We measured the receipt of specific psychosocial EBPs and any psychosocial services (not exclusively EBPs). Table A.7 summarizes the approach used to measure psychosocial services.
1. National Codes Used to Identify Psychosocial EBPs
We identified psychosocial EBPs using HCPCS, ICD-9, CPT, and state-specific billing codes in states that deliver mental health services under FFS arrangements (Table A.8). We did not attempt to measure the receipt of psychosocial EBPs among beneficiaries who receive mental health services through managed care arrangements because we have no way of knowing what codes (if any) managed care entities use for psychosocial EBPs.
2. Identification of State Codes for Psychosocial Services
Because some states have developed their own Medicaid billing codes for psychosocial services, we attempted to identify those codes that are used for specific psychosocial EBPs to include in the numerator of our measures. When states submit Medicaid claims data to CMS, they classify each claim into one of 30 types of service (TOS) codes that generally correspond to the basis for coverage under the Medicaid state plan. During the process of creating the MAX files, claims are classified according to four TOS codes--durable medical equipment, residential care, adult day care, and psychiatric services. This re-classification of claims uses national HCPCs, CPT, and ICD-9 procedure codes as well as state-specific procedure codes that the MAX team has identified through research and consultation with each states Medicaid agency.
We examined state-specific codes that were mapped to the MAX TOS code for “psychiatric services” to identify codes that could identify specific psychosocial EBPs and those that identified other psychosocial services that may or may be evidence-based. Table A.9 summarizes the decision rules used to classify state-specific procedure codes as being a psychosocial EBP or as being for some other psychosocial treatment.