Utah Peer Support & Medicaid Guide

Utah has a formal statewide peer support system serving people with mental health conditions, substance use disorders, co-occurring behavioral health needs, children and families, and people receiving Medicaid-funded behavioral health services.

The state’s primary peer credential is the Certified Peer Support Specialist, commonly abbreviated CPSS.

The Utah Department of Health and Human Services, or DHHS, administers the certification program through the Office of Substance Use and Mental Health, or OSUMH.

Utah defines a Certified Peer Support Specialist as someone who uses lived experience in recovery from mental illness and/or substance use disorder, together with skills learned through formal training, to provide services that promote recovery and resiliency. Current state application materials require at least one year of successful recovery, a minimum age of 18, a valid Utah mailing address, and completion of a 40-hour training program. (DSAMH Training)

Utah Medicaid formally covers individual and group Peer Support Services. Current Medicaid policy uses H0038 for individual services and H0038 HQ for group services, both in 15-minute units. (Medicaid - Utah DHHS)

Utah Peer Support Quick Facts

Category	Utah overview
State Medicaid program	Utah Medicaid
State behavioral health authority	Utah Department of Health and Human Services
Peer program office	Office of Substance Use and Mental Health
Primary peer credential	Certified Peer Support Specialist
Abbreviation	CPSS
Minimum age	18
Lived experience	Required
Recovery requirement	At least 1 year
Utah mailing address	Required for current certification pathway
CPSS training	40 hours
Certification renewal	Every 2 years
Continuing education	20 hours per 2 years
Peer-specific CE	At least 5 hours
Ethics CE	3 hours
Suicide prevention CE	2 hours
Medicaid peer support	Yes
Individual Medicaid code	H0038
Group Medicaid code	H0038 HQ
Billing unit	15 minutes
Medicaid group ratio limit	Maximum 1 peer to 8 members for reportable groups
Licensed therapist referral	Required under current Medicaid policy
Last reviewed	August 2026

What Is Peer Support in Utah?

Utah describes Certified Peer Support Specialists as people who use their own lived experience in recovery from:

Mental illness
Substance use disorder
Or both

to help other people pursue recovery and resiliency.

The state defines recovery as a process through which people improve their health and wellness, live self-directed lives, and work toward reaching their full potential. (DSAMH Training)

Peer support may include:

Recovery mentoring
Wellness support
Goal setting
Self-advocacy
Recovery planning
Community integration
Behavioral health navigation
Resource connection
Coping support
Recovery education
Natural support development
Treatment engagement

Peer support remains distinct from psychotherapy, diagnosis, medication management, and other clinical services requiring professional licensure.

Certified Peer Support Specialist

The Certified Peer Support Specialist, or CPSS, is Utah’s primary formal peer credential.

Current OSUMH materials describe a CPSS as an individual who combines lived recovery experience with formal peer training to deliver services promoting:

Recovery
Resiliency
Self-direction
Wellness

(DSAMH Training)

CPSS professionals may work within:

Community mental health services
Substance use disorder services
Behavioral health organizations
Medicaid-funded programs
Community-based recovery services
Integrated behavioral health settings
Other qualifying programs

CPSS Eligibility Requirements

Current Utah application guidance identifies the following requirements:

Be at least 18 years old
Identify as having lived experience with mental health and/or substance use challenges
Have at least one year of successful recovery
Have a valid Utah mailing address
Successfully complete a 40-hour peer support training program

(DSAMH Training)

Organizations and applicants should verify the current application materials before beginning certification because state requirements may change.

Lived Experience Requirement

Lived experience is central to Utah’s CPSS credential.

Applicants must identify as having personal experience involving:

Mental health challenges
Substance use challenges
Or both

and be in successful recovery. (DSAMH Training)

The credential is therefore built around personal recovery experience rather than simply professional experience working in behavioral health.

Recovery Requirement

Current Utah application guidance requires at least:

One year of successful recovery

before certification. (DSAMH Training)

Utah describes recovery as an ongoing process of improving health and wellness, living a self-directed life, and striving toward one’s full potential.

Age Requirement

Applicants must be at least:

18 years old. (DSAMH Training)

Utah Residency and Mailing Requirement

Current certification application materials require applicants to have a:

Valid Utah mailing address. (DSAMH Training)

Applicants moving to or from Utah should verify current certification and reciprocity rules before assuming a credential automatically transfers.

