{
  "_metadata": {
    "source": "Policy logic extracted from: Process_Guide_-_APA__ADLTC_How_To_Guide_2.19.25.pdf",
    "generator": "Policy Logic Extractor",
    "format": "json-rules-engine"
  },
  "rules": [
    {
      "name": "MAGI New Cert Period Start Date",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "programType",
            "operator": "equal",
            "value": "MAGI"
          }
        ]
      },
      "event": {
        "type": "new-cert-period-start-month-set-to-month-after-determination-date",
        "params": {
          "ruleId": "rule-001",
          "ruleName": "MAGI New Cert Period Start Date",
          "consequence": "new_cert_period_start_month = month_after_determination_date",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
          "sourceSection": "FIRST MONTH OF NEW CERT PERIOD",
          "ruleType": "computation",
          "calculationMethod": "month_after_determination"
        }
      }
    },
    {
      "name": "SDX Client Deceased Alert Cannot Verify Death",
      "priority": 150,
      "conditions": {
        "all": [
          {
            "fact": "alertType",
            "operator": "equal",
            "value": "SDX_CLIENT_DECEASED"
          }
        ]
      },
      "event": {
        "type": "alert-cannot-be-used-as-death-verification",
        "params": {
          "ruleId": "rule-002",
          "ruleName": "SDX Client Deceased Alert Cannot Verify Death",
          "consequence": "alert_cannot_be_used_as_death_verification; death_must_be_verified_through_other_means",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_How_To_Guide_CC_L&D_01_2025",
          "sourceSection": "SDX_CLIENT_DECEASED",
          "ruleType": "prohibition"
        }
      }
    },
    {
      "name": "Non-MAGI Timely Review New Cert Period Start Date",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "programType",
            "operator": "notEqual",
            "value": "MAGI"
          },
          {
            "fact": "reviewType",
            "operator": "equal",
            "value": "timely"
          }
        ]
      },
      "event": {
        "type": "new-cert-period-start-month-set-to-month-after-current-cert-period-end",
        "params": {
          "ruleId": "rule-003",
          "ruleName": "Non-MAGI Timely Review New Cert Period Start Date",
          "consequence": "new_cert_period_start_month = month_after_current_cert_period_end_date",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
          "sourceSection": "FIRST MONTH OF NEW CERT PERIOD / REGISTRATION PROCESS STEPS FOR EARLY APA/ME REVIEWS",
          "ruleType": "computation",
          "calculationMethod": "month_after_current_cert_period_end",
          "reviewClassification": "timely"
        }
      }
    },
    {
      "name": "SDX Client Deceased - Verify Death",
      "priority": 140,
      "conditions": {
        "all": [
          {
            "fact": "alertType",
            "operator": "equal",
            "value": "SDX_CLIENT_DECEASED"
          }
        ]
      },
      "event": {
        "type": "verify-client-is-deceased",
        "params": {
          "ruleId": "rule-004",
          "ruleName": "SDX Client Deceased - Verify Death",
          "consequence": "verify_client_is_deceased",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_How_To_Guide_CC_L&D_01_2025",
          "sourceSection": "SDX_CLIENT_DECEASED",
          "ruleType": "procedural",
          "step": 2,
          "verificationMethods": [
            "INME_13",
            "INME_14",
            "Obituary",
            "Collateral_Contacts",
            "Burial_Application"
          ]
        }
      }
    },
    {
      "name": "SSI Recipients Ineligible for ATAP",
      "priority": 100,
      "conditions": {
        "all": [
          {
            "fact": "parentReceivesSsi",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "parent-ineligible-for-atap",
        "params": {
          "ruleId": "rule-005",
          "ruleName": "SSI Recipients Ineligible for ATAP",
          "consequence": "parent_ineligible_for_atap",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_process_guide_2025.pdf",
          "sourceSection": "ATAP WITH APA - SSI Recipients",
          "ruleType": "disqualification",
          "reference": "ATAP MS 754-8, 758-6"
        }
      }
    },
    {
      "name": "Dollar-for-Dollar Allocation Reduction of Sponsor Income",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "sponsorGrossIncome",
            "operator": "greaterThan",
            "value": 0
