3. EPMO Open Source Coordination Office Redaction File Detail Report

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3.1 Files compared

#	Location	File	Last Modified
1	ES5.6_docs.zip\ESCC	TS - Real-Time CCP Eligibility Determination.docx	Wed Mar 27 20:26:44 2019 UTC
2	ES5.6_docs.zip\ESCC	TS - Real-Time CCP Eligibility Determination.docx	Thu Apr 11 16:34:52 2019 UTC

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	1	Enrollment System (E S)
	2	Real-Time Community Care Progr am (CCP) E ligibility Determina tion
	3	Technical Specificat ion
	4
	5	Department of Vetera ns Affairs
	6	Office of Informatio n and Tech nology (OI T)
	7	Product De velopment
	8	Documentat ion Versio n 1.2
	9
	10	Revision H istory
	11	Date
	12	Revision
	13	Descriptio n
	14	Author
	15	01/31/2019
	16	1.2
	17	Updates fo r Mission Act
	18	Manoj Sach anandani
	19	01/28/2019
	20	1.1
	21	Updated De termineVCE rule flow and other details a s per impl ementation
	22	Manoj Sach anandani
	23	11/07/2018
	24	1.0
	25	Initial do cument
	26	Manoj Sach anandani
	27
	28	Table of C ontents
	29	1.Introduc tion1
	30	1.1.Purpos e1
	31	1.2.Scope1
	32	2.System C omponents and Proces ses2
	33	2.1.Geocod ing and Dr iving Dist ance2
	34	2.1.1.Proc essES_PSSG ETL Proje ct2
	35	2.1.2.ES A DR.ADDRESS UPDATE3
	36	2.2.Wait T ime Data E xtract fro m CDW3
	37	2.3.Care d ata provid ed by VSSC 3
	38	2.4.Determ ination of Community Care Prog ram Eligib ility3
	39	2.5.Health Benefit P lan11
	40	2.6.TPA11
	41	2.7.Batch Processes1 2
	42	2.7.1.Reca lculateVCE 12
	43	2.7.2.Titl e38Recalcu late12
	44	2.8.VCE Pa rameters12
	45	3.Referenc e Document s14
	46
	47
	48	Introducti on
	49	One of the requireme nts of the Community Care Prog ram (CCP) is to impr ove Vetera n support through au tomated Co mmunity Ca re Eligibi lity Deter mination a nd interfa ce with Ge ocoding, D riving Dis tance, Wai t-Time, an d Title 38 Care data . The Enro llment Sys tem (ES) i s identifi ed as the source to collect Ge ocoding, W ait-Time a nd Care in formation, and to ma ke Communi ty Care el igibility determinat ions based on that d ata. ES co llects and sends Com munity Car e informat ion to the Third-Par ty Adminis trator (TP A), so tha t TPA can contact Ve terans who are eligi ble to rec eive Commu nity Care services.
	50	ES uses an Exchange, Transform , and Load (ETL) mec hanism to extract Wa it-Time an d Care inf ormation f rom the Co rporate Da ta Warehou se (CDW), request an d process Geocoding informatio n from the Planning System Sup port Group (PSSG) an d to deter mine Commu nity Care eligibilit y. The ETL process r uns in a b atch mode at various intervals . The rea l-time Com munity Car e eligibil ity determ ination in ES uses t he current data on f ile.
	51	In the fut ure, PSSG is plannin g to host a web serv ice that c an be acce ssed on-de mand to co llect Geoc oding info rmation. T his will f urther imp rove near real-time determinat ion.
	52	The wait-t ime inform ation extr action fro m CDW must be perfor med on an ETL server . This inf ormation i s extracte d daily at end-of-th e-day. The Community Care elig ibility de terminatio n will use current w ait-time d ata on fil e in ES.
