source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBARXEU1.m@ 1464

IBARXEU1 ;AAS/ALB - RX EXEMPTION UTILITY ROUTINE (CONT.) ; 3/27/07 3:10pm

 ;;2.0;INTEGRATED BILLING;**26,112,74,275,367**;21-MAR-94;Build 11

 ;;Per VHA Directive 10-93-142, this routine should not be modified.

 ;

STATUS(DFN,IBDT) ; -- Determine medication copayment exemption status

 ; -- requests data from MAS

 ;

 ;    returns :        = exemption reason (pointer to 354.2) ^ date

 ;

 N X,Y

 I $G(IBDT)="" S IBDT=DT

 S X=$$AUTOST(DFN,IBDT)

 I X'="" G STATUSQ

 S X=$$INCST(DFN,IBDT)

STATUSQ Q X

 ;

AUTOST(DFN,IBDT) ; -- Determine automatically exempt patients.

 ;    input :     dfn  =  patient file pointer

 ;               ibdt  =  internal form of effective date

 ;

 ;    returns :        =  exemption reason (pointer to 354.2) ^ date

 ;                        null if no autostatus

 ;

 N IBEXREA,IBEXMT,I

 S (IBEXREA,IBEXMT)=""

 I $G(IBDT)="" S IBDT=DT

 ;

 ; -- ask mas if in receipt of pension/a&a/hb, etc.

 ;    the automatic determinations

 ;    returns:

 ; sc>50% ^ rec a&a ^ rec hb ^ rec pen ^ n/a ^ non-vet ^ ^ POW ^ Unempl. 

 ;   1         1        1         1                1        1      1

 ;    pieces =1 if true

 S IBEXMT=$$AUTOINFO^DGMTCOU1(DFN) I IBEXMT="" G AUTOSTQ

 I IBEXMT[1 F I=1,2,3,4,6,8,9 I $P(IBEXMT,"^",I)=1 S IBEXREA=I*10 Q  ;lookup code is piece position time 10

 ;

AUTOSTQ I IBEXREA="" Q IBEXREA

 Q $O(^IBE(354.2,"ACODE",+IBEXREA,0))_"^"_IBDT

 ;

 ;

INCST(DFN,IBDT) ; -- return medication copayment exemption reason/date

 ; -- ask mas for income data

 ;

 ;    returns :  = exemption reason (pointer to 354.2) ^ date

 ;

 N IBDATA,X,DGMT,CLN,CONV

 S IBDATA=$G(^DGMT(408.31,+$$LST^DGMTCOU1(DFN,IBDT,3),0)) ;get any test

 I $$PLUS^IBARXEU0(+IBDATA)<IBDT S X=$O(^IBE(354.2,"ACODE",210,0))_"^"_IBDT G INCSTQ ; means test too old -no data

 I $P(IBDATA,U,23)=2 D  G:CONV INCSTQ ;skip Edb conv. tests

 .;Loop through the MT comments, Check for EDB converted test

 .;No comments to check

 .S (CLN,CONV)=0,DGMT=$$LST^DGMTCOU1(DFN,IBDT,3)

 .F  S CLN=$O(^DGMT(408.31,+DGMT,"C",CLN)) Q:'CLN!(CONV)  D

 ..;If most recent test is a converted test use current info from IBA(354

 ..I $G(^DGMT(408.31,+DGMT,"C",CLN,0))["Z06 MT via Edb" S CONV=1,X=$P($G(^IBA(354,DFN,0)),"^",5)_"^"_$P($G(^IBA(354,DFN,0)),"^",3)

 ;

 I $$NETW^IBARXEU1 S X=$$MTCOMP^IBARXEU5($$INCDT(IBDATA),IBDATA)

 I '$$NETW^IBARXEU1 S X=$$INCDT(IBDATA),X=$P(X,"^",3)_"^"_$P(X,"^",2)

INCSTQ Q X

 ;

INCDT(IBDATA) ; -- calcualtes copay exemption status based on income

 ; and net worth

 ;    input  := zeroth node from 408.31

 ;    output := 1 = exempt    ^date of test^ exemption reason 

 ;              2 = non-exempt^...

