hccinfhir 0.2.6__tar.gz → 0.2.8__tar.gz

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/PKG-INFO

@@ -1,6 +1,6 @@
 Metadata-Version: 2.3
 Name: hccinfhir
-Version: 0.2.6
+Version: 0.2.8
 Summary: HCC Algorithm for FHIR Resources
 Project-URL: Homepage, https://github.com/mimilabs/hccinfhir
 Project-URL: Issues, https://github.com/mimilabs/hccinfhir/issues

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/hccinfhir/datamodels.py

@@ -276,7 +276,7 @@ class EnrollmentData(BaseModel):
         is_partial_benefit_dual: Partial Benefit Dual (uses CPA_/CPD_ prefix)
         medicare_status_code: QMB, SLMB, QI, QDWI, etc.
         medi_cal_aid_code: California Medi-Cal aid code
-        medi_cal_eligibility_status: Medi-Cal eligibility status from REF*6O
+        medi_cal_eligibility_status: Medi-Cal eligibility status (derived: "Active"/"Terminated"/None)
 
         # CA DHCS / FAME Specific
         fame_county_id: FAME county ID (REF*ZX or N4*CY)

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/hccinfhir/extractor_834.py

@@ -216,6 +216,36 @@ def is_new_enrollee(coverage_start_date: Optional[str], reference_date: Optional
         return False
 
 
+def derive_medi_cal_eligibility_status(coverage_end_date: Optional[str], report_date: Optional[str]) -> Optional[str]:
+    """Derive Medi-Cal eligibility status from coverage end date and report date.
+
+    Args:
+        coverage_end_date: Coverage end date in YYYY-MM-DD format
+        report_date: Report date in YYYY-MM-DD format
+
+    Returns:
+        "Active" if coverage extends through or beyond report month
+        "Terminated" if coverage ended before report month
+        None if no coverage_end_date
+    """
+    if not coverage_end_date:
+        return None
+    try:
+        end_date = datetime.strptime(coverage_end_date, "%Y-%m-%d").date()
+        if report_date:
+            ref_date = datetime.strptime(report_date, "%Y-%m-%d").date()
+        else:
+            ref_date = date.today()
+        # Get first day of report month for comparison
+        first_of_report_month = ref_date.replace(day=1)
+        if end_date < first_of_report_month:
+            return "Terminated"
+        else:
+            return "Active"
+    except (ValueError, AttributeError):
+        return None
+
+
 def contains_any_keyword(text: str, keywords: set) -> bool:
     """Check if text contains any of the keywords"""
     text_upper = text.upper()
@@ -326,10 +356,15 @@ def parse_ref_dx(value: str, member: MemberContext) -> None:
 
 
 def parse_ref_17(value: str, member: MemberContext) -> None:
-    """REF*17: YYYYMM;;... (FAME redetermination date)"""
+    """REF*17: YYYYMM;YYYYMMDD;YYYYMM (redetermination date; death date; reporting month)"""
+    # Position 0: FAME redetermination date (YYYYMM)
     yyyymm = get_composite_part(value, 0)
     if yyyymm and len(yyyymm) >= 6:
         member.fame_redetermination_date = f"{yyyymm[:4]}-{yyyymm[4:6]}-01"
+    # Position 1: FAME death date (YYYYMMDD)
+    death_date_str = get_composite_part(value, 1)
+    if death_date_str and len(death_date_str) == 8:
+        member.fame_death_date = parse_date(death_date_str)
 
 
 # ============================================================================
@@ -503,6 +538,7 @@ def _finalize_member(member: MemberContext, source: str, report_date: str) -> En
     dual_code = determine_dual_status(member)
     is_fbd, is_pbd = classify_dual_benefit_level(dual_code)
     new_enrollee = is_new_enrollee(member.coverage_start_date)
+    medi_cal_elig_status = derive_medi_cal_eligibility_status(member.coverage_end_date, report_date)
 