	53	The Title 38 Care in formation provided b y VSSC (VH A Support Service Ce nter) must be extrac ted on an ETL server . This inf ormation i s extracte d daily at end-of-th e-day. The Community Care elig ibility de terminatio n will use current C are data o n file in ES.
	54	Purpose
	55	The purpos e of this document i s to descr ibe system component s and proc esses used for real- time Commu nity Care eligibilit y determin ation in t he ES appl ication.
	56	Scope
	57	This docum ent descri bes the st eps to be performed in Enrollm ent System applicati on and on ETL server .
	58
	59	System Com ponents an d Processe s
	60	Geocoding and Drivin g Distance
	61	The Proces sES_PSSG E TL project will dete rmine reco rds to be sent to PS SG for geo coding bas ed on addr ess update s. The PSS G response will be p rocessed a nd a geoco ding flag and geocod ing result will be d etermined for each V eteran.
	62	ProcessES_ PSSG ETL P roject
	63	The reques t ES_PSSG_ Delta ETL job will s can the AD R.ADDRESS table for records wi th GEOCODI NG_REQUIRE D_IND colu mn value o f ‘Y’ and will only include th ese record s in the r equest to PSSG. When the recor d is inclu ded in req uest table , it will update GEO CODING_REQ UIRED_IND column in ADR.ADDRES S to ‘I’ t o indicate geocoding is in pro cess.
	64
	65	The respon se PSSG_ES _Delta ETL job perfo rms the fo llowing:
	66	Updates (o r inserts a record) ADR.GEOCOD E_TRANSMIT table wit h response from PSSG .
	67	Updates GE OCODING_RE QUIRED_IND column in ADR.ADDRE SS to ‘N’, only if i t was set to ‘I’.
	68	Updates VC E_RECALC_R EQUIRED_IN D column t o ‘Y’ in A DR.VCELIGI BILITY tab le, if eit her the DR IVING_DIST ANCE or GE OCODE_STAT ION_ID has changed f rom its pr evious val ue. If the re is no r ecord exis ting in AD R.VCELIGIB ILITY, ins erts a new record wi th VCESTAT USTYPE=’ND ’.
	69
	70	The ES_PSS G_Monthly ETL job pr ocesses al l active r ecords for enrolled Veterans w ith Grandf athered st atus. The response P SSG_ES_Mon thly ETL j ob perform s the foll owing:
	71	Updates (o r inserts a record) ADR.GEOCOD E_TRANSMIT table wit h response from PSSG for all ~ 9M record s.
	72	Updates VC E_RECALC_R EQUIRED_IN D column t o ‘Y’ in A DR.VCELIGI BILITY tab le, if eit her the DR IVING_DIST ANCE or GE OCODE_STAT ION_ID has changed f rom its pr evious val ue. If the re is no r ecord exis ting in AD R.VCELIGIB ILITY, ins erts a new record wi th VCESTAT USTYPE=’ND ’.
	73
	74	The Update GeocodingF lag ETL jo b will rec alculate t he geocodi ng flag an d geocodin g result t ext for ea ch record in Geocode _Transmit database t able, base d on new V CE paramet ers.
	75	ES ADR.ADD RESS UPDAT E
	76	ES will up date the G EOCODING_R EQUIRED_IN D column i n ADR.ADDR ESS table to a value of ‘Y’ wh en there i s a change in the ad dress. Al l address updates ma de in the ES applica tion will be routed through th e ContactI nfoRuleSer vice. A ch ange in th e address will be de tected by comparing the addres s of incom ing and on -file pers ons.
	77	Wait Time Data Extra ct from CD W
	78	The Proces sCDW_ES ET L project will extra ct wait-ti me data wi th the des ired appoi ntment dat e within t he past tw o years. I f a record of an app ointment o lder than two years exists in wait-time data, the record is removed fr om ADR.WAI TTIME. If a record o f an appoi ntment no longer exi sts in wai t-time dat a, the rec ord is rem oved from the ADR.WA ITTIME. Al l other ap pointment records ar e updated with the n ew days el apsed valu e.
