Project overview

Status: Proxi-controlled Cloudflare operating manual, eight-pillar sequence atlas, and review inbox published; owner adjudication of workforce and SOP semantics is in progress
Last updated: 2026-10-05

This directory is the source of truth for defining the work ProxI-enabled CMS GUIDE services must actually perform. The inventory contains359 tasks across the eight GUIDE service domains,138 program-operation tasks and106 work types organizing candidate additional value with explicit shared baseline interfaces:603 classified work types, not603 distinct care events. Each body identifies the literal work, potential automation, actual paid performer, GUIDE standing, person-facing value and exact clinical-thinking boundary. An enhanced label never makes required base work optional or proves additional service credit.

Current-phase guardrail#

Work on the business service semantics first. Expand the literal procedure, required result, source facts, preparation work, automation opportunity, human judgment, minutes, failure handling, and completion evidence before building software scaffolding. Do not add versions, hashes, machine schemas, state machines, fault gates, or automation implementation during this phase. Review one service procedure at a time and correct the actual work, candidate Proxi contribution, and human responsibility.

Governing premise#

Probabilistic systems may observe, extract, transform, summarize, and speak. They do not decide. Versioned deterministic rules govern workflow, routing, permissions, state transitions, escalation, and closure. Licensed humans exercise clinical judgment where required. Deterministic executors act only after every required fact and authorization is present.

Document map#

Current continuation checkpoint#

The stable current-work pointer is the newest append-only record in reviews/checkpoints/CURRENT.md. It records the active Codex task, newest controlling user instruction, last completed artifact checkpoints, and exact bounded continuation. Append a START, PAUSE, or DONE record at the corresponding boundary; do not rely on the sidebar as the sole continuation record.

The whole-manual review is in reports/GUIDE manual gap review 2026.md; current correction progress and publication state are recorded in the newest reviews/checkpoints/CURRENT.md entry. The preferred reading and owner-review surface is the Proxi-controlled Cloudflare website at https://guide.proxi.care, generated from website/, with no ChatGPT or Claude authentication layer. Current source changes are not live until the journal records their verified publication. The source set now contains detailed individual cards for all 359 service tasks, including all 63 Care Coordination and 38 Medication tasks; the tested publication status is in the journal. The site maps 28 documents with source-bound comments. The Review Inbox at /review preserves comments for later adjudication; role proposals remain distinct from adopted SOP authority.

The last completed semantic checkpoint is reviews/checkpoints/eight-pillar-service-integration.md. All eight service SOPs now participate in one source-preserving service loop: Comprehensive Assessment establishes the initial, annual, or bounded current baseline; Care Plan carries beneficiary-led actions; Ongoing Monitoring and Support follows results and returns material changes; and 24/7 Access, Care Coordination, Medication Management, Referral/Services, and Caregiver Education/Support open and return their own distinct work. D-021 still controls preparation before judgment, and D-016 still counts shared human work once while requiring separate service content and results. Program Operations remains supporting infrastructure, not a ninth care pillar. Formal actor, timing, release, service-evidence, workload, and Participant-specific validation remains open in the linked decision log. Do not begin Fault Gate 2, Fault Gate 17, machine representation, or automation implementation until the semantic procedures are accepted.

The portfolio workforce totals remain provisional until event assumptions, incidence, shared-interaction accounting, actual nurse/contractor rates, paid availability and low/typical/high rollups are validated. D-026 clarifies the 24/7 base: Philippine nurses staff a nonclinical human helpline; continuous Puerto Rico or in-house clinical staffing is not inferred from the public access clause. Substantive caregiver support requires an approved care-team act, and clinical questions use their exact authorized response route. The commercial scope remains settled: Proxi maintains, staffs and furnishes all eight GUIDE domains as applicable, excluding respite. It does not require every beneficiary to receive every domain every month.

Program Operations' 138 rows now separate software, actual paid staff, source-owned clinical products and institutional permissions. The RCC move procedure shows all approval/arrangement combinations and the exact public AND trigger. D-027 names the designated Administrative Manager for partner/service/coverage business commitments—not routine cases or inferred CMS/clinical/signing powers. Navigator employee learning is paid workforce time even when content is web-based. The broader labor-owner matrices and event/rate assumptions still need reconciliation; source card counts alone do not prove the full goal or field readiness.

The 49 Assessment and 52 Care Plan helper rows separate actual paid Proxi work from customer/recipient/outside acts. D-028 selects an outsourced onsite social worker/home-safety specialist paired with an appropriately scoped Proxi telehealth clinician. The reference in-person case has 47 PR + 40 onsite minutes, with 65 L3/110 L4 unchanged and reused once. Low-tier remote delivery has no automatic onsite fee. Contractor approval, telehealth authority and actual fees/travel/availability remain dependencies.