          },
          {
            "fact": "calculationContext",
            "operator": "equal",
            "value": "alien_deeming_allocation"
          }
        ]
      },
      "event": {
        "type": "subtract-allocation-amounts-dollar-for-dollar-from-sponsor-income",
        "params": {
          "ruleId": "rule-006",
          "ruleName": "Dollar-for-Dollar Allocation Reduction of Sponsor Income",
          "consequence": "subtract_allocation_amounts_dollar_for_dollar_from_sponsor_income",
          "confidence": 0.97,
          "sourceDocument": "APA_ADLTC_How-To_Process_Guide",
          "sourceSection": "APA MS 460-5B",
          "ruleType": "computation",
          "reductionMethod": "dollar_for_dollar"
        }
      }
    },
    {
      "name": "APA Application Denial - Pended Case Not in SSI Pay Status",
      "priority": 75,
      "conditions": {
        "all": [
          {
            "fact": "alertType",
            "operator": "equal",
            "value": "SDX_TERMINATED"
          },
          {
            "fact": "caseType",
            "operator": "equal",
            "value": "APA_APP"
          },
          {
            "fact": "caseWasPended",
            "operator": "equal",
            "value": true
          },
          {
            "fact": "caseSsiInPayStatus",
            "operator": "equal",
            "value": false
          }
        ]
      },
      "event": {
        "type": "deny-application-for-not-being-in-ssi-pay-status",
        "params": {
          "ruleId": "rule-007",
          "ruleName": "APA Application Denial - Pended Case Not in SSI Pay Status",
          "consequence": "deny_application_for_not_being_in_SSI_pay_status",
          "confidence": 0.97,
          "sourceDocument": "APA_ADLTC_process_guide_CC_LD_01_2025",
          "sourceSection": "SDX-TERMINATED-STEP-5a",
          "ruleType": "eligibility",
          "caseType": "APA_APP",
          "action": "deny",
          "reason": "not_in_SSI_pay_status"
        }
      }
    },
    {
      "name": "No Proration of Deemed Income for Multiple Aliens",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "sponsorNumberOfFinanciallyResponsibleAliens",
            "operator": "greaterThan",
            "value": 1
          },
          {
            "fact": "calculationContext",
            "operator": "equal",
            "value": "alien_deeming"
          }
        ]
      },
      "event": {
        "type": "apply-full-deemed-income-amount-to-each-alien-without-proration",
        "params": {
          "ruleId": "rule-008",
          "ruleName": "No Proration of Deemed Income for Multiple Aliens",
          "consequence": "apply_full_deemed_income_amount_to_each_alien_without_proration",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_How-To_Process_Guide",
          "sourceSection": "APA MS 460-2B",
          "ruleType": "computation",
          "prorationProhibited": true
        }
      }
    },
    {
      "name": "Prohibition - Do Not Update Name Without Proof",
      "priority": 150,
      "conditions": {
        "all": [
          {
            "fact": "alertType",
            "operator": "equal",
            "value": "SVES_DOB_SSN_CONFLICT"
          },
          {
            "fact": "proofOfNameReceived",
            "operator": "equal",
            "value": false
          }
        ]
      },
      "event": {
        "type": "do-not-update-name-in-eis",
        "params": {
          "ruleId": "rule-009",
          "ruleName": "Prohibition - Do Not Update Name Without Proof",
          "consequence": "do_not_update_name_in_EIS",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_How-To_Process_Guide_CC_LD_01_2025",
          "sourceSection": "SVES DOB/SSN CONFLICT - Step 5",
          "ruleType": "prohibition"
        }
      }
    },
    {
      "name": "APA Application Pend - Case Not Pended and SSI Pay Status Needed",
      "priority": 60,
      "conditions": {
        "all": [
          {
            "fact": "alertType",
            "operator": "equal",
            "value": "SDX_TERMINATED"
          },
          {
            "fact": "caseType",
            "operator": "equal",
            "value": "APA_APP"
          },
          {
            "fact": "caseWasPended",
            "operator": "equal",
            "value": false
          },
          {
            "fact": "caseSsiInPayStatusNeeded",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "pend-case-for-ssi-application-pursuit-and-pay-status-using-p007",
        "params": {
