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Ports the public CMS "LEAD Model PY 2027 Alignment and Financial Methodology Paper" v1.2 (bib E4PEU3HV) as generic engines: parameters come from the paper, everything CMS computes per ACO or per year comes from the caller. No participant data, no organization-specific rules. - lead.params: Table 5.2.1 discounts, 3% Quality Withhold, 2% retention incentive, Box 5.3.3 Stop-Loss bands, Tables 5.4.1/5.4.3 corridors, 2% sequestration, base-year weights, Table 3.5.1 ACPT guardrails, risk-score growth caps, REA/PSA shares and caps, voluntary guardrail and 500 minimum, Table 2.6.1 base-year alignment minimums. - lead.settlement: Final Financial Settlement, Table 5.6.1 line by line (settle(SettlementInputs) -> SettlementLines). - lead.stop_loss: Box 5.3.3 charge, banded payout, neutrality factor, application to PY expenditure. - lead.monies_owed: Table 5.5.1 Total Monies Owed, APO reconciliation. - lead.timing: run-out end, settlement-basis rule, settlement-stage inputs. - lead.benchmark: §3 formulas — risk standardization, two-/three-way trend, base-year weights and sufficiency, voluntary guardrail, regional FFS, spending designation, REA, PSA, risk-score cap, hybrid alignment dollars, category blend. - lead.express: the same as narwhals Exprs; express.settlement.settle settles a frame of scenarios on any backend. Rounding: every dollar line rounds to the cent (half away from zero) as it is produced; PBPMs, rates and factors never do. It is the only rule under which Tables 3.3.3, 3.5.3.2, 3.5.4, 5.5.1 and 5.6.1 all reproduce (3.5.4 line 24 sums cent-rounded cells; 3.3.3 carries unrounded PBPMs). The Expr cents snaps its ÷100 with round(2): polars 2.0 divides a column by a literal as a reciprocal multiply (k × 0.01), one ulp off k/100 for ~15% of values. Missing inputs stay missing (None/null or a refused input model); the only zeros are the paper's own (Professional "N/A" discount, no Stop-Loss election, sequestration on losses, ineligible REA/PSA). Paper inconsistencies recorded in tests: Table 5.5.1 line 2 is a cent below Table 5.6.1 line 28 (.43 vs .44); Box 3.3.2 prints 1.104 then says 1.103; §3.5.1 prose widens the ACPT lower bound a year later than Table 3.5.1 (the table is followed). Tests: 283 in tests/lead — every published line to the cent, Expr builders on polars and DuckDB, bit-for-bit scalar/frame parity over 160 scenarios; 100% of src/lead.
251 lines
7.8 KiB
Python
251 lines
7.8 KiB
Python
"""Worked examples printed in the LEAD PY2027 methodology (bib E4PEU3HV).
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Test fixtures only — never runtime parameters. Each value is copied from
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the paper as printed; percentages are written as shares.
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"""
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from __future__ import annotations
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# ── Table 5.6.1: Full Settlement Calculation ──────────────────────────────
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TABLE_5_6_1_INPUTS = {
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"py_benchmark": 150_000_000.00, # line 1
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"spending_designation": "Lower-spending", # 3.00% discount (line 2)
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"performance_year": 2027,
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"quality_score": 0.95, # line 6
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"capitation_payments": 10_000_000.00, # line 10
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"participant_provider_claims": 1_003_442.00, # line 11
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"preferred_provider_claims": 33_435_084.00, # line 12
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"non_aco_provider_claims": 91_355_457.00, # line 13
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"stop_loss_elected": True,
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"stop_loss_charge": 2_948_334.28, # line 17
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"stop_loss_payout": 2_900_000.00, # line 18
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"stop_loss_neutrality_factor": 0.930, # line 19
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"retention_incentive_applies": False,
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}
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# (paper line, SettlementLines field). Lines 16, 23 and 24 restate 15, 22
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# and 9; "26.1"–"26.4" are the "Retained ... in Corridor n" lines.
