add eligibility rules for alive status verification type (#4041)

* add eligibility rules for alive status verification type

* refactor validation logic

* rubocop fix

* add more code changes and specs

* add specs

* fix typo

* add more specs

---------

Co-authored-by: haridhar yamjala <[email protected]>

app/domain/operations/families/verifications/dmf_determination/build_cv3_family_payload_for_dmf.rb

@@ -11,7 +11,6 @@ module DmfDetermination
         class BuildCv3FamilyPayloadForDmf
           include Dry::Monads[:result, :do]
           include ::Operations::Transmittable::TransmittableUtils
-          include DmfUtils
 
           # @return [ Cv3Family ] Job successfully completed
           def call(family, transmittable_params)
@@ -22,7 +21,6 @@ def call(family, transmittable_params)
 
             cv3_family = yield build_cv3_family
             valid_cv3_family = yield validate_cv3_family(cv3_family)
-
             yield validate_all_family_members(valid_cv3_family)
             result = yield confirm_transmittable_payload(valid_cv3_family)
 
@@ -32,47 +30,48 @@ def call(family, transmittable_params)
           private
 
           def build_cv3_family
-            cv3_family = Operations::Transformers::FamilyTo::Cv3Family.new.call(@family)
-            return handle_dmf_failure("Unable to transform family into cv3_family: #{cv3_family.failure}", :build_cv3_family) if cv3_family.failure?
+            result = Operations::Transformers::FamilyTo::Cv3Family.new.call(@family)
+            return handle_dmf_failure("Unable to transform family into cv3_family: #{result.failure}", :build_cv3_family) if result.failure?
 
-            cv3_family
+            result
           end
 
           def validate_cv3_family(cv3_family)
-            valid_cv3_family = AcaEntities::Operations::CreateFamily.new.call(cv3_family)
-            return handle_dmf_failure("Invalid cv3 family: #{valid_cv3_family.failure}", :validate_cv3_family) if valid_cv3_family.failure?
+            result = AcaEntities::Operations::CreateFamily.new.call(cv3_family)
+            return handle_dmf_failure("Invalid cv3 family: #{result.failure}", :validate_cv3_family) if result.failure?
 
-            valid_cv3_family
+            result
           end
 
-          def validate_all_family_members(aca_family)
-            invalid_persons = aca_family.family_members.map do |aca_member|
-              family_member = @family.family_members.detect { |fm| fm.hbx_id == aca_member.hbx_id }
+          def validate_all_family_members(family_entity)
+            family_members = @family.family_members
+            entity_subjects = family_entity.eligibility_determination.subjects
 
-              # check if member does not have an enrollment
-              unless member_dmf_determination_eligible_enrollments(family_member, @family)
-                vh_message = "Family Member with hbx_id #{aca_member.hbx_id} does not have a valid enrollment"
-                update_verification_type_histories(vh_message, [family_member])
-                next vh_message
-              end
+            members_data = family_entity.family_members.collect do |member_entity|
+              family_member = family_members.detect { |fm| fm.hbx_id == member_entity.hbx_id }
+              entity_subject = entity_subjects.collect{|_k,v| v if v[:hbx_id] == member_entity.hbx_id }.flatten.compact.first
 
-              # check if member is valid (valid_ssn, etc.)
-              encrypted_ssn = aca_member&.person&.person_demographics&.encrypted_ssn
-              # using the same Validator used by FDSH for consistency
-              valid_ssn = AcaEntities::Operations::EncryptedSsnValidator.new.call(encrypted_ssn)
-              next if valid_ssn.success?
+              result = Operations::Fdsh::PayloadEligibility::CheckDeterminationSubjectEligibilityRules.new.call(entity_subject, :alive_status)
 
-              vh_message = "Family Member with hbx_id #{aca_member.hbx_id} is not valid: #{valid_ssn.failure}"
-              update_verification_type_histories(vh_message, [family_member])
-              vh_message
+              if result.success?
+                {member_entity.hbx_id => {'status' => true, 'error' => :no_errors}}
+              else
+                error = result.failure
+                person = family_member.person
+                message = "Family Member is not eligible for DMF Determination due to errors: #{error}"
+                add_verification_history(person, "DMF_Request_Failed", message)
+                {member_entity.hbx_id => {'status' => false, 'error' => result.failure}}
+              end
             end.compact
 
-            # invalid_persons.size == family_members.size indicates no family members were valid
-            return Success(aca_family) unless invalid_persons.size == aca_family.family_members.size
+            member_status = members_data.collect { |hash| hash.collect{|_k,v|  v["status"]} }.flatten.compact
 
