[{"_1":2,"_111":-5,"_112":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,99],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6155235,"mediaKeyId","5480561-1d49c67de75cd45a445b2e1351c1eb57","parentId",5480561,"title","OCAH outlines allocation method for non‑claims behavioral health spending and seeks input on taxonomy expansion for BH‑in‑primary‑care module","audioSeconds",1467,"startMs",3734960,"endMs",5202360,"viewUrl","/Search/View?dp=1&key=5480561-1d49c67de75cd45a445b2e1351c1eb57&start=3734&end=5202","thumbnailUrl","https://assets.pipeline.soar.com/5480561-1d49c67de75cd45a445b2e1351c1eb57/thumbnail_3734960.jpg","articleUrl","/articles/6155235/California/OCAH-outlines-allocation-method-for-nonclaims-behavioral-health-spending-and-seeks-input-on-taxonomy-expansion-for-BHinprimarycare-module","mediaUrl","https://secure.pipeline.soar.com/6155235-b2c8d0cbbc63b3dd4b7a9fcfae587673/orig.mp4?Expires=1770727601&Signature=oL1nU6Wxx8OhllYWbF16ucao9HR4tqFqQzY0iHprHsG6HYOjjeb3DFwMbCsYyg7x9Z3ri50x2iuhIVJjrYVwr7b4qm6zOR8xPbNo4PwnnlYbEGr31ShTQLCRcIxFuMSDCsmWNeV544-YBSsofaFyYqsHonX3ShyNmLnmgts539XnjQ2kQY~Il-HE~SB4BTaIWX9Rb5iQbhL8B085Qv6ezu8e2nMYnEzmPFSevRGBKn65zaI0L41dF5YZkKFtpJViC07wWKElhW~kfr1y8QPqsMF7Ud2NuHts2fvOiYU47mZ9LPcDZY2onrbM7nMlls7B15m1yzFenvFvpvmBU-pjEA__&Key-Pair-Id=KUT5TJCACFTXG","author","Department of Health Care Access and Information","date","2025-07-26T03:54:59.96Z","article","Bob Seifert, a Friedman consultant supporting OCAH, reviewed the recommended approach for classifying non‑claims behavioral health payments. The approach applies the OCA expanded framework and uses rules and proportional allocations to limit recognition of general practice transformation and other infrastructure payments to the share attributable to behavioral health, based on claims and capitation proportions. Category‑specific rules were described for population health and practice infrastructure payments, performance payments, shared savings arrangements, capitation, and other non‑claims payments; formulas for proportional allocation appear in the presentation appendix.

Seifert said 100% of explicit behavioral health capitation (behavioral health‑specific capitation) would be counted as behavioral health spend. For other capitation types (professional, global, or integrated system payments), the behavioral health portion would be estimated by allocating payments using encounter data, analogous to the method used for primary care allocations.

OCAH also presented the behavioral health‑in‑primary‑care module, a separate measure designed to capture spending that counts as both behavioral health and primary care (for example, behavioral health screenings and brief interventions delivered in a primary care setting). To avoid double counting and to keep primary care and behavioral health buckets mutually consistent, OCAH proposed expanding the list of primary care provider taxonomies to include some behavioral health professions when they deliver services using primary‑care service codes and at primary care places of service. OCAH recommended excluding applied behavior analysis (ABA) taxonomies and certain psychoanalyst taxonomies from the primary care list at present, while considering school counselor taxonomy for inclusion because schools are an identified place of service.

Participants asked for more detail about how taxonomy expansion would work in practice, emphasized the need to tie provider taxonomy to place of service and eligible CPT/HCPCS codes, and suggested reconvening with a technical subgroup or bringing this back for a deeper review. OCAH agreed to follow up with more specifics and to consider a targeted future discussion on taxonomy choices and the capitation allocation formulas.","mediaType","Video","parentTitle","July 2025 | OHCA Investment and Payment Workgroup Meeting","oneSentenceSummary","Consultants reviewed a proportional allocation method for non‑claims payments (infrastructure, capitation, performance) and proposed expanding the primary care provider taxonomy to capture behavioral health services delivered in integrated primary care settings; stakeholders asked for further detail and follow‑up.","taxTitle","Department of Health Care Access and Information, Agencies under Office of the Governor, Executive, California","taxId",16207,"location","California","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6155240,"Work group debates including TBI, dementia G‑codes and Z‑codes in behavioral health definition",1301,2432820,3734740,"/Search/View?dp=1&key=5480561-1d49c67de75cd45a445b2e1351c1eb57&start=2432&end=3734","https://assets.pipeline.soar.com/5480561-1d49c67de75cd45a445b2e1351c1eb57/thumbnail_2432820.jpg","/articles/6155240/California/Work-group-debates-including-TBI-dementia-Gcodes-and-Zcodes-in-behavioral-health-definition","https://secure.pipeline.soar.com/6155240-c1af621ff6e9e0515ea8afeab11236b0/orig.mp4?Expires=1770727601&Signature=HWL5vZtKDNDYOkFP6XVyxd3w4yhbEpG4HDIAcymuC-7kHrpfPJ0GVCZTGt0xXLu-b19ZcbaN56VJT-piPCecl7qrp09~3DPsAsLTIzeLZ2fVr2khT2jn~JMQJ1YkuC-u2o8pckSx0epFVRX5sl-iCeQknBjf3p-GCXaA0KAiryhL~apqDgx0ZJueycLJIHJsXBLDpq1fU58npZ750wgoEqIx719rtADr2fSAA0Jpf31DVXiRiuSoVS~R3mWejhj4JgIQCy30-IRoLzO7TrYxVuUhAycpjd6XYcuiRNq320OmN38YH3dIfqflh3bdsxO4SxyhzfYtbUHwu~TkbzGe6w__&Key-Pair-Id=KUT5TJCACFTXG","The work group reviewed which diagnosis codes should count a claim as behavioral health spending and considered three contested categories: traumatic brain injury (TBI), G‑codes for neurological disorders that can cause dementia, and Z‑codes used to document social determinants of health.

