Enhancing Medicaid Behavioral Health Crisis Reporting: A Multisource Approach to Capturing Crisis Service Events.

Area of Science:

• Health Services Research
• Public Health Surveillance
• Behavioral Health Policy

Background:

• Traditional billing codes inadequately capture the full scope of behavioral health crisis events.
• Accurate identification of behavioral health crises is crucial for resource allocation and system evaluation.

Purpose of the Study:

• To assess the adequacy of existing billing codes for identifying behavioral health crises.
• To develop and validate a comprehensive claims-based methodology for crisis event identification among Medicaid beneficiaries.

Main Methods:

• Retrospective analysis of Medicaid claims data (2016-2021).
• A five-step, multisource approach integrating traditional codes, emergency department/urgent care encounters, diagnosis codes (suicide attempts, self-harm), naloxone administration, and crisis-related procedures.
• Utilized diagnosis, service, and place-of-service indicators for enhanced identification.

Main Results:

• An expanded approach identified over 2.3 million beneficiaries in 2021, compared to 645,940 using traditional codes (<28% capture rate).
• Crisis service events increased by 6.6% from 2016-2021, with notable rises in naloxone administration (50.0%) and suicide attempt/self-harm (14.8%).
• The expanded method captured more rural residents, older individuals, and those without formal diagnoses.

Conclusions:

• Traditional billing codes significantly underestimate the prevalence of behavioral health crises in Medicaid populations.
• A multisource claims-based methodology offers a more accurate and inclusive framework for crisis surveillance.
• Findings have critical implications for evaluating and enhancing behavioral health crisis response systems.