OCA work group debates what counts as behavioral health spending for new state measurement

Margaretta Brandt, assistant deputy director for health system performance at the Office of Health Care Affordability, opened the Investment and Payment Work Groupmeeting in December 2024 to focus on how to define and measure behavioral health spending using claims data.

The discussion centered on the OCAproposal to measure total behavioral health spending broadly while using a narrower subset of codes and settings to set an investment benchmark. OCA staff said they plan a phased approach that begins with the commercial and Medicare Advantage markets, will adapt definitions for MediCal later, and will iterate the code set over time.

Why it matters: the state statute directing OCA requires measurement of behavioral health spending as a share of total medical expenses. How OCA chooses diagnoses, services, places of service and drug codes will determine reported totals and what counts toward any future investment benchmark intended to increase behavioral health capacity and culturally responsive care.

OCA staff described the technical approach and sources: they plan to start from the Milbank Groupspecifications (which rely on HEDIS value sets and state code lists), review Department of Managed Health Care and MediCal code sets for alignment, and then publish a draft ICD-10/procedure/drug code list for work group review. Staff also noted they will use CMS place-of-service codes and National Uniform Billing Committee revenue codes to organize care settings.

Key points of debate

- Diagnosis inclusion: Work group members debated whether to include dementia (major neurocognitive disorders), autism and "adverse effects…