OCAH staff recommended excluding TBI from the behavioral health diagnosis list, saying inclusion might capture primarily medical spend and clinicians advised that behavioral symptoms related to TBI are usually coded under behavioral health diagnoses (for example, depression) that are already in the code set. Staff also proposed including F‑codes for dementia (mental disorders due to physiological conditions) but excluding G‑codes that represent underlying neurological diseases such as Alzheimer’s, on the grounds that behavioral health providers typically bill with F‑codes.

Clinicians pushed back on some of the coding assumptions. Geriatric psychiatrist Parnika (Parnika Saxena) said it would be appropriate to use G‑codes, but described barriers in practice: psychiatrists sometimes do not get paid when they submit G‑codes, so they use F‑codes because payers accept them. Primary care clinicians and others also questioned whether excluding G‑codes or TBI might undercount behavioral health services for some patients.

The group also debated Z‑codes (social determinants). OCAH noted Z‑codes cannot be used as a primary billing diagnosis on standard payment claims and would not change claims‑based expenditure totals; they could appear in encounter data used to allocate capitation. Some clinicians and stakeholders (including Parnika, Carrie and Vicky) urged collection of relevant Z‑codes because they document time‑intensive activities addressing social needs and could inform future payment reforms. Other participants, including Jeff, said adding Z‑codes to the payer submission code set would add complexity and may not materially change measured behavioral health spending.

OCAH will review the feedback and consider HPD‑based analyses of Z‑code use and dementia/TBI coding practices; staff did not commit to a final list during the meeting and said they will incorporate the discussion into the public comment draft.","Members discussed whether to include traumatic brain injury diagnoses, G‑codes for underlying neurological disorders, and Z‑codes (social determinants) in the behavioral health code set; clinicians said coding practice and payment constraints affect how conditions appear on claims.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":80,"_47":93,"_49":94,"_51":95,"_53":96,"_55":56,"_57":58,"_59":97,"_61":62,"_63":64,"_65":98,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6155245,"OCAH proposes removing mobile clinic and long‑term care subcategories from payer reporting; HPD to provide granular analysis",1399,1033280,"/Search/View?dp=1&key=5480561-1d49c67de75cd45a445b2e1351c1eb57&start=1033&end=2432","https://assets.pipeline.soar.com/5480561-1d49c67de75cd45a445b2e1351c1eb57/thumbnail_1033280.jpg","/articles/6155245/California/OCAH-proposes-removing-mobile-clinic-and-longterm-care-subcategories-from-payer-reporting-HPD-to-provide-granular-analysis","https://secure.pipeline.soar.com/6155245-98f0103314ab143e10caf5046bb442be/orig.mp4?Expires=1770727601&Signature=CXfj6VSLddmP9~YOEZi0Dslwfnb3iwMG5a017c0Xt2sDNwNjcP15odfwzUs0p6eOubow1mjLSziNc~P7GSmXSz6a6osm-igIpd014t9xUdQlF3mNPRE3CFSqdIQBvvXhInm4HUvBZBKJem8A6EpHJQNkkLTwlXA~KYy~-N1Y32kLI3w96mkqApbrckDJE2EiyMjpVByxJm1yG52g3kIGLuuHN9m98d9BWI98eNcci-4VbumlglEqC9HLsJPtwb26x3A0iZjwtLak0htMfE58it~Kgu5wEo2UDbiK954H9FCrxRtNcuLbBimG0DMyJVWOEpSWRId84UNPBPzQHbQkzA__&Key-Pair-Id=KUT5TJCACFTXG","OCAH staff proposed removing the distinct reporting subcategories for mobile clinic services (and a separate “crisis care” subcategory) and for long‑term care from the payer submission template. The change would not exclude the spending from measurement, staff said; instead, those payments would be captured in broader outpatient or “other services” categories for payer reporting to reduce data submitter burden.

Staff explained that preliminary HPD analysis found commercial spending on mobile clinic services to be negligible (below one‑tenth of 1% of commercial behavioral health spending from 2018–2023) and long‑term care spending similarly small. Medi‑Cal showed modest mobile clinic spending (about 4% during 2018–2023), staff said. Because those services are both small in payer data submissions and often require more granular encounter‑level information to understand utilization, OCAH recommended using HPD for deeper analysis of crisis and mobile clinic services.

