The State of Vermont has released an explanation of how the Medicaid cost shift impacts health care providers and how that in turn affects premiums. Governor Peter Shumlin in his Budget Address earlier this month said that a 0.7 percent payroll tax could raise $90 million a year to offset this cost shift. The governor said that all businesses would be required to pay the tax, which would thus reduce premiums for those businesses who currently offer health insurance to their employees. Medicaid reimburses doctors and hospitals at only 40 to 60 cents for a dollar of cost. To make up for those losses, doctors and hospitals have to charge those with private insurance higher rates for the same services. That shift of costs from Medicaid to private insurance it what is referred to as the Medicaid Cost Shift.WHY IS IT A PROBLEM? Right now, according to the governor, Vermont’s primary care system is at risk. Hospitals are having trouble recruiting and retaining doctors, nurses, nurse practitioners and other critical health care providers. Vermonters sometimes have to travel long distances to find a doctor willing to treat them. The problem is worse in rural areas and in places with a high concentration of Medicaid patients because health care providers are not paid fairly by Medicaid.Meanwhile, those with private insurance end up paying more than their fair share. Businesses and individuals who buy insurance are being overcharged to the tune of $150 million every year in their insurance premiums to help make up for the chronic underpayment for services by Medicaid.Fixing this is critical for access to quality health care and for our economy. We cannot afford to let this problem continue.RELATED: Governor Shumlin talks taxes, education reform and MedicaidHOW DOES THE PLAN WORK?The governor’s plan helps fix the Medicaid costs shift, lower private insurance costs, and strengthen our health care system for the long term.To do this, the governor’s plan would require businesses to pay a seven tenths of one percent payroll tax, which will raise $90 million a year. That will be matched with another $100 million in federal funds for a total of $190 million. It will more than double the funds available to shore up the health care system by leveraging federal funds.The state will then dedicate $140 million of the total to shore up Medicaid payments and drive down private insurance rates. This will result in a 5 percent reduction in private insurance costs. Stated simply, every dollar of state tax raised will be used to lower private insurance rates. The result will be a more balanced payment system for doctors and hospitals that will be more fair to those who accept Medicaid.The state will then invest the other $50 million in strengthening the overall health care system to ensure better outcomes at a lower cost.That means, according to the governor, that businesses providing insurance will benefit from lower health care costs. That is why the governor believes it is reasonable to use the payroll tax. Businesses pay the vast majority of private health care costs now; they are the ones being overcharged now; and they will be the ones that will get the greatest relief if the state lowers private insurance costs by shoring up Medicaid.Shumlin said that if the state does not do this, the problems in Vermont’s health care system will get worse. An increasing number of Vermonters receiving Medicaid, to some extent because the program has expanded eligibility. The lower reimbursements for Medicaid are not sustainable, according to the governor. Those with private insurance, he said, will continue to overpay year after year if the cost shift is not addressed.Meanwhile, Shumlin said, Vermont will continue to have trouble recruiting and retaining doctors, nurses, nurse practitioners and other health care providers, meaning Vermonters will have a harder time getting the health care they need.Source: Governor’s office. 1.29.2015
Two years have passed since the accession of the Republic of Croatia to the European Union and the acceptance of its rules of trade, value added tax agreement, consumer protection, compliance with roaming tariffs and the definition of online services.Although we have learned a lot, a lot of open questions remain, ambiguities and misunderstandings emerge from Landlord Club and bring a VAT flyer and assign a VAT identification number to renters who are not subject to VAT. The club of renters is designed to support private renters in their work with the aim of educating and informing through the internet portal, newsletter, lectures and the like to contribute to increasing the quality of private accommodation.The leaflet provides answers to the questions: Which category of renters is required to request a VAT ID and which is not? Why is there a VAT ID and to which system is it subject? Who are small taxpayers and who are flat rate renters? Which laws are subject to certain obligations?The aim of the leaflet is to present the necessary information to as many renters as possible in as much detail and simplicity as possibleASSIGNMENT OF VAT IDENTIFICATION NUMBER TO CITIZENS TO PRIVATE RENTERS
