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Lame Duck 2013 Gubernatorial Action – Two Successes for Physicians
Lame Duck 2013 Legislative Action
(the Governor has 10 days to sign or pocket veto all bills signed at the end of the two year legislative session)
APN Scope of Practice
Despite our protest, both houses have passed a bill that would permit Advanced Practice Nurses to certify cause of death. MSNJ opposes this bill because cause of death is in fact a medical diagnosis and should be provided only by a physician. Read MSNJ's opposition letter. We are hoping for a pocket veto by the Governor, as he did two years ago when the Legislature rushed the bill through in an identical manner.
Pharmacy Vaccines
A3251, the bill allowing pharmacies to administer vaccines has passed both houses and awaits action by the Governor. The bill allows pharmacies to administer to patients 18 and older a vaccine (1) pursuant to a prescription, (2) in immunization programs authorized by a prescriber's standing order for the vaccine or (3) in immunization programs and programs sponsored by governmental agencies that are not patient specific . Under the bill, a pharmacist may administer an influenza vaccine to a patient who is seven years of age or older. For a patient who is under 18 years of age, a pharmacist shall not administer a vaccine except with the permission of the patient's parent or legal guardian. For a patient who is under 12 years of age, a pharmacist shall not administer a vaccine unless pursuant to a prescription by an authorized prescriber. A patient 12 years of age or older does not need a prescription for an influenza vaccine. MSNJ, NJAFP and NJAAP opposed this bill in its original form, but softened when the vaccines for children were limited to flu. This bill still represents a scope of practice expansion of concern to MSNJ.
Physician Loan Redemption
The Legislature passed S162, which establishes a Physician Loan Redemption Program. The bill awaits action by the Governor. MSNJ, along with NJ AFP and COTH worked expediently to improve the bill that was passed by the Senate in a skeletal, flawed form. With our input, the bill now provides for redemption of eligible qualifying loan expenses for physicians who work for no less than four years at an approved site in the clinical practice of primary care or in the clinical practice of specialized care if the specialty is projected to experience a significant shortage.
Pain Medicine Restrictions
The Senate Budget Committee approved a bill that would limit insurers from using step therapy protocols for pain medication. Though the bill had already passed the Assembly, the Senate failed to vote on it, so it died at the end of the legislative session. MSNJ supported this bill and will work with legislators on the issue in 2014. Our larger goal is to balance drug abuse reduction with proper access to pain medicine for patients who need it.
Medicaid Provider Rates
Both houses passed S2241, which would prohibit Medicaid managed care organizations from reducing certain provider reimbursement rates without approval from DHS. The bill stems from an attempt by Horizon last year to slash home care provider rates after the Governor began moving most Medicaid services from fee for service to managed care. The insurance companies oppose the bill and stated that the bill would create a regulatory situation that is not used by any other state and that it will ultimately increase costs to the state. They also stated that the record of managed care in New Jersey is very good and the system is fair. MSNJ supports the bill, which awaits action by the Governor.
Higher Education Epinephrine Emergency Treatment Act
Both houses passed S2448, which allows public and independent institutions of higher education in New Jersey to develop a policy for the emergency administration of epinephrine to a member of the campus community for anaphylaxis when a medical professional is not available. Institutions of higher education that develop such policies must designate an appropriately licensed physician, physician assistant, advanced practice nurse, or registered nurse to serve as the "licensed campus medical professional," who will oversee the institution's epinephrine administration and train designees in the administration of epinephrine via a pre-filled auto-injector mechanism. The Secretary of Higher Education is to establish guidelines for the development of a policy for the emergency administration of epinephrine, which will be disseminated to the president of each institution of higher education. In addition, the bill provides immunity for a licensed campus medical professional, a trained designee, and a prescribing physician for good faith acts or omissions committed in accordance with the bill's provisions. MNSJ supports this bill, which awaits action by the Governor.
State Trauma Plan
Both houses passed a bill that provides for the establishment of a formal Statewide trauma care system plan, which will include all health care facilities in the State providing care to injured patients in the State, to the extent that their resources and capabilities allow. The Department of Health sought counsel with the American College of Surgeons Trauma System Evaluation and Planning Committee regarding the State's trauma system. This bill incorporates the recommendations that resulted from that interaction. The commissioner is required to appoint a State Trauma Medical Director to oversee the planning, development, ongoing maintenance, and enhancement of the formal trauma system in collaboration with a multidisciplinary advisory body called the State Trauma System Advisory Committee (STSAC). The STSAC is required to study the State's trauma care system, collect data, and provide a report on the development of a formal Statewide trauma system plan. The STSAC's recommendations will provide the basis for the commissioner's development of regulations implementing the plan. The STSAC's initial report, containing the formal Statewide trauma system plan, is due within one year. Thereafter, the STSAC will be required to systematically review strategies to maintain and improve the State trauma system, submit an annual report to the commissioner and the director on its activities, and provide recommendations it determines are necessary to improve the State trauma system. MSNJ is neutral on this bill, which awaits action by the Governor.
Breast Density
Both houses have finally passed the final version of A2022/S792, which now awaits action by the Governor. MSNJ worked on this bill in great detail. The bill 1) requires insurance companies to cover certain screenings, 2) requires physicians to provide information to certain patients regarding breast density and 3) requires study of breast cancer risk factors. Radiology facilities must distribute to certain patients a notice that reads as follows: "Your mammogram may show that you have dense breast tissue as determined by the Breast Imaging Reporting and Data System established by the American College of Radiology. Dense breast tissue is very common and is not abnormal. However, in some cases, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with a risk factor for breast cancer. Discuss this and other risks for breast cancer that pertain to your personal medical history with your health care provider. A report of your results was sent to your health care provider. You may also find more information about breast density at the website of the American College of Radiology, www.acr.org." The bill states that it does not impose a standard of care obligation upon a patient's health care provider. The bill requires the Mandated Health Benefits Advisory Commission to prepare a report regarding the implementation and administration of the bill, including analyses of social, medical and financial impact. The bill requires the Department of Health, in conjunction with the Medical Society of New Jersey, to convene a work group to review and report on strategies to improve the dialogue between patients and health care professionals regarding risk factors for breast cancer and breast imaging options. Though we may have improved the bill, MSNJ remains concerned about legislative interventions into the physician-patient relationship, in general, and notification mandates, specifically.
