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HCAI outlines behavioral-health spending definition, plans HPD analyses and Medi-Cal adjustments
Summary
HCAI staff summarized the behavioral-health spending definition (primary-diagnosis rule for claims; NDC-based pharmacy identification; allocation methods for non-claims) and said HPD analyses and DHCS collaboration will inform future benchmarks; Medi-Cal under-21 services will be included regardless of diagnosis in 2026 reporting.
Debbie Lindes, health care delivery system group manager at HCAI, walked the work group through the agency's behavioral-health spending definition and the analytic work planned to support a future investment benchmark.
"The main test is whether the claim includes a behavioral health diagnosis as its primary diagnosis," Lindes said, noting an exception for screening and assessment lines that do not require a primary behavioral-health diagnosis. Pharmacy spending will be identified by national drug codes, and non-claims payments will be allocated to behavioral health using an expanded framework that…
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