Sep 13, 2012 (CIDRAP News) – A detailed look at California children during the state’s large pertussis outbreak in 2010 revealed that protection from the diphtheria, tetanus, and pertussis (DTaP) vaccine wanes 5 years after kids receive their last dose, which could be fueling outbreaks. The new study on pertussis in California children, published today in the New England Journal of Medicine (NEJM), is the first to focus on the cohort of children who have received only the DTaP since birth. Jul 19 CIDRAP News story “CDC: Pertussis numbers suggest vaccine protection gap” “Prevention of future outbreaks may be best achieved by developing new pertussis-containing vaccines or reformulating current vaccines to provide long-lasting immunity,” she said. However, Klein emphasized that the DTaP is effective and is still an important tool for protecting children and communities. “Following current CDC recommendations remains important,” She said. Michele Roberts, MPH, with the Washington State Department of Health immunization program, has been involved with the state’s epidemiologic investigations of pertussis activity and took note of the new NEJM findings. She said the vaccine protection drop-off the Kaiser team found is another piece of the puzzle that will help experts better understand how to use the vaccine to control outbreaks. Jul 20 MMWR report In the late 1990s the United States transitioned from a whole-cell pertussis vaccine to an acellular version, due to a fairly high rate of minor side effects with the older vaccine. Klein NP, Bartlett J, Rowhani-Rahbar A, et al. Waning protection after fifth dose of acellular pertussis vaccine in children. N Engl J Med 2012 (published online Sep 13) [Abstract] The amount of protection that remained after 5 years depended on the initial effectiveness of the vaccine, according to the study. For example, if the initial effectiveness was 90%, it would drop to 42% after 5 years. Scientists don’t have a clear understanding of why the vaccine doesn’t protect very well, and developing a better vaccine could be a long way off, because there’s not much in the pipeline, Clark said. “A lot of us are saying ‘start now,’ ” he added. The researchers analyzed the risk of pertussis in California children from 2006 to 2011 in relation to the time since their last dose of DTaP vaccine, finding that protection wanes 42% each year after the fifth dose (odds ratio of 1.42 [95% confidence interval, 1.21 to 1.66]). Nicola Klein, MD, PhD, who led the study and co-directs the KPVSC, said in a Kaiser Permanente press release that the findings suggest that pertussis control measures may need to be reconsidered. Roberts echoed the point that health officials are still embracing use of the vaccine. She said its short-term protection is good and it is useful for helping prevent the spread of the disease, especially in outbreak settings, and to mitigate the severity of infections. See also: The findings come on the heels of a warning earlier this summer from the US Centers for Disease Control and Prevention (CDC). The agency, along with state health department partners, found an unusual illness spike in Washington state 13- and 14-year-olds, which also raised the possibility of waning pertussis (whooping cough) vaccine protection. Health officials are also seeing waning protecting with the tetanus, diphtheria, and pertussis (Tdap) booster recommended for 11-year-old children, he said, adding that protection gaps from both vaccines appear to be fueling the current epidemic. The United States is headed toward its worst pertussis year in decades, CDC officials said in July, and two states—Washington and Colorado—have declared epidemics. Clark coauthored a July report in Morbidity and Mortality Weekly Report (MMWR) that highlighted the illness spike in 13- and 14-year-olds in Washington’s recent outbreak Tom Clark, MD, MPH, a medical epidemiologist with the CDC’s Meningitis and Vaccine Preventable Diseases Branch, told CIDRAP News that researchers have already illustrated the waning protection from an epidemiologic perspective, and now this study and others soon to be published are measuring the degree of risk from the reduced vaccine effectiveness. The study focused on Kaiser Permanente’s northern California population, which includes 3.3 million members in a system that has electronic medical records and a central laboratory. It compared 277 children between ages 4 and 12 years who tested positive for pertussis with 3,318 kids who tested negative, with a separate comparison involving 6,086 matched controls. The nation’s number of pertussis cases reported so far this year—27,726—has surpassed the final number of 27,550 reported for 2010, making 2012 the hardest-hit year in decades, Clark said. The updated pertussis total appears in today’s issue of MMWR. They noted that the sharp increase in 8- to 11-year-olds, followed by a sharp pertussis drop in 12- to 15-year-olds, hasn’t been seen in the epidemiology of unvaccinated people in previous outbreaks. She said the next step is to evaluate the duration of protection from the Tdap vaccine, adding that studies are already under way to shed light on that issue. Pertussis is a difficult disease to understand, Roberts said, because natural infection doesn’t provide long-term immunity, and there are still several unanswered scientific questions. Sep 12 Kaiser Permanente press release The large size of California’s pertussis outbreak allowed researchers at Kaiser Permanente Vaccine Study Center (KPVSC) to examine the relationship between the time since pertussis vaccination and how likely children were to test positive for the disease. The CDC recommends five DTaP doses for children, given at 2, 4, and 6 months; at 15 to 18 months; and when the youngster enters school, between 4 and 6 years of age. In the meanwhile, pertussis vaccination is still the best way to fight the disease and is still a very important tool, especially since there is a lot of ongoing pertussis activity, he said. Sep 14 MMWR notifiable diseases and mortality tables Pertussis incidence was highest in kids ages 8 to 11 years, suggesting that the drop-off in efficacy after the fifth dose in schoolchildren played a role in fueling and sustaining California’s pertussis outbreak. Investigators wrote that this observation was surprising, because teenagers are typically considered a pertussis reservoir and have been disproportionately affected in previous outbreaks.
