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old ASS2 PRD

PRD — ASS2: Inclusion Lifecycle, Needs, Compliance & Action-Plan Engine

1. Executive Summary

ASS2 delivers the full downstream governance engine for Assistive Technology & Home Modifications (ATHM) under Support at Home (SAH).
Where ASS1 provides structured assessment intake, AI extraction, Recommendations, and backend Inclusion seeds, ASS2 activates:

  • the complete Inclusion lifecycle\
  • Needs modelling and consolidation\
  • readiness and eligibility rules\
  • funding pathway logic\
  • automated invoice gating and matching\
  • Inclusion index & detail view\
  • structured Action Plans powered by a clinical criteria index

ASS2 ensures full compliance, traceability, auditability, and financial correctness.

2. Problem Statement

Trilogy currently has no regulated downstream engine to validate, govern, or enforce ATHM funding rules.

ASS1 introduced structured Recommendation and Inclusion seed creation, but does not provide:

  • governed Inclusion lifecycle\
  • readiness rules\
  • eligibility/funding workflow\
  • Needs modelling\
  • automated invoice gating\
  • clinical criteria—driven action plans

ASS2 provides the rule-driven system required for SAH compliance, audit, and operational efficiency.

3. Audience

  • Care Partners\
  • Billing Processors\
  • Compliance & Audit\
  • Supplier Relations\
  • Data & Operations\
  • Coordinators (action plans)

4. Goals & Success Metrics

Goal Metric Target

Ensure all ATHM % invoices matched to a ≥95% spend follows Ready Inclusion
readiness &
eligibility rules

Reduce manual Invoice-on-hold volume −40% in 6 weeks billing effort reduction

Establish unified % Inclusions linked to a 100% clinical planning Need

Improve traceability Completeness across Need 100% → Inclusion → Assessment
chain

Assumptions

  • ASS1 Recommendation quality is consistent\
  • Clinical criteria index available\
  • Funding rules are stable

5. Background / Context

Support at Home requires every ATHM item to be clinically justified, traceable, and compliant with evidence, eligibility, and funding rules.

ASS2 covers:

  • Inclusion lifecycle\
  • Needs modelling\
  • Readiness checks\
  • Eligibility/funding rules\
  • Invoice gating\
  • Clinical criteria mapping\
  • Assessment consolidation

It enables consistent downstream decisioning and structured planning.

6. Requirements (User Stories)

Below is the unified ASS2 user story set.

ASS2-1 --- Create Full Inclusion Objects

As a CP/System, I want backend seeds from ASS1 to instantiate into full Inclusion objects.
AC:\

  • Links to Assessment, Recommendation, Budget, Tier-5\
  • Visible in Inclusion index & detail view

ASS2-2 --- Inclusion Lifecycle States

As the System, I want a full lifecycle (Draft → Ready → Active → Closed).
AC:\

  • Moves to Ready when readiness checks pass\
  • Actions requiring readiness cannot proceed if not Ready\
  • Active/Closed transitions governed by defined rules

ASS2-3 --- Readiness Checklist

As a CP, I want readiness items visible so I know what is required before progression.
AC:\

  • Checklist items: evidence, Tier-5, quotes, eligibility, staleness\
  • Progression blocked when requirements are unmet\
  • Auto-updates when evidence arrives

ASS2-4 --- Funding Pathway Assignment

As the System, I want to assign funding pathways so approvals are consistent.
AC:\

  • Rules run automatically\
  • Applies contribution and eligibility logic\
  • Prevents ineligible items from reaching Ready state with clear reason codes

ASS2-5 --- Create Need Objects

As the System, I want Needs created from Recommendations.
AC:\

  • Needs created and linked to Inclusions\
  • Retro-creation for historical V1 data

ASS2-6 --- Needs Consolidation

As the System, I want to consolidate multiple assessments into stable Needs.
AC:\

  • Consolidation rules define overrides and merges\
  • Links maintained to history

ASS2-7 --- Invoice Gating & Auto-Matching

As a Billing Processor/System, I want invoices auto-matched and gated based on Inclusion readiness.
AC:\

  • Auto-hold when no Ready Inclusion\
  • Auto-release when criteria met\
  • Displays strong match and confidence signals

ASS2-8 --- Inclusion Index & Search

As a CP/Compliance, I want to search and filter all Inclusions.
AC:\

  • Filters: Tier-5, Need, lifecycle state, supplier, funding stream\
  • Detail view shows complete history & evidence

ASS2-9 --- Action Plan Engine

As a Coordinator, I want structured action plans generated automatically.
AC:\

  • Based on Needs + Inclusion readiness gaps\
  • Tasks update dynamically when state changes

ASS2-10 --- Clinical Criteria Index

As the System Owner, I want a canonical criteria index.
AC:\

  • Used for mapping Needs, Inclusions, and Requests\
  • Versioned and centrally governed

ASS2-11 --- Assessment Consolidation Engine

As the System, I want to unify overlapping assessment data.
AC:\

  • Rules determine whether to merge or separate\
  • Maintains full history & traceability

7. Out of Scope

ASS2 excludes: - New extraction or mapping logic (ASS1)\

  • Assessment upload workflow\
  • Recommendation acceptance workflows\
  • Budget prepopulation logic

8. User Interaction & Design Notes

Inclusion Index

  • Table view with filters\
  • Lifecycle badges & state indicators

Inclusion Detail Page

  • Linked Recommendations and Assessments\
  • Readiness checklist\
  • Evidence viewer\
  • Funding pathway & eligibility reasons

Invoice Matching UI

  • Match strength indicators\
  • Auto-hold reason codes\
  • Release workflow

Action Plans

  • Task grouping by criteria\
  • Real-time updates

9. Milestones

Design: In progress
Development: Pending
QA / UAT: Pending
Release: Pending

10. Reference Materials

  • High-Level Architecture Summary\
  • Epic Split Master Map\
  • SAH Reform Requirements\
  • Internal BRP documentation\
  • Confluence PRD templates