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OKA outlines behavioral health spending definition and planned HPD analyses; DHCS collaboration noted
Summary
Debbie Lindis described OKA's behavioral health spending methodology (primary-diagnosis test for claims, formulas for non-claims allocation), reported Advisory and Board feedback, and said OKA will run HPD analyses (market, age, geography, price vs utilization and secondary-diagnosis impacts) and work with DHCS on including county behavioral health spending.
Debbie Lindis, Healthcare Delivery System Group Manager at OKA, walked the group through the agency's behavioral health (BH) spending definition and clarified how claims and non-claims payments will be identified and allocated. "The main test is whether the claim includes a behavioral health diagnosis as its primary diagnosis," Lindis said, and she noted an exception for screening and assessment claim lines that can be counted without a primary BH diagnosis.
Lindis said pharmacy claims will be identified as BH by national drug codes and that every claim can be categorized as mental health or substance use disorder to permit separate reporting. For non-claims payments, OKA will apply multiple allocation methods: classifying population-health,…
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