$TXT Created by DESMOND,LINDA at DEVVDD.FO-ALBANY.MED.VA.GOV (KIDS) on Monday, 06/19/06 at 13:59 ============================================================================= Run Date: SEP 27, 2006 Designation: DG*5.3*717 Package : DG - REGISTRATION Priority: Mandatory Version : 5.3 SEQ #635 Status: Released Compliance Date: OCT 16, 2006 ============================================================================= Associated patches: (v)DG*5.3*672 <<= must be installed BEFORE `DG*5.3*717' Subject: MODIFICATIONS TO CONTINUOUS ENROLLMENT RULES Category: - Routine - Enhancement (Mandatory) Description: ============ In support of the anticipated deployment of Enrollment System Redesign (ESR), the Continuous Enrollment (CE) software enhancement formalizes a list of rules used to determine whether a veteran will be continuously enrolled for VA health care. Continuous enrollment applies only to those veterans who applied for enrollment after January 16, 2003 and were at some point eligible for enrollment but whose eligibility status may have changed, such as when a veteran's VA Pension benefit is terminated. VistA will invoke CE rules when the veteran is assigned a base priority group (PG) that is greater than the enrollment group threshold (EGT) and if the EGT setting is Enrollment Decision. Currently, the EGT is set at PG 8. Therefore, when a record is determined to be PG 8, VistA will invoke the CE rules to determine the appropriate subpriority group. These rules have been built into the VistA software and are based on VA policy and regulation. While VHA staff remain responsible for entering data into VistA, the VistA system will apply the Continuous Enrollment rules to those records staff enter. CE rules that were in place prior to this patch will no longer apply. The following rules will be implemented for continuous enrollment: To determine a veteran's current enrollment record for the purpose of continuous enrollment, ignore any records with an enrollment status in the following list and look to the most recent record that is not in one of these statuses: * Pending Means Test Required * Pending Purple Heart Unconfirmed * Pending Eligibility Status Unverified * Pending Other * Pending No Eligibility Code * Deceased * Not Eligible; Ineligible Date * Not Eligible; Refused to Pay Copay Once the current enrollment record has been determined, the following rules will be executed in this order: 1. If the enrollment record is in a REJECTED enrollment status due to a manual override [at the HEC] (i.e., Enrollment Status Override =YES), it will remain in a REJECTED status unless the veteran is assigned to an enrollment priority group that is being enrolled, OR Until a new EGT is set that could qualify the veteran for enrollment OR The record in a REJECTED enrollment status is manually overridden [at the HEC] to ENROLLED 2. If the enrollment record is in a REJECTED enrollment status, it will stay REJECTED as long as the veteran stays in an enrollment priority group that is not being accepted for new enrollment. 3. If the enrollment record is in a VERIFIED enrollment status due to a manual override [at the HEC] (i.e., Enrollment Status Override =YES), the veteran will remain ENROLLED until a new EGT is set that could disqualify the veteran from enrollment OR The record in an ENROLLED category is manually overridden [at the HEC] to a REJECTED enrollment status 4. If the enrollment record is in a CANCEL/DECLINED enrollment status on or after the EGT Effective Date, it will be treated the same as a record in a REJECTED enrollment status. The veteran will not be continuously enrolled as long as s/he stays in an enrollment priority group that is not being accepted for new enrollments. 5. If the current enrollment record does not meet any of the conditions in Rules 1-4 above, the veteran's enrollment records will be evaluated from most current to earliest, with the following rules applied in this order: * If the earliest Effective Date of Change is prior to the EGT Effective Date, the veteran will be continuously enrolled. * If there is any application date prior to the EGT Effective Date, the veteran will be continuously enrolled. 6. If the veteran has ever had a verified enrollment record with an eligibility in the following list, s/he will be continuously enrolled: * SC 10% or greater AND SC% is changed to SC 0% non compensable (total check amount $0 or null) * Aid & Attendance = YES AND A&A is now not YES * Housebound = YES AND Housebound is now not YES * VA Pension = YES AND VA Pension is now not YES * AO indicator = YES AND Location = DMZ was entered prior to Enrollment System Redesign V. 3.0 (ESR) implementation. (The date that will be used is 12/29/2040 until ESR is implemented. The date will be changed to the ESR implementation date by a subsequent patch). * The CV End Date expires on or after the Enrollment Application Date (or, in the absence of an Application Date, the earliest Effective Date of Change) AND The CV End Date has not been removed * The veteran is enrolled due to a Means Test that qualifies for enrollment, AND A subsequent income year Means Test was added or edited that would place the veteran in a priority group that is not being enrolled UNLESS: The Means Test on the first verified enrollment record is edited to a Means Test Status that places the record in a priority group not being enrolled and veteran has no subsequent record that would quality for enrollment, OR The Means Test on the first verified enrollment record is converted by IVM to a Means Test Status that places the record in a priority group not being enrolled and veteran has no subsequent record that would quality for enrollment. 