Purpose

This WS is designed to qualify Medication request (post) - check the ability to use Medication request within the Medication program and receive program participants

Specification

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Link

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https://ehealthmisapi1.docs.apiary.io/#reference/public.-reimbursement/medication-request/qualify-medication-request-by-id

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Посилання на Apiary або Swagger

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Resource

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Purpose

This WS is designed to qualify Medication request (post) - check the ability to use Medication request within the Medication program and receive program participants

Specification

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1. For info - status charts: Medication_request.

2. Check Medication Request `status` = ACTIVE

   1. if invalid - return 409 error (message: "Invalid status Medication request for qualify action!")'.

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1. Verify Care plan:

   1. It should be in active status

      1. in case of error - return 409 (message: "Invalid care plan status").

   2. Care plan's period end (if exist) should be greater than current date or equal

      1. in case of error - return 409 (message: “Care plan expired“).

2. Verify care plan Activity:

   1. It has scheduled, in_progress status

      1. in case of error - return 409 (message: "Invalid activity status").

   2. Validate quantity is not exceeded

      1. Select all MD (medication dispenses) in status PROCESSED related to the Medication requests which based_on one activity 

         1. Sum medication_qty in the filtered Medication dispenses as dispensed_qty

         2. medication_qty from current MR as current_qty

         3. Calculate remaining_qty = activity.quantity - (dispensed_qty+current_qty)

      2. Check remaining_qty is greater then zero

         1. error return 409 "The total amount of the dispensed medication quantity exceeds quantity in care plan activity"

Validate division

1. Validate division is active

   1. in case of error - return 409 ("Division is not active")

2. Validate division belongs to user's legal entity

   1. in case of error - return 409 ("Division does not belong to user's legal entity")

3. If chart parameter DISPENSE_DIVISION_DLS_VERIFY is on, then validate division is DLS verified (dls_verified=true)

   1. in case of error - return 409 "Division is not verified in DLS"

4. Check division participates in submitted programs. Validate Provision for each Medical Program:

   1. If the medical program has no setting skip_contract_provision_verify or it is equal to false/null:

      1. if medical program in the request has funding_source one of NHS, LOCAL

         1. In case of error - return status=INVALID for a program, rejection_reason="Program was configured incorrectly. Either incorrect source of funding or option skip_contract_provision_verify"

      2. provision exist and active for the division:

         1. in case of error - return status=INVALID for a program, rejection_reason= "Division does not provide the medical program"

      3. if medical program in the request has funding_source = NHS:

         1. provision relates to the actual reimbursement contract: contract.start_date <= current_date <= contract.end_date, is_active = true, status = VERIFIED, contracts.type==reimbursement, contracts.contractor_legal_entity_id=token.client_id, contracts.medical_program_id==$.medical_program_id

            1. in case of error - return status=INVALID for a program, rejection_reason="Medical program provision is not related to any actual contract for the current date"

         2. contract is_suspended = false

            1. in case of error - return status=INVALID for a program, rejection_reason="Contract with number <contract_number> is suspended"

         if medical program in the request has funding_source = LOCAL, then check medical_program_provision.msp_

         1. 1. suspended"

      4. if medical program in the request has funding_source = LOCAL, then check medical_program_provision.msp_legal_entity_id = medication_request.legal_entity_id

         1. in case of error - return status=INVALID for a program, rejection_reson = "Medical program can not be provided for the legal entity specified in the medication request"

   2. else if skip_contract_provision_verify = true, then skip provision verification for the medical program

5. Get license_types_allowed parameter from settings of medical program from request $.medical_program_id:

   1. if it is exists and not empty, get list of all license types from parameter.
      Check that division has active healthcare services with following parameters:

6. Get info from Medication request  by id in payload, set temp variable object `_MR`.

7. Validate the compatibility of innm with the medication program list 

   1. if data is not

      1. legal_entity_id = medication_request.legal_entity_idclient_id from access token

      2. division_id = division_id from request

      3. status = 'ACTIVE'

      4. licensed_healthcare_service.status = 'ACTIVE'

      5. healthcare_service.license_id is not null and licenses.type = value from license_types_allowed parameter

         1. in case of error - return  return status=INVALID for a program, rejection_reson = "Medical program can not be provided for the legal entity specified in the medication request"

   2. else if skip_contract_provision_verify = true, then skip provision verification for the medical program

8. Get license_types_allowed parameter from settings of medical program from request $.medical_program_id:

   1. if it is exists and not empty, get list of all license types from parameter.
      Check that division has active healthcare services with following parameters:

      1. legal_entity_id = client_id from access token

      2. division_id = division_id from request

      3. status = 'ACTIVE'

      4. licensed_healthcare_service.status = 'ACTIVE'

      5. healthcare_service.license_id is not null and licenses.type = value from license_types_allowed parameter

         1. in case of error - return status=INVALID for a program, rejection_reason = 'Division does not have active licenses to provide the medical program'

Logic for qualify (analyze compliance with programs)

• Each Medical program may have its unique conditions for the medication dispense. It can be based on analysis of personal info, medications list, terms, locations and combinations of them.

  Also, it is possible to have the medication dispense without any Medical program.

  However for any Medical program we need a separate block of branching logic.

  Check compatibility only for programs which are available in payload (array)

  If program status is invalid, the reason must be saved and returned in response.