For Profit Hospital Reporting
After two years of amendments and negotiations, a bill regarding for profit hospitals is finally settled. The Governor rejected a bill in 2012 that would have required detailed financial reports by for profit hospitals, which were growing in numbers at the time. On the last day of the two year session, the Legislature accepted the watered down rewrite of the bill by the Governor. The bill now requires the Commissioner of Health to undertake a review of New Jersey's hospital financial reporting requirements and shall report any findings and recommendations directly to the Governor no later than six months from the date of enactment of. Specifically, the Commissioner shall examine the impact of, and make recommendations on, the following areas for all entities receiving Health Care Subsidy Fund payments from the State: Internal Revenue Service filings, Securities and Exchange Commission filings, and audited financial statements. The bill takes effect immediately.
Vaccines for Healthcare Workers
Both houses passed A2172, sponsored by Chairman Herb Conaway, which requires health care facilities to annually offer influenza vaccination to their health care workers and require the implementation of an annual influenza vaccination program in accordance with the current recommendations of the Advisory Committee on Immunization Practices of the federal Centers for Disease Control and Prevention and any rules and regulations adopted by the Commissioner of Health. In lieu of receiving the vaccine at work, a health care worker would be permitted to present acceptable proof, including an attestation by the health care worker, of a current influenza vaccination from another vaccination source, or sign a written declination statement. Each facility would be required to maintain a record of influenza vaccinations, retain each signed attestation and declination statement, and report to the Department of Health (DOH) the vaccination percentage rate of its health care workforce as part of its program or by other means as attested to by the health care worker. Each facility would also be required to provide an educational component to its influenza vaccination program and annually evaluate the program with the goal of improving the rate of vaccination among its health care workers. The bill awaits action by the Governor, who pocket vetoed the bill last year.
Newborn Screenings
Both houses passed S2318, a bill that requires newborn infant screening for tongue tie. MSNJ was neutral on the bill. The bill awaits action by the Governor.
Stillbirth Education
Both houses passed the "Autumn Joy Stillbirth Research and Dignity Act," which requires DOH to establish protocols for stillbirths and establishes a stillbirth research database. The bill awaits action by the Governor.
Pediatric Respite Care
Both houses approved A3558, which would provide for licensure of pediatric respite care facilities. The facilities will provide end-of-life care for children up to age 21 with limited life expectancies or complex, life-limiting illnesses and support for their families, and employ interdisciplinary teams to assist in providing curative treatment when possible, palliative care, and supportive services to meet the physical, emotional, spiritual, social, and economic needs of children and their families during illness, as well as during dying and bereavement if no cure is attained. The bill awaits action by the Governor.
Drug Adherence Efforts
Both houses passed A1214, which requires the State Health Benefits Commission and the State Health Benefits Plan Design Committee to establish a three-year pilot program to provide benefits coverage to select employees with chronic health conditions using a value-based benefit design under the State Health Benefits Program (SHBP). The value-based benefit design will target the following chronic health conditions: diabetes, high cholesterol, hypertension, and asthma. The coverage design will utilize explicit financial incentives to increase the employee's interaction with appropriate health care providers, and encourage use of those health benefits that specifically relate to the employee's chronic health condition. The value-based benefit design pilot program will assign a participating employee to a pharmacist, who, in collaboration with the employee's primary treating physician, will be responsible for coordinating medication therapy management services within the scope of the pharmacist's license to practice pharmacy in the State of New Jersey.
The following financial incentives directly related to the diagnosis, care, mitigation, or treatment of the condition for which the employee is participating in the program will be provided:
(1) all tuition costs for any education class attended by the employee which provides medical condition self-management, recommended to the employee by the primary treating physician or assigned pharmacist;
(2) all costs for private visits with the employee's assigned pharmacist;
(3) all costs for a medical device or supply deemed medically necessary by the primary treating physician or assigned pharmacist;
(4) all costs for laboratory testing; and
(5) waiver of all copayments for any prescription drug..
This bill is based on the well-known Ashville Project. The bill will most likely be approved by the Senate and head to the Governor's desk in lame duck.
Reconstructive Breast Surgery
Both houses passed S374, which grants a state sales tax exemption for services prescribed by a doctor in conjunction with reconstructive breast surgery. The procedures, currently subject to the 7 percent tax rate, are utilized to restore the appearance of the breast. The bill addresses a current loophole where insurance providers cover the costs of the procedures but pass on the cost of the sales tax to the patient. The bill awaits action by the Governor.
Medical Marijuana
Both houses passed A765, which requires that a registered qualifying patient's authorized use of medical marijuana be considered equivalent to using any other prescribed medication and not the use of an illicit substance that would otherwise disqualify a qualifying patient from needed medical care, including organ transplantation. The bill awaits action by the Governor.
Lame Duck 2013 Veto Action
Gender Changes on Birth Certificates
The Senate and Assembly have both passed A4097/S2876, which allows more people to change their birth certificates. To obtain the amended certificate, a person would be required to submit: 1) a form provided by the State registrar of vital statistics and completed by the person's licensed health care provider which indicates that the person has undergone clinically appropriate treatment for the purpose of gender transition, based on contemporary medical standards, or that the person has an intersex condition; and 2) a certified copy of a court order indicating the person's name change, if the person has changed his or her name. Under current law, a person is required to undergo sex reassignment surgery to receive an amended birth certificate.
