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        "description": "# hccpy \n\nHierachical Condition Categories Python Package.\n\nThis module implements the [Hierachical Condition Categories](https://www.cms.gov/cciio/resources/forms-reports-and-other-resources/downloads/ra-march-31-white-paper-032416.pdf) that are used for adjusting risks for the Medicare population.\nThe original SAS implementation can be found [here](https://www.nber.org/data/cms-risk-adjustment.html).\nCurrently, hccpy supports CMS-HCC V22, V23, and V24 (beta) and HHS-HCC Year 2019.\n\nNOTE: This package does not support for ICD-9.\n\n## Installing\n\nInstalling from the source:\n\n```\n$ git clone git@github.com:yubin-park/hccpy.git\n$ cd hccpy\n$ python setup.py develop\n```\nOr, simply using `pip`:\n\n```\n$ pip install hccpy\n```\n\n## File Structure\n\n- `hccpy/ `: The package source code is located here.\n  - `data/`: The raw data files directly downloaded from [the National Burequ of Economics Research](https://www.nber.org/data/cms-risk-adjustment.html)\n    - Here, you see the original SAS scripts and data files for the CMS HCC models.\n  - `_AGESEXV2.py`: a Python re-write of the `AGESEXV2.TXT` SAS script.\n  - `_V2218O1M.py`: a Python re-write of the `V2218O1M.TXT` SAS script.\n  - `_V2218O1P.py`: a Python re-write of the `V2219O1P.TXT` SAS script.\n  - `_V22I0ED2.py`: a Python re-write of the `V22I0ED2.TXT` SAS script.\n  - `_V2318P1M.py`: a Python re-write of the `V2318P1M.TXT` SAS script.\n  - `_V2419P1M.py`: a Python re-write of the `V2419P1M.TXT` SAS script.\n  - `hcc.py`: the **main** module that combines the various logical components for CMS-HCC\n  - `hhshcc.py`: the **main** module for HHS-HCC\n  - `utils.py`: utility functions for reading data files\n- `tests/`: test scripts to check the validity of the outputs.\n- `LICENSE.txt`: Apache 2.0.\n- `README.md`: This README file.\n- `setup.py`: a set-up script.\n\n## Code Examples\n\n`hccpy` is really simple to use.\nPlease see some examples below:\n\n### Importing \n\nTo import the `HCCEngine` class from `hccpy`:  \n\n```python\n>>> import json\n>>> from hccpy.hcc import HCCEngine\n>>> he = HCCEngine()\n>>> print(he.profile.__doc__)\nReturns the HCC risk profile of a given patient information.\n\n        Parameters\n        ----------\n        dx_lst : list of str\n                 A list of ICD10 codes for the measurement year.\n        age : int or float\n              The age of the patient.\n        sex : str \n              The sex of the patient; {\"M\", \"F\"}\n        elig : str\n               The eligibility segment of the patient.\n               Allowed values are as follows:\n               - \"CFA\": Community Full Benefit Dual Aged\n               - \"CFD\": Community Full Benefit Dual Disabled\n               - \"CNA\": Community NonDual Aged\n               - \"CND\": Community NonDual Disabled\n               - \"CPA\": Community Partial Benefit Dual Aged\n               - \"CPD\": Community Partial Benefit Dual Disabled\n               - \"INS\": Long Term Institutional\n               - \"NE\": New Enrollee\n               - \"SNPNE\": SNP NE\n        orec: str\n              Original reason for entitlement code.\n              - \"0\": Old age and survivor's insurance\n              - \"1\": Disability insurance benefits\n              - \"2\": End-stage renal disease \n              - \"3\": Both DIB and ESRD\n        medicaid: bool\n                  If the patient is in Medicaid or not.