hccinfhir 0.1.0__py3-none-any.whl → 0.1.1__py3-none-any.whl

hccinfhir/hccinfhir.py

@@ -16,16 +16,16 @@ class HCCInFHIR:
     def __init__(self, 
                  filter_claims: bool = True, 
                  model_name: ModelName = "CMS-HCC Model V28",
-                 proc_filtering_filename: ProcFilteringFilename = "ra_eligible_cpt_hcpcs_2025.csv",
-                 dx_cc_mapping_filename: DxCCMappingFilename = "ra_dx_to_cc_2025.csv"):
+                 proc_filtering_filename: ProcFilteringFilename = "ra_eligible_cpt_hcpcs_2026.csv",
+                 dx_cc_mapping_filename: DxCCMappingFilename = "ra_dx_to_cc_2026.csv"):
         """
         Initialize the HCCInFHIR processor.
         
         Args:
             filter_claims: Whether to apply filtering rules to claims. Default is True.
             model_name: The name of the model to use for the calculation. Default is "CMS-HCC Model V28".
-            proc_filtering_filename: The filename of the professional cpt filtering file. Default is "ra_eligible_cpt_hcpcs_2025.csv".
-            dx_cc_mapping_filename: The filename of the dx to cc mapping file. Default is "ra_dx_to_cc_2025.csv".
+            proc_filtering_filename: The filename of the professional cpt filtering file. Default is "ra_eligible_cpt_hcpcs_2026.csv".
+            dx_cc_mapping_filename: The filename of the dx to cc mapping file. Default is "ra_dx_to_cc_2026.csv".
         """
         self.filter_claims = filter_claims
         self.model_name = model_name

hccinfhir/model_calculate.py

@@ -8,7 +8,7 @@ from hccinfhir.model_interactions import apply_interactions
 from hccinfhir.utils import load_dx_to_cc_mapping, load_is_chronic
 
 # Load default mappings from csv file
-mapping_file_default = 'ra_dx_to_cc_2025.csv'
+mapping_file_default = 'ra_dx_to_cc_2026.csv'
 dx_to_cc_default = load_dx_to_cc_mapping(mapping_file_default)
 
 # Load default mappings from csv file
@@ -87,8 +87,25 @@ def calculate_raf(diagnosis_codes: List[str],
         if is_chronic_mapping.get((hcc, model_name), False):
             hcc_chronic.add(hcc)
 
-    coefficients_demographics = apply_coefficients(demographics, set(), {}, model_name)
-    coefficients_chronic_only = apply_coefficients(demographics, hcc_chronic, {}, model_name)
+    demographic_interactions = {}
+    for key, value in interactions.items():
+        if key.startswith('NMCAID_'):
+            demographic_interactions[key] = value
+        elif key.startswith('MCAID_'):
+            demographic_interactions[key] = value
+        elif key.startswith('LTI_'):
+            demographic_interactions[key] = value
+        elif key.startswith('OriginallyDisabled_'):
+            demographic_interactions[key] = value
+
+    coefficients_demographics = apply_coefficients(demographics, 
+                                                   set(), 
+                                                   demographic_interactions, 
+                                                   model_name)
+    coefficients_chronic_only = apply_coefficients(demographics, 
+                                                   hcc_chronic, 
+                                                   demographic_interactions, 
+                                                   model_name)
     
     # Calculate risk scores
     risk_score = sum(coefficients.values())

hccinfhir/model_coefficients.py

@@ -3,7 +3,7 @@ import importlib.resources
 from hccinfhir.datamodels import ModelName, Demographics
 
 # Load default mappings from csv file
-coefficients_file_default = 'ra_coefficients_2025.csv'
+coefficients_file_default = 'ra_coefficients_2026.csv'
 coefficients_default: Dict[Tuple[str, ModelName], float] = {}  # (diagnosis_code, model_name) -> value
 
 try:
@@ -80,6 +80,7 @@ def get_coefficent_prefix(demographics: Demographics,
         return 'INS_'
         
     if demographics.new_enrollee:
+
         return 'SNPNE_' if demographics.snp else 'NE_'
         
     # Community case
@@ -139,5 +140,6 @@ def apply_coefficients(demographics: Demographics,
             value = coefficients[key]
             output[interaction_key] = value
 