	79	The CDW_ES ETL job w ill update VCE_RECAL C_REQUIRED _IND colum n to ‘Y’ i n ADR.VCEL IGIBILITY table if a ny new wai t-time rec ord for a Veteran is inserted into ADR.W AITTIME or a wait-ti me record is removed from ADR. WAITTIME.
	80	Note: The wait-time data extra ct only in cludes har dship rela ted data f or Air, Bo at and Fer ry and Geo -burden ha rdships.
	81	Care data provided b y VSSC
	82	The Proces sVSCC_ES E TL project will extr act Care d ata provid ed by VSSC and will update the records i n ADR data base. The Care data including Urgent car e is used to determi ne CCP eli gibility.
	83	Determinat ion of Com munity Car e Program Eligibilit y
	84	The real-t ime CCP el igibility determinat ion is imp lemented a s an ILOG rule in ES . The rule Determine VCE is a s ub-flow of existing DetermineE nrollment rule flow.
	85	When a new Veteran i s added or any updat e to the e nrollment status is made, or a Veteran i s re-enrol led, the D etermineEn rollment r ules will be execute d. The Det ermineVCE rules will be execut ed as part of Determ ineEnrollm ent, thus providing real-time determinat ion of CCP eligibili ty.
	86	The Missio n Act, whi ch goes in to effect on June 6, 2019, wil l have sev eral chang es made to the curre nt Communi ty Care el igibility. CCP eligi bility, fo r all enro lled Veter ans, will be recalcu lated on t he effecti ve date wi th new rul es for Gra ndfatherin g on exist ing eligib le Veteran s. All new Veterans enrolled o n or after the effec tive date, will be a ssigned CC P eligibil ity throug h new Miss ion Act ru les.
	87
	88	The Determ ineVCE wil l follow t he flow as shown in the diagra m below an d rules as per the U se Case Sp ecificatio n - Determ ine Commun ity Care P rogram (CC P) Eligibi lity docum ent.
	89
	90
	91	Figure 1: Sub Flow: DetermineV CE
	92
	93
	94
	95
	96	Figure 2: Sub Flow: VCENotEnro lledFlow
	97
	98
	99
	100
	101
	102
	103
	104
	105
	106
	107
	108	Figure 3: Sub Flow: VCEEnrolle dFlow
	109
	110
	111
	112
	113
	114
	115
	116
	117
	118
	119
	120
	121
	122	Figure 4: Sub Flow: IsMileageE ligibleOn6 _6_19
	123
	124
	125
	126
	127
	128
	129
	130
	131	Figure 5: ChoiceMile ageRuleFlo w
	132
	133
	134
	135
	136
	137
	138	Figure 6: Sub Flow: GrandFathe rRuleFlow
	139
	140
	141
	142
	143
	144	Figure 7: Sub Flow: GFMoveRule Flow
	145
	146
	147
	148
	149
	150
	151	Figure 8: Sub Flow: ChoiceMile ageRuleFlo w
	152
	153
	154
	155
	156
	157	Figure 9: Sub Flow: MileageDet ermination RuleFlow
	158
	159
	160
	161
	162	Figure 10: Sub Flow: ProcessMa nualOverri de
	163
	164
	165	The follow ing ETL jo bs are no longer req uired:
	166	VCE_INIT_C ALC
	167	VCE_INIT_C ALC_RE_ELI GIBLE
	168	VCE_PARAMS _RECALC
	169	HBP
	170	Health Ben efit Plan
	171	The Determ ineVCE rul e flow wil l update t he Health Benefit Pl an (HBP) b ased on th e new elig ibility fo r the Vete ran and re move previ ously assi gned HBPs correspond ing to Com munity Car e eligibil ity. HBPs for a Vete ran could be one of other plan s that are assigned not as res ult of CCP eligibili ty. The ot her plans are not to be remove d. The HBP is not up dated if t here is no change in CCP eligi bility.
