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RULES[2027] from the CY2027 PFS final rule (CMS-1848-F, 91 FR 70992, :pincite:JCWARTJD): non-QP CF 32.6286, QP CF 32.9548, non-QP anesthesia 20.1056 (QP 20.3068 noted), -0.12% budget neutrality (91 FR 71653), and the Q3014 fee $32.68 read from Table A-C1, an image at 91 FR 71027. The NPRM block moves from PROPOSED[2027] to RULES[2027].proposed, so proposed_for(2027) is unchanged for callers; PROPOSED is empty until CY2028's NPRM. Table A-C1 is CMS's full Q3014 history, and it shows two registry errors: CY2025 held 29.96 (CY2024's fee; correct $31.01) and CY2026 held 30.38 (no such year; correct $31.85).
431 lines
15 KiB
Python
431 lines
15 KiB
Python
"""Tests for pfs.rules — RuleYear model and RULES dict with annual PFS parameters.
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Covers every line of pfs/rules/__init__.py:
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- RuleYear construction with required and default fields
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- RULES dict: years 2014-2026 (13 entries), all RuleYear instances
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- Convenience aliases: cy2024, cy2025, cy2026
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- Specific parameter values for spot-checked years
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- PROPOSED registry (final-less years) and proposed_for() helper
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"""
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from __future__ import annotations
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import pytest
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from pfs.rules import (
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PROPOSED,
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RULES,
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ProposedRule,
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RuleYear,
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cy2024,
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cy2025,
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cy2026,
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proposed_for,
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)
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# ── RuleYear model ───────────────────────────────────────────────
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class TestRuleYear:
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"""RuleYear Pydantic model construction and defaults."""
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def test_required_fields(self):
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ry = RuleYear(year=2026, conversion_factor=32.3465)
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assert ry.year == 2026
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assert ry.conversion_factor == 32.3465
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def test_default_cf_qp(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.cf_qp is None
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def test_default_budget_neutrality_adjustor(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.budget_neutrality_adjustor == 1.0
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def test_default_work_gpci_floor(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.work_gpci_floor == 1.0
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def test_default_pe_gpci_floor(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.pe_gpci_floor is False
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def test_default_anesthesia_cf(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.anesthesia_cf is None
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def test_default_mppr_diagnostic_imaging_pct(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.mppr_diagnostic_imaging_pct == 0.50
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def test_default_mppr_therapy_pct(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.mppr_therapy_pct == 0.50
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def test_default_telehealth_fee(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.telehealth_originating_site_fee is None
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def test_default_clinical_labor_rate_update(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.clinical_labor_rate_update is False
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def test_default_supply_equipment_price_update(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.supply_equipment_price_update is False
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def test_default_federal_register_citation(self):
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ry = RuleYear(year=2020, conversion_factor=36.0)
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assert ry.federal_register_citation == ""
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def test_all_fields_supplied(self):
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ry = RuleYear(
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year=2026,
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conversion_factor=32.3465,
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cf_qp=32.67,
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budget_neutrality_adjustor=1.0,
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work_gpci_floor=1.0,
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pe_gpci_floor=True,
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anesthesia_cf=22.0,
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mppr_diagnostic_imaging_pct=0.50,
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mppr_therapy_pct=0.50,
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telehealth_originating_site_fee=30.38,
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clinical_labor_rate_update=True,
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supply_equipment_price_update=True,
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federal_register_citation="90 FR 101174",
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)
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assert ry.year == 2026
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assert ry.pe_gpci_floor is True
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assert ry.anesthesia_cf == 22.0
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assert ry.supply_equipment_price_update is True
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# ── RULES dict structure ─────────────────────────────────────────
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class TestRulesDict:
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"""RULES maps calendar year -> RuleYear for 2014-2027."""
