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            Automate Eligibility Determinations

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            Automate Eligibility Determinations

            Use Business Rules Engine to determine benefit eligibility and the benefit amounts for qualified applicants. First, create a decision matrix that defines the income threshold based on the income and household size. Then build an expression set that uses the matrix to find benefit eligibility and calculate eligible benefit amounts. Use Decision Explainer to share the reasoning behind application decisions, eligibility determinations, and benefit amount calculations with constituents.

            Required Editions

            View supported product editions.
            User Permissions Needed
            To create decision matrices and expression sets: Rule Engine Designer
            To create and edit Decision Explainer entities: Decision Explainer Service Access

            Create a Decision Matrix to Calculate the Benefit Amount

            Create a decision matrix that defines the income threshold based on the income and household size to calculate the benefit amount that applicants are eligible to receive.

            1. From the App Launcher, find and select Lookup Tables.
            2. Click New, and then select Decision Matrix.
            3. Click Next.
            4. Specify these details.
              1. For Name, enter CalculateBenefitAmount_NetIncomePointsTable.
                Use this name for the decision matrix, because it’s referenced in the benefit application Omniscript.
              2. For Type, select Standard.
            5. Save your work.
            6. On the record page of the decision matrix, on the Related tab, click version 1 of the matrix.
            7. To define your input and output data, add columns to the matrix.
              1. Click Add Column. For Column Header, enter HouseholdSize, for Header Type select Input, and for Data Type select Number.
              2. Click Add Column. For Column Header, enter ThreePointsLimit, for Header Type select Output, and for Data Type select Currency.
              3. Click Add Column. For Column Header, enter TwoPointsLimit, for Header Type select Output, and for Data Type select Currency.
              4. Click Done.
              Important
              Important Use these column headers, which are referenced in the benefit amount expression set. You can change the values if necessary.
            8. Add these rows for input and output data values.
              Input Data Output Data
              HouseholdSize (Number) ThreePointsLimit (Currency) TwoPointsLimit (Currency)
              1 $1074 $1610
              2 $1452 $2178
              3 $1830 $2745
              4 $2209 $3313
              5 $2587 $3880
              6 $2965 $4448
              7 $3344 $5016
              8 $3722 $5583
            9. Activate the decision matrix.

            Build the Benefit Amount Expression Set

            Create the benefit amount expression set from an expression set template.

            1. From the App Launcher, find and select Expression Set Templates.
            2. Select PSSExpCloud_CalculateBenefitAmount and then click Save As.
            3. In the expression set builder, set the properties for the expression set version.
              1. Click Expression Set Properties, and then enter a start date time and an end date time for the expression set version.
              2. Enter a rank number.
                Note
                Note When more than one enabled version matches an expression set call and the date-time periods overlap, the version with the highest rank is chosen. For example, if two enabled versions have the rank values 1 and 2, the version with rank 2 is chosen.
            4. Save and activate the expression set.

            Set Up Decision Explainer for Eligible Benefit Amount

            Configure Decision Explainer to share the reasoning behind benefit application decisions, such as eligibility determination and benefit calculation, with constituents.

            1. Create explainability message templates for the PSSExpCloud_CalculateBenefitAmount expression set. For more information, see Create Explainability Message Templates.
            2. To show explanations to constituents, modify the expression set version configuration. For more information, see Show Rule Explanations to External Users.
            3. Create an application subtype definition. For more information, see Create Application Subtype Definitions.
            4. Create a business process type definition. For more information, see Create Business Process Type Definitions.
              Next, define the metadata for the Decision Explainer business rule by creating an explainability action definition
            5. From Setup, in the Quick Find box, enter Decision Explainer, and then select Explainability Action Definition.
            6. Click New Explainability Action Definition.
            7. For Label, enter BenefitApplicationLogs, and then press Tab to autofill the developer name.
              Important
              Important Use BenefitApplicationLogs for both the label and the developer name.
            8. For Business Process Type, click Search icon, and then select the business process type definition for this explainability action definition.
            9. For Application Type, select Public Sector.
            10. For Action Log Schema Type, select Expression Set.
            11. If necessary, enter a description.
            12. For Application Subtype, click Search icon, and then select the application subtype definition for the explainability action definition.
            13. Save your changes.
              Next, define and store a version of the explainability action that your Decision Explainer business rule uses.
            14. From Setup, in the Quick Find box, enter Decision Explainer, and then select Explainability Action Version.
            15. Click New Explainability Action Version.
            16. For Label, enter a name.
            17. Activate the explainability action version.
              Note
              Note You can’t edit or delete active explainability action version records.
            18. For Explainability Action Definition, click images/seach_icon.png, and then select BenefitApplicationLogs.
            19. If necessary, enter a description.
            20. Save your changes.

            Build the Member Eligibility Expression Set

            Use an expression set template to create the expression set that determines the benefit eligibility of a household member. To be eligible for benefits, the household member must be a US citizen.

            1. From the App Launcher, find and select Expression Set Templates.
            2. Select PSSExpCloud_MemberBenefitEligibility, and then click Save As.
            3. In the expression set builder, set the properties for the expression set version.
              1. Click Expression Set Properties, and then enter a start date time and an end date time for the expression set version.
              2. Enter a rank number.
                Note
                Note When more than one enabled version matches an expression set call and the date-time periods overlap, the version with the highest rank is chosen. For example, if two enabled versions have the rank values 1 and 2, the version with rank 2 is chosen.
            4. Save and activate the expression set.
             
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