Daily Archives: April 15, 2022

Executive Summary

The California Department of Managed Health Care (DMHC) issued a recent guidance interpreting the application of the No Surprises Act (NSA)a new federal law prohibiting out-of-network healthcare providers from balance-billing patients for certain emergency and non-emergency servicesin California. Significantly, when determining which payment and dispute resolution processes will apply in a dispute regarding the value of non-contracted emergency and non-emergency services, the NSA expressly defers to existing state law which already protects patients from receiving surprise medical bills, as long as such state laws conform to certain requirements set forth in the NSA. The NSA refers to such qualifying laws as specified State law[s]. However, the NSA does not explicitly indicate which states existing balance billing laws qualify as specified State law[s]rather, each state must independently review the provisions of the NSA to determine if its existing balance billing laws qualify.

The DMHC recently issued an All-Plan Letter (APL) confirming that California law governing health care service plans, as set forth in the Knox-Keene Health Care Service Plan Act of 1975 and its implementing regulations, constitutes specified State law and will continue to govern out-of-network disputes for certain emergency and non-emergency services provided in California, rather than the payment and dispute resolution provisions of the NSA. However, in all states, the NSA governs disputes relating to air ambulance services, not state law.

Background of the NSA

The NSA, which went into effect on January 1, 2022, limits the amount an out-of-network provider can charge for emergency services, nonemergency services provided at in-network facilities, and air ambulance services. When a patient receives services covered by the NSA from an out-of-network provider, the NSA generally caps the patients cost sharing obligation at the median in-network contracted rate that the health plan agreed to pay for similar services from in-network providers for the same services in the same geographic region. In addition, the NSA also creates a dispute resolution process for out-of-network payment disputes. Under the NSAs baseball style dispute resolution process, when providers and payors cannot come to an agreement, each side submits an offer that an approved Independent Dispute Resolution Entity must select between as the final payment amount. The payment and dispute resolution processes of the NSA do not apply to every dispute, however. Before the enactment of the NSA, many states already had surprise billing laws in place, and the NSA does not fully preempt state payment standards. Instead, it expressly defers to the requirements of qualifying specified State law[s]e.g., a qualifying balance billing law as specified by the NSA. The NSA also envisions that states may revise their balance billing laws to qualify as specified State law in response to the passage of the NSA and its implementing regulations. See 86 Fed. Reg. 36,925 (July 13, 2021).

The DMHCs APL Confirms the Application of the NSA in California

On March 21, 2022, the DMHC issued an APL confirming that California law qualifies as specified State law for: (i) non-emergency, noncontracted services at an in-network facility by a noncontracted provider; and (ii) out-of-network emergency services. Federal law governs disputes relating to out-of-network services provided by air ambulance providers.

The DMHC stated that it expects CMS to issue an updated letter consistent with its interpretation of Californias balance billing laws.

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DMHC Guidance Confirms that California Law, Not the Federal No Surprises Act, Governs Payment and Dispute Resolution Processes for Certain...

Former National Security Adviser John Hannah argues Ukraine is going to be 'extremely dependent' on massive quantities of Russian arms.

During his appearance on "Cavuto: Coast to Coast" Monday, former National Security Adviser John Hannah discussed the ongoing invasion into Ukraine as the West secures weapons for the country amid its war with Russia, arguing Ukraine is the subject of a "massive war we haven't seen the likes of since WWII."

JOHN HANNAH: Ukraine is, you know, the subject of a massive war that we haven't seen anything the likes of since World War II. Russian territory and Russian economic targets are kind of off-limits to the Ukrainians. So this is not really a fair fight

IMAGES SHOW UKRAINIAN TROOPS FIGHTING BACK AGAINST RUSSIA AS BATTLE SHIFTS EAST

Former National Security Adviser to V.P. Cheney discusses foreign affairs on "Cavuto: Coast to Coast" on April 11, 2022. (Fox News)

Ukraine is going to be extremely dependent on both massive, massive quantities of Russian arms, especially with this new offensive coming in the east and the south, and undoubtedly on massive western international financial and economic assistance to keep them fighting another day to ensure that Putin can't achieve his strategic objectives here. It's going to be very, very costly bill for the West and for the United States.

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Former National Security Adviser to V.P. Cheney John Hannah discusses China reportedly expanding its nuclear war chest, Russia's new commander, Biden's meeting with Indian PM Modi and the ongoing war in Ukraine.

