OCA proposes rules to count non‑claims behavioral‑health payments, recommends excluding plan‑level connector spend

The Office of Health Care Affordability on Oct. 9 outlined a methodology for counting non‑claims payments toward statewide behavioral‑health spending, saying payments must be made to behavioral‑health providers to be fully included and recommending limits on some categories of infrastructure and transformation payments.

OCA staff described the approach during the work group’s meeting and sought feedback from clinicians, consumer advocates and payer representatives. Margaret DeBrant, assistant deputy director for health system performance at the Office of Health Care Affordability, opened the meeting and framed the session as a continuation of the agency’s efforts to define behavioral‑health spending for measurement and benchmarking.

Why it matters: Non‑claims payments are widely used to fund care integration, workforce supports and practice transformation. How OCA counts those dollars will affect the state’s measurement of payer investment in outpatient and community behavioral‑health services and the baseline used to set any investment benchmark.

Key elements of OCA’s proposal

- Payments to behavioral‑health providers: OCA recommends including in behavioral‑health spending those non‑claims payments made directly to behavioral‑health providers for population‑health work, behavioral‑health integration and…