Advocacy Alert: Massachusetts Closes in on Passing Discriminatory Licensure Board Bill for Peer Specialists

UPDATE: We are now hearing that legislators have agreed to remove CPSs from S. 2681 and that the Recovery Coaching certification is now being incorporated into H.4758, which is also focused on treatment for people who have problems with substances.

We remain very concerned that this Bill got so far without the vast majority of people knowing about it and would like to give some thought as to how there can be better established methods for sending out alerts as soon as possible after relevant legislation has been proposed (or changed)!!

We will be looking more into this to confirm what is now being reported!

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On May 16, 2024, the Health Care Financing Committee of the Commonwealth of Massachusetts recommended that S.2681, An Act relative to recovery coach licensure “ought to pass” and sent it along to the Senate Ways and Means Committee. The Senate Ways and Means Committee is typically the last stop before a bill is passed into law.

But, what is S.2681 and how did it get this far without anyone noticing? S.2681 would establish a Board of licensure for both recovery coaches and certified peer specialists. It is much like S.1452 about which we sent out alerts and articles in 2021, but that seemed to fade away after all people who showed up to the public hearing spoke in opposition to it.

These bills are hugely problematic for many reasons, including that Recovery Coaches and Certified Peer Specialists are distinctly different roles and should be treated as such. So, how did we not know about S.2681 until now?

Well, for one and as aforementioned, they’ve named the bill, “An Act Relative to Recovery Coach Licensure”. Not only does this communicate loud and clear which of the two is being treated preferentially, but it also meant that many of us working primarily on the CPS side of things simply didn’t take note of this bill, including the public hearing apparently held on September 18, 2023. In reality, we are often dependent on attorneys groups and others who have the funding to pay for bill tracking. And while it’s not uncommon that bills have vague or positive-sounding names for negative or dangerous legislation, vagueness is a far cry from a title that so explicitly says it’s about Recovery Coaches and not CPS.

So, what are some of the differences between Recovery Coaches and Certified Peer Specialists? The differences are actually pretty vast and would take a lot of unpacking to fully detail, but some of them include:

• Recovery Coaches are not historically required to have lived experience
• Recovery Coaches – although not intended to be strictly abstinence-based – tend to come from a lineage of the Twelve Step world where self-determination (a fundamental value for CPS’s) is sometimes seen as a problem
• Recovery Coach trainings are notoriously problematic when it comes to topics like suicide risk

There are numerous places throughout S.2681 where bias in favor of Recovery Coaches becomes clear. Aside from the title of the entire bill, for example:

• The proposed membership of the Licensure Board includes the Commissioner of the Department of Public Health (DPH awards contracts for substance-focused recovery centers, but the Department of Mental Health awards most contracts related to CPS work)
• The only proposed role on the Licensure Board focused strictly on lived experience reads “1 of whom shall be a person with lived experience from a substance use disorder and received peer specialist or recovery coaching services”
• The only proposed role on the Licensure Board to represent marginalized communities “shall represent communities that have been disproportionately impacted by historical over-policing relative to drug enforcement” (in spite of the fact that there are clearly communities disproportionately impacted by police and other system violence related to having a psychiatric history)
• When discussing the powers of the Licensure Board, the text of the proposed legislation reads that the Board will have the right “to summarily suspend a peer specialist or recovery coach who poses an imminent danger to the public; provided, that the recovery coach shall be afforded a hearing within 7 business days to determine whether the summary action is warranted”. Whether this signifies a bias against people with psychiatric histories or simply fact that CPSs were included in this legislation, it does not bode well. (And yes, there are a number of concerning elements about the proposed powers for the Board, including requiring that individuals have been in “recovery” for two or more years with no clear definition of what that even means.)
• The legislation indicates that there will be 13 members of this board, 12 of them holding specific experiences as indicated by the text of the bill. Of the 12 dictated seats, seven are in favor of substance use experience with only four clearly identified for people with CPS or mental health-specific experience. (One position – for someone involved with a healthcare plan – doesn’t have an obvious bias in either direction). This means that even if the one flexible seat consistently went to someone with mental health-specific experience (which seems unlikely), the Board would inherently be biased toward people with substance use experience.