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EXPECTED_YEARS = list(range(2014, 2028))
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def test_count(self):
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assert len(RULES) == 14
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def test_keys(self):
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assert sorted(RULES.keys()) == self.EXPECTED_YEARS
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@pytest.mark.parametrize("year", list(range(2014, 2028)))
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def test_values_are_ruleyear(self, year):
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assert isinstance(RULES[year], RuleYear)
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@pytest.mark.parametrize("year", list(range(2014, 2028)))
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def test_year_field_matches_key(self, year):
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assert RULES[year].year == year
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# ── Convenience aliases ──────────────────────────────────────────
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class TestAliases:
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"""cy2024, cy2025, cy2026 point to the correct RULES entries."""
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def test_cy2024_is_rules_2024(self):
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assert cy2024 is RULES[2024]
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def test_cy2025_is_rules_2025(self):
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assert cy2025 is RULES[2025]
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def test_cy2026_is_rules_2026(self):
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assert cy2026 is RULES[2026]
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# ── Spot-check specific year values ─────────────────────────────
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class TestSpecificValues:
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"""Verify key parameters for specific years match published CMS data."""
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def test_cy2026_conversion_factor(self):
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# CY2026 non-APM standard CF per AMA history :pincite:`VVBEVYLC`.
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# Earlier values (32.3465, etc.) were stale copies from CY2025.
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assert cy2026.conversion_factor == 33.4009
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def test_cy2026_cf_qp(self):
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# CY2026 APM standard CF — $0.1666 higher than non-APM under
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# MACRA 2015 per :pincite:`VVBEVYLC`.
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assert cy2026.cf_qp == 33.5675
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def test_cy2026_telehealth_fee(self):
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# Table A-C1 (Q3014 history), 91 FR 71027 — was mis-recorded as 30.38.
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assert cy2026.telehealth_originating_site_fee == 31.85
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def test_cy2026_federal_register(self):
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assert cy2026.federal_register_citation == "90 FR 49266"
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def test_cy2026_clinical_labor_update(self):
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assert cy2026.clinical_labor_rate_update is True
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def test_cy2025_conversion_factor(self):
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assert cy2025.conversion_factor == 32.3465
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def test_cy2025_telehealth_fee(self):
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# Table A-C1, 91 FR 71027 — 29.96 was CY2024's fee.
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assert cy2025.telehealth_originating_site_fee == 31.01
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def test_cy2024_conversion_factor(self):
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assert cy2024.conversion_factor == 33.2875
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def test_cy2024_federal_register(self):
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assert cy2024.federal_register_citation == "88 FR 78818"
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def test_2022_clinical_labor_rate_update(self):
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assert RULES[2022].clinical_labor_rate_update is True
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def test_2022_conversion_factor(self):
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assert RULES[2022].conversion_factor == 34.6062
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def test_2023_supply_equipment_price_update(self):
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assert RULES[2023].supply_equipment_price_update is True
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def test_2014_conversion_factor(self):
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assert RULES[2014].conversion_factor == 35.8228
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def test_2014_federal_register(self):
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assert RULES[2014].federal_register_citation == "78 FR 74230"
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def test_2021_conversion_factor(self):
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assert RULES[2021].conversion_factor == 34.8931
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# ── Gap coverage — missed lines ────────────────────────────────
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class TestCfForDate:
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"""Lines 176-181: cf_for_date with segments, no segments, and outside segments."""
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def test_cf_for_date_with_segments(self):
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"""Line 176-178: date falls within a segment."""
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from datetime import date
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from pfs.rules import CfSegment
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ry = RuleYear(
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year=2024,
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conversion_factor=33.2875,
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cf_segments=[
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CfSegment(start=date(2024, 1, 1), end=date(2024, 3, 8), cf=32.7442),
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CfSegment(start=date(2024, 3, 9), end=date(2024, 12, 31), cf=33.2875),
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],
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)
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assert ry.cf_for_date(date(2024, 2, 1)) == 32.7442
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assert ry.cf_for_date(date(2024, 6, 1)) == 33.2875
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def test_cf_for_date_no_segments(self):
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"""Lines 179-180: no segments → returns conversion_factor."""