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TABLE_5_6_1_LINES = (
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("1", "py_benchmark"),
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("2", "discount_rate"),
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("3", "discount_amount"),
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("4", "benchmark_after_discount"),
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("5", "quality_withhold"),
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("6", "quality_score"),
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("7", "quality_earn_back"),
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("8", "net_quality_withhold"),
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("9", "benchmark_after_adjustments"),
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("10", "capitation_payments"),
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("11", "participant_provider_claims"),
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("12", "preferred_provider_claims"),
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("13", "non_aco_provider_claims"),
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("14", "total_ffs_payments"),
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("15", "py_expenditure"),
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("16", "py_expenditure"),
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("17", "stop_loss_charge"),
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("18", "stop_loss_payout"),
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("19", "stop_loss_neutrality_factor"),
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("20", "adjusted_stop_loss_payout"),
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("21", "net_stop_loss_impact"),
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("22", "py_expenditure_after_stop_loss"),
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("23", "py_expenditure_after_stop_loss"),
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("24", "benchmark_after_adjustments"),
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("25", "gross_savings_losses"),
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("26", "shared_savings_losses"),
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("26.1", "retained_corridor_1"),
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("26.2", "retained_corridor_2"),
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("26.3", "retained_corridor_3"),
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("26.4", "retained_corridor_4"),
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("27", "sequestration_amount"),
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("28", "shared_savings_losses_after_sequestration"),
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)
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_COMMON = {
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"1": 150_000_000.00,
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"5": 4_500_000.00, # printed ($4,500,000.00): a reduction
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"6": 0.95,
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"7": 4_275_000.00,
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"8": 225_000.00, # printed ($225,000.00): a reduction
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"10": 10_000_000.00,
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"11": 1_003_442.00,
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"12": 33_435_084.00,
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"13": 91_355_457.00,
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"14": 125_793_983.00,
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"15": 135_793_983.00,
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"16": 135_793_983.00,
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"17": 2_948_334.28,
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"18": 2_900_000.00,
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"19": 0.930,
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"20": 2_697_000.00,
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"21": 251_334.28,
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"22": 136_045_317.28,
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"23": 136_045_317.28,
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"26.2": 0.00,
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"26.3": 0.00,
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"26.4": 0.00,
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}
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TABLE_5_6_1 = {
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"Global": {
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**_COMMON,
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"2": 0.03,
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"3": 4_500_000.00,
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"4": 145_500_000.00,
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"9": 145_275_000.00,
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"24": 145_275_000.00,
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"25": 9_229_682.72,
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"26": 9_229_682.72,
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"26.1": 9_229_682.72,
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"27": 184_593.65,
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"28": 9_045_089.07,
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},
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"Professional": {
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**_COMMON,
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"2": 0.00,
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"3": 0.00, # printed "N/A"
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"4": 150_000_000.00,
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"9": 149_775_000.00,
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"24": 149_775_000.00,
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"25": 13_729_682.72,
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"26": 8_237_809.63,
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"26.1": 8_237_809.63,
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"27": 164_756.19,
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"28": 8_073_053.44,
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},
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}
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# ── Table 5.5.1: Calculation of Total Monies Owed (Professional, TCC) ─────
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TABLE_5_5_1 = {
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"1": 6_456_540.00, # Provisional Settlement Shared Savings (Losses)
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"2": 8_073_053.43, # Final Settlement Shared Savings (Losses)
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"3": 1_616_513.43, # Shared Savings (Losses) Owed
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"4": 160_700.00, # Under (Over) Payments from Payment Arrangements
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"4.capitation": 160_700.00,
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"5": 100_000.00, # High-Performers Pool Incentive
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"6": 260_700.00, # Adjustments Owed
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"7": 1_877_213.43, # Total Monies Owed
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}
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# ── Box 5.3.3: Stop-Loss charge and payout illustration ───────────────────
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STOP_LOSS_CHARGE = {
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"1": 946.97, # Average Reference Year Expenditure PBPM, Trended
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"2": 132_000, # ACO-Aligned Beneficiary Months in PY
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"3": 1.160, # ACO Average Risk Score in PY
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"4": 145_000_046.40, # Total Trended, Risk-Adjusted Reference Expenditure