Check compliance for programs

1. Validate 2 checks (below in the text) for programs

   1. if passed - save status this program for response = VALID.

Check INNM_dosage compliance for the programs

Validation purpose:  There is a list of medications (which links to innm_dosage) which can be used for the program. It must be check whether there is at least one available medication for the innm_dosage for the particular program.

1. 1. 1. 1. reason = 'Division does not have active licenses to provide the medical program'

Logic for qualify (analyze compliance with programs)

• Each Medical program may have its unique conditions for the medication dispense. It can be based on analysis of personal info, medications list, terms, locations and combinations of them.

  Also, it is possible to have the medication dispense without any Medical program.

  However for any Medical program we need a separate block of branching logic.

  Check compatibility only for programs which are available in payload (array)

  If program status is invalid, the reason must be saved and returned in response.

Check compliance for programs

1. Validate 2 checks (below in the text) for programs

   1. if passed - save status this program for response = VALID.

Check INNM_dosage compliance for the programs

Validation purpose:  There is a list of medications (which links to innm_dosage) which can be used for the program. It must be check whether there is at least one available medication for the innm_dosage for the particular program.

Check that there is at least one medication (brand or innm_dosage) associated with medical program that can be dispensed to the patient

1. Get info from Medication request  by id in payload, set temp variable object `_MR`

2. Validate the compatibility of innm with the medication program list 

   1. Search for active innm_dosages that associated with medical program

      1. medications.is_active = true

      2. medications.type = INNM_DOSAGE

      3. program_medications.is_active = true

   2. Search for active brands that have innm_dosage as primary ingredient and are associated with medical program

      1. medications.is_active = true

      2. medications.type = BRAND

      3. ingredients.is_primary = true

      4. program_medications.is_active = true

   3. if nothing found:

      1. add to response: status = INVALID

      2. add to response: rejection_reason = "Innm not on the list of approved innms for program '#{program.name}"

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1. For info - status charts: Medication Request Status Chart & Medication Dispense Status Chart

2. Get `check_innm_id`

   Code Block
   SELECT I.innm_child_id FROM ingredients I WHERE I.parent_id = _MR.medication_id AND I.is_primary = TRUE

3. Get Medication requests with their linked completed Medication dispense by person_id & innm_id

   Code Block

   SELECT * FROM medication_requests MR INNER JOIN medication_dispense MD ON MD.medication_request_id = MR.id AND MD.status IN (PROCESSED) INNER JOIN ingredients I ON I.parent_id = MR.medication_id -- type = INNM_DOSAGE AND I.innm_child_id = `check_innm_id` AND I.is_primary = TRUE WHERE MR.person_id == _MR.person_id AND MR.status IN (ACTIVE, COMPLETED) AND NOT($.started_at> MR.ended_at OR $.ended_at < MR.started_at)

4. Validate medication request_id

   1. for medication_dispense.medication_request_id !== $.id

      1. Validate exist (IF EXIST ()  - that is any crossing  calculating term (started_at + ended_at) for payload with terms selecting Medication requests with linked Medication dispense (started_at + ended_at))

      2. if found 

         1. get $.medical_programs.medical_program_setting by medical_program_id from request

            1. validate skip_mnn_in_treatment_period variable

               1. in case skip_mnn_in_treatment_period == FALSE (or absent) 

                  1. validate request according to logic:

                     1. add to response: status = INVALID

                        add to response: rejection_reason = "For the patient at the same term there can be only 1 dispensed medication request per one and the same innm!"

               2. in case skip_mnn_in_treatment_period == TRUE

                  1. skip validating frequency of receiving drugs

   2. for medication_dispense.medication_request_id = $.id

      1. Validate medication request qty: sum(medication_dispenses.medication_qty) >= medication_request.medication_qty 

      2. if found

         1. add to response: status = INVALID

            add to response: rejection_reason = "Sum of dispense's medication quantity can not be more then medication_request.medication_qty".

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• Collect response array for all programs in payload with status for each (VALID or INVALID) and rejection_reason

• For all VALID programs - Get linked medications (type = BRAND) with reimbursement info 

• Show only active program medications based on start_date and end (start_date must be earlier or equal to current date or empty, end_date must be greater or equal to current date or empty)

  • Filter participants simultaneously by container_dosage and max_request_dosage

SELECT *
FROM program_medications pm
    INNER JOIN ingredients i ON (i.parent_id = pm.medication_id
                                 AND i.medication_child_id = :medication_request_medication_id
                                 AND i.is_primary = TRUE)
    INNER JOIN medications m ON (m.id = pm.medication_id)
WHERE pm.medical_program_id = $.id
      AND pm.is_active = TRUE
      AND m.is_active = TRUE
      AND (pm.start_date <= now() OR pm.start_date IS NULL)
      AND (pm.end_date >= now() OR pm.end_date IS NULL)
 
-- added 2022-05-20:
      AND (
      ((M.container ->> 'numerator_unit' = $mr.container_dosage.code) AND
      (M.container ->> 'numerator_value' <>  $mr.container_dosage.value)) OR
           ( ($mr.dosage_container.code is NULL) AND ($mr.container_dosage.value is NULL) )
        )
      AND (M.max_request_dosage >= $.medication_qty or M.max_request_dosage is null)

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