+
     return output
 

hccinfhir/model_demographics.py

@@ -57,6 +57,14 @@ def categorize_demographics(age: Union[int, float],
         raise ValueError("Sex must be 'M', 'F', '1', or '2'")
     
     # Determine if person is disabled or originally disabled
+    # SAS code:
+    # DISABL = (&AGEF < 65 & &OREC ne "0");
+    # ORIGDS  = (&OREC = '1')*(DISABL = 0);
+    # The vairable names can be misleading. 
+    # disabled is true if the person is disabled and the age is less than 65
+    # - basically, the person is in Medicare due to disability not due to age
+    # orig_disabled is true if the person started Medicare due to disability, but now aged in
+    # - basically, the person is in Medicare due to age (not disability anymore)
     disabled = age < 65 and (orec is not None and orec != "0")
     orig_disabled = (orec is not None and orec == '1') and not disabled
 

hccinfhir/model_dx_to_cc.py

@@ -3,7 +3,7 @@ from hccinfhir.datamodels import ModelName
 from hccinfhir.utils import load_dx_to_cc_mapping
 
 # Load default mappings from csv file
-mapping_file_default = 'ra_dx_to_cc_2025.csv'
+mapping_file_default = 'ra_dx_to_cc_2026.csv'
 dx_to_cc_default = load_dx_to_cc_mapping(mapping_file_default)
 
 def get_cc(

hccinfhir/model_hierarchies.py

@@ -2,29 +2,33 @@ from typing import Dict, Set, Tuple
 import importlib.resources
 from hccinfhir.datamodels import ModelName  
 
-# Load default mappings from csv file
-hierarchies_file_default = 'ra_hierarchies_2025.csv'
-hierarchies_default: Dict[Tuple[str, ModelName], Set[str]] = {}  # (diagnosis_code, model_name) -> {cc}
+def load_hierarchies(hierarchies_file: str) -> Dict[Tuple[str, ModelName], Set[str]]:
+    """Load hierarchies from a CSV file."""
+    hierarchies = {}
+    try:
+        with importlib.resources.open_text('hccinfhir.data', hierarchies_file) as f:
+            for line in f.readlines()[1:]:  # Skip header
+                try:
+                    cc_parent, cc_child, model_domain, model_version, _ = line.strip().split(',')
+                    if model_domain == 'ESRD':
+                        model_name = f"CMS-HCC {model_domain} Model {model_version}"
+                    else:
+                        model_name = f"{model_domain} Model {model_version}"
+                    key = (cc_parent, model_name)
+                    if key not in hierarchies:
+                        hierarchies[key] = {cc_child}
+                    else:
+                        hierarchies[key].add(cc_child)
+                except ValueError:
+                    continue  # Skip malformed lines
+    except Exception as e:
+        print(f"Error loading mapping file: {e}")
+        hierarchies = {}
+    return hierarchies
 
-try:
-    with importlib.resources.open_text('hccinfhir.data', hierarchies_file_default) as f:
-        for line in f.readlines()[1:]:  # Skip header
-            try:
-                cc_parent, cc_child, model_domain, model_version, _ = line.strip().split(',')
-                if model_domain == 'ESRD':
-                    model_name = f"CMS-HCC {model_domain} Model {model_version}"
-                else:
-                    model_name = f"{model_domain} Model {model_version}"
-                key = (cc_parent, model_name)
-                if key not in hierarchies_default:
-                    hierarchies_default[key] = {cc_child}
-                else:
-                    hierarchies_default[key].add(cc_child)
-            except ValueError:
-                continue  # Skip malformed lines
-except Exception as e:
-    print(f"Error loading mapping file: {e}")
-    hierarchies_default = {}
+# Load default mappings from csv file
+hierarchies_file_default = 'ra_hierarchies_2026.csv'
+hierarchies_default: Dict[Tuple[str, ModelName], Set[str]] = load_hierarchies(hierarchies_file_default)
 
 def apply_hierarchies(
     cc_set: Set[str],  # Set of active CCs

{hccinfhir-0.1.0.dist-info → hccinfhir-0.1.1.dist-info}/METADATA

@@ -1,6 +1,6 @@
 Metadata-Version: 2.3
 Name: hccinfhir
-Version: 0.1.0
+Version: 0.1.1
 Summary: HCC Algorithm for FHIR Resources
 Project-URL: Homepage, https://github.com/mimilabs/hccinfhir
 Project-URL: Issues, https://github.com/mimilabs/hccinfhir/issues
@@ -182,10 +182,12 @@ Each method returns a RAFResult containing:
 - Processed service level data (when applicable)
 
