Office proposes two‑tier penalties to enforce timely health spending data submissions

The Office of Health Care Affordability staff proposed a staged enforcement approach for data submissions that pairs technical assistance with escalating penalties when required filings are late or not provided. Under the plan, data due September 1 would be subject to two optional 15‑day extensions during which the submitter must provide periodic status updates and accept technical assistance. If data are not submitted after those extensions, staff would assess a flat untimely‑submission penalty (illustratively $10,000) and begin progressive enforcement steps that include a 30‑day remediation period. If data remain missing after an agreed remediation plan deadline, the office would assess a higher per‑member failure‑to‑submit penalty (illustratively $5 per covered life) and could pursue additional legal remedies. Why this matters: the office will expand the number of required data submitters from 17 (2024) to about 51 in 2025 as reporting moves from parent organizations to licensed entities and adds files such as alternative payment model and primary care data. Staff said missing data would impede statewide reporting, attribution and target enforcement and could skew analyses used in future regulatory actions. Staff emphasized multiple goals: make penalties strong enough to deter non‑cooperation, keep penalties reasonable for small entities, and preserve incentives to provide accurate and complete files rather than minimal or blank submissions. Board members asked staff to consider monthly tolling or progressive escalation for repeated noncompliance, public testimony to increase transparency and steps short of monetary penalties for initial failures. Public commenters and board members urged clarity about timing and the office’s technical support role. Elizabeth Mitchell said the penalty amounts must exceed a “cost of doing business” threshold to be effective; Richard Kronick described federal transparency rules that became effective only after penalties increased. Staff said they would return with refined regulatory language, with a public rulemaking timeline through early 2026 and effective dates aligned to the 2026 submission cycle. Next steps: staff will collect stakeholder input, discuss the proposal with the advisory committee in September and seek board approval of final penalty parameters between October and December, then advance regulations in early 2026.