	172	In additio n to HBP u pdate, an ORUZ11 mes sage will be sent to VistA. Th e HBPlanPr ocess batc h job, whi ch is used to send O RUZ11 mess ages, is n o longer r equired.
	173	On and aft er effecti ve date of Mission A ct, new HB Ps for exi sting, Bas ic (B) and Hardship (H) eligib ilities an d new, Gra ndfathered (G), Stat e with No Full-Servi ce VA Medi cal Facili ty (N) and Urgent Ca re (U) eli gibilities will be u sed.
	174	TPA
	175	The Determ ineVCE rul e flow wil l update t he VCESTAT USTYPE_ID in ADR.VCE LIGIBILITY table wit h the new eligibilit y status. When the n ew eligibi lity is di fferent fr om its cur rent value , the VCAD MISTATUS_T YPE_ID in ADR.VCADMI N table wi ll also be updated w ith approp riate valu es as belo w.
	176	2000587–TP A Positive , Veteran records fo r all Vete rans who q ualify for services through th e Communit y Care Pro gram.
	177	2000589–TP A Negative , Veteran records fo r any Vete rans who p reviously qualified for the Co mmunity Ca re Program , but are no longer enrolled.
	178	Batch Proc esses
	179	Recalculat eVCE
	180	Address up dates and wait time updates fl ag records that requ ire re-cal culation o f Communit y Care Pro gram Eligi bility. ES batch pro cess Recal culateVCE processes records ma rked with VCE_RECALC _REQUIRED_ IND column ‘Y’ in AD R.VCELIGIB ILITY tabl e. This ba tch proces s executes the Deter mineEnroll ment rules for these records, which in t urn execut es the Det ermineVCE, updates t he eligibi lity and m arks the r ecords to be sent to TPA for p ositive an d negative file.
	181	The batch process, R ecalculate VCE is sch eduled to run daily at 2:00 pm and 6:00 pm CST.
	182	Title38Rec alculate
	183	The Title 38 care pr ovision ex pires on J une 7, 202 0. The bat ch process , Title38R ecalculate will be e xecuted on June 7, 2 020. All V eterans wh o have a C CP eligibi lity of Gr andfather, will be r e-processe d to calcu late CCP e ligibility . Any Vete ran who ha s a Grandf ather stat us due to Title 38 c are rules, may lose the Grandf ather stat us.
	184	VCE Parame ters
	185	The CC eli gibility d eterminati on will be based on parameter values set according to curren t law. Whe n there is a change in regulat ion, one o r more of these para meters may have a di fferent va lue. The C C eligibil ity determ ination fo r Veterans affected by this ch ange will have to be re-calcul ated based on new pa rameter va lues.
	186	On the eff ective dat e of June 6, 2019 fo r Mission Act, the f ollowing V CE paramet ers will b e turned o ff and rem oved:
	187	Consults
	188	Electronic Wait List
	189	Mileage Ex ception
	190	VCL PO Box Exception
	191
	192	The batch process VC EParameter sChanged w ill identi fy the enr olled reco rds that n eed re-cal culation d ue to chan ge in VCE parameter values and execute t he VCE eli gibility r ules. Enro lled recor ds are tho se that me et the “Ba sic qualif ications f or the Vet erans Choi ce Program ” defined in the Det ermine Com munity Car e Program (CCP) Elig ibility – Use Case S pecificati on documen t.
	193	The recalc ulated CCP eligibili ty will be updated f or all 9 m illion rec ords even if for som e records where ther e will be no change from its p revious va lue.
	194
	195	Reference Documents
	196	Determine Community Care Progr am (CCP) E ligibility – Use Cas e Specific ation
	197	ES TPA Ext ract Techn ical Speci fication
	198	Trigger pr ocess to r ecalculate CC Eligib ility base d on new V CE Paramet ers