The34 caregiver,37 Ongoing,29 Access and57 Referral rows preserve actual paid work, source/subject/location authority, shared events and distinct service/usefulness/qualification results. Enhanced106 now has12 entry/branch/return procedures, a scoped professional selector and row-specific baseline/additional results; direct factual/choice/content work is separated from actual human coaching and clinical/therapy work. Portfolio counts are88S/302D/57G/156H across603 indexed work types—not hours. Extra promise, cost/capacity, instrument/state authority and source-fit dependencies remain explicit under O-052. Current verified publication is in the newest journal; source edits are not automatically live.

Manual22 now reconciles actual episode demand with scheduled paid capacity. D-029 confirms PR $22 for every scheduled hour; the existing 160 hours/month at 70% productive load is retained. Current low/ordinary/high contact, caregiver and clinical scenarios, first-horizon assessment events, actual shared-pool/Participant multiplicity and training/replacement/shift handover are explicit and counted once. Rates, availability, fees and real scaling inputs remain provisional or unpriced; the model is not a full-service quote or approved caseload. Verified publication remains controlled by the newest continuity entry.

Manual20 reconciles the settled eight-domain base with all twelve additional-value candidates. Its three recommended priorities are practical caregiver skill-in-use coaching, targeted wandering preparedness and meaningful activity participation; none is an activated or priced offer under O-052. Required GUIDE care remains independent, paid contracted fulfillment is not free outside labor, and 390 of 603 principally automatable components is not a payroll percentage. D-030 assigns routine factual/logistical human help to Philippine support and relationship/distress/required navigator work to the PR navigator. D-032 places the first family meeting during initial assessment/planning; actual assignment, accepted coverage and mode remain O-053. Clinical, release, signing and company-commitment authority are unchanged. The newest journal controls verified publication.

Manual17 now answers the original minimum/value/clinical-work questions together, with all eight linked service boundaries, supporting programme tasks, the current three unactivated recommendations and exact medical/nursing/behavioral/pharmacy/therapy/swallowing/nutrition/dental/sensory work. It does not treat all106 shared baseline/candidate rows as optional or task-type percentages as clinician time. Leon confirms the executed Agreement/Appendix D is unavailable; only the affected Participant-specific terms remain unconfirmed, while public semantic work continues. Proxi's non-respite scope does not waive the Participant's applicable respite obligation. The narrow administrative manual-send worker for an already-approved Care Plan to an authorized PCP remains O-014, not clinical re-review or blanket release authority. Publication is controlled by the newest journal.

D-031 selects Philippine support for manual sending of approved coordination provider packets and clinician-approved medication recommendations to authorized PCP/specialist when automation is unavailable. The selection grants neither clinical authorship/agreement nor release permission, patient-order delivery or O-014 Care Plan sending. D-032 places the accepted primary PR navigator's first family meeting during initial assessment/planning within useful existing work, not an extra welcome call or claimed service merely from an introduction. Actual assignment/coverage/mode and contract acceptance remain separate; verified publication is in the newest journal.

The requirements map separates medical content, sharing permission, class-rule authorization and delivery. D-033 selects automatic approved-rule sending for routine authorized-provider requests/information and unchanged US-clinician-approved recommendations to selected PCP/specialist, with no extra per-packet OK. D-007's ordinary community-referral check and other classes remain separate; actual clinical work, genuinely mandatory case review and restrictions remain protected. HHS sources clarify the federal baseline, not Proxi handling authority. O-008/O-021/O-030 retain actual class/contract/authority acceptance. No care-engine implementation or field activation is claimed; newest journal controls publication.

Working method#

1. Break each GUIDE service obligation into the actual tasks needed to deliver it.
2. Describe what each task entails instead of restating the service heading.
3. Identify the concrete part Proxi could potentially perform or accelerate.
4. Separate Proxi-paid work from beneficiary, caregiver, participant-customer, clinician, and external-party actions before discussing staffing or cost.
5. State whether a person is required, name the actual role, and state whether Proxi or the customer would supply that role under the proposed service offer.
6. Separately state the GUIDE standing, customer-value position, and clinical lane; never use “human required” as a synonym for “clinical judgment required.”
7. Keep distinct beneficiary, caregiver, clinical-provider, transition, and community-service routes separate.
8. Review and correct one service table at a time until the business work is accepted.
9. Only after semantic acceptance, apply Fault Gate 2 and then Fault Gate 17.
10. Leave implementation mechanics until after those reviews.

Current scope#

This working set covers eight GUIDE service domains:

• Comprehensive assessment
• Person-centered care plan
• Ongoing monitoring and support
• 24/7 access
• Care coordination and transitional care management
• Referral and coordination of services and supports
• Medication management and reconciliation
• Caregiver education and support

Respite is intentionally excluded from this operating scope.

Status notation#

• SETTLED: Governing assumption; do not change without a decision-log entry.
• PROVISIONAL: Working design requiring operational, clinical, contractual, or legal validation.
• OPEN: Unresolved decision with an assigned owner.
• BLOCKED: Cannot proceed until a named dependency is resolved.