October 30 was not the first time Lisa Rooney, the Montauk woman who allegedly was drunk when her vehicle struck and killed a bicyclist, had been arrested by East Hampton Town police.On the night of August 10, 2018, Rooney was tending bar at Liar’s Saloon in Montauk when she allegedly served two beers to an 18-year-old undercover agent. Rooney failed to proof the young woman, police said. The arrest was part of a sweep in Montauk that night by the town police to enforce State Liquor Authority regulations regarding the sale of alcohol to minors.Rooney was placed under arrest, charged with a misdemeanor crime for selling alcohol to an underage buyer, the police said. She was taken to headquarters, processed, and released, with an appearance ticket, to be arraigned in front of Justice Lisa Rana August 29.Her attorney on August 29 was Christopher Carillo, the same attorney who represented Rooney after her October 30 arrest. Carillo’s family owns Liar’s Saloon.Rooney’s initial case was adjourned to October 11, 2018. At that point, it was agreed that as long as Rooney stayed out of trouble for six months, the case would be dismissed, which it was in April of this year. The court file was sealed. None of this was unusual for a first-time offender. Three others arrested at other Montauk bars that night on the same charge received the same treatment.On October 30, starting at 6:04 PM, after the accident which killed John James Usma-Quintero, a Colombian in Montauk on a work visa, police received two calls reporting the accident. Police were on the scene at 6:08, and an officer questioned Rooney, who apparently had exited the 2019 Chevrolet Silverado police said she was driving. “I swerved to avoid a car in the middle of the road,” she allegedly told police.At 6:34, after failing sobriety tests, Rooney was charged with driving while intoxicated, and was taken to headquarters. There, she was asked to take a blood test. She wrote on the request form, in large, scrawling script, “Refuse.” On another form, an officer notated that Carillo arrived at police headquarters in Wainscott at 7:56 PM, and “advised no further questions for his client.”Police later obtained a warrant from a judge, forcing Rooney to have blood drawn. At 9:33 PM, three and a half hours after the accident, blood was finally firstname.lastname@example.org Share
Subscribe Get instant access to must-read content today!To access hundreds of features, subscribe today! At a time when the world is forced to go digital more than ever before just to stay connected, discover the in-depth content our subscribers receive every month by subscribing to gasworld.Don’t just stay connected, stay at the forefront – join gasworld and become a subscriber to access all of our must-read content online from just $270.
