Peer-to-peer relationship must be grounded in mutual learning, hope, collaboration, respect, self-responsibility, and self-determination. Relationship-building is the foundation of all core functions — document explicitly as the service activity.
2
Provides support
H0038 2015
- Validates peers' experiences and feelings
- Encourages exploration and pursuit of community roles
- Conveys hope to peers about their own recovery
- Celebrates peers' efforts and accomplishments
- Provides concrete assistance to help peers accomplish tasks and goals
TIP 64 adds: PSS are relationship-focused, person-centered, and voluntary. Document the mutual nature of support and the person's active agency in directing the interaction.
3
Shares lived experiences of recovery
H0038 2015
- Relates own recovery stories, and with permission, the recovery stories of others, to inspire hope
- Discusses ongoing personal efforts to enhance health, wellness, and recovery
- Recognizes when to share experiences and when to listen
- Describes personal recovery practices and helps peers discover practices that work for them
TIP 64 adds: Lived experience disclosure is an ethical act. Peer must consider purpose, potential impact, how to respond to reactions, and self-care afterward. Supervisory consultation before disclosing trauma is recommended. Documentation field: lived experience shared: yes/no — purpose — peer response.
4
Personalizes peer support
H0038 2015
- Understands own values and culture and how these may contribute to biases, judgments, and beliefs
- Appreciates and respects the cultural and spiritual beliefs and practices of peers and their families
- Recognizes and responds to the complexities and uniqueness of each peer's recovery process
- Tailors services and support to meet the preferences and unique needs of peers and their families
TIP 64 adds: Trauma-informed personalization is a cross-cutting principle. Peers must: acknowledge trauma is widespread; recognize trauma signs without diagnosing; respond appropriately using organizational training; stay in their lane; avoid retraumatizing through forced disclosure. Documentation field: trauma-informed approach applied: yes/no.
5
Supports recovery planning
H0038 T1016 boundary 2015
- Assists and supports peers to set goals and to dream of future possibilities
- Proposes strategies to help a peer accomplish tasks or goals
- Supports peers to use decision-making strategies when choosing services and supports
- Helps peers to function as a member of their treatment/recovery support team
- Researches and identifies credible information and options from various resources
H0038 vs T1016 boundary: Peer recovery planning is goal-oriented, strengths-based, driven by self-determination. Case management (T1016) involves formal needs assessment, individualized service plans, eligibility determination, and coordinated referrals. TIP 64 (Exhibit ES.2): a peer worker is explicitly not a case manager.
6
Links to resources, services, and supports
H0038 H0023 2015
- Develops and maintains up-to-date information about community resources and services
- Assists peers to investigate, select, and use needed and desired resources and services
- Helps peers to find and use health services and supports
- Accompanies peers to community activities and appointments when requested
- Participates in community activities with peers when requested
TIP 64 adds: "Warm handoff" (personal introduction to new provider vs. passive referral) is a named peer function. Resource navigation is billable peer activity under H0038. Pre-engagement outreach to persons not yet in treatment → H0023 (requires MD standing order; OAR 410-120-0000 supports billing for suspected/unconfirmed conditions).
7
Provides information about skills related to health, wellness, and recovery
H0038 H0023 2015
- Educates peers about health, wellness, recovery, and recovery supports
- Participates with peers in discovery or co-learning to enhance recovery experiences
- Coaches peers about how to access treatment and services and navigate systems of care
- Coaches peers in desired skills and strategies
- Educates family members and other supportive individuals about recovery and recovery supports
- Uses approaches that match the preferences and needs of peers
TIP 64 adds: Peer insider knowledge enables warm handoffs and system navigation coaching — distinct from clinical education. Education about MOUD options is peer-appropriate; recommending or evaluating specific medications is not (Exhibit 3.4: role drift into medical provider).
8
Helps peers to manage crises
H0038 Crisis-adjacent — H2011? 2015
- Recognizes signs of distress and threats to safety among peers and in their environments
- Provides reassurance to peers in distress
- Strives to create safe spaces when meeting with peers
- Takes action to address distress or a crisis using knowledge of local resources, treatment, services, and support preferences of peers
- Assists peers in developing advance directives and other crisis prevention tools
TIP 64 critical boundary: Peer crisis support is relational, de-escalating, and presence-based. Peers do NOT perform clinical risk assessment, safety planning, or initiate involuntary holds (Exhibit 3.4). Crisis prevention planning (advance directives, safety contacts) is peer-appropriate under H0038. H2011 ($41.70/15 min) is in the fee schedule — whether peers can bill it requires OHA clarification. Confirm with Liz Lohrke.