          "ruleId": "rule-010",
          "ruleName": "APA Application Pend - Case Not Pended and SSI Pay Status Needed",
          "consequence": "pend_case_for_SSI_application_pursuit_and_pay_status_using_P007",
          "confidence": 0.97,
          "sourceDocument": "APA_ADLTC_process_guide_CC_LD_01_2025",
          "sourceSection": "SDX-TERMINATED-STEP-5b",
          "ruleType": "procedural",
          "caseType": "APA_APP",
          "action": "pend",
          "form": "P007",
          "pendDurationDays": 30
        }
      }
    },
    {
      "name": "APA Ongoing Pend - Case Not Pended and SSI Pay Status Needed",
      "priority": 60,
      "conditions": {
        "all": [
          {
            "fact": "alertType",
            "operator": "equal",
            "value": "SDX_TERMINATED"
          },
          {
            "fact": "caseType",
            "operator": "equal",
            "value": "APA_ONGOING"
          },
          {
            "fact": "caseWasPended",
            "operator": "equal",
            "value": false
          },
          {
            "fact": "caseSsiInPayStatusNeeded",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "pend-case-for-ssi-application-pursuit-and-pay-status-using-p006",
        "params": {
          "ruleId": "rule-011",
          "ruleName": "APA Ongoing Pend - Case Not Pended and SSI Pay Status Needed",
          "consequence": "pend_case_for_SSI_application_pursuit_and_pay_status_using_P006",
          "confidence": 0.97,
          "sourceDocument": "APA_ADLTC_process_guide_CC_LD_01_2025",
          "sourceSection": "SDX-TERMINATED-STEP-5b",
          "ruleType": "procedural",
          "caseType": "APA_ONGOING",
          "action": "pend",
          "form": "P006",
          "pendDurationDays": 30
        }
      }
    },
    {
      "name": "TA Recipients Ineligible for IA",
      "priority": 100,
      "conditions": {
        "all": [
          {
            "fact": "clientReceivesTa",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "client-ineligible-for-ia",
        "params": {
          "ruleId": "rule-012",
          "ruleName": "TA Recipients Ineligible for IA",
          "consequence": "client_ineligible_for_ia",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_process_guide_2025.pdf",
          "sourceSection": "ATAP WITH APA - TA and IA Eligibility",
          "ruleType": "disqualification",
          "reference": "APA MS 426-9"
        }
      }
    },
    {
      "name": "QMB No Retro Eligibility",
      "priority": 100,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          }
        ]
      },
      "event": {
        "type": "retro-eligibility-not-allowed",
        "params": {
          "ruleId": "rule-013",
          "ruleName": "QMB No Retro Eligibility",
          "consequence": "retro_eligibility_not_allowed",
          "confidence": 0.99,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
          "ruleType": "eligibility",
          "retroEligibility": false
        }
      }
    },
    {
      "name": "Update APA Living Arrangement When ATAP Opens or Closes",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "atapCaseStatusChanged",
            "operator": "equal",
            "value": true
          },
          {
            "fact": "atapCaseNewStatus",
            "operator": "in",
            "value": [
              "opened",
              "closed"
            ]
          }
        ]
      },
      "event": {
        "type": "update-apa-living-arrangement",
        "params": {
          "ruleId": "rule-014",
          "ruleName": "Update APA Living Arrangement When ATAP Opens or Closes",
          "consequence": "update_apa_living_arrangement",
          "confidence": 0.97,
          "sourceDocument": "APA_ADLTC_process_guide_2025.pdf",
          "sourceSection": "ATAP WITH APA - Update APA Living Arrangement",
          "ruleType": "procedural",
          "triggerEvents": [
            "ATAP_opened",
            "ATAP_closed"
          ]
        }
      }
    },
    {
      "name": "QMB Household Size",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          }
        ]
      },
      "event": {
        "type": "set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse",
        "params": {
          "ruleId": "rule-015",
          "ruleName": "QMB Household Size",
          "consequence": "set_household_size_to_1_if_PI_only_or_2_if_PI_and_spouse",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
          "ruleType": "procedural",
          "householdSizeOptions": [
            1,