Several participants supported the change but raised caveats. Kirsten Barlow of the California Hospital Association supported removing the mobile clinic and long‑term care subcategories for the payer reporting template, noting that mobile clinic programs are largely rolled out through Medi‑Cal and county behavioral health systems that the initial payer submissions do not comprehensively capture. Beth and Carrie emphasized the importance of making clear in OCAH public materials what payer submissions include and what will be studied using HPD. Hector noted AB 988’s requirement for private plans to cover mobile crisis services and suggested OCAH monitor trends and reconsider adding the subcategories if utilization grows.

OCAH staff said the recommended change is intended to simplify reporting while preserving total spending measurement; the team committed to using HPD to monitor mobile crisis and related service utilization and to revisit subcategory definitions in future reporting cycles if warranted.","OCAH staff recommended folding mobile clinic/crisis care and long‑term care spending into broader outpatient categories for payer reporting to reduce submitter burden; HPD analyses will be used for detailed study of crisis and mobile services.",{"_33":100,"_35":36,"_37":38,"_39":101,"_41":102,"_43":103,"_45":104,"_47":105,"_49":106,"_51":107,"_53":108,"_55":56,"_57":58,"_59":109,"_61":62,"_63":64,"_65":110,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6155250,"OCAH to collect behavioral health spending data for 2024–25; benchmark deferred until more analysis",485,203110,688750,"/Search/View?dp=1&key=5480561-1d49c67de75cd45a445b2e1351c1eb57&start=203&end=688","https://assets.pipeline.soar.com/5480561-1d49c67de75cd45a445b2e1351c1eb57/thumbnail_203110.jpg","/articles/6155250/California/OCAH-to-collect-behavioral-health-spending-data-for-202425-benchmark-deferred-until-more-analysis","https://secure.pipeline.soar.com/6155250-12604848dbde084a22193f129e235ce8/orig.mp4?Expires=1770727601&Signature=g9lx-COgYUeA4Pdxkv2tD8szOKagiV-6GOXn~t~R0M0v2iraR96f7D81Myk-L72r9peSy4kiz8FYbYPFg07xAnUiRwAY0flp5YwUjNV1czDUMetxA~Uvz7ap6aygXSwp1~mZC-6Y09suAk2THwcLSyaOSQgrROr6xU4ywBHkrtFsZG--RQN8iBEoMuNS2eXSuB9YqbIJW6aH-54xqK-foPpwak0qwXaDTm5JESm9Jj9AMl3EyDYHAF3Pcdd9SAN~6970AkEl6gI3L9aSrSaN317NkfJAHBTT0afuDoMZiEei1hUY46AnnrvUaLF2dbR7PNMq7ICHblbg4DBsXeNixA__&Key-Pair-Id=KUT5TJCACFTXG","OCAH Assistant Deputy Director Margaret DeBrant said payers will submit behavioral health spending data in fall 2026 covering performance years 2024 and 2025, and OCA plans to publish the first report in summer 2027. The statutory mandate, she said, requires measuring behavioral health spending relative to total health care spending and setting benchmarks intended to promote better outcomes and increased capacity.

The work group was told entities required to submit data are payers and fully integrated delivery systems that cover a minimum of 40,000 lives in the commercial, Medicare Advantage and Medi‑Cal managed care markets. DeBrant added that the detailed methodology will be published in an updated data submission guide in spring 2026 and that submitted data will be aggregated by performance year and market category.

The work group discussed the role of the Health Care Payments Database (HPD) in supplementing OCA’s reporting. DeBrant said HPD can support more granular analyses of utilization and spending — for example, to study mobile crisis services and other emerging modalities that may be sparsely represented in payer submissions. Several participants urged OCAH to be explicit in public presentations about what the payer data include and what will instead be examined via HPD analyses.

DeBrant also summarized the OCA board’s decision to postpone setting an investment benchmark. The board will revisit the benchmark next summer after additional data collection and HPD analysis; the work group’s members were told the 2026 payer submissions will be used for measurement and reporting only, not for immediate comparison to a benchmark.

The work group requested that OCAH continue to coordinate with the Department of Health Care Services (DHCS) over the summer and fall to understand how Medi‑Cal programs that do not flow through managed care (for example, some county mental health programs) might be tracked for behavioral health spending. DeBrant said the team will incorporate those follow‑up plans and clarify limits of the initial dataset in future presentations and in the data submission guide.","The OCAH work group said payers will submit behavioral health spending data covering 2024–25 in fall 2026, with a first OCA report expected summer 2027. The OCA board has chosen to delay adopting an investment benchmark until it has more data and HPD analyses.","actionData","errors"]

Article not found

OCAH outlines allocation method for non‑claims behavioral health spending and seeks input on taxonomy expansion for BH‑in‑primary‑care module

Work group debates including TBI, dementia G‑codes and Z‑codes in behavioral health definition

OCAH proposes removing mobile clinic and long‑term care subcategories from payer reporting; HPD to provide granular analysis

OCAH to collect behavioral health spending data for 2024–25; benchmark deferred until more analysis