CPSS Training

Utah requires successful completion of a:

40-hour Peer Support Specialist training program. (DSAMH Training)

The training is intended to help people with lived experience use that experience intentionally and professionally.

Topics generally support competencies involving:

Recovery
Peer relationships
Ethics
Boundaries
Communication
Recovery planning
Resiliency
Self-advocacy
Community resources
Professional peer roles

Applicants should ensure the training is approved under Utah’s current certification framework.

How to Become a CPSS in Utah

Step 1: Meet the Age Requirement

Be at least 18 years old.

Step 2: Meet the Lived Experience Requirement

Identify as having lived experience with mental health and/or substance use challenges.

Step 3: Meet the Recovery Requirement

Have at least one year of successful recovery.

Step 4: Maintain a Valid Utah Mailing Address

Current application materials require a Utah mailing address.

Step 5: Complete the 40-Hour Training

Successfully complete a state-approved CPSS training program.

Step 6: Complete the Certification Application

Submit required materials through the current Utah peer certification process.

Step 7: Maintain Certification

Complete continuing education and recertification requirements every two years.

CPSS Certification Renewal

Utah CPSS certification currently operates on a:

24-month renewal cycle.

The July 2026 recertification application requires professionals to complete:

20 hours of continuing education during the preceding 24 months. (DSAMH Training)

Continuing Education

Utah’s current CPSS recertification requirements specify:

At least 5 hours in Peer Support Services
3 hours in Ethics
2 hours in Suicide Prevention
Up to 10 hours in general health, mental health, or substance use disorder topics

Total:

20 hours

during the 24-month renewal period. (DSAMH Training)

Continuing Education Documentation

Utah requires professionals to retain documentation for continuing education.

Current recertification materials state that documentation should identify at least:

Date of the course
Course provider
Course title
Number of continuing education hours
Course objectives

(DSAMH Training)

DHHS may request supporting documentation to verify continuing education.

Code of Ethics

As part of recertification, Utah CPSS professionals attest that they agree to follow the Utah Peer Support Code of Ethics. (DSAMH Training)

Ethics are therefore not limited to initial training.

They remain an ongoing certification requirement.

Important peer ethics topics may include:

Appropriate use of lived experience
Confidentiality
Boundaries
Participant choice
Conflicts of interest
Dual relationships
Professional conduct
Self-determination

Mental Health Peer Support

Utah’s CPSS credential includes people with lived experience involving mental health challenges.

Mental health peer support may involve:

Recovery mentoring
Wellness support
Self-advocacy
Community integration
Coping strategies
Natural support development
Behavioral health navigation
Goal setting
Treatment engagement
Community connection

Utah Medicaid describes Peer Support Services as specialized therapeutic interactions performed by people who are current or former recipients of behavioral health services. (Medicaid - Utah DHHS)

Substance Use Peer Support

The Utah CPSS pathway also includes lived experience involving substance use challenges. (DSAMH Training)

Substance use peer support may include:

Recovery mentoring
Treatment navigation
Recovery planning
Recovery capital development
Mutual support connection
Community resources
Housing resources
Employment resources
Self-advocacy
Recovery maintenance
Wellness

Co-Occurring Behavioral Health Needs

A Utah CPSS may qualify through lived experience involving mental health, substance use, or both.

This makes peer support particularly relevant for people navigating co-occurring conditions.

Peers may help participants:

Navigate multiple services
Develop recovery goals
Maintain engagement
Build natural supports
Access community resources
Strengthen wellness and resiliency

Utah Medicaid Peer Support Services

Utah Medicaid formally covers Peer Support Services.

Current Medicaid policy describes these as specialized therapeutic interactions delivered by individuals who:

Are current or past recipients of behavioral health services
Are trained and certified
Support recovery
Help participants integrate into the community
Provide understanding, coping skills, empowerment, mentoring, and related support

(Medicaid - Utah DHHS)

Who Can Deliver Medicaid Peer Support?

Utah Medicaid requires Peer Support Services to be delivered by a Peer Support Specialist certified through the Office of Substance Use and Mental Health certification process. (Medicaid - Utah DHHS)

Certification and Medicaid provider requirements should therefore be evaluated separately.

Holding a CPSS credential does not automatically mean that every peer interaction is Medicaid reimbursable.