            2
          ]
        }
      }
    },
    {
      "name": "QMB Spouse Registration and Coding",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          },
          {
            "fact": "householdHasSpouse",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "register-sp-but-code-only-pi-as-in",
        "params": {
          "ruleId": "rule-016",
          "ruleName": "QMB Spouse Registration and Coding",
          "consequence": "register_SP_but_code_only_PI_as_in",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
          "ruleType": "procedural"
        }
      }
    },
    {
      "name": "QMB Auth Screen - Dual Eligible",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          },
          {
            "fact": "clientIsDualEligibleWithApa",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "use-auth-screen-apas",
        "params": {
          "ruleId": "rule-017",
          "ruleName": "QMB Auth Screen - Dual Eligible",
          "consequence": "use_auth_screen_APAS",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB)",
          "ruleType": "procedural",
          "authScreen": "APAS"
        }
      }
    },
    {
      "name": "APA Applicant Residency Verification Required",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "personProgram",
            "operator": "equal",
            "value": "APA"
          },
          {
            "fact": "personStatus",
            "operator": "equal",
            "value": "applicant"
          }
        ]
      },
      "event": {
        "type": "residency-verification-required",
        "params": {
          "ruleId": "rule-018",
          "ruleName": "APA Applicant Residency Verification Required",
          "consequence": "residency_verification_required",
          "confidence": 0.99,
          "sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
          "sourceSection": "verifying_ak_residency",
          "ruleType": "verification"
        }
      }
    },
    {
      "name": "APA Recipient Residency Verification Only If Questionable",
      "priority": 40,
      "conditions": {
        "all": [
          {
            "fact": "personProgram",
            "operator": "equal",
            "value": "APA"
          },
          {
            "fact": "personStatus",
            "operator": "equal",
            "value": "recipient"
          },
          {
            "fact": "personResidencyIsQuestionable",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "residency-verification-required",
        "params": {
          "ruleId": "rule-019",
          "ruleName": "APA Recipient Residency Verification Only If Questionable",
          "consequence": "residency_verification_required",
          "confidence": 0.97,
          "sourceDocument": "APA_ADLTC_process_guide_01_2025.pdf",
          "sourceSection": "verifying_ak_residency",
          "ruleType": "verification"
        }
      }
    },
    {
      "name": "SLMB Coverage - Medicare Part B Only",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "slmb-covers-medicare-part-b-only",
        "params": {
          "ruleId": "rule-020",
          "ruleName": "SLMB Coverage - Medicare Part B Only",
          "consequence": "SLMB_covers_Medicare_Part_B_only",
          "confidence": 0.99,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "benefit_coverage"
        }
      }
    },
    {
      "name": "SLMB Case Numbering - Standalone",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "use-standalone-case-number",
        "params": {
          "ruleId": "rule-021",
          "ruleName": "SLMB Case Numbering - Standalone",
          "consequence": "use_standalone_case_number",
          "confidence": 0.99,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural"
        }
      }
    },
    {
      "name": "SLMB Benefit Start Date",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "set-benefit-start-date-to-application-month",
        "params": {
          "ruleId": "rule-022",
          "ruleName": "SLMB Benefit Start Date",
          "consequence": "set_benefit_start_date_to_application_month",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "eligibility_date"
        }
      }
    },
    {
      "name": "SLMB Retro Eligibility - Limited to January",
      "priority": 25,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          },
          {
            "fact": "caseRetroEligibilityRequested",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "allow-retro-eligibility-no-further-back-than-january",
        "params": {