Declarations of Death
The Governor signed a bill that removes the statutory authority of the Department of Health (DOH) and the State Board of Medical Examiners (BME) over medical standards governing declarations of death upon the basis of neurological criteria. The bill requires that a declaration of death upon the basis of neurological criteria be made by a licensed physician professionally qualified by specialty or expertise, based upon the exercise of the physician's best medical judgment and in accordance with currently accepted medical standards. Joint DOH/BME regulations would no longer be needed to set forth currently accepted medical standards (including criteria, tests, and procedures) to govern declarations of death upon the basis of neurological criteria. If they are used, the regulations concerning the declaration of death upon the basis of neurological criteria may not require the use of any specific test or procedure in the declaration of death upon the basis of such criteria. MSNJ supports this bill.
Self-Referral Laws
The Governor signed a bill which allows practitioner with financial interest in health care service providing lithotripsy to refer patients to that health care service if certain conditions are met. MSNJ and New Jersey urologists support this bill, which is a "clean up" to the reforms made to self-referral laws (the Codey Act) in 2009. Lithotripsy was left out of the exemptions in 2009.
2014 Medicare Physician Fee Schedule Issues
It was recently brought to our attention that Novitas has yet to post the correct 2014 conversion factor for anesthesia. We also have concerns that the ambulatory surgery center and vaccine fee schedules are not up to date. MSNJ asked Novitas about the timeline for posting the corrected fee schedules. We were advised that they are in the process of updating the anesthesia conversion factor on the website. We are still awaiting information on the ASC and vaccine fee schedules.
Novitas also advised MSNJ that it has loaded the regular 2014 fee schedule and is prepared to accept 2014 claims. Novitas is still working on posting the 2014 physician fee schedule in the file formats that may be imported into billing software. For now, Novitas is posting the files in a basic text only format to give practices an opportunity to review the 2014 fees. Likewise, these fees are not yet available in Novitas' interactive fee calculator.
We believe that if you bill Medicare less than the 2014 fee schedule amount, Medicare will pay the lesser amount based on past experience. Likewise, in the past, Medicare would not reconsider claims that were paid at a billed amount that is less than the current Medicare fee schedule. We have requested clarification on this issue from Novitas since it appears from the web site that these fees are up to date and physicians may have charged less than what they are entitled to through no fault of their own. To avoid this issue, physicians may want to consider billing Medicare at the practice's regular fee schedule to ensure that the amount billed is above the Medicare fee schedule amount. Another option is to hold claims until the correct information is posted on the Novitas website.
Please stay tuned to e-News for more information as it becomes available.
Medicaid Expansion Update—Enrollment Glitches
In November, the NJ Medicaid program advised that for individuals applying through the federal Marketplace there would be a lag time between federal and New Jersey approval. It further advised that it was able to handle the lag and that New Jersey had the second highest number of Medicaid enrollments of states using the federal Marketplace.
On December 20th, a story broke indicating that State officials said that those who applied for health coverage using the federal government's website are actually unable to be enrolled because the State cannot process the eligibility information from the federal web site. Per the article, "New Jersey Medicaid said information it received from the federal insurance marketplace for about 25,000 residents who qualify for free health coverage from New Jersey's program for the poor is 'unusable.' Their applications can't be processed, and they can't yet be enrolled for coverage that is supposed to begin on January 1." See more.
But, MSNJ was recently informed that though,
"the flat file sent to NJ Medicaid by the federal Marketplace still is unusable…individuals who applied to the Marketplace between October 1 and December 31, who are verified as Medicaid eligible, will have their coverage backdated to January 1."
MSNJ immediately asked the Division for guidance and was given the following advice:
-This problem actually affects about 60,000 patients.
-Patients in this category will have letters from CMS stating that they are considered eligible by CMS. This letter only confirms eligibility; it does not place the patient in a plan or provide an ID number. Please be advised that CMS is telling patients that physicians will be able to confirm enrollment, but that is not the case. The following advice that CMS is giving to patients is not accurate for enrollees in New Jersey:
"If you received a letter telling you that you have been enrolled in Medicaid or CHIP, but you haven't received an enrollment card from your state agency or from one of its health plans, you should still be able to get health care services. If you need care, show your provider a copy of your eligibility letter. Your provider can verify your enrollment when you go for care."
- As such, these patients will be treated much like presumptively eligible patients are already treated in New Jersey: they will be considered traditional Fee for Service (FFS) until the State has been able to confirm their eligibility and enroll them in a plan.
-True Medicaid HMO plan enrollment cannot be done until February 1st, which is the next enrollment period for Medicaid plans.
-While other states are asking patients to re-enroll directly with the State Medicaid program, New Jersey is not doing so. NJ Medicaid will work to process the applications that came through the federal exchange as soon as possible.
View the CMS FAQs.
Bottom line for our members: You may wish to see a patient who presents a CMS letter, but there is no obligation to do so. The clients will be considered traditional FFS until they select and are enrolled in an HMO, so a provider would bill Medicaid and get paid the FFS rate. Once enrolled in a health plan, the client will have to go to a provider within that network.
UHC Terminations of Physicians in Medicare Advantage Plan
In mid-October UHC began terminating physicians in their Medicare Advantage plan. We immediately reached out to UHC when it appeared that the terminations were not isolated, but rather part of a broad initiative. This week, UHC responded to some of our questions. We are disappointed that there was no warning of this termination initiative which appears to be a significant redesign of the UHC Medicare Advantage network, nationwide, and that information is sparse. For example, UHC would not tell us how many physicians in New Jersey were terminated or whether any specialties were immune to the termination initiative. Yet, UHC assured us that the network had been "tested and retested" for network adequacy and that there would not be a specialty access issue.