\n>>>\n```\n\n### HCC-Profiling a Member with Diagnosis Codes\n\nTo get a HCC profile from a list of diagnosis codes (in ICD-10):\n\n```python\n>>> rp = he.profile([\"E1169\", \"I5030\", \"I509\", \"I211\", \"I209\", \"R05\"])\n>>> print(json.dumps(rp, indent=2))\n{\n  \"risk_score\": 1.3139999999999998,\n  \"details\": {\n    \"CNA_M70_74\": 0.379,\n    \"CNA_HCC85\": 0.323,\n    \"CNA_HCC88\": 0.14,\n    \"CNA_HCC18\": 0.318,\n    \"CNA_HCC85_gDiabetesMellit\": 0.154,\n    \"CNA_DIABETES_CHF\": 0.0\n  },\n  \"hcc_lst\": [\n    \"HCC85\",\n    \"HCC88\",\n    \"HCC18\"\n  ],\n  \"hcc_map\": {\n    \"I5030\": \"HCC85\",\n    \"I209\": \"HCC88\",\n    \"E1169\": \"HCC18\",\n    \"I509\": \"HCC85\"\n  },\n  \"parameters\": {\n    \"age\": 70,\n    \"sex\": \"M\",\n    \"elig\": \"CNA\",\n    \"medicaid\": false,\n    \"disabled\": 0,\n    \"origds\": 0\n  }\n}\n>>>\n```\n\n### HCC-Profiling a New Member\n\nIf a member is new, then provide the `elig=\"NE\"` in the input:\n\n```python\n>>> rp = he.profile([], elig=\"NE\", age=65)\n>>> print(json.dumps(rp, indent=2))\n{\n  \"risk_score\": 0.514,\n  \"details\": {\n    \"NE_NMCAID_NORIGDIS_NEM65\": 0.514\n  },\n  \"hcc_lst\": [],\n  \"hcc_map\": {},\n  \"parameters\": {\n    \"age\": 65,\n    \"sex\": \"M\",\n    \"elig\": \"NE_NMCAID_NORIGDIS_NE\",\n    \"medicaid\": false,\n    \"disabled\": 0,\n    \"origds\": 0\n  }\n}\n>>>\n```\n\n### HCC-Profiling a Intitutionalized Member\n\nIf a member has a different eligibility status, change the eligibility as follows (e.g. institutionalized member):\n\n```python\n>>> rp = he.profile([\"E1169\", \"I5030\", \"I509\", \"I209\"], elig=\"INS\")\n>>> print(json.dumps(rp, indent=2))\n{\n  \"risk_score\": 2.6059999999999994,\n  \"details\": {\n    \"INS_M70_74\": 1.323,\n    \"INS_HCC88\": 0.497,\n    \"INS_HCC18\": 0.441,\n    \"INS_HCC85\": 0.191,\n    \"INS_HCC85_gDiabetesMellit\": 0.0,\n    \"INS_DIABETES_CHF\": 0.154\n  },\n  \"hcc_lst\": [\n    \"HCC88\",\n    \"HCC18\",\n    \"HCC85\"\n  ],\n  \"hcc_map\": {\n    \"I209\": \"HCC88\",\n    \"E1169\": \"HCC18\",\n    \"I509\": \"HCC85\",\n    \"I5030\": \"HCC85\"\n  },\n  \"parameters\": {\n    \"age\": 70,\n    \"sex\": \"M\",\n    \"elig\": \"INS\",\n    \"medicaid\": false,\n    \"disabled\": 0,\n    \"origds\": 0\n  }\n}\n```\n\n### HCC-Describing a Hierachical Condition Category\n\nTo get the description, hierarchy parents and children of a HCC:\n\n```python\n>>> hcc_doc = he.describe_hcc(\"HCC19\")  # either \"HCC19\", \"hcc19\" or \"19\"\n>>> print(json.dumps(hcc_doc, indent=2))\n{\n  \"description\": \"Diabetes without Complication\",\n  \"children\": [],\n  \"parents\": [\n    \"HCC17\",\n    \"HCC18\"\n  ]\n}\n```\n\n### Eligible Risk Adjustment Codes\n\nNot all claims are eligible for risk adjustment.\nFor professional claims, a certain set of CPT codes is required to be eligible, while for institutional claims, a certain set of bill types is needed.\nThis module provides an easy interface for determining if a certain claim is eligible for risk adjustment or not.\n\nNOTE: This function uses CPT codes, and this requires [AMA CPT license](https://www.ama-assn.org/practice-management/cpt/ama-cpt-licensing-overview).\nOnce you carefully review the license, you need to download [a data file](https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/2019-Medicare-CPT-HCPC-List.zip).\n\n```python\n>>> from hccpy.raeligible import RAEligible\n>>> rae = RAEligible()\n>>> rae.load(fn=\"CY2019Q2_CPTHCPCS_CMS_20190425.csv\")\n>>> rae.is_eligible(pr_lst=[\"C5271\"])\nTrue\n>>> rae.is_eligible(pr_lst=[\"C5270\"])\nFalse\n>>>\n```\nNOTE: The data file (`CY2019Q2_CPTHCPCS_CMS_20190425.csv`) should be located in the same folder.\n\n## License\nApache 2.0\n\n## Authors\n- Yubin Park, PhD\n- Thomas Chen\n\n## References\n- https://www.nber.org/data/cms-risk-adjustment.html\n- https://www.cms.gov/medicare/health-plans/medicareadvtgspecratestats/risk-adjustors.html\n- https://github.com/calyxhealth/pyriskadjust\n- https://github.com/AlgorexHealth/hcc-python\n- https://github.com/galtay/hcc_risk_models\n- https://www.cms.gov/cciio/resources/forms-reports-and-other-resources/downloads/ra-march-31-white-paper-032416.pdf\n- https://www.cms.gov/cciio/resources/regulations-and-guidance/index.html\n\n\n\n",
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