As the nation debates health reform options, Governor Jim Douglas today announced that Vermont was chosen to participate in Transforming Care for Dual Eligibles, a national initiative that will test innovative models for people who are dually eligible for Medicare and Medicaid . Vermont will join six states in developing and implementing strategies to improve care and control costs for dual eligibles, a high-need population with individual health care costs nearly five times those of other Medicare beneficiaries. The program is designed by the Center for Health Care Strategies (CHCS) and supported by The Commonwealth Fund. I m so proud that Vermont is once again leading the nation in its health care reform efforts, said Governor Jim Douglas. Vermont is first in the nation to have a Choices for Care 1115 Long Term Care Waiver program, which equalizes entitlement to nursing home and home/community based services for long term care Medicaid eligible Vermonters. In addition, Vermont developed the Global Commitment 1115 Waiver, a first in the nation Medicaid Waiver wherein the State is the managed care organization. This grant will help us continue to make progress toward lowering the growth in health care costs for Vermonters eligible for both Medicare and Medicaid.Under the new grant, Vermont will work with CHCS and the Centers for Medicare and Medicaid Services (CMS) on the authority and process to create a pilot where Vermont would be a Special Needs Plan (SNP). As a SNP, Vermont would work with local providers to serve dually eligible beneficiaries across both of Vermont s waivers. As we look toward reforming our health care system, there are significant opportunities to improve the quality and cost-effectiveness of care for people who are eligible for both Medicaid and Medicare coverage, whose needs are often overlooked, said Commonwealth Fund President Karen Davis. The work of these seven states in designing patient-centered delivery models, if successful, could help pave the way for other states seeking to improve care for these vulnerable beneficiaries.Nationally, the more than eight million adults who are dually eligible represent approximately 18% of the Medicaid population, but account for 46% of the program s costs due to their complex array of medical, behavioral, and long-term care needs. A majority of dual eligibles are in fragmented fee-for-service systems, with little to no care coordination. Integrating the financing, delivery, and administration of services across Medicaid and Medicare could significantly reduce unnecessary hospitalizations and decrease the use of institutional care over time. This is exactly that type of program integration we need in order to provide better care for our citizens, Douglas continued. Through my work as co-chair of the National Governors Association State Alliance for e-Health, we are pursuing strategies for increased long-term care coordination with electronic medical records to better serve those with chronic conditions. I will continue to lead both nationally and here at home so that we can make important reforms and provide better care to Vermonters.Vermont is joining Colorado, Maryland, Massachusetts, Michigan, Pennsylvania, and Texas, in seeking to eliminate the barriers to integrating Medicaid- and Medicare-covered services. Through the 18-month program, participating states will receive in-depth technical assistance addressing program design, care models, financing mechanisms, contracting strategies, and working with CMS. With growing momentum, including Congressional interest, for integrating care, it is an ideal time to develop and test new state approaches to improve the quality of care for duals, said Melanie Bella, Senior Vice President at CHCS. We applaud Vermont for its commitment to establish practical and replicable solutions for integrating Medicaid and Medicare and improve care for dual eligibles in the state.The Transforming Care initiative continues the work begun by CMS and five states under CHCS’ earlier Integrated Care Program to address operational hurdles to integrating care by contracting with SNPs. The new program s goal is to develop a range of integrated delivery models for dual eligibles that can be implemented by other states across the country. Lessons from participating states will be disseminated to Medicaid stakeholders throughout the course of the initiative.The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system. For more information, visit www.commonwealthfund.org(link is external).The Center for Health Care Strategies (CHCS) is a nonprofit policy resource center dedicated to improving health care quality for low-income children and adults, people with chronic illnesses and disabilities, frail elders, and racially and ethnically diverse populations experiencing disparities in care. CHCS works with state and federal agencies, health plans, and providers to develop innovative programs that better serve Medicaid beneficiaries. For more information, visit www.chcs.org(link is external).Source: Governor’s officeVermont Resources:For details about the Choices fro Care Waiver, please refer to http://www.ddas.vermont.gov/ddas-programs/programs-cfc/programs-cfc-defa(link is external)…).For details about he Global commitment waiver, please refer to: http://ovha.vermont.gov/administration/2008-global-commitment-to-health-(link is external)…)
