The Promoting Effective and Empowering Recovery Services in Medicare Act of 2025 would amend title XVIII of the Social Security Act to add peer support services as a Medicare-covered benefit when provided at designated facilities. It defines both the services and the peer support specialist, and expands eligible settings to include community mental health centers, rural health clinics, federally qualified health centers, and certified community behavioral health clinics.
The bill also adjusts Medicare’s exclusions to ensure these services are covered only when delivered in those specific settings. An effective date is set for items and services furnished on or after January 1, 2027, giving programs time to implement the new definitions, credentialing, and billing pathways.
At a Glance
What It Does
Defines and adds peer support services to Medicare benefits, to be furnished at community mental health centers, rural health clinics, federally qualified health centers, and certified community behavioral health clinics. It also defines what constitutes a peer support specialist and links reimbursement to these designated providers.
Who It Affects
Medicare beneficiaries with mental health or substance use conditions who access services at CMHCs, RHCs, FQHCs, or certified community behavioral health clinics; the facilities and the peer support specialists who work there; CMS as the payer.
Why It Matters
Creates a formal reimbursement pathway for recovery-oriented supports, standardizes provider roles, and situates peer support within trusted community health settings, potentially improving access and outcomes for individuals navigating mental health and substance use recovery.
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What This Bill Actually Does
The PEERS Act of 2025 adds peer support services to the roster of Medicare-covered items and services. It specifies that these services can be furnished by certain qualifying facilities—community mental health centers, rural health clinics, federally qualified health centers, and certified community behavioral health clinics—and must be delivered by a peer support specialist.
The definitions codify what peer support services are (emotional, informational, instrumental, and social/community supports) and who can be a peer support specialist (an individual in recovery who is certified under accepted national guidelines and state processes).
The Five Things You Need to Know
The bill adds ‘peer support services’ to Medicare as defined in the Social Security Act.
Coverage is limited to services furnished by CMHCs, RHCs, FQHCs, or certified community behavioral health clinics.
A new definition for ‘peer support specialist’ requires recovery and state- or Secretary-approved certification.
Exclusion for peer services remains, but only when not furnished by the named facilities.
The provisions take effect for services furnished on or after January 1, 2027.
Section-by-Section Breakdown
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Inclusion at Community Mental Health Centers
The bill amends Section 1832(a)(2)(J) to replace the phrase ‘intensive outpatient services’ with a broader allowance that includes ‘intensive outpatient services, and peer support services’ provided by a community mental health center. This secures Medicare reimbursement for peer support when delivered in CMHC settings, aligning recovery-oriented supports with existing behavioral health services.
Inclusion as RHC and FQHC Services
Section 1861(aa)(1)(B) is amended to add a new provision allowing peer support services to be reimbursed when furnished by a Rural Health Clinic or a Federally Qualified Health Center, in addition to existing facilities. The modification ensures that peer support is recognized as a reimbursable service within these safety-net settings when delivered by qualified providers.
Definition of Peer Support Services and Peer Support Specialist
A new subsection (nnn) to 1861 defines two terms: ‘peer support services’ and ‘peer support specialist.’ Peer support services include emotional, informational, instrumental, and social/community supports delivered by a qualifying facility to individuals diagnosed with a mental health condition or substance use disorder, aiming to assist recovery, community integration, and self-determination. A peer support specialist is someone in recovery who is certified to provide these services under guidelines established by the State or Secretary, incorporating National Practice Guidelines for Peer Supporters and SAMHSA Core Competencies.
Exclusion Modification
The act amends 1862(a)(1) to add a new subparagraph (Q) that clarifies coverage limits: peer support services are reimbursable only if furnished by a CMHC, an RHC, an FQHC, or a certified community behavioral health clinic. Services not provided by these facilities fall outside Medicare coverage, tightening the scope of eligible settings while preserving the intended care pathway.
Effective Date
The amendments apply to items and services furnished on or after January 1, 2027. This delays implementation to allow payer and provider systems to align credentialing, coding, and payment processes with the new definitions and provider types.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Medicare beneficiaries diagnosed with mental health conditions or substance use disorders who receive peer support at CMHCs, RHCs, FQHCs, or certified CC BHCs.
- Community Mental Health Centers, Rural Health Clinics, Federally Qualified Health Centers, and Certified Community Behavioral Health Clinics that will be able to offer reimbursable peer support services.
- Peer support specialists who are recovering individuals and will be credentialed to provide support under established guidelines.
- Medicare program administrators and CMS employees who will implement and manage the new reimbursement framework.
Who Bears the Cost
- Medicare (Trust Fund) will incur new reimbursement expenditures for peer support services.
- Facilities (CMHCs, RHCs, FQHCs, CC BHCs) may incur costs to hire, train, and certify personnel to provide peer support services.
- States and facilities may face upfront administrative costs to update billing, documentation, and credentialing to comply with the new requirements.
- Potential short-term administrative burdens on CMS to develop guidelines and monitor adherence to the new definitions and provider qualifications.
Key Issues
The Core Tension
Should Medicare broadly reimburse peer support services within a defined set of facilities, balancing the potential for improved recovery outcomes against the costs and administrative complexity of credentialing, billing, and quality assurance?
The PEERS Act introduces a new service line into Medicare, but it raises questions about implementation, oversight, and evidence of effectiveness. While it defines who can provide peer support and where it may be delivered, the bill leaves the specifics of reimbursement rates, data reporting, and quality controls to agencies yet to publish guidance.
The reliance on state-level certification and national practice guidelines means state variation could influence access and consistency. There is also the tension between expanding access to recovery supports and ensuring rigorous credentialing without creating undue administrative barriers for providers, especially in under-resourced facilities.
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