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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.
72 lines
3.0 KiB
Python
72 lines
3.0 KiB
Python
"""lead.monies_owed reproduces Table 5.5.1 and keeps who-owes-whom signs."""
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from __future__ import annotations
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from lead.monies_owed import (
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apo_adjustment,
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payment_arrangement_adjustments,
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total_monies_owed,
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)
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from lead.settlement import SettlementInputs, settle
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from tests.lead.paper import TABLE_5_5_1, TABLE_5_6_1_INPUTS
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def test_table_5_5_1_every_line():
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# The example ACO elected TCC: no Enhanced PCC or APO (footnote 1).
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arrangements = payment_arrangement_adjustments(
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capitation_under_over_payment=TABLE_5_5_1["4.capitation"],
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enhanced_pcc_paid=0.0,
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apo_adjustment=0.0,
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)
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assert arrangements.capitation_under_over_payment == TABLE_5_5_1["4.capitation"]
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assert arrangements.payment_arrangement_adjustments == TABLE_5_5_1["4"]
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owed = total_monies_owed(
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provisional_shared_savings_losses=TABLE_5_5_1["1"],
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final_shared_savings_losses=TABLE_5_5_1["2"],
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payment_arrangement_adjustments=arrangements.payment_arrangement_adjustments,
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high_performers_pool_incentive=TABLE_5_5_1["5"],
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)
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assert owed.shared_savings_losses_owed == TABLE_5_5_1["3"]
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assert owed.high_performers_pool_incentive == TABLE_5_5_1["5"]
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assert owed.adjustments_owed == TABLE_5_5_1["6"]
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assert owed.total_monies_owed == TABLE_5_5_1["7"]
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def test_table_5_5_1_line_2_is_a_cent_below_table_5_6_1_line_28():
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# The paper's own inconsistency: Table 5.5.1 carries the Professional
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# final Shared Savings as $8,073,053.43, Table 5.6.1 line 28 as .44
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# (60% × 13,729,682.72 = 8,237,809.632; less 2% = 8,073,053.439).
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final = settle(SettlementInputs(**TABLE_5_6_1_INPUTS, risk_option="Professional"))
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assert final.shared_savings_losses_after_sequestration == 8_073_053.44
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owed = total_monies_owed(
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provisional_shared_savings_losses=TABLE_5_5_1["1"],
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final_shared_savings_losses=final.shared_savings_losses_after_sequestration,
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payment_arrangement_adjustments=TABLE_5_5_1["4"],
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high_performers_pool_incentive=TABLE_5_5_1["5"],
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)
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assert owed.total_monies_owed == 1_877_213.44 # Table 5.5.1 line 7: .43
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def test_signs_follow_who_owes_whom():
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# Overpaid capitation and the Enhanced PCC recoupment are owed to CMS.
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lines = payment_arrangement_adjustments(
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capitation_under_over_payment=-5_000.0,
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enhanced_pcc_paid=120_000.0,
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apo_adjustment=0.0,
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)
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assert lines.enhanced_pcc_repayment == -120_000.0
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assert lines.payment_arrangement_adjustments == -125_000.0
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owed = total_monies_owed(
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provisional_shared_savings_losses=500_000.0,
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final_shared_savings_losses=-200_000.0,
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payment_arrangement_adjustments=lines.payment_arrangement_adjustments,
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high_performers_pool_incentive=0.0,
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)
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assert owed.total_monies_owed == -825_000.0
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def test_apo_reconciliation():
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# Reductions above the APO payment are credited; below it, recouped.
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assert apo_adjustment(110_000.0, 100_000.0) == 10_000.0
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assert apo_adjustment(90_000.0, 100_000.0) == -10_000.0
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