OCA proposes a behavioral‑health‑in‑primary‑care module to avoid double counting and better capture integrated care

Summary

OCA proposed a modular approach that counts integrated behavioral health services as both primary care and behavioral health while subtracting the overlap when reporting totals; it also proposed expanding the primary care provider taxonomy to include certain behavioral health clinicians to reduce undercounting.

The Office of Health Care Affordability proposed a behavioral health and primary care module to capture services provided in primary care settings that qualify as behavioral health while avoiding double counting in total medical spending calculations.

The module would identify services that fall within OCA’s primary care definition (by provider taxonomy and place of service) and also qualify as behavioral health when accompanied by a behavioral health primary diagnosis. Debbie Lindes, manager in OCA’s Healthcare Delivery System Group, said the module "allows OCHA to calculate combined behavioral health and primary care spend without double counting" and "separately identify spending for behavioral health care that's provided in a primary care setting, which can support further integration."

What OCA proposes - Expand the primary care provider taxonomy to include certain behavioral health professionals (for example, psychologists, social…

OCA proposes a behavioral‑health‑in‑primary‑care module to avoid double counting and better capture integrated care

Summary

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