Network Adequacy: Obviously, MSNJ has no way of evaluating the impact on the network without more information. Therefore, we are asking all physicians who received termination letters, to provide us with information so that we can better evaluate network adequacy concerns. CMS has agreed to help us with that assessment.
Lack of Transparency: In addition to our network adequacy concerns, we are troubled that patients may be enrolling or re-enrolling in the UHC Medicare Advantage plan now, because seniors are in the middle of open enrollment, believing that they will be able to continue to be treated by physicians who are currently in the plan. UHC agreed to consider our complaint on lack of transparency on the 2014 network, given that seniors are enrolling now based on the current network. It is important to note that patients may change their network selection. CMS will honor the last selection made by the patient by December 7 when open enrollment ends.
Continuity of Care: We expressed our concerns about continuity of care and a disruption of established physician-patient relationships. We urged UHC to carve out an exception for patients who wish to continue to see their current physician. UHC agreed to consider this request. We believe that patients should have the right to choose their physicians and must know their network status to make those choices.
Discussions with CMS: With a reopening of the federal government, we have contacted CMS about our network adequacy and continuity of care concerns. Our Region 2 office has been facilitating communication with the Region 9 office which is responsible for the UHC Medicare Advantage network. CMS Region 9 is charged with ensuring network adequacy and transparency for Medicare beneficiaries in their selection of a Medicare product. CMS has offered to test areas for network adequacy. Please provide us with information so that we can identify geographical and specialty areas of concern.
What to do: Last week we urged physicians who wished to stay in the Medicare Advantage network to appeal and provided suggestions for those appeals. We will continue to update our advice to members as more information becomes available to us. Visit our web site for a list of Do's and Don'ts, Appeal Suggestions, a template letter to inform patients of your imperiled status in the UHC Medicare Advantage Network.
Visit MSNJ's UHC Webpage for more information.
Save the date for MSNJ's UHC Termination Update webinar on Tuesday, October 29 at 7:00PM. Details to follow on www.msnj.org.
Medicaid Agrees to Retroactive Payment to January 1
Medicaid has agreed to pay certain resubmitted claims retroactive to January 1 in response to an MSNJ request. In January 2013, the Medicaid program required that all physicians who order, refer, or attend Medicaid beneficiaries, but do not bill for their services, enroll in the program as non-billing providers. The program confirmed to MSNJ that enrolling will not cause a physician to become a participating provider, but it will allow participating providers to be paid and will bring the program into compliance with the Affordable Care Act.
MSNJ subsequently received complaints from Medicaid participating providers who are not being paid due to the ordering/referring physician's failure to enroll as a non-billing provider. In April MSNJ requested that the Medicaid program "consider making an exception that allows for resubmission of claims for payment once the non-billing provider has enrolled." The program recently advised that the treating physician may resubmit denied claims after the ordering/referring physician enrolls as a non-billing provider.
In 2013, non-billing provider enrollment will be retroactive to January 1, 2013. In 2014 and going forward, non-billing provider enrollment will be retroactive to one year prior to receipt of the enrollment application. For instance, a non-billing provider who submits an enrollment application on March 15, 2014 will be retroactively enrolled back to March 15, 2013. This is to allow participating physicians enough time to resubmit claims within the timely filing limit (up to one year).
MSNJ appreciates the Medicaid program's response to our request.
Medicaid Primary Care Incentive Payment Attestation: Deadline Extended to April 30th
The Division of Medical Assistance and Health Services (DMAHS) confirmed that all physicians who qualify for the ACA enhanced payments to Medicaid primary care providers must complete an attestation form indicating board certification status in a primary care specialty. The deadline for submission of the ACA Self-Attestation Form for traditional fee-for-service Medicaid has been extended to April 30, 2013.
Physicians must submit the attestation by April 30th in order to be eligible for retroactive incentive payments going back to January 1, 2013. Physicians who submit the attestation after April 30th will receive incentive payments starting from the first day of the month the attestation was submitted. For example, if the attestation is submitted on July 17, 2013, then the incentive payments will apply to claims starting July 1st. An original signature is required; therefore the form must be mailed to: Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650. Please note: the fee-for-service deadline does not apply to physicians in the MCOs; a deadline will be provided in a letter to the physician from the MCO.
Medicaid Primary Care Incentive Payment Attestation: March 15th Deadline for FFS Physicians
CMS clarified that all physicians who qualify for the ACA enhanced payments to Medicaid primary care providers must complete an attestation form indicating board certification status in a primary care specialty. The deadline for submission of the ACA Self-Attestation Form for traditional fee-for-service Medicaid is March 15, 2013. An original signature is required; therefore the form must be mailed to: Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650. Fee for service physicians who do not file the attestation form by March 15th will not receive the retroactive payments. Fee-for-service physicians are also being "reminded of the importance of reporting their true usual and customary charges on these claims" to "ensure that adjustment payments for eligible claims can be processed correctly." Please see the DMAHS newsletter for details. The fee-for-service deadline does not apply to physicians in the MCOs; a deadline will be provided in a letter to the physician from the MCO. Read more.
News: Medicaid Primary Care Incentive Payments
Medicaid Primary Care Incentive Payments Delayed, but will be Retroactive
MSNJ confirmed with DMAHS that the division will file the necessary State Plan Amendment (SPA) to obtain federal approval for the primary care incentive payments for fee-for service physicians. The SPA is due to the federal government by March 31st. Once the State receives approval and increases the rates, retroactive payments (going back to January 1, 2013) will be made to physicians who qualify under the federal regulations. Read more. DMAHS is also working to ensure that physicians in MCOs will receive the primary care incentive payments retroactively. This implementation process is separate from the fee-for-service process. Read the separate article on steps that fee-for-service providers must take by March 15th to receive retroactive payments.