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from datetime import date
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ry = RuleYear(year=2025, conversion_factor=32.3465)
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assert ry.cf_for_date(date(2025, 6, 1)) == 32.3465
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def test_cf_for_date_outside_segments(self):
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"""Line 181: date outside all segments → ValueError."""
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from datetime import date
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import pytest
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from pfs.rules import CfSegment
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ry = RuleYear(
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year=2024,
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conversion_factor=33.2875,
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cf_segments=[
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CfSegment(start=date(2024, 3, 1), end=date(2024, 6, 30), cf=33.0),
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],
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)
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with pytest.raises(ValueError, match="outside every CF segment"):
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ry.cf_for_date(date(2024, 1, 15))
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# ── ProposedRule — CY2026 NPRM parameters ────────────────────────
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class TestProposedRule:
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"""ProposedRule model and RULES[2026].proposed values."""
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def test_cy2026_has_proposed_rule(self):
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p = RULES[2026].proposed
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assert p is not None
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assert p.cms_rule_id == "CMS-1832-P"
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assert p.fr_document_number == "2025-13271"
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assert p.published.year == 2025
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assert p.comment_close > p.published
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# exact transcribed values — from data/fr_downloads/2025-13271.txt
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assert p.conversion_factor == 33.4209
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assert p.cf_qp == 33.5875
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assert p.conversion_factor != RULES[2026].conversion_factor # proposed ≠ final
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def test_cy2026_proposed_anesthesia_cfs(self):
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p = RULES[2026].proposed
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assert p.anesthesia_cf == 20.5728
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assert p.anesthesia_cf_qp == 20.6754
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def test_cy2026_proposed_budget_neutrality_adjustor(self):
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assert RULES[2026].proposed.budget_neutrality_adjustor == 1.0055
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def test_cy2026_proposed_telehealth_fee(self):
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assert RULES[2026].proposed.telehealth_originating_site_fee == 31.85
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def test_cy2026_proposed_federal_register_citation(self):
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assert RULES[2026].proposed.federal_register_citation == "90 FR 32352"
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def test_cy2026_proposed_published_date(self):
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from datetime import date
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assert RULES[2026].proposed.published == date(2025, 7, 16)
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def test_cy2026_proposed_comment_close_date(self):
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from datetime import date
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assert RULES[2026].proposed.comment_close == date(2025, 9, 12)
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def test_pre_2026_years_have_no_proposed_block(self):
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assert RULES[2025].proposed is None
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def test_proposed_rule_default_notes(self):
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from datetime import date
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p = ProposedRule(
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cms_rule_id="CMS-0000-P",
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fr_document_number="2099-00000",
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federal_register_citation="99 FR 1",
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published=date(2099, 1, 1),
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comment_close=date(2099, 3, 1),
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conversion_factor=1.0,
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)
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assert p.notes == ""
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assert p.cf_qp is None
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assert p.anesthesia_cf is None
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assert p.anesthesia_cf_qp is None
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assert p.budget_neutrality_adjustor == 1.0
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assert p.telehealth_originating_site_fee is None
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# ── PROPOSED registry + proposed_for() ───────────────────────────
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class TestProposedForHelper:
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"""proposed_for() resolution across RULES[year].proposed and PROPOSED."""
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def test_resolves_from_rules_when_year_present(self):
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# 2026 is in RULES and has a .proposed block — proposed_for
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# should return that same object, not consult PROPOSED.
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assert proposed_for(2026) is RULES[2026].proposed
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def test_resolves_from_proposed_registry_when_year_absent_from_rules(
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self, monkeypatch
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):
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# A final-less year (CY2028's NPRM, next July) lives in PROPOSED.
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prop = RULES[2027].proposed.model_copy(update={"cms_rule_id": "CMS-9999-P"})
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monkeypatch.setitem(PROPOSED, 2028, prop)
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assert 2028 not in RULES
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assert proposed_for(2028) is prop
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def test_missing_year_returns_none(self):
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assert proposed_for(1999) is None
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assert 1999 not in RULES
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assert 1999 not in PROPOSED
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def test_rules_year_without_proposed_block_returns_none(self):
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# 2025 is in RULES but has no .proposed block.