This is not intended to communicate that Recovery Coaches are less important or somehow not a valuable role. Both roles deserve to be recognized and supported. However, even if the bill were edited to more fairly represent CPSs and their interests, all the other issues remain. Additionally, the proposed Board make-up is fundamentally discriminatory. The simple fact that many of the foremost, longstanding peer support leaders in the state were unaware of this legislation is a clear red flag, particularly in a field that centers “nothing about us without us”. However, the discrimination runs far deeper than that.

At one point, Bill S.2681 proposes an amendment to “SECTION 3. Section 1 of chapter 112…by inserting after the word “dentistry”, in line 12, the following words:- , the board of registration of peer specialists and recovery coaches.”

Although there is little relationship between the Boards for dentistry versus peer specialists and recovery coaches, it’s worth taking a look at the make up of the former and compared to the latter.

*Vacant for an unknown period of time

In contrast with the Board proposed in S.2681, 46% members of the Board of Dentistry are dentists. 69% work directly in offices doing the work of dentistry. Only four of the 13 designated Board positions are identified for people not working specifically in a dentist’s office. However, it’s worth noting that three of those four positions are currently unfilled and so 90% of current members work directly as or with dentists (with dentists holding a 60% majority). This is especially important  given that it’s not uncommon that Boards of this nature that designate seats for people outside of the immediate profession commonly know those seats unfilled. This allows them to look like they’re seeking diversity while still maintaining a majority of power.

Meanwhile, only 15% of the roles on the CPS/Recovery Coach Board are designated for people who are currently or have previously worked as a CPS or Recovery Coach and only 23% require that someone has lived experience (with two of the three roles for people specifically with substance use experience).  

If you’re wondering why we’re not automatically counting the training seats, that’s worth unpacking a bit. Upon close inspection, it is clear that the language for these seats is vague and doesn’t even specify that someone must be or have been an actual trainer.  Additionally, there is no national standard requiring trainers for these roles to have actually worked in the roles themselves (or even to have relevant lived experience). While it’s true that the current certifying body for the CPS credential does profess to use only people with lived experience (last we knew, anyway!), it actually has a long history of at least one trainer who have never worked as a CPS (or any related role). Finally, there is no requirement that we’re aware of at the state level that the CPS training contract will always go to a vendor who will only use trainers with lived experience and so the wording here is important.

Perhaps most importantly, on the dentistry board, dentists not only hold the most seats but also hold the most power of people represented on the board. On the other hand, CPSs and Recovery Coaches frequently hold the least power in their workplaces, especially when compared to a Commissioner, doctors and any other licensed clinician.

The disparity here is not unique to the Board of Dentistry. The Board of Social Workers in Massachusetts currently has eight seats and 100% of them are held by people with advanced degrees in social work (three of them apparently working for the Department of Children and Families).

In fact, it is highly unusual that a licensing Board would have only a minority representation. It’s perhaps even more unusual that that licensing board would be subject to the interference of individuals who have historically held significant power over peer roles in both practice and payment. Unfortunately, all signs (and rumors) point toward this whole bill being aimed at satisfying insurance funding stream requirements (which itself comes with a variety of concerns and risks).

This is unacceptable. If the state wishes to enact licensing boards, then we must demand the following:

• That substantively different fields of practice be respected and – like any other distinct field of practice – afforded their own Board
• That there be involvement of people practicing in the relevant field(s) right from the start and consistently from there on
• That any proposed legislation be properly titled and communicated to the field(s) to which it is relevant so that the public has the opportunity to participate in a public hearing (as required by Massachusetts Law Part I, Title III, Chapter 30A, Section 2)

We are trying to find out more information concerning a possible timeline for S.2681. The Massachusetts legislature is no longer in active session, but it still has the ability to pass Bills into law until December 31, particularly if they appear not controversial.

Let’s make sure they know this bill is highly controversial.

Join us by sending letters to the Senate Ways and Means Committee by clicking HERE.

You may also view the membership and contact info for the Committee HERE.

Author: Sera Davidow