Medicaid Primary Care Incentive Payment Attestation: March 15th Deadline for FFS Physicians
CMS clarified that all physicians who qualify for the ACA enhanced payments to Medicaid primary care providers must complete an attestation form indicating board certification status in a primary care specialty. The deadline for submission of the ACA Self-Attestation Form for traditional fee-for-service Medicaid is March 15, 2013. An original signature is required; therefore the form must be mailed to: Molina Medicaid Solutions, P.O. Box 4804, Trenton, NJ 08650. Fee for service physicians who do not file the attestation form by March 15th will not receive the retroactive payments. Fee-for-service physicians are also being " reminded of the importance of reporting their true usual and customary charges on these claims" to " ensure that adjustment payments for eligible claims can be processed correctly." Please see the DMAHS newsletter for details.
The fee-for-service deadline does not apply to physicians in the MCOs; a deadline will be provided in a letter to the physician from the MCO. The New Jersey Division of Medical Assistance and Health Services (DMAHS) explained that physicians may have to complete separate attestation forms for the Medicaid Managed Care Organizations (MCOs), if the MCO does not have a record of board certification on file. DMAHS is working with the MCOs to coordinate an outreach effort to the physicians that will need to provide an attestation. MSNJ will continue to communicate with the Medicaid program about MCO attestation requirements and retroactive payments. Please stay tuned to e-News for more information as it becomes available.
MSNJ's Statement on NJ Medicaid Expansion
Governor Christie's decision to expand Medicaid is a positive step that will create access to health insurance for many uninsured residents. Importantly, this decision will make additional investment in the program possible. This is also an opportunity to align incentives and create a robust network of physicians and other healthcare providers for the Medicaid program. Expanding an underfunded program will increase access to insurance, but will not deliver adequate access to physician services for our newly insured citizens.
The Medical Society of New Jersey supports reform of the state's Medicaid Program. Our Medicaid Program is one of the poorest paying healthcare programs in the nation.* Conversely, practice expenses in New Jersey are among the highest in the nation. These unfortunate facts prevent many physicians and other healthcare providers from being financially able to participate in the Medicaid program. We look forward to working with our government and private sector partners to ensure access to quality healthcare for all New Jersey residents.
*Health Affairs August 2012 vol. 31 no. 8 1673-1679
MSNJ News Roundup – January 4, 2013
Medicare Fee Cut Averted Through 2013; Sequester Cut Delayed for Two Months On January 1st Congress passed the American Taxpayer Relief Act and successfully averted the average 26.5% cut in the Medicare physician fee schedule The act dodges the scheduled fee cut due to the sustainable growth rate (SGR), but does not repeal the flawed formula. The 2% sequestration cuts to Medicare payments have also been delayed, but for only two months. MSNJ and our members actively lobbied our congressional delegation to stop the Medicare fee cut, repeal the SGR and replace it with new payment models that will be sustainable. This action stops the fee cut and allows a year for the repeal and replacement of the SGR. While we are thankful that Congress prevented the drastic cut in fees, MSNJ still believes that a permanent fix to the SGR is necessary and overdue. See Senator Menendez's response to MSNJ's request that the SGR be repealed. We will continue our efforts to repeal the SGR.
This $25 billion band-aid was offset by assorted provisions. Thankfully, as advocated by MSNJ and the AMA, the increase in Medicaid payments to primary care providers and funds for preventive services remain untouched. Unfortunately, the offsets will have a negative impact on payments for advanced imaging services and will extend the statute of limitations on recoupment to 5 years. In addition, the act takes back unobligated funds for health insurance co-ops as a cost savings. Existing obligations will be honored.
For details on Medicare and other health provisions contained in the American Taxpayer Relief Act, visit the AMA's website.
2013 Medicare Fee Schedule- Billing Update & Participation Deadline Extension
Many members have questions about billing Medicare, now that the cut has been averted. Although the fee cut has been prevented, it is an average, not applicable to each CPT code and there may be other changes affecting the 2013 Medicare fee schedule, besides the SGR. While the SGR cut has been delayed until after December 31, 2013, Relative Value Unit (RVU) changes will be different from last year, thus changing the 2013 fee schedule for certain CPT codes–either up or down.
We have asked for implementation information from Novitas (New Jersey's Medicare Contractor). So far, there is no official Novitas position, but CMS published notice indicating that it is updating the 2013 Medicare Physician Fee Schedule. CMS also noted that the Medicare contractors may hold claims until January 15, 2013, while they test and implement the fee schedule. This falls within the prompt pay timeframe.
CMS will give Novitas until January 23, 2013 to post the updated fee schedule on its website. As of today, the Medicare fee schedule posted on the Novitas website still reflects the scheduled fee cut. In the meantime, we recommend that members hold claims until Novitas posts the corrected 2013 fee schedule. If a practice uses the wrong fee schedule and bills Medicare less than the new fee schedule amount, Medicare will pay the lesser of the two fees and will not reconsider the claim. CMS has also extended the deadline for changing participation status to February 15, 2013. We will notify members, once additional information is received from Novitas.
First HIPAA Breach Settlement Involving Fewer than 500 Patients Announced
The U.S. Department of Health and Human Services (HHS) recently announced a resolution agreement in which the Hospice of North Idaho (HONI) agreed to pay $50,000 for potential HIPAA violations involving less than 500 patients. This is the first settlement involving a breach of protected health information (PHI) of fewer than 500 patients. HONI also agreed to a corrective action plan (CAP) that requires HONI to notify HHS of any violation of HONI's privacy and security policies within 30 days of the breach for two years after the date of the resolution agreement. As part of the CAP, HONI must include a description of the events leading up to the breach, a copy of the policy violated, and a description of the corrective actions taken.