 ## Testing
+
+After installing `hatch`
 ```bash
-$ python3 -m hatch shell
-$ python3 -m pip install -e .
-$ python3 -m pytest tests/*
+$ hatch shell
+$ pip install -e .
+$ pytest tests/*
 ``` 
 
 ## Dependencies
@@ -267,36 +269,83 @@ $ python3 -m pytest tests/*
 
 ## Data Files
 
-`ra_dx_to_cc_mapping_2025.csv`
+`ra_dx_to_cc_mapping_2026.csv`
 ```sql
-SELECT diagnosis_code, cc, model_name 
-FROM ra_dx_to_cc_mapping 
-WHERE year = 2025 and model_type = 'Initial';
+WITH latest_years AS (
+  SELECT 
+    model_name,
+    MAX(year) as latest_year
+  FROM mimi_ws_1.cmspayment.ra_dx_to_cc_mapping 
+  WHERE model_type = 'Initial'
+    AND year <= 2026  -- Don't go beyond 2026
+  GROUP BY model_name
+)
+SELECT 
+  r.diagnosis_code, 
+  r.cc, 
+  r.model_name
+FROM mimi_ws_1.cmspayment.ra_dx_to_cc_mapping r
+INNER JOIN latest_years l 
+  ON r.model_name = l.model_name 
+  AND r.year = l.latest_year
+WHERE r.model_type = 'Initial'
+ORDER BY r.model_name, r.diagnosis_code;
 ```
 
-`ra_hierarchies_2025.csv`
+`ra_hierarchies_2026.csv`
 ```sql
-SELECT cc_parent, 
-  cc_child, 
-  model_domain, 
-  model_version, 
-  model_fullname
-FROM ra_hierarchies
-WHERE eff_last_date > '2025-01-01';
+WITH latest_dates AS (
+  SELECT 
+    model_domain,
+    model_version,
+    model_fullname,
+    MAX(eff_last_date) as latest_eff_last_date
+  FROM mimi_ws_1.cmspayment.ra_hierarchies 
+  GROUP BY model_domain, model_version, model_fullname
+)
+SELECT 
+  r.cc_parent, 
+  r.cc_child, 
+  r.model_domain, 
+  r.model_version, 
+  r.model_fullname
+FROM mimi_ws_1.cmspayment.ra_hierarchies r
+INNER JOIN latest_dates l 
+  ON r.model_domain = l.model_domain 
+  AND r.model_version = l.model_version
+  AND r.model_fullname = l.model_fullname
+  AND r.eff_last_date = l.latest_eff_last_date
+ORDER BY r.model_domain, r.model_version, r.model_fullname, r.cc_parent, r.cc_child;
 ```
 
-`ra_coefficients_2025.csv`
+`ra_coefficients_2026.csv`
 ```sql
-SELECT coefficient, value, model_domain, model_version 
-FROM ra_coefficients 
-WHERE eff_last_date > '2025-01-01';
+WITH preferred_records AS (
+  SELECT 
+    model_domain,
+    model_version,
+    MAX(eff_last_date) as latest_eff_last_date
+  FROM mimi_ws_1.cmspayment.ra_coefficients
+  GROUP BY model_domain, model_version
+)
+SELECT 
+  r.coefficient,
+  r.value, 
+  r.model_domain, 
+  r.model_version
+FROM mimi_ws_1.cmspayment.ra_coefficients r
+INNER JOIN preferred_records p
+  ON r.model_domain = p.model_domain 
+  AND r.model_version = p.model_version
+  AND r.eff_last_date = p.latest_eff_last_date
+ORDER BY r.model_domain, r.model_version, r.coefficient;
 ```   
 
-`ra_eligible_cpt_hcpcs_2025.csv`
+`ra_eligible_cpt_hcpcs_2026.csv`
 ```sql
 SELECT DISTINCT cpt_hcpcs_code
 FROM mimi_ws_1.cmspayment.ra_eligible_cpt_hcpcs
-WHERE is_included = 'yes' AND YEAR(mimi_src_file_date) = 2024;
+WHERE is_included = 'yes' AND YEAR(mimi_src_file_date) = 2025;
 ```
 
