Score all 10 rows × 5 objectives = 50 cells. Use only the evidence base appended to this message. Do not invent facts outside it. "The evidence base does not say" is a valid finding and usually means score 3 (unevidenced-neutral), per the disciplines below.
Architectures (rows) — score as specified, not as an idealized redesign
Use these IDs exactly in your matrix:
| ID | Architecture | Spec to score |
|---|---|---|
| a1_medicaid_rate_floor | Medicaid behavioral rate floor + administrative simplification | Pay enough that panels open; cut prior-auth friction for routine outpatient codes. States already set fee schedules / MCO rates. |
| a2_ccbhc_expansion | CCBHC expansion as default safety-net model | Prospective payment, crisis required, measured access — score the §223 demonstration / expansion class as evidenced, not an idealized national default. |
| a3_imd_repeal_waiver | IMD repeal or broad MH IMD waiver | Let Medicaid buy adult inpatient capacity where clinically needed. Distinct from SUD IMD. Score statutory constraint + §1115 SMI/SED patchwork evidence. |
| a4_bed_rebuild | Bed rebuild / state hospital reinvestment | Targeted acute/forensic reinvestment on contemporary bed constructs only. Do not use “beds since 1955” / 95%-closed arithmetic — the evidence base treats that as citogenic. |
| a5_crisis_continuum | 988 + mobile crisis + stabilization continuum completion | Fund the middle tier so ED/law-enforcement are not the default. Separate 988 volume from causal diversion claims. |
| a6_parity_erisa | Parity enforcement with ERISA teeth | Federal exams that reach self-funded plans; network adequacy secret-shopper standards. Score examined-band evidence and enforcement capacity honestly. |
| a7_aot_expansion | Assisted outpatient treatment expansion | Civil-court leverage into treatment (Kendra’s / Laura’s Law class). Selection effects are the whole game — score selected-SMI cohorts, not population outpatient access. |
| a8_collaborative_care | Primary-care behavioral integration / Collaborative Care (CoCM) | Scale evidence-based integration billing rather than specialty-only supply. |
| a9_workforce_liberalization | Workforce liberalization | Interstate compacts, supervision-ratio reform, peer specialists with Medicaid billing. |
| a10_do_nothing | Do-nothing comparator | Current 988 funding path, patchwork IMD waivers, parity-on-paper trajectory. Identical treatment; no charity, no penalty for being a comparator. |
Dimensions (columns) — use these exact names
Anchored 1–5 meanings are in 00-scales.md in the evidence base. Columns in matrix order:
O1_realized_accessO2_acute_crisis_capacityO3_workforce_takes_payerO4_financial_protection_parityO5_state_capacity_federalism
Mental-health-specific notes (do not override the disciplines)
- KC1: There is no national by-payer outpatient wait/acceptance series. Score O1 on secret-shopper / clinic-access / crisis-connection proxies the record actually contains; do not invent a national series.
- KC2: Drop absolute “beds since 1955” claims. O2 uses contemporary constructs (state-hospital vs hospital psychiatric beds) named in the evidence.
- KC3: Commercial parity for the ERISA self-funded majority is often band-only / unknown. Do not score O4=5 on “ERISA teeth” without evidence of census-style reach.
- AMI and SMI are different markets — do not mix bands without saying so.
- Awards share of mental disorders on SSDI is not ~⅓ of awards in this record; do not use a false awards plurality to score any cell.
- Prefer cited evaluation effects over mechanism stories. Mechanism without evidence → 3.