The investigation was prompted by HONI's submission of a breach report to HHS, a requirement under the HITECH Act. A HONI laptop containing electronic PHI was stolen, putting the privacy of 441 patients at risk. After investigation, HHS found that HONI did not perform necessary risk analysis and failed to establish adequate policies and procedures regarding the security of laptops and other mobile devices containing PHI. These inadequacies were in direct violation of the HIPAA Security Rule.
In its article, New Year, Same Old Health Data Breaches, FierceHealthIT noted that security risks continue to be a problem for the healthcare industry and listed several recent cases of PHI security breaches. HHS recognized that physician education is essential to reduce the frequency of such breaches. In response, HHS developed an educational initiative, Mobile Devices: Know the RISKS. Take the STEPS. PROTECT and SECURE Health Information, to assist physicians with HIPAA compliance when using laptops, smart phones, and tablets. Members are encouraged to review the HHS materials and to take the appropriate steps to protect electronic PHI contained in laptops or other mobile devices.


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As the cold continues -- people will be firing up home heating appliances to stay warm. But those heating devices could be very dangerous even leading to house fires.
Our crews turned to the experts for some tips on staying safe.
Every year the Beckley Fire Department responds to numerous structure fires that are associated with the improper use of household heaters.
The National Fire Protection Association said home-heating equipment is the leading cause of home fire fatalities.
But that doesn't faze on Raleigh County man named Gary Bone.
"We always make sure we have a new filter and if we use the portable heater we also make sure nothing is around it because of fire," Bone said.
Bone said his family makes sure in the most dangerous heating fire months of December, January, and February-- they use caution. But how much caution is enough?
Our reporter uses a space heater and our crews wanted to ask experts to evaluate the usage.
"The picture I am seeing the heater is too close to combustibles," Ed Wills, Capt. Beckley Fire Department said.
Well now that you know what not to do. What should you do with a heater?
Experts said make sure a heater is 3 feet away from all objects in the room and make sure heaters are in a large, well ventilated room.
Experts said that is especially important with kerosene heaters.
They need a lot of room to prevent carbon monoxide build up and users don't want to switch fuels either.
"For example if you put gasoline in a kerosene heater it will explode," Wills continued.
Finally, there is one simple tool that can help save your life no matter what time of the year.
"We always put out batteries in our smoke alarms," Gary Bone said.
"We always have our alarms," Bobby Cook said.
For more safety tips click here.

subset: commoncrawl


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Our Team
At Toms River Animal Hospital, we love our pets. They're not just our pets, they're our family. Our patient care team's over 200 furry, feathery and scaly family members include more than 80 dogs, more than 90 cats and more than 40 exotics. We all want our pets to live long, happy, healthy lives. Our pets and their good health are important to us, and we know that your pet family members' health is important to you. When our pets come to our hospital to visit, we are passionate about making sure their stay is comfortable and as stress-free while we provide them extraordinary care. Our goal for our clients and patients is simple, we take care of our clients' pets the same way we take care of our own. We are dedicated to becoming your partner in your pets' health care, and we are driven to take exceptional care of our patients.
Want to join our team? Visit our Careers section.
Get to know us
Explore our staff biographies and learn about the people who make our facility an excellent choice for your pet care needs.


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By Kevin Henkin
Last October at the end of preseason, I ran a Van Halen-themed Celtics column to coincide with the band's reunion show in Boston. That was 66 regular season wins and two playoff round advancements ago. Fast forward seven full months later and we find the Celtics exactly where we expected them to be, namely deadlocked with the Detroit Pistons in the Eastern Conference Finals. With the return of Van Halen to the area in Providence on Sunday night (tremendous show, by the way), it seemed fitting to close the loop with another VH crossover piece. As such, I offer the following insights on all things related to this epic Celtics/Pistons series unfolding before our eyes, structured within the aforementioned Van Halen song title format:
Jamie's Cryin'
I'm just wondering, has there ever been a foul call against the Pistons that one of their current players have ever agreed with? I mean it. Ever? Even in the cases where blatant visible contact is made, the Detroit players act amazed and outraged by the call that follows. Honestly, Billups, Wallace or Hamilton could lay a Kermit Washington haymaker on Rajon Rondo on his way up the court and then act shocked beyond belief at the sound of the official's whistle. If they played clean, this might just be a minor annoyance. But they don't. The Pistons seem to pride themselves on their ability to either draw fouls on exaggerated flops or to get away with arm hooks, moving picks and sneaky push offs. Johnny Most would positively despise these guys. We can only imagine the nicknames. McBaldspot and McFacemask? Little Lord Chauncey-pants? The possibilities are endless.
Where Have All the Good Times Gone
Did anyone catch Dan Shaughnessy's piece in the Sunday Globe? I had to check the date on the paper to make sure it wasn't April 1st just because of the sheer ludicrousness of the theme of the article. In short, it was a lamentation by Shaughnessy that the media rules have changed to the point where A) too many people (read: bloggers) are getting media passes and therefore are ruining access for everyone else, B) neither he nor Bob Ryan share rides to the airport with Celtics players and thus don't really know them anymore, and C) that because media icons like Shaughnessy and Ryan have to petition for access to the players just like everyone else, the poor readers end up suffering from that lack of access. This is just too rich, coming from a guy who includes "Antagonize readers" on the top of his list of daily chores, next to "Rigorous One Mile Run". Shaughnessy also mentioned that the players are growing increasingly distrustful of the media under the present rules in place. Again, this from a guy who once called Jose Offerman a "piece of junk", David Ortiz a "sack of you-know-what" and has since engaged in his own personal and highly unprofessional war of words against Curt Schilling. Are you kidding me? This is like Hannibal Lecter preaching to us about the evils of cannibalism. It would be funnier if it wasn't yet another stark reminder of just how far the quality of the Boston Globe sports page has fallen over the past two decades.