 ## Contributing

{hccinfhir-0.1.0.dist-info → hccinfhir-0.1.1.dist-info}/RECORD

@@ -1,25 +1,29 @@
 hccinfhir/__init__.py,sha256=OCyYCv4jTOlYHZbTw2DTks3e6_YT1N2JXAOuyR03KNE,43
-hccinfhir/datamodels.py,sha256=2zdJf7oBF1j281bbi3hzIUWInUrWeU6IsC51EoV14Mo,4972
+hccinfhir/datamodels.py,sha256=lMLGSuWTlpzoWenKsfhF8qQF3RZJV2NNGyIm_rBkd0o,5038
 hccinfhir/extractor.py,sha256=-jHVCIJqFAqvrI9GxkkXZVDQjKDa-7vF7v3PGMGAMnA,1801
 hccinfhir/extractor_837.py,sha256=vkTBCd0WBaJoTrUd-Z-zCIaoLk7KV2n4AGqIORhONIk,7147
 hccinfhir/extractor_fhir.py,sha256=Rg_L0Vg5tz_L2VJ_jvZwWz6RMlPAkHwj4LiK-OWQvrQ,8458
 hccinfhir/filter.py,sha256=8uYThN0-AqwVAKyti29WGiFwQKDiremMhYd_m6QcXhM,2193
-hccinfhir/hccinfhir.py,sha256=DxTkqbgVXsOsvX1M_UXemb68UMfC8oVCGus2CYIAiTM,6837
-hccinfhir/model_calculate.py,sha256=0IJctgfROAJR_3FU_x3VbX0oS3cyn29hFBzbkbEjoOs,4718
-hccinfhir/model_coefficients.py,sha256=UrDAEWBoqooSC8hy9YSUsLMmmfgIO0YGtVkui6ruOkE,5528
-hccinfhir/model_demographics.py,sha256=CMnD2-Au9Q6HNZrJUZqVVJRDEmSuK8ZpF39I22JkX8M,6564
-hccinfhir/model_dx_to_cc.py,sha256=jCFlnAOBkfI9FrCX6tZIh-Sp_DW0HwpY7QrPXGtwInI,1765
-hccinfhir/model_hierarchies.py,sha256=e8QtSayTrfPv2wh149FjK7ToiEmU1ISYMA1Pi38iVk0,2700
+hccinfhir/hccinfhir.py,sha256=gVdQ6e1rJRVwIEcSw2cAUjnXH5WsCqaeDudn1Ol2_0w,6837
+hccinfhir/model_calculate.py,sha256=3lKpNSdTNFn3OREw8yjlOhoNcDhs7LpQj7TIHQ1HvxQ,5519
+hccinfhir/model_coefficients.py,sha256=ZsVY0S_X_BzDvcCmzCEf31v8uixbGmPAsR6nVEyCbIA,5530
+hccinfhir/model_demographics.py,sha256=7W5NLW7aAjpn25BJzqfP8iSouD9uA6epGguJJ6BPuC0,7043
+hccinfhir/model_dx_to_cc.py,sha256=guJny2Mb9z8YRNWCXGSIE3APbE06zwnA2NRkjAeUs60,1765
+hccinfhir/model_hierarchies.py,sha256=0kdBmF_8e_ikMHBDhlw2I7jT3DupHfUn6o5mWj7v3Yo,2910
 hccinfhir/model_interactions.py,sha256=ZLiKJepPjPkYceKDf7dLXoYE0p44I7t9y2sTOlrxojo,20264
 hccinfhir/utils.py,sha256=AAHwzMSW8O9VZp1KLcdlN3OeBbxQtqQRtbTTdrKf7M0,2784
 hccinfhir/data/__init__.py,sha256=SGiSkpGrnxbvtEFMMlk82NFHOE50hFXcgKwKUSuVZUg,45
 hccinfhir/data/hcc_is_chronic.csv,sha256=eVVI4_8mQNkiBiNO3kattfT_zfcV18XgmiltdzZEXSo,17720
 hccinfhir/data/ra_coefficients_2025.csv,sha256=I0S2hoJlfig-D0oSFxy0b3Piv7m9AzOGo2CwR6bcQ9w,215191