          "ruleId": "rule-023",
          "ruleName": "SLMB Retro Eligibility - Limited to January",
          "consequence": "allow_retro_eligibility_no_further_back_than_January",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "eligibility",
          "retroEligibility": true,
          "retroLimit": "January of current year"
        }
      }
    },
    {
      "name": "SLMB Not Dual Eligible",
      "priority": 100,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "client-is-not-dual-eligible-with-apa-or-medicaid",
        "params": {
          "ruleId": "rule-024",
          "ruleName": "SLMB Not Dual Eligible",
          "consequence": "client_is_not_dual_eligible_with_APA_or_Medicaid",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "eligibility"
        }
      }
    },
    {
      "name": "SLMB Certification Period",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "certify-for-12-months",
        "params": {
          "ruleId": "rule-025",
          "ruleName": "SLMB Certification Period",
          "consequence": "certify_for_12_months",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural",
          "certificationPeriodMonths": 12
        }
      }
    },
    {
      "name": "SLMB Household Size",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "set-household-size-to-1-if-pi-only-or-2-if-pi-and-spouse",
        "params": {
          "ruleId": "rule-026",
          "ruleName": "SLMB Household Size",
          "consequence": "set_household_size_to_1_if_PI_only_or_2_if_PI_and_spouse",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural",
          "householdSizeOptions": [
            1,
            2
          ]
        }
      }
    },
    {
      "name": "SLMB Spouse Registration and Coding",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          },
          {
            "fact": "householdHasSpouse",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "register-sp-but-code-only-pi-as-in",
        "params": {
          "ruleId": "rule-027",
          "ruleName": "SLMB Spouse Registration and Coding",
          "consequence": "register_SP_but_code_only_PI_as_in",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural"
        }
      }
    },
    {
      "name": "SLMB Auth Screen",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "use-auth-screen-apmm",
        "params": {
          "ruleId": "rule-028",
          "ruleName": "SLMB Auth Screen",
          "consequence": "use_auth_screen_APMM",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural",
          "authScreen": "APMM"
        }
      }
    },
    {
      "name": "SLMB Paid Benefits Issuance Code",
      "priority": 20,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          },
          {
            "fact": "benefitIsPaid",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "benefit-shows-with-issuance-code-b-on-mebh",
        "params": {
          "ruleId": "rule-029",
          "ruleName": "SLMB Paid Benefits Issuance Code",
          "consequence": "benefit_shows_with_issuance_code_B_on_MEBH",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural",
          "issuanceCode": "B"
        }
      }
    },
    {
      "name": "SLMB Final Action - Check MEBH Screen",
      "priority": 10,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          }
        ]
      },
      "event": {
        "type": "initialize-and-authorize-into-current-system-month-and-check-mebh-screen",
        "params": {
          "ruleId": "rule-031",
          "ruleName": "SLMB Final Action - Check MEBH Screen",
          "consequence": "initialize_and_authorize_into_current_system_month_and_check_MEBH_screen",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural"
        }
      }
    },
    {
      "name": "SLMB Notice Code - Application Approved",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          },
          {
            "fact": "caseAction",
            "operator": "equal",
            "value": "APPLICATION"
          },
          {
            "fact": "caseStatus",
            "operator": "equal",
            "value": "APPROVED"
          }
        ]
      },
      "event": {
        "type": "use-notice-code-m113",
        "params": {
          "ruleId": "rule-032",
          "ruleName": "SLMB Notice Code - Application Approved",
          "consequence": "use_notice_code_M113",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural",
          "noticeCode": "M113"
        }
      }
    },
    {
      "name": "SLMB Notice Code - Renewal Approved",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "SLMB"