Outta Love Again
I'm putting together a petition that says "Can We Go Back to Sitting Sam Cassell in Favor of Eddie House Again?" I'm pretty sure I can get 10,000 signatures by noon. Yes, yes, I know all about Lindsey Hunter and his effect on House's handle coming up the floor. However, I thought Boston's previous switch to Pierce and Posey on ball handling duties with House in the game worked fairly well. Beyond Cassell's superior ball handling, there is simply no other reason to play him over House. On defense, Cassell has been getting burned more often than Charles Barkley at a Casino table. On the other end, he famously hogs the ball (did you see Pierce steadily denying him the rock two games ago?) and, too often, he alters the offense to fit his own game. Cassell also has a disturbing tendency of hefting up ill-advised long jumpers before the offense even has a chance to set up. To justify such a bold shot selection, he damned well better be knocking those down, but he hasn't been. As they say, the definition of insanity is doing the same thing over and over again and expecting different results. Sam Cassell is clearly insane but if Rivers continues to send him out there, then I'll begin to wonder about the coach's mental health as well.
I'll Wait
Think about the huge play of Pistons' players such as Rodney Stuckey and Jason Maxiell. Lindsey Hunter has also done an exceptional job in filling his role as the primary harrasser on the ball. Unfortunately, the Celtics have received nothing close to such a sustained level of contribution from their bench players thus far in this series. It's been a major issue for Boston and will continue to be so unless the reserves find a way to step up their game. At this point in the season, the Celtics need several things to happen at the same time to continue winning: Play lockdown defense, receive strong offensive play from two of The Big Three, and receive a lift from the bench (Rondo's play is also important but, for the sake of argument, let's keep things simple). The Celtics' starters are obviously tired and that fatigue is leading to breakdowns on the defensive end. How many times have we seen them play excellent defense for the first 20 or 22 seconds, only to see it fall apart at the end of the possession? It's the legs. They're running short on juice. To help alleviate the problem, the starters need more rest but Doc Rivers hasn't been able to provide that rest because his reserves haven't been getting the job done. How this issue plays out will have a crucial impact on the reaminder of this series and (hopefully) beyond.
Happy Trails…
…until we meet again, in the wake of the monumentally important Game 5…


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Rule 1: Proteins, Starches and Fruits Should Not Be Combined
Marilu believes there are three foods that should never be combined: Proteins, starches and fruits. The reason to avoid eating them together is because they contain components that are mainly digested in different parts of the body. Fruits contain simple sugars, which are first processed by enzymes in your saliva; by the time they reach your stomach, they're already partially digested. Starches like potatoes, grains, pasta, bread and rice are mostly digested in the intestines. Meanwhile proteins like poultry, fish and eggs are broken down mostly by enzymes in the stomach. Marilu believes that if these foods are eaten together, your body struggles to simultaneously produce the separate enzymes necessary to properly digest the food. The result, Marilu claims, is an extended, energy-depleting digestion process.
To maximize your energy levels, Marilu suggests you eat proteins or starches with an energy-boosting helper. Try legumes like beans, tofu or peanuts. You can also combine proteins or starches with vegetables like cabbage, lettuce, mushrooms and other leafy greens. These foods will speed up digestion and increase your energy.
Put Marilu's plan into action using her meal plan below:
Breakfast: Burrito Omelet
Start your morning with an omelet with beans and veggies. This meal combines the protein of eggs with legumes and vegetables.
Lunch: Mashed Potatoes and Arugula Salad
Combine arugula with potatoes. The starch and veggies are the perfect combination for a satisfying energy-boosting lunch.
Dinner: Shrimp and Peanut Lettuce Wraps
If you always feel like you are going to bed bloated, this meal will prevent that discomfort. It's a perfect food combination because your protein (shrimp) is paired with legumes (peanuts) and veggies (lettuce). This meal ensures smooth digestion before bedtime.
Rule 2: Eat Fruit Alone
Marilu is a big believer of snacks. Eating frequently, whether it's 6 small meals a day or meals with snacks in between, is like shoveling coal in the furnace to replenish your energy flame. For maximum energy benefits, snack on fruits, and eat them on their own.
Rule 3: Eat Your Water – Don't Drink It
Marilu does not advocate drinking water with your meals, as she believes doing so will dilute your digestive juices. Instead, she recommends eating "wet" foods – like tomatoes, zucchini or red kidney beans that have a high-water content. These selections will help you digest and stay hydrated, a key to long-lasting energy.
Marilu suggests following these rules for 7 days to see if you note an improvement in your digestion and energy levels.


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Intro 1.16.12: Videos from Kelly Clarkson, Static Jacks, Cults and more
Kelly Clarkson is stronger. Proof comes at Radio City Music Hall on Saturday.
Intro brings you the week's hottest videos and shows every Monday. To catch up on all the Intros and watch classic Long Island music scene videos, check out Newsday Music's YouTube channel at http://www.youtube.com/newsdaymusic.
KELLY CLARKSON, "What Doesn't Kill You (Stronger)." At Radio City Music Hall Saturday.
STATIC JACKS, "Into the Sun." At Music Hall of Williamsburg Thursday.
I AM THE AVALANCHE, "Brooklyn Dodgers." At Broadway Bar Sunday.
ANTHONY GREEN, "Only Love." At Looney Tunes Tuesday and Bowery Ballroom Thursday.
JEFF MANGUM, "Everything Is." At BAM Friday and Saturday.
CULTS, "Go Outside." At Webster Hall Thursday.
JONATHA BROOKE, "Crumbs." At Lincoln Center Tuesday.
