<%@ page import="gov.va.med.esr.ui.util.SessionManager"%>
<%@ page import="gov.va.med.esr.ui.financials.action.ThresholdAction"%>
<%@ taglib uri="/tags/struts-bean-el" prefix="bean-el" %>
<%@ taglib uri="/tags/struts-bean" prefix="bean" %>
<%@ taglib uri="http://struts.apache.org/tags-html" prefix="html-el" %>
<%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c" %>
<%@ taglib uri="/tags/esr-core" prefix="esrcore" %>
<%@ taglib uri="/tags/fw" prefix="fw" %>

<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<html-el:form action="/thresholds" method="post">
  <%@ include file="/admin/csrfgentoken.jsp" %>
<tr>
<td width="100%">
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
   <tr>
     <td colspan="3">
         <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead" role="presentation">
           <tr>
			<td class="moduleBlueBox"><img alt=""  src="../images/spacer.gif" width="28" height="23"/></td>
			<td nowrap class="moduleHeadline">Income Year</td>
			<td width="100%"><img alt=""  src="../images/spacer.gif"/> 			   
           </tr>
         </table>
     </td>
    </tr>

    <tr>
        <td width="25%" class="moduleLabel"><fw:label property="incomeYear" forId="idIncomeYear">Income Year:</fw:label></td>
        <td width="25%" class="moduleValue">
	        <html-el:select title="Income Year" styleClass="moduleEdit" styleId="idIncomeYear" property="incomeYear" >
	        <html-el:option value=""><bean-el:message key="label.select" /></html-el:option>
			<esrcore:options collection="<%= ThresholdAction.THRESHOLD_INCOME_YEAR_LIST_SESSION_KEY %>" property="value" labelProperty="label"/>
	        </html-el:select>
		</td>
  	    <td width="50%" class="moduleValue">
	        <table border="0" align="left" cellspacing="0" cellpadding="0" role="presentation">
            <tr>
              <td><img alt=""  src="../images/buttonEndLeft.gif"/></td>
              <td><html-el:submit property="methodName" style="width:70; vertical-align: top;" styleClass="buttonText"><bean-el:message key="button.viewData"/></html-el:submit></td>
              <td><img alt=""  src="../images/buttonEndRight.gif"/></td>
            </tr>
			</table>
		</td>
	</tr>
   </table>
</td>
</tr>
</table>
<br>
<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<tr>
<td width="100%">
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
   <tr>
     <td colspan="5">
         <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead" role="presentation">
           <tr>
        	<td class="moduleBlueBox"><img alt=""  src="../images/spacer.gif" width="28" height="23"/></td>
	    	<td class="moduleHeadline">Inpatient Copayments and Per Diem Charges - <c:out value="${thresholdForm.incomeYear}"/></td>
           </tr>
         </table>
     </td>
    </tr>
      <tr valign="top">
        <td width="207" class="darkLabel"><div align="left">Effective Date:</div></td>
        <td colspan="2" class="darkValue"><esrcore:displayValue name="thresholdForm" property="incomeThreshold.thresholdEffectiveDate"/></td>
        <td class="darkLabel">&nbsp;</td>
        <td class="darkValue">&nbsp;</td>
      </tr>
      <tr valign="top">
        <td colspan="2" class="label"> <div align="left">1st 90 Days Hospitalization Copay:</div></td>
        <td class="value"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.ninetyDayHospitalCopay" nullText="0.0"/></td>
        <td class="label"><div align="left">Additional 90 Days Hospitalization Copay:</div></td>
        <td width="130" class="value"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.add90DayHospitalDeductible" nullText="0.0"/></td>
      </tr>
      <tr valign="top">
        <td colspan="2" class="darkLabel"><div align="left">Per Diem Charges:</div></td>
        <td width="137" class="darkValue"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.inpatientPerDiem" nullText="0.0"/></td>
        <td width="217" class="darkLabel">&nbsp;</td>
        <td class="darkValue">&nbsp;</td>
      </tr>
    </table>
</table>
<br>
<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<tr>
<td width="100%">
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
   <tr>
     <td colspan="5">
         <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead" role="presentation">
           <tr>
        	<td class="moduleBlueBox"><img alt=""  src="../images/spacer.gif" width="28" height="23"/></td>
	    	<td class="moduleHeadline">GMT Copayments and Per Diem Charges - <c:out value="${thresholdForm.incomeYear}"/></td>
           </tr>
         </table>
     </td>
    </tr>

