OCA refines behavioral health claims code set; clinicians press to include traumatic brain injury, members debate crisis‑care grouping

The Office of California (OCA) presented a revised claims code set to measure behavioral health spending and asked its investment and payment work group for feedback on two contested issues: whether to include traumatic brain injury (TBI) diagnoses and whether to replace a community‑based mobile clinic category with a broader crisis care category.

Debbie Lindes, manager of the Healthcare Delivery System Group at the Office of Healthcare Affordability, reviewed the code‑set approach and explained the measurement will span three modules: claims‑paid behavioral health care, non‑claims spending, and a behavioral‑health‑in‑primary‑care module. Lindes said the primary care module exists so integrated primary care behavioral health services can be counted in both primary care and behavioral health without double counting.

Key proposed rules and clarifications

Lindes said OCA will: keep drugs on the code set if at least one approved indication is for a behavioral health condition (while acknowledging some over‑counting of drug spending will occur), and exclude pharmacy spending from the behavioral…