-            message = "DMF Determination not sent: no family members are eligible"
-            # 'false' as third param prevent updating verification histories -> have already been updated
-            handle_dmf_failure(message, :build_cv3_family, update_histories: false)
+            if member_status.all?(false)
+              message = "DMF Determination not sent: no family members are eligible"
+              handle_dmf_failure(message, :build_cv3_family, update_histories: false)
+            else
+              Success(family_entity)
+            end
           end
 
           def confirm_transmittable_payload(valid_cv3_family)
@@ -107,11 +106,15 @@ def handle_dmf_failure(message, state, update_histories: true)
 
           def update_verification_type_histories(message, family_members = @family.family_members)
             family_members.each do |member|
-              alive_status_verification = member&.person&.alive_status
-              next unless alive_status_verification
-              alive_status_verification.add_type_history_element(action: "DMF Determination Request Failure", modifier: "System", update_reason: message)
+              add_verification_history(member.person, "DMF_Request_Failed", message)
             end
           end
+
+          def add_verification_history(person, action, update_reason)
+            alive_status_verification = person.verification_types.alive_status_type.first
+            return unless alive_status_verification
+            alive_status_verification.add_type_history_element(action: action, modifier: "System", update_reason: update_reason)
+          end
         end
       end
     end

app/domain/operations/families/verifications/dmf_determination/request_dmf_determination.rb

@@ -24,7 +24,7 @@ def call(payload)
 
             @transmission = yield build_and_create_request_transmission(values)
             @transaction = yield build_and_create_request_transaction(values)
-
+            yield record_verification_history
             payload = yield build_cv3_family_payload
             event = yield build_event(payload)
             result = yield publish(event)
@@ -98,13 +98,20 @@ def build_event(payload)
             event('events.families.verifications.dmf_determination.requested', attributes: payload)
           end
 
+          def record_verification_history
+            @family.family_members.each do |member|
+              message = "DMF Determination request for Family with hbx_id #{@family.hbx_assigned_id} is submitted"
+              person = member.person
+              alive_status_type = person.verification_types.alive_status_type.first
+              alive_status_type.add_type_history_element(action: "DMF_Request_Submitted", modifier: "System", update_reason: message)
+            end
+
+            Success(true)
+          end
+
           def publish(event)
-            hbx_id = @transaction.json_payload[:family_hash][:hbx_id]
             event.publish
-
-            message = "DMF Determination request for Family with hbx_id #{hbx_id} sent successfully"
-            people = @family.family_members.map(&:person)
-            people.select(&:alive_status).each { |p| p.alive_status.add_type_history_element(action: "DMF Determination Request", modifier: "System", update_reason: message) }
+            message = "DMF Determination request for Family with hbx_id #{@family.hbx_assigned_id} is submitted"
             update_status(message, :succeeded, { transmission: @transmission, transaction: @transaction })
 
             Success(message)

app/domain/operations/fdsh/payload_eligibility/check_base_eligibility_rules.rb

@@ -14,7 +14,7 @@ class CheckBaseEligibilityRules
           ssa: [:validate_ssn],
           dhs: [:validate_vlp_documents],
           local_residency: [],
-          alive_status: [:validate_ssn],
+          alive_status: [:validate_ssn, :is_member_enrolled?],
           income: [:validate_ssn],
           esi_mec: [:validate_ssn],
           non_esi_mec: [:validate_ssn],

app/domain/operations/fdsh/payload_eligibility/check_determination_subject_eligibility_rules.rb

@@ -0,0 +1,56 @@
+# frozen_string_literal: true
+
+# This module defines operations related to FDSH payload eligibility.
+module Operations
+  module Fdsh
+    module PayloadEligibility
+      # This class checks the eligibility rules for a determination subject within the FDSH payload.
+      # It extends `CheckBaseEligibilityRules` to leverage common eligibility rule checks.
+      class CheckDeterminationSubjectEligibilityRules < CheckBaseEligibilityRules
+        # Valid eligibility states for health and dental product enrollments.
+        VALID_ELIGIBLITY_STATES = [
+          'health_product_enrollment_status',
+          'dental_product_enrollment_status'
+        ].freeze
+
+        private
+
+        # Validates the payload entity to ensure it is a valid Subject object and then
+        # calls the superclass's validate method.
+        #
+        # @param payload_entity [Subject Hash] The subject entity to validate.
+        # @param request_type [Symbol] The type of request being validated.
+        # @return [Dry::Monads::Result] Success or Failure indicating the validation result.
+        def validate(payload_entity, request_type)
+          return Failure("Invalid Subject Object #{payload_entity}") unless payload_entity.is_a?(Hash)
+          super(request_type)
+        end
+
+        # Validates the Social Security Number (SSN) of the payload entity.
+        #
+        # @param payload_entity [Subject Hash] The subject entity whose SSN is to be validated.
+        # @return [Dry::Monads::Result] Success or Failure indicating the validation result of the SSN.
+        def validate_ssn(payload_entity)
+          encrypted_ssn = payload_entity[:encrypted_ssn]
+          return Failure("No SSN for member #{payload_entity[:hbx_id]}") if encrypted_ssn.nil? || encrypted_ssn.empty?
+
+          AcaEntities::Operations::EncryptedSsnValidator.new.call(encrypted_ssn)
+        end
+
+        # Checks if the member is enrolled based on the eligibility states provided in the payload.
+        #
+        # @param payload_entity [Subject Hash] The subject entity to check enrollment status for.
+        # @return [Dry::Monads::Result] Success if the subject is enrolled in either health or dental enrollment,
+        #   otherwise Failure.
+        def is_member_enrolled?(payload_entity)
+          states = payload_entity[:eligibility_states].collect { |k, v| v[:is_eligible] if VALID_ELIGIBLITY_STATES.include?(k.to_s) }.flatten.compact
+
+          return Failure("No states found for the given subject/member hbx_id: #{payload_entity[:hbx_id]} ") unless states.present?
+          return Success() if states.any?(true)
+
+          Failure("subject is not enrolled in health or dental enrollment")
+        end
+      end
+    end
+  end
+end