Image courtesy of Apple Anyone played with an iPad yet? Obiter had one thrust into his palms by a beaming chum only last week, but embarrassingly mistook it for an oversized iPhone (‘Where’s the earpiece’ rather gave the game away). Still, it seems the folk at national firm Eversheds are rather more tech savvy. Last week they were trumpeting a ‘groundbreaking’ deal, dubbed ‘Eversheds Anywhere’, whereby all of the firm’s lawyers will be given an iPad. The firm wants to ‘allow lawyers to review documents, host virtual meetings, arrange schedules and access mail and business intelligence from wherever they may be in the world.’ So in Eversheds’ eyes, the iPad is the new BlackBerry. You can certainly do a lot more with it (apart from make calls, as hapless Obiter discovered). It looks slick, modern, and it fits in your… well, briefcase, handbag, manbag, or whatever. Having on-demand connectivity, and allowing lawyers to ‘access the data they need 24/7,’ seems to make business sense. However, Obiter suspects that much of that 24/7 will involve holiday booking, football score checking, game playing, app downloading, and then perhaps some document review (such as the latest Andy McNab classic). Functionality breeds temptation, does it not?
AN EXTENSION of Calgary’s Northeast light rail line from Whitehorn to McKnight-Westwinds opened for revenue service on December 17. Built at a cost of C$75m, the 2·7 km extension will serve one of the city’s fastest-growing suburbs, and a maintenance facility just beyond the new terminus costing a further C$100m. A one-stop extension of the Northwest line from Dalhousie to Crowfoot is scheduled to open this year, as part of a C-Train expansion programme that includes 33 new LRVs, reconstruction of the oldest city-centre stations and platform lengthening to accommodate four-car trains. On November 20 the city council approved funding for the C$700m, six-station West LRT extension along Bow Trail and 17th Avenue, from the current terminus at 7th Avenue to 17th Avenue & 69th Street SW, on which work could begin by October for opening in 2013. The council had already agreed to spend C$50m on land acquisition and C$84m for another 21 LRVs to work the 8 km corridor, which will serve approximately 120 000 inhabitants. The line will mostly run on the surface, with an underground section from 33rd Street to 41st Street SW.
AUSTRALIA: Detailed plans for the break-up and partial privatisation of QR were announced on December 8 by Queenland’s state Premier Anna Bligh. The coal and general freight business, including some network infrastructure, is to be floated on the Australian stock market at the end of 2010. The new company will adopt the QR National brand used for QR’s competitive rail freight activities outside the state.’QR’s coal and freight businesses have a proud history of more than 140 years. Now is the time for a brand new era for a true Queensland champion’, said Bligh, adding that QR National is set to be a ‘top 50 ASX company and Australia’s biggest coal transport and freight business’.QR Chairman John Prescott welcomed the announcement. ‘This is a decision for government, but one that makes sense’, he said, adding that ‘we are Australia’s largest rail operator with high quality assets and world-class talent and expertise’. CEO Lance Hockridge said ‘the reality is that around the world, the most vibrant and successful freight railways are privately owned and vertically integrated’.Bligh pointed out that the flotation would give Queenslanders the chance to buy a stake in the ‘new-look, publicly-floated, nationally-focused transport giant. Through their investment, they will get the opportunity to watch this business grow into a truly national and international company.’ Existing QR staff will be allocated free shares valued at A$1 000 each, and be given the opportunity to purchase an additional A$4 000 in shares at a discounted rate.State Treasurer Andrew Fraser said the government would initially retain a 25% to 40% shareholding, offering the new entity ‘short to medium term stability’. However, he added that ‘it is not our intention to remain a shareholder in the longer term. It is not the government’s role to own and operate coal businesses. Instead of putting money towards new coal trains, the government can better focus on its key role delivering social infrastructure and services for the public – like schools and hospitals. It is the government’s view that the private sector is better placed to take on the expense and risk of running these commercial businesses.’The government intends to retain QR’s passenger services in public ownership, establishing a new state-owned corporation, which will ‘be entirely focused on delivering the public transport system Queenslanders need’ and ‘will also hold the balance of the network.’ To be headquartered in the Brisbane suburb of Ipswich, the new Queensland Rail is to be set up by June 2010.The premier also confirmed that three other state-owned assets would be leased progressively from next year. A 99-year lease on the Port of Brisbane will be offered to the market in mid-2010, and a similar lease for the coal port at Abbot Point will be offered in December 2010. A 50-year franchise to run Queensland’s motorway network will go to market in mid 2011. Bids for state-owned Forestry Plantations Queensland were invited on November 26, with the sale of the timber business to be completed by June.
