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March 2026 Top of Mind

Expanded Peer Recovery Coaching available for those with SUD

Peer Recovery Coach (PRC) coverage expanded this year to include Administrative Services Only (ASO) commercial plans. Beginning Jan. 1, 2026, PRC services are now covered by both ASO and fully insured Commercial plans. This includes services rendered by in- and out-of-network providers. Reimbursement will be no less than the Massachusetts Medicaid rate.

Additionally, the Massachusetts Health Connector, the state's official health insurance marketplace, indicated it will follow MassHealth requirements for coverage of PRC services for Individual and Family plans, commonly called marketplace or exchange plans. Additional details can be found in the state SUD Recovery Coach state mandate, Bill H.5143.   

The coding and billing for PRC services remains unchanged: H2016-HM: Comprehensive community support program, per diem

Peer Recovery Coach Requirements

The guidelines for PRC services are based on MassHealth requirements. Peer Recovery Coaches must:

  • Have at least 2 years of sustained recovery from Substance Use Disorder
  • Meet the state Executive Office of Health and Human Services (EOHHS) requirements and all applicable certification board requirements
  • Meet any additional criteria required by provider organizations to ensure adherence to their PRC service principles

Peer Recovery Coaches can also obtain certification as a Certified Addiction Recovery Coach through:

  1. The Massachusetts Board of Substance Abuse Counselor Certification, or
  2. Another licensure/certification process as determined by EOHHS

To be considered as working toward certification, a Peer Recovery Coach must:

  • Complete 60 hours of training, including the 30-hour CCAR Recovery Coach Academy and 16 hours of Ethics training
  • Be actively completing required supervision, and
  • Complete any additional trainings or other requirements, as needed

Individuals who do not complete CARC certification within 2 years of hire may not continue providing PRC services.

Contracting and billing
  • Organizations may contract with any provider group that meets their requirements for PRC services
  • Contracts are not established with individual PRCs as solo practitioners but are with the groups or contracted providers that employ PRCs
Need more information?

For additional support regarding Peer Recovery Coach services, please call the Optum Massachusetts dedicated provider line at 1-866-860-7308 Monday–Friday 7 a.m.–7 p.m. (ET).


 

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