+hccinfhir/data/ra_coefficients_2026.csv,sha256=0gfjGgVdIEWkBO01NaAbTLMzHCYINA0rf_zl8ojngCY,288060
 hccinfhir/data/ra_dx_to_cc_2025.csv,sha256=4N7vF6VZndkl7d3Fo0cGsbAPAZdCjAizSH8BOKsZNAo,1618924
+hccinfhir/data/ra_dx_to_cc_2026.csv,sha256=YT9HwQFUddL_bxuE9nxHWsBtZzojINL0DzABBMp6kms,1751007
 hccinfhir/data/ra_eligible_cpt_hcpcs_2023.csv,sha256=VVoA4s0hsFmcRIugyFdbvSoeLcn7M7z0DITT6l4YqL8,39885
 hccinfhir/data/ra_eligible_cpt_hcpcs_2024.csv,sha256=CawKImfCb8fFMDbWwqvNLRyRAda_u9N8Q3ne8QAAe54,40191
 hccinfhir/data/ra_eligible_cpt_hcpcs_2025.csv,sha256=-tMvv2su5tsSbGUh6fZZCMUEkXInBpcTtbUCi2o_UwI,40359
+hccinfhir/data/ra_eligible_cpt_hcpcs_2026.csv,sha256=1oXFcLJQPF_fbGd1sLZU6IPolKCXOculovqIUAoMgLc,40359
 hccinfhir/data/ra_hierarchies_2025.csv,sha256=HQSPNloe6mvvwMgv8ZwYAfWKkT2b2eUvm4JQy6S_mVQ,13045
+hccinfhir/data/ra_hierarchies_2026.csv,sha256=Q7xi5PpgJ4LETadup4vKoKud9ZWeu2OZVpwgr4VLpMw,19248
 hccinfhir/samples/__init__.py,sha256=SGiSkpGrnxbvtEFMMlk82NFHOE50hFXcgKwKUSuVZUg,45
 hccinfhir/samples/sample_837_0.txt,sha256=eggrD259uHa05z2dfxWBpUDseSDp_AQcLyN_adpHyTw,5295
 hccinfhir/samples/sample_837_1.txt,sha256=E155MdemSDYoXokuTXUZ6Br_RGGedYv5t5dh-eMRmuk,1322
@@ -37,7 +41,7 @@ hccinfhir/samples/sample_eob_1.json,sha256=_NGSVR2ysFpx-DcTvyga6dFCzhQ8Vi9fNzQEM
 hccinfhir/samples/sample_eob_2.json,sha256=FcnJcx0ApOczxjJ_uxVLzCep9THfNf4xs9Yf7hxk8e4,1769
 hccinfhir/samples/sample_eob_200.ndjson,sha256=CxpjeQ1DCMUzZILaM68UEhfxO0p45YGhDDoCZeq8PxU,1917986
 hccinfhir/samples/sample_eob_3.json,sha256=4BW4wOMBEEU9RDfJR15rBEvk0KNHyuMEh3e055y87Hc,2306
-hccinfhir-0.1.0.dist-info/METADATA,sha256=iao0WVikTc_19EBBI3QuSPrO5KSffu_IZFBoiYZkcUs,11567
-hccinfhir-0.1.0.dist-info/WHEEL,sha256=C2FUgwZgiLbznR-k0b_5k3Ai_1aASOXDss3lzCUsUug,87
-hccinfhir-0.1.0.dist-info/licenses/LICENSE,sha256=xx0jnfkXJvxRnG63LTGOxlggYnIysveWIZ6H3PNdCrQ,11357
-hccinfhir-0.1.0.dist-info/RECORD,,
+hccinfhir-0.1.1.dist-info/METADATA,sha256=t5eApNi_1F-OCQiB16B2W6AUxS-mPpRTni6swrLqbRg,12881
+hccinfhir-0.1.1.dist-info/WHEEL,sha256=C2FUgwZgiLbznR-k0b_5k3Ai_1aASOXDss3lzCUsUug,87
+hccinfhir-0.1.1.dist-info/licenses/LICENSE,sha256=xx0jnfkXJvxRnG63LTGOxlggYnIysveWIZ6H3PNdCrQ,11357
+hccinfhir-0.1.1.dist-info/RECORD,,