Reassessment Processing for a Benefit Case

This section demonstrates the normal reassessment process for a benefit case. The eligibility and entitlement engine determines that reassessment is required on a case where the from date of a new decision is before the latest cover period to date for all ILIs on that case. If reassessment is necessary, the eligibility and entitlement engine calculates the reassessment period, determines the reassessment details for this period, and stores these results. As part of determining the reassessment details for the reassessment period, the eligibility and entitlement engine retrieves the processed ILIs and creates in memory financial data for the virtual financial components. The eligibility and entitlement engine then compares the financial data to the processed ILIs to determine if any over or underpayments exist. If an over or underpayment is found, the eligibility and entitlement engine records the over or underpayment details and initiates over or underpayment processing.

Extending the Eligibility and Entitlement Period: The eligibility and entitlement engine determines whether or not the eligibility and entitlement period needs to be extended based on the decision dates for both the stored decisions and the new decisions. For cases where there is a list of new decisions, as well as a list of stored decisions, the eligibility and entitlement engine will extend the eligibility and entitlement period to be the earliest decision from date and the latest decision to date for all overlapping decisions.

For the purpose of demonstrating the normal reassessment process, this section applies a change in circumstance to the sample data in Financial Component Processing. The change in circumstance is an adjustment to the case certification period. The following table describes how the change in circumstance affects the original sample data:

Table 1. Change in Circumstance to Sample Data
Sample Data	Sample Data before Change	Sample Data after Change
Primary Client	James Smith.	Same.
Product Type	Sample Benefit product.	Same.
Product Rerate Frequency	Every week on a Wednesday.	Same.
Case Certification Period	Certification period from April 1st - April 30th, 2004.	Certification period from March 15 - April 15th, 2004.
Case Start Date	April 1st, 2004.	March 15th, 2004.
Case Expected End Date	April 30th, 2004.	April 30th, 2004.
Case Nominee Delivery Pattern	Weekly in advance on a Friday.	Same.
Daily Rate	The daily rate is $10 until April 5th, 2004, when legislation increases the value of the daily rate to $11.	Same.
Weekly Rate	The weekly rate is $70 until April 5th, 2004, when legislation increases the value of the weekly rate to $77.	Same.
Rules Objective	James Smith, the primary client, is eligible for the Max Personal rules objective.	Same.
Date up to which benefit has already been covered.	No ILIs have been created for the benefit, thus there is no date up to which the benefit has already been covered.	April 30th. This means that all existing FCs on or before April 30th have been realized into actual financial transactions, i.e., ILIs.