      <tr valign="top">
        <td colspan="2" class="darkLabel"> <div align="left">GMT Inpatient Copay 1st 90 Days:</div></td>
        <td class="darkValue"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.gmtInpatient90DayCopay" nullText="0.0"/></td>
        <td class="darkLabel"><div align="left">GMT Inpatient Copay Additional 90 Days:</div></td>
        <td width="139" class="darkValue"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.gmtInpatientAdd90DayCopay" nullText="0.0"/></td>
      </tr>
      <tr valign="top">
        <td colspan="2" class="label"><div align="left">GMT Per Diem:</div></td>
        <td width="137" class="value"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.gmtInpatientPerDiem" nullText="0.0"/></td>
        <td width="208" class="label">&nbsp;</td>
        <td class="value">&nbsp;</td>
      </tr>
    </table>
</table>
<br>
<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<tr>
<td width="100%">
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
   <tr>
     <td colspan="4">
         <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead" role="presentation">
           <tr>
        	<td class="moduleBlueBox"><img alt=""  src="../images/spacer.gif" width="28" height="23"/></td>
	    	<td class="moduleHeadline">Outpatient Copayments - <c:out value="${thresholdForm.incomeYear}"/></td>
           </tr>
         </table>
     </td>
    </tr>

      <tr valign="top">
        <td class="darkLabel"> <div align="left" class="darkLabel">Effective Date:</div></td>
        <td class="darkValue"><div align="left"><esrcore:displayValue name="thresholdForm" property="incomeThreshold.thresholdEffectiveDate"/></div></td>
        <td class="darkLabel">&nbsp;</td>
        <td class="darkValue">&nbsp;</td>
      </tr>
      <tr valign="top">
        <td width="197" class="label"><div align="left">Basic Care Services:</div></td>
        <td width="150" class="value"><div align="left"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.outpatientCopay" nullText="0.0"/></div></td>
        <td width="206" class="label"><div align="left">Specialty Care Services:</div></td>
        <td width="139" class="value"><div align="left"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.outpatientSpecialtyCopay" nullText="0.0"/></div></td>
      </tr>
      <tr valign="top">
        <td class="darkLabel"><div align="left">Preventive Care Services:</div></td>
        <td class="darkValue"><div align="left"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.outpatientPreventiveCopay" nullText="0.0"/></div></td>
        <td class="darkLabel">&nbsp;</td>
        <td class="darkValue">&nbsp;</td>
      </tr>
    </table>
</table>
<br>
<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<tr>
<td width="100%">
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
   <tr>
     <td colspan="4">
         <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead" role="presentation">
           <tr>
        	<td class="moduleBlueBox"><img alt=""  src="../images/spacer.gif" width="28" height="23"/></td>
	    	<td class="moduleHeadline">Medication Copayments - <c:out value="${thresholdForm.incomeYear}"/></td>
           </tr>
         </table>
     </td>
    </tr>

      <tr valign="top">
        <td width="161" class="darkLabel"><div align="left">Medication Copay:</div></td>
        <td width="184" class="darkValue"><div align="left"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.medicationCopay" nullText="0.0"/></div></td>
        <td width="209" class="darkLabel"><div align="left">Medication Copay Cap:</div></td>
        <td width="138" class="darkValue"><div align="left"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.medicationCopayAnnualCap" nullText="0.0"/></div></td>
      </tr>
    </table>
</table>
<br>
<table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShell" role="presentation">
<tr>
<td width="100%">
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
   <tr>
     <td colspan="4">
         <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead" role="presentation">
           <tr>
        	<td class="moduleBlueBox"><img alt=""  src="../images/spacer.gif" width="28" height="23"/></td>
	    	<td class="moduleHeadline">Long Term Care Copayments - <c:out value="${thresholdForm.incomeYear}"/></td>
           </tr>
         </table>
     </td>
    </tr>

      <tr valign="top">
        <td colspan="2" class="darkLabel"> 
		  <div align="left" class="darkLabel">Inpatient Maximum per day for Nursing Home, Respite, and Geriatric Evaluation:</div>
          <div align="left"></div></td>
        <td width="138" class="darkValue"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.ltcInpatientCopay" nullText="0.0"/></td>
      </tr>
      <tr valign="top">
        <td colspan="2" class="label">
			<div align="left">Outpatient Maximum per day for Adult Day Health Care, Respite, and Geriatric Evaluation:</div></td>
        <td class="value"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.ltcOutpatientCopay" nullText="0.0"/></td>
      </tr>
      <tr valign="top">
        <td colspan="2" class="darkLabel"><div align="left">Domiciliary Maximum per day:</div></td>
        <td class="darkValue"><esrcore:displayCurrency name="thresholdForm" currencyProperty="incomeThreshold.ltcDomiciliaryCopay" nullText="0.0"/></td>
      </tr>
    </table>
</html-el:form>
</table>