9
Values communication
H0038 2015
- Uses respectful, person-centered, recovery-oriented language in all written and verbal interactions
- Uses active listening skills
- Clarifies understanding of information when in doubt of the meaning
- Conveys point of view when working with colleagues
- Documents information as required by program policies and procedures
- Follows laws and rules concerning confidentiality and respects others' rights for privacy
TIP 64 adds: Using clinical language is a role-drift warning sign (Exhibit 3.4). Documentation time is includable in H0038 unit time when it directly supports the peer encounter — not separately billable. 42 CFR Part 2 applies in SUD contexts.
10
Supports collaboration and teamwork
H0038 T1016 boundary 2015
- Works together with colleagues to enhance the provision of services and supports
- Assertively engages providers from mental health, addiction, and physical medicine to meet peer needs
- Coordinates efforts with health care providers to enhance health and wellness of peers
- Coordinates efforts with peers' family members and other natural supports
- Partners with community members and organizations to strengthen opportunities for peers
H0038 vs T1016 boundary: Peer coordination is relational and communication-based — connect, introduce, accompany, advocate. T1016 case management involves formal interagency coordination, service plan management, and administrative tracking. TIP 64: peer worker role is to extend case manager services, not duplicate them.
11
Promotes leadership and advocacy
H0038 2015
- Uses knowledge of relevant rights and laws (ADA, HIPAA, Olmstead) to ensure peer's rights are respected
- Advocates for needs and desires of peers in treatment team meetings, community services, and living situations
- Uses knowledge of legal resources and advocacy organizations to build an advocacy plan
- Participates in efforts to eliminate prejudice and discrimination of persons with behavioral health conditions
- Educates colleagues about the process of recovery and the use of recovery support services
- Actively participates in efforts to improve the organization
- Maintains a positive reputation in peer/professional communities
TIP 64 adds: Advocacy is a defined peer worker role distinct from clinical or administrative advocacy. The advocacy plan template is a peer-appropriate deliverable and a potential Creative Commons product (P3 grant).
12
Promotes growth and development
H0038 2015
- Recognizes the limits of their knowledge and seeks assistance from others when needed
- Uses supervision effectively by monitoring self and relationships, preparing for meetings, and engaging in problem-solving with the supervisor
- Reflects and examines own personal motivations, judgments, and feelings that may be activated by the peer work
- Seeks opportunities to increase knowledge and skills of peer support
TIP 64 adds (substantial): Supervision can be provided by an experienced peer provider, a specially trained treatment provider, or a combination. The OE MD-directed model satisfies TIP 64's dual supervision framework. Supervisor competencies must include: recovery principles, peer roles, ROSCs, trauma, social inequities. This framework + OAR 410-141-3820(3) is the clinical and regulatory basis for OE's ILOS shield argument.
TIP 64 additions not in the 2015 competencies
Role boundary taxonomy (TIP 64, Ch. 2 + Exhibit 3.4)
- Role confusion — unclear understanding of peer specialist's role. Reduced by clear job descriptions and org-wide training.
- Role drift — peer performs tasks outside scope (suited to case manager or licensed provider). OE's competency documentation is a structural defense against role drift claims.
- Role strain — stress from role confusion, drift, or stigma.
Exhibit 3.4 — Out-of-lane indicators:
- Counselor: diagnosing, acting as "expert," using clinical language, interpreting motives
- Case manager: formal needs assessment, service plan authorship, administrative coordination
- Medical provider: offering medical advice, commenting on prescriptions, suggesting/disagreeing with diagnoses
- Sponsor: guiding steps, acting as both sponsor and peer specialist to same person
OE Medical Stewardship and TIP 64 supervision framework
- TIP 64 endorses dual supervision: experienced peer provider + treatment provider + administrator
- OE's MD-directed model satisfies the "specially trained treatment provider" supervisor role (TIP 64, Ch. 5)
- Supervisor competencies: recovery principles, peer roles, ROSCs, trauma, social inequities, health disparities
- This framework + OAR 410-141-3820(3) = clinical and regulatory basis for OE's ILOS shield argument
Primary sources: SAMHSA (2015). Core Competencies for Peer Workers in Behavioral Health Services. · SAMHSA (2023). TIP 64: Incorporating Peer Support Into Substance Use Disorder Treatment Services. HHS Pub. No. PEP23-02-01-001. Both U.S. Government works, freely citable. · Billing rates: OHA BH Fee Schedule (Feb 2026). H0038 $26.49/15 min; H0023 $62.97/service (HF or HG required); T1016 $34.49/15 min; H2011 $41.70/15 min. TN modifier 127%; QDP/TBHA 110% stacking pending OHA confirmation. · Internal OE reference only. Not legal or billing advice. · Oregon Erratics LLC · david@oregonerratics.com