 ;              3 = pending adjudication (if active)^...

 ;

 N X,IBDT,IBINCOM,IBEXREA,IBDEPEN,IBNETW,IBTABLE,IBLEVEL,IBTHRES

 I '$D(DFN) N DFN S DFN=$P(IBDATA,"^",2)

 S IBEXREA=""

 ;

 ; -- if test incomplete, no longer required, no longer applicable, or

 ;    required set to no income data 

 ;    autoexempt test should be done first before getting to here

 S X=$P(IBDATA,"^",3) I X=1!(X=3)!(X=10)!(X=9)!($P(IBDATA,"^",14)) S IBEXREA=$S($P(IBDATA,"^",14):110,1:210) G NO

 ;

 S IBDT=+IBDATA

 S IBINCOM=$P(IBDATA,"^",4)-$P(IBDATA,"^",15) I IBINCOM<0 S IBINCOM=0

 S IBDEPEN=$P(IBDATA,"^",18),IBNETW=$P(IBDATA,"^",5)

 ;

 ; -- get A&A income level

 ;S IBLEVEL=$$THRES(IBDT,2,IBDEPEN)

 S IBLEVEL=$$THRES(IBDT,$S($E(IBDT,1,5)'<29612:1,1:2),IBDEPEN)

 I $P(IBLEVEL,"^",3) S IBPRIOR=$P(IBLEVEL,"^",3)

 ;

 S IBEXREA=120 ; low income

 I IBINCOM>+IBLEVEL S IBEXREA=110 G NO ;high income not exempt

 ;

 I '$$NETW G NO

 ;

 ; -- get networth threshold amount

 S IBTHRES=+$$THRES(IBDT,4,0)

 ; -- low income check for net worth

 S IBEXREA=$S((IBINCOM+IBNETW)>IBTHRES:130,1:120)

 ;

NO ; -- not enough information

 I IBEXREA="" S IBEXREA=210

 ;

 I $$NETW S Y=$S(IBEXREA=110:2,IBEXREA=120:1,IBEXREA=130:3,1:2)

 I '$$NETW S Y=$S(IBEXREA=120:1,1:2)

 ;

INCDTQ Q Y_"^"_+IBDATA_"^"_$O(^IBE(354.2,"ACODE",+IBEXREA,0))

 ;

THRES(DATE,TYPE,DEPEND) ; -- return threshold amount 

 ;

 ; -- if date is less than 12/1/92 will use 12/1 92 rates

 ;     date =: fileman format of effective date

 ;     type =: 2= pension plus A&A   1992 thru 1995

 ;     type =: 1= basic pension 1996 to present

 ;     depend =: number of dependents

 ;

 ; -- returns rate^effective date^prior year

 ;

 I DATE<2921201 S DATE=2921201 ; use threshold rates from 12/1/92

 N IBTABLE,IBLEVEL,IBPRIOR

 S IBLEVEL=""

 ; -- get entry to determine income amounts

 S IBTABLE=$G(^IBE(354.3,+$O(^(+$O(^IBE(354.3,"AIVDT",TYPE,-(DATE+.000001))),0)),0))

 G:IBTABLE="" THRESQ

 I TYPE=4 S DEPEND=0

 ;

 ; --see if rate is for prior year

 S IBPRIOR="" I $$PLUS^IBARXEU0(+IBTABLE)<DATE S IBPRIOR=+IBTABLE

 ;

 ; -- rates begin in piece 3 for veteran alone, piece 4 for 1 dependent..

 S IBLEVEL=$S(DEPEND<9:$P(IBTABLE,"^",DEPEND+3),1:"")

 I IBLEVEL="" S IBLEVEL=$P(IBTABLE,"^",4)+((DEPEND-1)*$P(IBTABLE,"^",12))

THRESQ Q IBLEVEL_"^"_+IBTABLE_"^"_IBPRIOR

 ;

NETW() ; -- use networth in determining copay exemptions - specs keep changing

 ;    returns 1 if should use networth in exemption determination

 ;    returns 0 if should not use networth in exemption

 Q 0