     hcp_history = [
         HCPCoveragePeriod(
@@ -530,6 +566,7 @@ def _finalize_member(member: MemberContext, source: str, report_date: str) -> En
         dual_elgbl_cd=dual_code, is_full_benefit_dual=is_fbd, is_partial_benefit_dual=is_pbd,
         medicare_status_code=member.medicare_status_code,
         medi_cal_aid_code=member.medi_cal_aid_code,
+        medi_cal_eligibility_status=medi_cal_elig_status,
         fame_county_id=member.fame_county_id, case_number=member.case_number,
         fame_card_issue_date=member.fame_card_issue_date,
         fame_redetermination_date=member.fame_redetermination_date,
@@ -583,6 +620,11 @@ def parse_834_enrollment(segments: List[List[str]], source: str = None, report_d
             member.maintenance_type = get_segment_value(segment, 3)
             member.maintenance_reason_code = get_segment_value(segment, 4)
             member.benefit_status_code = get_segment_value(segment, 5)
+            # INS12 is Member Death Date when INS11 = D8
+            if get_segment_value(segment, 11) == 'D8':
+                death_str = get_segment_value(segment, 12)
+                if death_str:
+                    member.death_date = parse_date(death_str)
 
         # REF - Reference identifiers
         elif seg_id == 'REF' and len(segment) >= 3:
@@ -641,9 +683,6 @@ def parse_834_enrollment(segments: List[List[str]], source: str = None, report_d
             if sex in X12_SEX_CODE_MAPPING:
                 member.sex = X12_SEX_CODE_MAPPING[sex]
             member.race = parse_race_code(get_segment_value(segment, 5))
-            death_str = get_segment_value(segment, 6)
-            if death_str and len(death_str) >= 8:
-                member.death_date = parse_date(death_str[:8])
 
         # DTP - Dates
         elif seg_id == 'DTP' and len(segment) >= 4:
@@ -675,7 +714,6 @@ def parse_834_enrollment(segments: List[List[str]], source: str = None, report_d
                             member.has_medicare = True
                         elif qualifier == '435':
                             member.death_date = parsed
-                            member.fame_death_date = parsed
 
         # HD - Health coverage
         elif seg_id == 'HD' and len(segment) >= 4:

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/hccinfhir/model_calculate.py

@@ -115,6 +115,8 @@ def calculate_raf(diagnosis_codes: List[str],
             demographic_interactions[key] = value
         elif key.startswith('OriginallyDisabled_'):
             demographic_interactions[key] = value
+        elif key == 'LTIMCAID':
+            demographic_interactions[key] = value
 
     coefficients_demographics = apply_coefficients(demographics,
                                                    set(),

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/hccinfhir/model_coefficients.py

@@ -101,7 +101,11 @@ def apply_coefficients(demographics: Demographics,
 
     # Apply the coefficients
     for hcc in hcc_set:
-        key = (f"{prefix}HCC{hcc}".lower(), model_name)
+        # For RxHCC models, use RXHCC prefix instead of HCC
+        if 'RxHCC' in model_name:
+            key = (f"{prefix}RXHCC{hcc}".lower(), model_name)
+        else:
+            key = (f"{prefix}HCC{hcc}".lower(), model_name)
 
         if key in coefficients:
             value = coefficients[key]

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/hccinfhir/model_interactions.py

@@ -309,7 +309,7 @@ def create_disease_interactions(model_name: ModelName,
             'HCC85_gRenal_V24': diagnostic_cats['CHF'] * diagnostic_cats['RENAL_V24'],
             'gCopdCF_CARD_RESP_FAIL': diagnostic_cats['gCopdCF'] * diagnostic_cats['CARD_RESP_FAIL'],
             'HCC85_HCC96': int('85' in hcc_set) * int('96' in hcc_set),
-            'gSubstanceAbuse_gPsych': diagnostic_cats['gSubstanceUseDisorder_V24'] * diagnostic_cats['gPsychiatric_V24'],
+            'gSubstanceUseDisorder_gPsych': diagnostic_cats['gSubstanceUseDisorder_V24'] * diagnostic_cats['gPsychiatric_V24'],
             'SEPSIS_PRESSURE_ULCER': diagnostic_cats['SEPSIS'] * diagnostic_cats['PRESSURE_ULCER'],
             'SEPSIS_ARTIF_OPENINGS': diagnostic_cats['SEPSIS'] * int('188' in hcc_set),
             'ART_OPENINGS_PRESS_ULCER': int('188' in hcc_set) * diagnostic_cats['PRESSURE_ULCER'],

{hccinfhir-0.2.6 → hccinfhir-0.2.8}/pyproject.toml

@@ -4,7 +4,7 @@ build-backend = "hatchling.build"
 
 [project]
 name = "hccinfhir"
-version = "0.2.6"
+version = "0.2.8"
 authors = [
   { name="Yubin Park", email="yubin.park@mimilabs.ai" },
 ]