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"5": 0.0203, # 3-Year Average Payout Percentage, printed 2.03%
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"RY": (0.0196, 0.0209, 0.0205),
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"6": 2_948_334.28, # PY Stop-Loss Charge
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}
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STOP_LOSS_PAYOUT = {
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"attachment_point": 150_000.00,
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"predicted": 100_000.00,
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"actual": 500_000.00,
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"residual": 400_000.00,
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"below_attachment_point": 150_000.00,
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"band_1_exposure": 150_000.00,
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"band_2_exposure": 100_000.00,
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"total_payout": 220_000.00,
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"band_1_payout": 120_000.00,
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"band_2_payout": 100_000.00,
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}
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# ── Table 3.3.3: Historical Benchmark Calculation (Newly Entering, A&D) ───
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TABLE_3_3_3 = {
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# base year: (payments, months, risk, line 3, line 5, trend, line 7, weight, line 9)
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"BY1": (87_856_003.26, 91_366, 1.122, 961.58, 857.03, 1.104, 946.16, 0.100, 94.62),
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"BY2": (93_375_409.42, 94_577, 1.115, 987.30, 885.47, 1.076, 952.76, 0.300, 285.83),
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"BY3": (
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106_794_359.82,
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104_671,
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1.087,
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1_020.29,
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938.63,
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1.000,
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938.63,
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0.600,
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563.18,
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),
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"historical_benchmark": 943.62,
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}
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# ── Table 3.4.2 / Tables 3.4.3.1–3.4.3.4 ──────────────────────────────────
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# category: (regional FFS PBPM, Historical Benchmark PBPM, BY 3 weight,
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# uncapped REA, USPCC, PY risk score, REA cap, applied REA,
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# Adjusted Historical Benchmark)
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REA_TABLES = {
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"A&D": (1_050, 1_000, 0.80, 25, 1_000, 1.02, 51, 25, 1_025),
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"ESRD": (8_000, 8_500, 0.05, 0, 8_000, 0.99, 396, 0, 8_500),
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"High Needs": (3_700, 3_200, 0.15, 250, 3_500, 1.03, 180.25, 180.25, 3_380.25),
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}
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TABLE_3_4_2_DIFFERENCE = 90.0
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# ── Table 3.5.3.2: Hybrid Alignment Benchmark Adjustment ──────────────────
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TABLE_3_5_3_2 = {
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"1": 1_125.00,
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"2": 60_000,
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"3": 4_500,
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"4": 1.0099,
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"5": 1_136.14,
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"6": 67_500_000.00,
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"7": 5_112_618.75,
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"8": 72_612_618.75,
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}
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# ── Table 3.5.4: Combined Benchmark Calculation ───────────────────────────
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# category: (adjusted HB PBPM, trend, PY risk, full months, hybrid months,
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# hybrid factor, line 8)
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TABLE_3_5_4_CLAIMS = {
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"ESRD": (10_175.00, 1.034, 1.007, 981, 120, 1.0099, 11_677_237.29),
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"A&D": (796.00, 1.042, 1.045, 56_677, 11_570, 1.0085, 59_238_767.92),
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"High Needs": (3_739.00, 1.037, 1.020, 9_806, 2_864, 1.0111, 50_234_182.06),
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}
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# category: (adjusted HB PBPM, trend, PY risk, full+Q1 months,
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# (Q2, Q3, Q4 months), (Q2, Q3, Q4 factors), line 22)
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TABLE_3_5_4_VOLUNTARY = {
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"ESRD": (
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9_543.00,
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1.034,
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0.990,
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421,
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(76, 62, 51),
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(1.0099, 1.0236, 1.0352),
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5_998_140.95,
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),
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"A&D": (
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716.00,
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1.042,
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0.866,
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5_514,
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(825, 753, 538),
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(1.0085, 1.0247, 1.0431),
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4_961_259.64,
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),
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"High Needs": (
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4_109.00,
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1.037,
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1.061,
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2_393,
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(734, 549, 240),
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(1.0111, 1.0233, 1.0527),
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17_855_909.55,
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),
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}
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TABLE_3_5_4_TOTALS = {
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"8": 121_150_187.27,
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"22": 28_815_310.14,
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"24": {
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"ESRD": 17_675_378.24,
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"A&D": 64_200_027.56,
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"High Needs": 68_090_091.61,
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"TOTAL": 149_965_497.41,
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},
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}
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