7. If the enrollment record history does not support any of Rules 1-6 above, AND The base priority is numerically greater than the EGT threshold, THEN The decision is to REJECT enrollment. The rules are complicated, but the overarching premise is that if a veteran's enrollment was based on valid eligibility factors and these factors have changed over time as a normal course and the veteran now qualifies for PG 8, the veteran will be placed in PG 8a or 8c and remain enrolled. However, if the veteran was enrolled based on one or more factors that were later found to be erroneous, the veteran would be placed in PG 8e or 8g and the veteran's enrollment discontinued. The following examples illustrate the continuous enrollment rules: * Veteran Alpha is a NSC, MT Copay Required Combat Veteran. He enrolled on January 15, 2005, in PG 6 with a June 1, 2006 Combat Veteran End Date. On June 2, Veteran Alpha's Combat Veteran Eligibility expires. The continuous enrollment rules are invoked and he is changed to PG 8c. * Veteran Bravo is 10 percent SC and is enrolled in PG 3. VBA readjusts his award down to zero percent SC and veteran completes a MT and is MT Copay Required. The continuous enrollment rules are invoked and Veteran Bravo is changed to Priority Group 8a. * NSC Veteran Charlie applies for enrollment on June 10, 2003, and is placed in PG 5 based on MT Copay Exempt status. IVM confirms the MT Copay Exempt status is appropriate. The veteran completes a new MT for the following income year and is placed in a MT Copay Required status. The continuous enrollment rules are invoked and Veteran Charlie is changed to PG 8c and remains enrolled. * NSC Veteran Delta applies for enrollment on March 15, 2003, and is placed in PG 5, based on MT Copay Exempt status. Her subsequent means tests place her in a MT Copay Required status. When the test that qualified Veteran Delta for enrollment is converted to a MT Copay Required Status by IVM, Veteran Delta is placed in PG 8e and her enrollment is discontinued. * Veteran Echo is enrolled as a 10 percent SC veteran and is placed in PG 3. HEC later confirms that the veteran has no service-connected disabilities and corrects the record. The veteran is placed in PG 8g and his enrollment is discontinued. * Veteran Foxtrot is a zero percent SC noncompensable, MT Copay Required veteran who was enrolled in PG 6 based on an assertion of Agent Orange Exposure while in service in Vietnam. He is subsequently found not to have served in Vietnam and the Agent Orange Exposure indicator is changed to No. As a result, Veteran Foxtrot's priority is reassessed and he is placed in PG 8e. Currently, HEC staff may manually override any enrollment determination either to reject or continuously enroll a veteran, regardless of any business rule. This capability will not change with the CE software enhancement. PARTICIPATING TEST SITES: ======================== Augusta, GA El Paso, TX NOTE: This patch received an exemption from production testing. This was necessary because, if a veteran's information is changed at the test site, it will be shared with all sites of record via the HEC. If a shared site of record is not running the test software, the veteran's information may not be properly updated, possibly creating serious data inconsistencies that could affect patient benefits and care. ROUTINE SUMMARY: ================ The following is a list of the routine(s) included in this patch. The second line of each of these routine(s) will look like: ;;5.3;Registration;**[patch list]**;Aug 13, 1993 OLD: CHECK^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== DGENEGT1 15405132 15911255 232,417,454,491 513,451,564,672 NEW: CHECK1^XTSUMBLD results Routine name Before Patch After Patch Patch List ============ ============ =========== ========== DGENEGT1 56378610 61320915 232,417,454,491 513,451,564,672 DOCUMENTATION RETRIEVAL: ======================== The user documentation is available on the Office of Information Field Office (OIFO) ANONYMOUS.SOFTWARE directories listed below: OIFO FTP address Directory Albany ftp.fo-albany.med.va.gov anonymous.software Hines ftp.fo-hines.med.va.gov anonymous.software Salt Lake City ftp.fo-slc.med.va.gov anonymous.software VistA download site download.vista.med.va.gov anonymous.software The user documentation files listed below may be obtained via FTP. The preferred method is to download the files from: download.vista.med.va.gov This method transmits the files from the first available FTP server. Sites may also elect to retrieve documentation from a specific server as shown in the above table. Filename Contents DG_5_3_P717_ADTBE_UM.DOC PIMS V.5.3 ADT Module User Manual The VistA Documentation Library [VDL] web site contains all end-user manuals. The address is http://www.va.gov/vdl/. INSTALLATION INSTRUCTIONS: =========================== This patch may be installed with users on the system but it is recommended that it be run during non peak hours. Installation will take less than 2 minutes. 1. Use the INSTALL/CHECK MESSAGE option on the PackMan menu to unload the KIDS distribution included with this message. NOTE: If the required patches are not installed, the transport global will be removed. If the transport global is removed you will need to repeat this step. 2 From the Kernel Installation and Distribution System Menu, select the Installation menu. 3. From this menu, you may elect to use the following options (when prompted for INSTALL NAME, enter DG*5.3*717): a. Compare Transport Global to Current System - this option will allow you to view all changes that will be made when the patch is installed. It compares all components of the patch (routines, DDs, templates, etc.). b. Verify Checksums in Transport Global - this option will allow you to ensure the integrity of the routines that are in the transport global. c. Print Transport Global - this option will allow you to view the components of the KIDS build. d. Backup a Transport Global - This option will create a backup message of any routines exported with this patch. It will not backup any other changes such as DD's or templates. 4. Use the Install Package(s) option and select the package DG*5.3*717. 5. When prompted 'Want KIDS to INHIBIT LOGONs during the install? YES//', respond NO. 6. When prompted 'Want to DISABLE Scheduled Options, Menu Options, and Protocols? NO//', respond YES. When prompted, 'Enter options you wish to mark as 'Out Of Order':', enter: Register a Patient [DG REGISTER PATIENT] Load/Edit Patient Data [DG LOAD PATIENT DATA] Patient Enrollment [DGEN PATIENT ENROLLMENT] When prompted, 'Enter protocols you wish to mark as 'Out Of Order':', hit Enter. Routine Information: ==================== The checksums below are new checksums, and can be checked with CHECK1^XTSUMBLD. Routine Name: DGENEGT1 Before: B56378610 After: B61320915 **232,417,454,491,513,451,564, 672,717** ============================================================================= User Information: Entered By : DESMOND,LINDA Date Entered : JUN 08, 2006 Completed By: NAIK,CHINTAN Date Completed: SEP 20, 2006 Released By : HEUER,CINDY Date Released : SEP 27, 2006 ============================================================================= Packman Mail Message: ===================== $END TXT