app/models/eligibilities/subject.rb

@@ -49,8 +49,13 @@ def serializable_cv_hash
         ]
       end.reduce(:merge)
 
-      subject_attributes = attributes.slice('first_name', 'last_name', 'encrypted_ssn', 'hbx_id',
-                                            'person_id', 'outstanding_verification_status', 'is_primary')
+      subject_attributes = attributes.symbolize_keys.slice(:first_name, :last_name, :encrypted_ssn, :hbx_id, :person_id, :is_primary, :outstanding_verification_status)
+
+      if subject_attributes[:encrypted_ssn].present?
+        encrypted_ssn = AcaEntities::Operations::Encryption::Encrypt.new.call(value: SymmetricEncryption.decrypt(subject_attributes[:encrypted_ssn])).value! # For CV3 payload
+        subject_attributes[:encrypted_ssn] = encrypted_ssn
+      end
+
       subject_attributes[:dob] = dob
       subject_attributes[:eligibility_states] = eligibility_states_hash
 

spec/domain/operations/families/verifications/dmf_determination/build_cv3_family_payload_for_dmf_spec.rb

@@ -5,8 +5,30 @@
 RSpec.describe Operations::Families::Verifications::DmfDetermination::BuildCv3FamilyPayloadForDmf, dbclean: :after_each do
   include Dry::Monads[:result, :do]
 
-  let(:family) { FactoryBot.create(:individual_market_family_with_spouse) }
-  let(:primary) { family.primary_person }
+  let(:primary_dob){ Date.today - 57.years }
+  let(:family) do
+    FactoryBot.create(:family, :with_primary_family_member, :person => primary)
+  end
+
+  let(:spouse_person) { FactoryBot.create(:person, :with_consumer_role, dob: spouse_dob, ssn: 101_011_012) }
+  let!(:spouse) { FactoryBot.create(:family_member, person: spouse_person, family: family) }
+  let(:spouse_dob) { Date.today - 55.years }
+  let(:product) { FactoryBot.create(:benefit_markets_products_health_products_health_product, :with_issuer_profile, metal_level_kind: :silver, benefit_market_kind: :aca_individual) }
+  let!(:enrollment) do
+    FactoryBot.create(:hbx_enrollment,
+                      :with_enrollment_members,
+                      family: family,
+                      enrollment_members: enrolled_members,
+                      household: family.active_household,
+                      coverage_kind: :health,
+                      effective_on: Date.today,
+                      kind: "individual",
+                      product: product,
+                      rating_area_id: primary.consumer_role.rating_address.id,
+                      consumer_role_id: family.primary_person.consumer_role.id,
+                      aasm_state: 'coverage_selected')
+  end
+
   let(:date) { DateTime.now }
 
   let(:job) do
@@ -58,47 +80,34 @@
   end
 
   let(:transmittable_params) {{ job: job, transmission: transmission, transaction: transaction }}
-
-  # lambda to change member eligibility
-  let(:change_member_eligibility) do
-    lambda { |member_hbx_ids|
-      subjects = family.eligibility_determination.subjects
-      eligible_subjects = subjects.select { |sub| member_hbx_ids.include?(sub.hbx_id) }
-      eligible_subjects.each do |subject|
-        key = 'health_product_enrollment_status'
-        state = subject.eligibility_states.where(eligibility_item_key: key).first
-        state.update(is_eligible: true)
-      end
-    }
-  end
-
   let(:dependent) { family.dependents.last.person }
 
   before do
+    BenefitMarkets::Products::ProductRateCache.initialize_rate_cache!
     allow(EnrollRegistry[:alive_status].feature).to receive(:is_enabled).and_return(true)
-    # need to run this operation to accurately handle cv3 family
+    primary.build_demographics_group
+    spouse_person.build_demographics_group
     Operations::Eligibilities::BuildFamilyDetermination.new.call({ effective_date: Date.today, family: family })
   end
 