Medicaid Individual Peer Support

Utah Medicaid uses:

H0038

for:

Individual Peer Support Services

The service is billed in:

15-minute units. (Medicaid - Utah DHHS)

Medicaid Group Peer Support

Utah Medicaid uses:

H0038 with the HQ modifier

for:

Group Peer Support Services

The service is also billed in:

15-minute units. (Medicaid - Utah DHHS)

Utah Medicaid Peer Support Codes

Service	Code	Unit
Individual Peer Support	H0038	15 minutes
Group Peer Support	H0038 HQ	15 minutes

(Medicaid - Utah DHHS)

Medicaid Group Size

Current Utah Medicaid policy states that a peer support group with a ratio greater than:

1 Peer Support Specialist to 8 participants

is not reportable for Medicaid members in the group. (Medicaid - Utah DHHS)

Organizations should therefore track:

Peer facilitator
Group size
Attendance
Start and end times
Participant-level service documentation

Licensed Therapist Referral Requirement

Current Utah Medicaid policy requires Peer Support Services to be:

referred by a licensed mental health therapist.

The participant’s record must identify which licensed mental health therapist recommended the Peer Support Services. (Medicaid - Utah DHHS)

This is a particularly important Medicaid compliance requirement.

A community peer interaction may be meaningful even without such a referral, but it should not automatically be treated as a Medicaid-covered H0038 service.

Peer Support for Children and Families

Utah Medicaid states that Peer Support Services may be delivered to:

Individuals
Groups

For children, services may be provided to:

Parents
Legal guardians
Other responsible caregivers

as appropriate to the child’s age. (Medicaid - Utah DHHS)

This creates a family-oriented peer support pathway within Utah’s Medicaid behavioral health infrastructure.

Dyadic Peer Support Services

Utah Medicaid also publicly includes peer support within its newer dyadic services framework.

Dyadic services focus on the relationship between a young child and caregiver.

For qualifying members from birth until age eight, Utah Medicaid identifies:

H0038 for individual Peer Support Services
H0038 HQ for group Peer Support Services

within the Dyadic Comprehensive Community Support Services benefit. (Medicaid - Utah DHHS)

Dyadic Services

Utah’s dyadic services are designed to support children from:

birth until age 8

through services focused on both the child and caregiver.

Peer support is one of the covered comprehensive community support services within the dyadic framework. (Medicaid - Utah DHHS)

This means a peer program serving young children may need to track relationships involving:

Child → Caregiver → Peer Support Service

rather than assuming the child alone is the direct recipient of every peer interaction.

Medicaid Timed Units

Utah Medicaid’s archived detailed behavioral health guidance describes the standard timed-service methodology for H0038.

The methodology included:

Less than 8 minutes = 0 units
8 through 22 minutes = 1 unit
23 through 37 minutes = 2 units
38 through 52 minutes = 3 units
53 through 67 minutes = 4 units
68 through 82 minutes = 5 units
83 through 97 minutes = 6 units
98 through 112 minutes = 7 units
113 through 127 minutes = 8 units

(Medicaid - Utah DHHS)

Because this detailed table comes from archived guidance, providers should verify that the current Medicaid billing methodology remains unchanged before using it for claims.

Medicaid Documentation

Utah’s publicly available Medicaid guidance requires peer documentation to establish key service details.

Archived detailed requirements identify elements including:

Date
Start time
Stop time
Duration
Setting where the service occurred
Telehealth notation when applicable
Specific service rendered

(Medicaid - Utah DHHS)

Current providers should use the most recent Utah Medicaid manual and payer guidance when designing documentation templates.

Activities That May Not Be Billable

Archived Utah Medicaid guidance specifically excluded certain activities from separately reportable Peer Support Services, including:

Routine transportation
Transportation to a location where peer support will occur
Activities without applicable peer support intervention

(Medicaid - Utah DHHS)

Organizations should therefore distinguish:

the peer service itself

from:

transportation or incidental activities surrounding the service.

Scope of Peer Support

Depending on program and payer requirements, Utah CPSS professionals may appropriately support participants through:

Sharing relevant lived experience
Recovery mentoring
Recovery planning
Wellness support
Goal setting
Self-advocacy
Resource navigation
Behavioral health navigation
Treatment engagement
Community integration
Natural support development
Coping strategies
Recovery education
Group peer support
Family and caregiver support

Activities Generally Outside Peer Scope

Unless separately licensed and authorized under another professional role, a CPSS generally should not:

Diagnose mental illness
Diagnose substance use disorders
Conduct psychotherapy
Provide licensed counseling
Prescribe medication
Provide medical advice
Conduct clinical assessments requiring licensure
Independently modify clinical treatment
Make involuntary treatment decisions
Represent themselves as a licensed clinician
Determine Medicaid eligibility
Provide legal advice

Peer support can complement clinical behavioral health services without becoming clinical treatment.