By Juan Delgado/Diálogo February 06, 2019 The Argentine and Chilean navies combined efforts once more to guarantee ship security and protect southern waters through the Combined Antarctic Naval Patrol (PANC, in Spanish). PANC’s 21st edition will patrol Antarctic waters until March 31. The objective of the binational military component is to keep vessels secure as they navigate Antarctic waters and respond to maritime emergencies. Naval units also bring logistics support to scientific activities and Antarctic bases. “PANC’s role is to provide search and rescue, maritime rescue, and pollution control,” Argentine Navy Lieutenant Commander Augusto Lizondo, chief of Southern Naval Operations (ANAU, in Spanish), told Diálogo. “The goal [is to] secure navigation and human life at sea, and help keep the waters free of pollution.” For the four-month mission, the Argentine Navy deployed the dispatch boat ARA Islas Malvinas, while Chile contributed with the tug vessel ATF-67 Lautaro and the maritime patrol boat OPV-83 Marinero Fuentealba. A total of 120 service members from both countries take part in PANC, including sailors, medical personnel, meteorologists, and tactical and rescue divers. Broad responsibility PANC’s tasks are performed in maritime areas beyond Tierra del Fuego, the southernmost tip of South America, shared by Argentina and Chile. “The activity period is divided into four stages of 33 days each, with a unit either from Chile or Argentina stationed in the Antarctic sector at each stage,” said Lt. Cdr. Lizondo. The Argentine and Chilean navy ships alternate the four periods—named Alfa, Bravo, Charlie, and Delta—configured as Antarctic service or support ships. Chile’s ATF-67 Lautaro kicked off PANC activities on November 15, 2018. On December 19, the ARA Islas Malvinas began patrolling the icy waters of Antarctica until January 22. The Chilean Navy leads the Charlie stage until February 26, while the ARA Islas Malvinas will conclude the patrol upon returning to its home port in Ushuaia in late March. “We conduct search-and-rescue missions and maritime rescue, and we provide support to units and bases in the Antarctic sector,” said Lt. Cmdr. Lizondo. “That way, mutual trust is established between the two countries, as well as support in monitoring the Antarctic areas of responsibility.” Other activities include meteorological support for vessels navigating the area, emergency medical assistance, transport of people—especially scientists between Antarctic bases or stations—and logistics supply. “Since PANC began, it assisted with many emergencies occurring in the area of responsibility, including rescuing ship crews stranded in this area,” Chilean Navy Captain Miguel Alarcón, chief of the Navy’s Antarctic Affairs, told Diálogo. Mutual trust To facilitate operations, an exchange officer of each navy boards each ship so that operations can run smoothly. ANAU and the Chilean Navy’s Third Naval Zone Command lead the activities that strengthen mutual trust between military institutions. “Considering that, based on the Antarctic Treaty, the continent is an area devoted to peace and science, with special care for the environment and its condition as a natural reserve, it’s been particularly relevant for both countries to combine work in activities meant to safeguard human life at sea,” said Capt. Alarcón. “In addition, it’s important to consider that PANC helps shorten response times and enable prompt, effective assistance in the area in case of emergencies.” Enduring friendship PANC was created after the 1984 Treaty of Peace and Friendship between Chile and Argentina, and has been conducted without interruption since 1998. According to Capt. Alarcón, Antarctica is crucial to both countries. “We should keep in mind that Chile and Argentina are the closest countries to the Antarctic Peninsula,” said Capt. Alarcón. “In Chile and Argentina’s maritime domains, this activity enabled us to standardize procedures, and increase interoperability between the two navies, as well as in search-and-rescue missions in Antarctica, contributing to the optimization of human and material resources for both institutions.” During the last edition of PANC, the binational military component provided support to 11 Antarctic bases, navigating more than 14,000 nautical miles in 120 days. “This joint effort shows the excellent level of interoperability in our combined maritime operations, achieved through a long process of fostering trust and friendship,” said Admiral José Luis Villán, chairman of the Argentine Navy’s Joint Chiefs of Staff.
“Middle-class taxpayers who file a Schedule C — freelancers, consultants and very small businesses — are three times as likely to be audited as those in the same income group with no such business income.” That’s according to a New York Times article about an increase in audits of the middle class: those earning between $25,000 and $100,000 annually. Though people who report very low and very high earning are audited at higher rates than middle-income Americans, the number of audits is increasing across tax brackets.