   context "success" do
+    let(:primary) { FactoryBot.create(:person, :with_consumer_role, dob: primary_dob, ssn: 101_011_011) }
+
     context 'with all valid members with an enrollment' do
-      it "should pass" do
-        # everyone subject is made eligible for enrollment
-        all_member_ids = family.family_members.map(&:hbx_id)
-        change_member_eligibility[all_member_ids]
+      let(:spouse_person) { FactoryBot.create(:person, :with_consumer_role, dob: spouse_dob, ssn: 101_011_012) }
+      let(:enrolled_members) { family.family_members }
 
+      it "should pass" do
         result = described_class.new.call(family, transmittable_params)
         expect(result).to be_success
       end
     end
 
     context 'with some non-enrolled members' do
-      let(:check_eligibility_rules) { double(Operations::Fdsh::PayloadEligibility::CheckPersonEligibilityRules) }
+      let(:spouse_person) { FactoryBot.create(:person, :with_consumer_role, dob: spouse_dob, ssn: 101_011_012) }
+      let(:enrolled_members) { [family.family_members.first] }
 
       before do
-        # dependent subject is not made eligible for enrollment
-        change_member_eligibility[primary.hbx_id]
-
         @result = described_class.new.call(family, transmittable_params)
       end
 
@@ -110,18 +119,16 @@
         dependent.reload
         element = dependent.alive_status.type_history_elements.last
 
-        expect(element.action).to eq 'DMF Determination Request Failure'
-        expect(element.update_reason).to eq "Family Member with hbx_id #{dependent.hbx_id} does not have a valid enrollment"
+        expect(element.action).to eq 'DMF_Request_Failed'
+        expect(element.update_reason).to eq "Family Member is not eligible for DMF Determination due to errors: [\"No states found for the given subject/member hbx_id: #{dependent.hbx_id} \"]"
       end
     end
 
     context 'with some members with invalid ssns' do
-      before do
-        # everyone subject is made eligible for enrollment
-        all_member_ids = family.family_members.map(&:hbx_id)
-        change_member_eligibility[all_member_ids]
+      let(:spouse_person) { FactoryBot.create(:person, :with_consumer_role, dob: spouse_dob, ssn: nil) }
+      let(:enrolled_members) { family.family_members }
 
-        dependent.update(ssn: '999999999')
+      before do
         @result = described_class.new.call(family, transmittable_params)
       end
 
@@ -133,19 +140,17 @@
         dependent.reload
         element = dependent.alive_status.type_history_elements.last
 
-        expect(element.action).to eq 'DMF Determination Request Failure'
-        expect(element.update_reason).to eq "Family Member with hbx_id #{dependent.hbx_id} is not valid: Invalid SSN"
+        expect(element.action).to eq 'DMF_Request_Failed'
+        expect(element.update_reason).to eq "Family Member is not eligible for DMF Determination due to errors: [\"No SSN for member #{dependent.hbx_id}\"]"
       end
     end
 
     context 'parsing cv3_family after being published' do
+      let(:enrolled_members) { family.family_members }
+
       it "should be able to be parsed from JSON and validate with AcaEntities::Operations::CreateFamily" do
-        # everyone subject is made eligible for enrollment
-        all_member_ids = family.family_members.map(&:hbx_id)
-        change_member_eligibility[all_member_ids]
         described_class.new.call(family, transmittable_params)
         transaction.reload
-
         # we will convert this to json and then parse with JSON to simulate FDSH handling the event
         payload = transaction.json_payload[:family_hash]
         json_payload = payload.to_json
@@ -158,6 +163,8 @@
   end
 
   context "failure" do
+    let(:primary) { FactoryBot.create(:person, :with_consumer_role, dob: primary_dob, ssn: 101_011_011) }
+    let(:enrolled_members) { [family.family_members.first] }
     let(:fake_cv3_transformer) { double(Operations::Transformers::FamilyTo::Cv3Family) }
 
     context 'cv3 transformation failure' do
@@ -229,6 +236,8 @@
     end
 
     context 'with all members ineligible' do
+      let(:enrolled_members) { [] }
+
       before do
         @result = described_class.new.call(family, transmittable_params)
       end
@@ -241,7 +250,7 @@
       it 'should add a history element to all alive_status verifications' do
         alive_status_elements = [primary.alive_status, dependent.alive_status].map(&:type_history_elements)
 
-        expect(alive_status_elements.all? { |elements| elements.last.update_reason.include?('does not have a valid enrollment') }).to be_truthy
+        expect(alive_status_elements.all? { |elements| elements.last.update_reason.match?("No states found for the given subject/member hbx_id") }).to be_truthy
       end
 
       it "should update the transmission" do