Peer Supervision

Peer programs should establish supervision that preserves the distinct nature of the peer role.

Supervision may address:

Appropriate use of lived experience
Recovery orientation
Ethics
Boundaries
Role fidelity
Documentation
Difficult participant interactions
Community resources
Crisis escalation
Staff wellness
Professional development

Utah law authorizes the state to establish rules specifying the type of supervision under which Peer Support Specialists must operate. (Utah Legislature)

Organizations should verify the current administrative rules and program-specific supervision requirements applicable to their services.

Documentation for Utah Peer Support

A strong Utah peer support note may include:

Participant identifier
Date
Start time
End time
Duration
Location
Modality
CPSS name
Certification
Referring licensed mental health therapist when Medicaid requires one
Recovery or wellness goal
Peer activity
Relevant use of lived experience
Mentoring
Recovery support
Resource navigation
Community integration
Participant response
Progress
Barriers
Follow-up
Signature or attestation

Documentation Should Be

Accurate
Timely
Person-centered
Recovery-oriented
Resiliency-focused
Strengths-based
Specific
Respectful
Relevant
Connected to participant goals
Consistent with peer scope

Documentation Should Avoid

Unsupported diagnoses
Clinical interpretations outside peer scope
Stigmatizing terminology
Generic statements such as “provided peer support”
Copy-and-paste notes
Unnecessary sensitive information
Services that did not occur
Personal opinions presented as clinical facts
Documentation written solely to justify reimbursement

Documentation and Billing Are Not the Same Thing

A completed peer support note does not automatically establish that an H0038 claim is payable.

Payment may also depend on:

Utah Medicaid eligibility
Covered service
CPSS certification
Provider enrollment
Licensed therapist referral
Participant service plan
Group size
Correct code
HQ modifier where applicable
Timed units
Documentation
Managed care requirements
Timely claim submission

Organizations should validate each requirement independently.

Confidentiality

Utah peer organizations may handle sensitive:

Mental health information
Substance use records
Recovery information
Family information
Child information

Applicable requirements may include:

HIPAA
42 CFR Part 2
Utah law
Utah Medicaid requirements
DHHS requirements
Organizational policies
Participant consent

Peer workers should receive role-specific training addressing:

Information access
Documentation
Participant authorization
Substance use records
Care-team communication
Family and caregiver information
Text messaging
Email
Telehealth
Social media
Crisis communication

Starting a Peer Support Program in Utah

Step 1: Define the Population

Determine whether the organization serves:

Adults with mental health conditions
People with substance use disorders
People with co-occurring conditions
Children and caregivers
Medicaid members
Community recovery populations
Other behavioral health populations

Step 2: Verify CPSS Eligibility

Confirm current requirements involving:

Age
Lived experience
Recovery duration
Utah mailing address
Approved training

Step 3: Complete State-Approved Training

Ensure prospective staff complete the current 40-hour certification training.

Step 4: Build Credential Tracking

Track:

Training
CPSS certification
Issue date
Expiration date
20 CE hours
5 peer-support CE hours
3 ethics hours
2 suicide-prevention hours
Recertification

Step 5: Establish Supervision

Determine:

Peer supervisor
Administrative supervisor
Clinical consultant
Program-required supervision
Frequency
Documentation

Step 6: Determine the Funding Model

Potential funding may include:

Utah Medicaid
Behavioral health contracts
State or local funding
Federal grants
Community programs
Other contracts

Step 7: Establish Medicaid Eligibility

If Medicaid reimbursement is planned, verify:

Participant Medicaid eligibility
Provider enrollment
Active CPSS certification
Licensed therapist referral
Service eligibility
Service plan
Group-size limit
Documentation requirements

Step 8: Configure Medicaid Coding

Systems should support:

H0038
H0038 HQ
15-minute units
Individual vs. group
Group attendance
Maximum 1:8 peer-to-member ratio
Referring therapist
Claim status

Step 9: Build the Service Workflow

Map:

Referral
Eligibility
Intake
Recovery goals
Peer assignment
Scheduling
Service delivery
Documentation
Supervision
Follow-up
Outcomes
Billing

Step 10: Measure Outcomes

Potential outcomes include:

Engagement
Recovery goal progress
Wellness
Resiliency
Treatment engagement
Self-advocacy
Community connection
Natural supports
Housing
Employment
Crisis utilization
Participant satisfaction
Peer workforce retention
Credential compliance

Common Challenges for Utah Peer Programs

Certification and Medicaid Are Separate

A person can hold a CPSS credential without every service they provide qualifying for Medicaid reimbursement.

