OCA board debates enforcement factors for spending targets including population shifts, outliers and new technologies

The Office of Cost and Accountability asked its board for guidance on how to contextualize spending growth when entities exceed legally established spending targets. Staff outlined a set of possible enforcement considerations and asked the board and public to weigh which factors should influence whether an entity advances from an initial review to technical assistance, performance-improvement steps or financial penalties.

Core questions presented: OCA staff described a staged enforcement workflow mandated by statute in which entities that exceed a spending target are first notified and may provide additional information; all such entities receive technical assistance; and OCA may then evaluate enforcement considerations to determine next steps. Staff emphasized these considerations would not change reported performance but could inform prioritization of enforcement resources.

Potential considerations discussed by the board and staff included: - Population characteristics: staff showed age- and demographic-adjusted growth estimates and suggested OCA could examine whether shifts in an entity's covered population (for example, an older caseload) materially contributed to higher spending. - High-cost…