          },
          {
            "fact": "caseAction",
            "operator": "equal",
            "value": "RENEWAL"
          },
          {
            "fact": "caseStatus",
            "operator": "equal",
            "value": "APPROVED"
          }
        ]
      },
      "event": {
        "type": "use-notice-code-m805",
        "params": {
          "ruleId": "rule-033",
          "ruleName": "SLMB Notice Code - Renewal Approved",
          "consequence": "use_notice_code_M805",
          "confidence": 0.97,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "SPECIFIED LOW INCOME MEDICARE BENEFICIARY (SLMB)",
          "ruleType": "procedural",
          "noticeCode": "M805"
        }
      }
    },
    {
      "name": "QMB Notice Code - Application Approved With Medicaid",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          },
          {
            "fact": "caseAction",
            "operator": "equal",
            "value": "APPLICATION"
          },
          {
            "fact": "caseStatus",
            "operator": "equal",
            "value": "APPROVED"
          },
          {
            "fact": "clientHasMedicaid",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "use-notice-code-m110",
        "params": {
          "ruleId": "rule-034",
          "ruleName": "QMB Notice Code - Application Approved With Medicaid",
          "consequence": "use_notice_code_M110",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
          "ruleType": "procedural",
          "noticeCode": "M110"
        }
      }
    },
    {
      "name": "QMB Notice Code - Renewal Approved With Medicaid",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          },
          {
            "fact": "caseAction",
            "operator": "equal",
            "value": "RENEWAL"
          },
          {
            "fact": "caseStatus",
            "operator": "equal",
            "value": "APPROVED"
          },
          {
            "fact": "clientHasMedicaid",
            "operator": "equal",
            "value": true
          }
        ]
      },
      "event": {
        "type": "use-notice-code-m804",
        "params": {
          "ruleId": "rule-035",
          "ruleName": "QMB Notice Code - Renewal Approved With Medicaid",
          "consequence": "use_notice_code_M804",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
          "ruleType": "procedural",
          "noticeCode": "M804"
        }
      }
    },
    {
      "name": "QMB Notice Code - Application Approved Without Medicaid",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          },
          {
            "fact": "caseAction",
            "operator": "equal",
            "value": "APPLICATION"
          },
          {
            "fact": "caseStatus",
            "operator": "equal",
            "value": "APPROVED"
          },
          {
            "fact": "clientHasMedicaid",
            "operator": "equal",
            "value": false
          }
        ]
      },
      "event": {
        "type": "use-notice-code-m116",
        "params": {
          "ruleId": "rule-036",
          "ruleName": "QMB Notice Code - Application Approved Without Medicaid",
          "consequence": "use_notice_code_M116",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
          "ruleType": "procedural",
          "noticeCode": "M116"
        }
      }
    },
    {
      "name": "QMB Notice Code - Renewal Approved Without Medicaid",
      "priority": 30,
      "conditions": {
        "all": [
          {
            "fact": "clientProgram",
            "operator": "equal",
            "value": "QMB"
          },
          {
            "fact": "caseAction",
            "operator": "equal",
            "value": "RENEWAL"
          },
          {
            "fact": "caseStatus",
            "operator": "equal",
            "value": "APPROVED"
          },
          {
            "fact": "clientHasMedicaid",
            "operator": "equal",
            "value": false
          }
        ]
      },
      "event": {
        "type": "use-notice-code-m816",
        "params": {
          "ruleId": "rule-037",
          "ruleName": "QMB Notice Code - Renewal Approved Without Medicaid",
          "consequence": "use_notice_code_M816",
          "confidence": 0.95,
          "sourceDocument": "caseworker_process_guide_APA.pdf",
          "sourceSection": "QUALIFIED MEDICARE BENEFICIARY (QMB) - NOTICE(S)",
          "ruleType": "procedural",
          "noticeCode": "M816"
        }
      }
    }
  ]
}