Programs should distinguish:

Peer certification
Provider enrollment
Medicaid member eligibility
Covered Peer Support Service
Referral requirement
Documentation
Billing

Licensed Therapist Referral

Utah Medicaid currently requires Peer Support Services to be referred by a licensed mental health therapist. (Medicaid - Utah DHHS)

This creates an important workflow requirement that may not exist in every non-Medicaid community peer program.

Group Size

Medicaid group Peer Support Services cannot exceed the current reportable ratio of:

1 peer to 8 participants. (Medicaid - Utah DHHS)

Organizations should prevent groups from being accidentally billed when attendance exceeds the allowable ratio.

Continuing Education Categories

Utah does not simply require 20 generic CE hours.

The current renewal structure separates:

Peer Support Services
Ethics
Suicide Prevention
General behavioral health topics

(DSAMH Training)

Credential systems should track CE categories rather than only total hours.

Family and Dyadic Services

Utah Medicaid includes peer support within services involving parents and caregivers, including its dyadic services framework for children under age eight. (Medicaid - Utah DHHS)

Systems should be able to distinguish:

Medicaid beneficiary
Child
Parent or caregiver
Person directly participating in the peer encounter

Documentation Burden

Peer support is fundamentally relationship-based.

Documentation should establish accountability and Medicaid compliance without forcing Peer Support Specialists to document as if they were therapists.

Role Drift

Peers may gradually become responsible for:

Generic case management
Administrative work
Transportation-only duties
Compliance monitoring
Clinical work

Organizations should preserve the distinct lived-experience function of peer support.

Frequently Asked Questions

What is Utah’s peer credential?

The Certified Peer Support Specialist, or CPSS. (DSAMH Training)

Who administers the credential?

The Utah Department of Health and Human Services through the Office of Substance Use and Mental Health.

Is lived experience required?

Yes.

Applicants identify as having lived experience involving mental health and/or substance use challenges. (DSAMH Training)

How much recovery is required?

Current Utah application guidance requires at least one year of successful recovery. (DSAMH Training)

How old must an applicant be?

At least 18 years old. (DSAMH Training)

Is a Utah address required?

Current application materials require a valid Utah mailing address. (DSAMH Training)

How much training is required?

40 hours. (DSAMH Training)

How often does certification renew?

Every 24 months under the current recertification process. (DSAMH Training)

How much continuing education is required?

20 hours during the 24-month certification period. (DSAMH Training)

How much peer-specific CE is required?

At least 5 hours in Peer Support Services. (DSAMH Training)

How much ethics CE is required?

3 hours. (DSAMH Training)

Is suicide-prevention CE required?

Yes.

Current renewal standards require 2 hours in Suicide Prevention. (DSAMH Training)

Is there a Medicaid group-size limit?

Yes.

A group with a ratio greater than 1 Peer Support Specialist to 8 members is not reportable. (Medicaid - Utah DHHS)

Does Medicaid require a referral?

Yes.

Current policy requires Peer Support Services to be referred by a licensed mental health therapist, and the record must identify the referring therapist. (Medicaid - Utah DHHS)

Can peer services involve parents or caregivers?

Yes.

For children, Medicaid Peer Support Services may be provided to parents, legal guardians, or other responsible caregivers as appropriate. (Medicaid - Utah DHHS)

Does Utah Medicaid include peer support in dyadic services?

Yes.

The current dyadic services framework includes H0038 individual and H0038 HQ group peer support for qualifying child-caregiver services. (Medicaid - Utah DHHS)

Are Utah CPSS professionals clinicians?

No.

The CPSS credential itself does not constitute professional clinical licensure.

Official Utah Peer Support Resources

Utah Certified Peer Support Specialist Application Guide

Official Utah DHHS resource describing the CPSS role, lived-experience requirement, one-year recovery requirement, minimum age, Utah mailing address requirement, and 40-hour training.