As of June 2023, the Colorado All Payer Claims Database (CO APCD) contained over 1 billion claims, representing over 5 million insured lives in Colorado, spanning from 2013-2022. Of these claims, there are over 65 million behavioral health claims contained in the CO APCD, representing over three million unique Coloradans who have received one or more behavioral health services.
Behavioral health is an umbrella term for behavioral factors that can impact health, including mental health conditions, stress-linked physical conditions, and substance use disorders (SUD). Behavioral health services are identified in the CO APCD through admitting, principal, or secondary diagnoses and procedure codes on claims. For the last several years, CIVHC’s intake processes did not support SUD data submission to the CO APCD, and it was not collected.
The CO APCD Insights Dashboard shows that claims for behavioral health services steadily increased across all payer types between 2013 to 2021 from 3.5 million claims to over 9.4 million, and decreased slightly to 8.8 million in 2022. CIVHC uses claims for behavioral health services to support a variety of analyses including trends in Emergency Department Use for Mental Health and Potential Self-Harm, and Understanding Use of Telehealth For Behavioral Health Services. The claims are also used in both the Community Dashboard and Health Equity Analysis to determine whether people are getting follow up care for mental health related ED visits and whether social factors are related to getting follow up care.
Regulating SUD Data
As the number of people living with substance use disorder (SUD) is a serious cause for concern, targeted interventions and programs would be easier to design and implement with more accessible data. Historically, the federal government has heavily regulated the information through part two of item 42 in the Code of Federal Regulations (referred to as 42 CFR Part 2).
Until very recently, the restrictions of 42 CFR Part 2, limited sharing SUD data to very specific and narrow circumstances. However, federal legislation has revised the rules around collection and use of SUD claims, allowing for regulated collection and analysis. Under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), passed in March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) significantly expanded the use of SUD data.
These changes to the regulations, the formation of the Colorado Behavioral Health Administration (BHA), and the implementation of new quality analytics in the CO APCD connected to SUD claims have opened the door for CIVHC to begin collecting SUD claims in the CO APCD in summer 2022.
SUD Claims in the CO APCD
In preparation for collecting SUD data and ensuring proper storage and use of the information, CIVHC worked with data manager, Human Services Research Institute (HSRI), in 2022 to implement a flag that identifies any SUD claim submitted to the CO APCD. This allows CIVHC and HSRI to store SUD claims separately from the other medical claims submitted to the CO APCD.
The new filter, implemented in the data warehouse refresh of January of 2023, contains a comprehensive list of SUD identifiers and separates any claims containing SUD data at the point of ingestion into the CO APCD. This ensures SUD data can be easily excluded from reporting as appropriate and lessens the potential for inconsistency in reporting if the flag was not implemented. The filter also segregates the SUD claims information, making it more easily accessible for any analyses where its release is allowed under the new guidelines.
To learn more about SUD claim collection and how CIVHC implements the proper measures to meet regulation requirements, read our SUD FAQ.
The Future of SUD Claims Reporting
There is a good deal of legislative and statewide activity around SUD and behavioral health, and guidelines are swiftly adjusting.
In December of 2022, another rule change was proposed to 42 CFR Part 2 by the Department of Health and Human Services (HHS) that would better align SUD information with data governance and patient protections in the Health Insurance Portability and Accountability Act (HIPAA). The rule change remains under review. CIVHC continues to monitor changes to 42 CFR Part 2 provisions as they pertain to the collection of SUD data.
As CIVHC continues to learn about the appropriate uses for collection and release of SUD data, we will share more information. In the meantime, please contact us at firstname.lastname@example.org for questions.