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OKA details behavioral-health spending definition and flags carve-outs and measurement limits
Summary
OKA presented its behavioral-health spending measurement principles—primary-diagnosis rule (with screening/assessment exception), NDC-based pharmacy inclusion and allocation rules for non-claims payments—and discussed a possible benchmark focused on outpatient and community-based services while acknowledging carve-outs, county spending and out-of-pocket costs complicate a single statewide benchmark.
Debbie Lindis, healthcare delivery system group manager at OKA, reviewed the agency’s approach to defining behavioral-health spending for measurement and for a potential focused investment benchmark.
Under OKA’s approach, claims are counted as behavioral health when the claim has a primary behavioral-health diagnosis; an exception is made for claims for screening or assessment of mental health or substance-use disorders, which are included regardless of primary diagnosis. Pharmacy claims are assessed using national drug codes (NDCs) to identify mental-health or substance-use disorder medications. Non-claims payments will be classified with an expanded…
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