RUSSIA: The southwestern city of Krasnodar has opted to develop its legacy tramway to support rapid economic development and combat worsening road congestion.On May 17, the municipality outlined the findings of a regional transport infrastructure plan worth 51·7bn roubles that has been developed by Moscow Higher School of Economics with consultancy A+S Transproject. The study has recommended retaining trams as the core high capacity transport mode, with the authors advocating substantial investment and network expansion. The tram network dates back to 1900 and today totals approximately 50 km with 13 routes. The transport plan calls for the commercial speed of the network to be raised from 15·6 km/h to around 19 km/h, while network development would focus on providing direct access by tram to new residential developments across the city.Short-term priorities include extensions totalling 8·7 km which would serve the northern part of the Moskovskaya Ulitsa Gidrostroy housing complex and the city’s international airport. Further expansion would occur gradually over the next 15 years so that by 2033 a further 48·8 km will have been added.The expansion would be supported by the acquisition of around 100 new trams over the next three years to augment the present 268-strong fleet, and an additional depot is also to be funded. The proposals are also designed to complement the planned development of a local suburban rail network, announced in March.
Credit: Paramount Home EntertainmentWith Stephen King having somewhat of a resurgence thanks to the huge success of the big screen adaptations of his classic horror IT and the critical acclaim of small screen series Castle Rock, which is inspired by the world King has created, it’s no surprise that his back catalogue is being looked into for new releases. The latest to arrive is The Stand, a mini-series from 1994 that featured a star-studded cast and ran for 6 hours over 4 episodes.The Stand focuses on a group of characters fighting back against a deadly disease following the accidental spread of a weaponised version of the flu that was created by the government in California. With 99.4% of the population wiped out, the scattered survivors are drawn to Mother Abagail (Ruby Dee), a woman who claims to be a prophet of God, and the demonic Randall Flagg (Jamey Sheridan). As they travel across the country and try to salvage what’s left of the world, tensions and jealousy threaten to rip them apart.An event series at the time (before the phrase was coined) The Stand is a sprawling and very lengthy watch. Much like the book it’s based on, and indeed the majority of King’s work, The Stand has some very strong ideas, which translate well to the screen, but it’s also bogged down by far too much going on. I’ve always found King to be a writer that says 1,000 words when often 10 will do and that’s most certainly the case here.The first episode is painstakingly slow as it sets up the world. You get the immediate rush of seeing the virus break out but then it’s a laborious task introducing the many characters that occupy the rest of the series. The faces are familiar – Rob Lowe, Gary Sinise and Molly Ringwald to name a few – and that will likely encourage some to revisit the series but they mostly flounder in this over-bloated adaptation.The Stand is essentially an exploration of good vs bad. Sadly the nuances of the book are lost in this adaptation where the characters are oddly two-dimensional and lacking the complexity they had in the novel. It’s established that those characters who travel to Abagail are good people and those who travel to Flagg are bad. There’s no real exploration or understanding of why the characters make the decisions they do.The cast is solid enough but they are hampered by the overly wordy dialogue and often very-on-the-nose lines they have to deliver. Gary Sinise is the best of the bunch as lead character Stu Redman and Rob Lowe does a decent job of playing the deaf and mute Nick Andros. Molly Ringwald is a little stilted and flat in parts as Frannie Goldsmith but she does find her groove as the series goes on.The Blu-ray transfer is a mixed bag. The picture looks great but it’s retained the 4:3 ratio it had for its original broadcast. The audio hasn’t been brushed up particularly well and is presented in Dolby Digital 2.0 Stereo, which is a bit disappointing. There are limited extras too with only an audio commentary and making of featurette.The Stand will have nostalgia value for some people, and it certainly did for me, but it wasn’t the amazing series I remember it being. There are moments of brilliance but they are fleeting and the over-riding feeling is that The Stand is far more drawn out than it needed to be. I wouldn’t be surprised if we get a big screen version in the coming years so unless you’re a hardcore Stephen King fan, I’d probably suggest giving this release a miss.Cast: Gary Sinise, Molly Ringwald, Jamey Sheridan, Laura San Giacomo, Ruby Dee, Ossie Davies, Rob Lowe Certificate: 15 Duration: 360 mins Released by: Paramount Home Entertainment Release date: 7th October 2019 Buy The Stand