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OCA outlines straw model for behavioral‑health investment benchmark focused on outpatient and community care
Summary
OCA proposed a two‑track approach: (1) measure total behavioral health spending broadly (claims, non‑claims, pharmacy and patient responsibility) and (2) set an investment benchmark focused on covered, in‑network outpatient and community‑based behavioral health services to advance access and equity.
The Office of Health Care Affordability presented a straw model for a behavioral‑health investment benchmark that separates measurement from the policy benchmark: OCA would measure total behavioral health spending broadly (claims, non‑claims, pharmacy and patient responsibility) but set a focused benchmark that counts covered in‑network outpatient and community‑based behavioral health services intended to expand timely, culturally responsive care and reduce out‑of‑pocket spending.
Staff said the benchmark would not initially include most inpatient, residential or long‑term‑care behavioral health spending but would include claims and non‑claims payments for outpatient services (telehealth, professional outpatient visits, mobile services and community programs). OCA staff said pharmaceuticals would be included in overall measurement but are under consideration for exclusion from the focused benchmark so as not to swamp changes in outpatient investment.
The office has been developing the approach with its investment and payment work group and the advisory committee. Board and work‑group members generally supported a focused benchmark but some participants urged OCA to track inpatient and residential spending separately; others urged linking benchmark performance to access and outcome metrics. The office plans to continue work‑group meetings through July and to return to the board with a recommended benchmark in July 2025.