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Ukraine the subject of 'massive war' we havent seen the likes of since WWII: Former NSA - Fox Business

Washington, Apr 10 (PTI) The US is taking aggressive action to help the Ukrainians succeed on the battlefield and help them have the best possible position at the negotiating table, a top White House national security official said on Sunday.

Speaking to CNN, US National Security Advisor Jake Sullivan said the US will play a key role in supporting Ukraine against Russia after Moscow attacked its neighbour.

We are taking aggressive action in an effort to both help the Ukrainians succeed on the battlefield and help the Ukrainians have the best possible position at the negotiating table, Sullivan said.

We will continue to do that. We will continue to rally the world in that regard. And the United States will play the key role it has played thus far in the days and weeks ahead, he added.

Referring to the appointment of General Aleksandr Dvornikov as new Russian commander in Ukraine, the US National Security Advisor said that no appointment of any general can erase the fact that Russia has already faced a strategic failure in Ukraine.

They thought that they were going to be able to conquer the capital city and take other major cities with little resistance, that theyd, in fact, be welcomed with open arms. And what we have learned in the first several weeks of this war is that Ukraine will never be subjugated to Russia. It doesnt matter which general President Putin tries to appoint, he said.

Sullivan alleged that the new general has a resume that includes brutality against civilians in other theaters, in Syria.

We can expect more of the same in this theater. But its not something that we need to anticipate looking forward to. As we have already seen it, and we can expect more of it, he alleged.

This general will just be another author of crimes and brutality against Ukrainian civilians. And the United States is determined to do all that we can to support the Ukrainians as they resist him and they resist the forces that he commands, Sullivan said.

President Joe Biden, he said, has been absolutely clear from before this conflict began that the United States is prepared to work with its allies to defend every inch of NATO territory.

That means every inch, including if mines showed up in a Romanian harbour or a Turkish harbour and caused damage or loss of life, he said.

In another interview to ABC News, Sullivan said the images that are being seen out of Bucha and other cities have been tragic, theyve been horrifying, theyve been downright shocking, but they have not been surprising.

We, in fact, before the war began, declassified intelligence and presented it indicating that there was a plan from the highest levels of the Russian government to target civilians who oppose the invasion, to cause violence against them, to organise efforts to brutalise them in order to try to terrorise the population and subjugate it. So this is something that was planned, he said.

Now in addition to that, I think there certainly are cases where individual soldiers or individual units got frustrated because the Ukrainians were beating them back. They had been told they were going to have a glorious victory and just ride into Kyiv without any opposition with the Ukrainians welcoming them. And when that didnt happen, I do think some of these units engaged in these acts of brutality, these atrocities, these war crimes even without direction from above, he said.

Responding to a question on ABC News, Sullivan said that the United States has not reached a determination on genocide.

We havent yet reached a determination on genocide. That is a determination that we work through systematically. There is a unit at the State Department that gathers evidence and then makes a legal analysis because genocide is actually a legal determination, he said.

But lets set legalities aside for a minute. I think we can all say that these are mass atrocities. These are war crimes. These are shocking and brutal acts that are completely unacceptable, beyond the pale for the international community. So whatever label one wants to affix to them, the bottom line is this, there must be accountability. And the United States will work with the international community to make sure theres accountability, he said. PTI LKJ RUP RUP RUP

This report is auto-generated from PTI news service. ThePrint holds no responsibility for its content.

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US taking 'aggressive action' to help Ukrainians succeed on the battlefield: NSA Sullivan - ThePrint

ELLICOTT CITY, Md. Originally from the San Francisco Bay Area in California, Dr. Tom Glenn originally enlisted in the Army so he could attend the Army Language School later called the Defense Language Institute, or DLI. With a passion and knack for linguistics, Glenn taught himself French and Italian as a child, studied Latin during high school and German during college.

With a craving for more, Glenn enrolled in DLI with the hopes of learning Chinese.

I wanted to go to the best language school in the U.S., maybe in the world, he said. But when I got [there], they told me they werent going to teach me Chinese, they were going to teach me a language I had never heard of: Vietnamese.

Glenn was a Soldier and had to follow orders, so he spent all of 1959 learning Vietnamese. He spent six hours a day in class with two hours of private study each night for a full year.

I graduated first in my class of ten, he said. I asked the Army to send me to Vietnam but [they said] they had nothing going on there. Instead, Glenn was assigned to the National Security Agency, or NSA, at Fort Meade, Maryland.

Still hoping to study Chinese, Glenn enrolled in George Washington University in Washington, D.C. as a part time graduate student. Glenn went on to earn a masters degree in government and a doctorate in public administration.