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assert RULES[2025].proposed is None
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assert proposed_for(2025) is None
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def test_2027_moved_from_proposed_to_rules(self):
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# The CY2027 final rule shipped: its NPRM block now hangs off
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# RULES[2027] and the PROPOSED entry is retired.
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assert 2027 not in PROPOSED
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assert proposed_for(2027) is RULES[2027].proposed
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assert proposed_for(2027).cms_rule_id == "CMS-1848-P"
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class TestCy2027Proposed:
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"""proposed_for(2027) — CY2027 NPRM (CMS-1848-P) transcribed values.
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Source: data/fr_downloads/2026-14327.txt, 91 FR 43842, published
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2026-07-16. Per :pincite:`5ITGVDJV`.
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"""
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def test_identity_fields(self):
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from datetime import date
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p = proposed_for(2027)
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assert p.cms_rule_id == "CMS-1848-P"
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assert p.fr_document_number == "2026-14327"
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assert p.federal_register_citation == "91 FR 43842"
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assert p.published == date(2026, 7, 16)
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def test_comment_close_date(self):
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from datetime import date
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# DATES block, file lines 108-109: "comments must be received
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# ... by September 14, 2026."
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assert proposed_for(2027).comment_close == date(2026, 9, 14)
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assert proposed_for(2027).comment_close > proposed_for(2027).published
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def test_standard_conversion_factors(self):
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p = proposed_for(2027)
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# RIA detailed derivation, file lines ~39095-39102 (91 FR 44242).
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assert p.cf_qp == 33.1693 # qualifying APM
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assert p.conversion_factor == 32.8409 # nonqualifying APM
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def test_anesthesia_conversion_factors(self):
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p = proposed_for(2027)
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assert p.anesthesia_cf_qp == 20.4165 # qualifying APM
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assert p.anesthesia_cf == 20.2143 # nonqualifying APM
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def test_budget_neutrality_adjustor(self):
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# "0.53 percent positive budget neutrality adjustment"
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assert proposed_for(2027).budget_neutrality_adjustor == 1.0053
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def test_telehealth_originating_site_fee(self):
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# HCPCS Q3014, file line ~2261 (91 FR 43843): "$32.65"
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assert proposed_for(2027).telehealth_originating_site_fee == 32.65
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def test_not_equal_to_cy2026_final_or_proposed(self):
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p2027 = proposed_for(2027)
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p2026 = RULES[2026].proposed
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assert p2027.conversion_factor != RULES[2026].conversion_factor
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assert p2027.conversion_factor != p2026.conversion_factor
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assert p2027.cf_qp != p2026.cf_qp
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class TestCy2027Final:
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"""RULES[2027] — CY2027 PFS Final Rule (CMS-1848-F), 91 FR 70992,
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published 2026-11-09, per :pincite:`JCWARTJD`. CF sentence at
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91 FR 71653; Q3014 fee in Table A-C1, 91 FR 71027."""
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def test_conversion_factors(self):
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r = RULES[2027]
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assert r.conversion_factor == 32.6286 # nonqualifying APM
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assert r.cf_qp == 32.9548 # qualifying APM
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assert r.anesthesia_cf == 20.1056 # nonqualifying APM anesthesia
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def test_budget_neutrality_and_fee(self):
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r = RULES[2027]
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assert r.budget_neutrality_adjustor == 0.9988 # -0.12 percent
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assert r.telehealth_originating_site_fee == 32.68
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def test_citation_and_single_segment(self):
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from datetime import date
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r = RULES[2027]
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assert r.federal_register_citation == "91 FR 70992"
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assert r.cf_for_date(date(2027, 7, 1)) == 32.6286
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def test_final_differs_from_proposed(self):
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r = RULES[2027]
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# NPRM 32.8409 / 33.1693 → final 32.6286 / 32.9548: BN flipped
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# from +0.53% proposed to -0.12% final.
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assert r.conversion_factor < r.proposed.conversion_factor
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assert r.cf_qp < r.proposed.cf_qp
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