By the time Glenn finished his enlistment in 1961, he said he was comfortably speaking Vietnamese, Chinese and French; the three main languages spoken in Vietnam.

The NSA immediately offered Glenn a job at five steps above the normal level and sent him to Vietnam for the first time in 1962 as a civilian.

Between 1962 and 1975, I spent more time in Vietnam than in the U.S., he said.

Despite being a civilian, Glenn lived with the military as if he were still a Soldier.

I was one of them sleeping on the ground next to them, eating [field rations while] sitting in the dirt by their side, using their latrines and going into combat with them, he said. I was the only civilian I knew who was willing to put his life on the line by working with the military in combat on the battlefield.

Glenns job was in intelligence; using signals intelligence, intercepting and exploiting the enemys radio communications, informing friendly forces on what enemy force intentions were and where they were.

He says that the strongest human bond hes ever seen was that between two men fighting side by side.

Glenn spent his thirteen years in Vietnam all over the country, wherever combat was going on. He worked most often in central Vietnam, just south of the demilitarized zone that separated North and South Vietnam. The day-to-day was just like any other Soldier in combat.

[The days were] defined by the boredom of waiting and the terror of close combat, he said.

Glenn wants Americans to know the grisly horror of war. He wants citizens to respect and admire service members who put their lives on the line for our good.

After the Vietnam War, Glenns readjustment to civilian life would have been more difficult had he been sent straight home. Instead, he was sent abroad to serve on the battlefield all over the world after Saigon fell in 1975.

Glenn retired from NSA in 1992.

Welcome home, brother

When Glenn meets other Vietnam veterans, he puts his hands on their shoulders and looks them in the eye. They share an experience unknown to other Americans.

For years following the war, many Americans saw Vietnam as the war we never should have been involved in. During those years, Glenn never mentioned his service overseas.

Then, several years ago, I was invited to a welcome-home party for Vietnam veterans, he said. After some hesitation, I went. A bunch of young people, who hadnt even been born before the end of [the war], shook my hand, hugged me and thanked me for my service.

Glenn urges other Americans to approach those who served and thank them. Only then will that service member know that their service is worthy of gratitude.

Award-winning author

The real adjustment [came] thirty years ago when I retired as early as I could [to] write full time, Glenn said. I was so intent on writing that the transition was a relief rather than an adjustment.

Glenns first book is titled Friendly Casualties and consists of a collection of short stories to highlight the horrors of war. He chose to write about Vietnam because of his post-traumatic stress injuries, or PTSI. [It] wounded my soul, he said.

He learned that the only way to survive his injuries was to face the memories head-on. The best way to force himself to face those memories was to write it all down, which has resulted in six books and 17 short stories as of March 2022.

Glenns books are categorized as fact-based fiction which he said is the only way he could delve into the emotions [he] lived through in real life. He said hes lived through experiences far more compelling than anything completely made up.

I want people to know what [it was like], he said. I needed to vent, to stand face-to-face with my memories and learn to live with them.

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Veteran, linguist reflects on Vietnam service | Article | The United States Army - United States Army

Findings of a recent survey completed by the National Sheep Association (NSA) have revealed that less than 5% of sheep farmers receive direct contact from the owners of dogs that have been involved in a sheep worrying attack on their livestock.

With almost 60% of survey respondents finding evidence of an attack having taken place rather than being alerted by the owner or another witness of an incident the result suggests animals are often likely to be left suffering and injured for a period of time causing extreme distress to the sheep and also the farmer on discovering the upsetting scenes.

NSA is therefore calling on dog owners to take responsibility for the attacks should their dog be involved in chasing and/or attacking sheep.

As the governments new draft Kept Animals Bill is proposing greater powers for police to trace and gain access to dogs involved in attacks this could create an improved situation for those involved.

NSA chief executive Phil Stocker commented: It may feel daunting as a dog owner to come forward to a farmer to admit responsibility, but NSA believes that farmers would rather be informed by the dog owners themselves rather than finding injured, or even worse, dead sheep in their fields.

Sheep worrying by dogs is a crime but openness from the dog owner can mean a more amicable resolution can hopefully be achieved and it is better than having to explain a failure to report if the dog is able to be traced.

"Often dog owners simply do not realise their pet is capable of doing so much damage, and while we appreciate this crime is not one that any animal lover would set out to commit, taking responsibility is crucial and could help reduce cases for the future.

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NSA pleas with dog owners to take responsibility for sheep worrying - Agriland.co.uk

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