MATT NATHANSON, "Faster." At Radio City Music Hall Saturday.
ROBERT EARL KEEN, "The Road Goes on Forever." At Irving Plaza Friday and The Paramount Saturday.
JANE MONHEIT, "I Won't Dance." At Birdland Tuesday, Wednesday, Thursday, Friday and Saturday.
Tags: Intro , Kelly Clarkson , Static Jacks , Anthony Green , I Am The Avalanche , Jeff Mangum , Cults , Jonatha Brooke , Matt Nathanson , Robert Earl Keen , Jane Monheit


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Founded in 1954 in Encino, California, El Torito has been a pioneer in the California full service Mexican casual dining restaurant segment. Leveraging more than 50 years of operational experience, El Torito is currently the largest Mexican restaurant brand in California in terms of number of restaurants. Designed to replicate authentic cooking found in a traditional Mexican hacienda, the concept focuses on using fresh, high-quality ingredients to prepare made-from-scratch Mexican cuisine. A staple of El Torito's menu, and an example of the Company's commitment to freshness, is the popular made-from-scratch tableside guacamole that is prepared according to the guests' specifications. Located predominantly in Southern California, the concept offers lunch, dinner and Sunday brunch.
Operating 59 locations, El Torito's menu features regional specialties created by its own executive chef, including sizzling fajitas, hand-made tamales, enchiladas and tacos as well as traditional Mexican combination platters. Salads and soups are also available for both lunch and dinner. El Torito offers a wide selection of upscale margaritas, in addition to a complete list of beers, tequilas and cocktails. El Torito also offers take-out and delivery, as well as catering and in-house banquet services.
The concept drives additional traffic during the traditionally slower day parts of early evening and weekly post lunch periods through Happy Hour offers and specialty theme menus. As part of the Happy Hour promotion, guests enjoy value-priced signature appetizers and drinks. The Company's Pronto Lunch Menu and Lunch Buffet offers guests. value priced entrees that are prepared quickly to accommodate time sensitive guests. El Torito stimulates incremental traffic with value promotions such as its $3 Happy Hour and its longstanding Tacorita Tuesday programs, where guests can enjoy .99 cent grilled chicken or steak tacos in the cantina.
Most El Torito restaurants offer a lunch, dinner and kid's menu daily along with a Sunday brunch buffet. The food at El Torito is prepared using the freshest ingredients, with an emphasis on high-quality meats and fresh vegetables, prepared in a traditional Mexican style. El Torito is known for tableside preparations, including that of its most popular appetizer, tableside guacamole, which is made to the guests' specifications. Additionally, El Torito, keeps its menu exciting by offering "Chef's Specials", which are regional Mexican appetizers, entrées and desserts that are prepared according to recipes collected by our executive chef during his frequent visits to Mexico. The menu offers a range of fajitas, enchiladas, tacos and burritos, as well as a variety of combinations of these menu items. The menu includes soups and entrée salads as well as a wide selection of desserts. The drink menu includes a variety of margaritas, tequila, Mexican and American beers and other liquors.
The design and architectural elements of El Torito's restaurants are key ingredients to the guest experience. The atmosphere at El Torito resembles that of a traditional Mexican hacienda that is welcoming, fun and festive.


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After Lying About His Wealth on National TV, Michael Moore Admits He's A One Percenter
On Wednesday NewsBusters exposed Occupy Wall Street supporter Michael Moore for lying on national television about his wealth.
Clearly feeling the pressure to come clean, the schlockumentary filmmaker took to his blog Thursday to set the record straight - kind of:
Twenty-two years ago this coming Tuesday, I stood with a group of factory workers, students and the unemployed in the middle of the downtown of my birthplace, Flint, Michigan, to announce that the Hollywood studio, Warner Bros., had purchased the world rights to distribute my first movie, 'Roger & Me.' A reporter asked me, "How much did you sell it for?"
"Three million dollars!" I proudly exclaimed. A cheer went up from the union guys surrounding me. It was absolutely unheard of for one of us in the working class of Flint (or anywhere) to receive such a sum of money unless one of us had either robbed a bank or, by luck, won the Michigan lottery.
Moore went on to explain what he did with his jackpot:
1. I would first pay all my taxes. I told the guy who did my 1040 not to declare any deductions other than the mortgage and to pay the full federal, state and city tax rate. I proudly contributed nearly 1 million dollars for the privilege of being a citizen of this great country.
2. Of the remaining $2 million, I decided to divide it up the way I once heard the folksinger/activist Harry Chapin tell me how he lived: "One for me, one for the other guy." So I took half the money -- $1 million -- and established a foundation to give it all away.
3. The remaining million went like this: I paid off all my debts, paid off the debts of some friends and family members, bought my parents a new refrigerator, set up college funds for our nieces and nephews, helped rebuild a black church that had been burned down in Flint, gave out a thousand turkeys at Thanksgiving, bought filmmaking equipment to send to the Vietnamese (my own personal reparations for a country we had ravaged), annually bought 10,000 toys to give to Toys for Tots at Christmas, got myself a new American-made Honda, and took out a mortgage on an apartment above a Baby Gap in New York City.
4. What remained went into a simple, low-interest savings account. I made the decision that I would never buy a share of stock (I didn't understand the casino known as the New York Stock Exchange and I did not believe in investing in a system I did not agree with).
It really is something when a man lies to cover up his lies.
After all, in 2005, Peter Schweizer in his book "Do As I Say (Not As I Do): Profiles in Liberal Hypocrisy" included a copy of Moore's schedule D from one of his tax filings showing that the schlockumentarian at one point owned almost 2,000 shares of Boeing, nearly 1,000 shares of Sonoco, more than 4,000 shares of Best Foods, more than 3,000 shares of Eli Lilly, more than 8,000 shares of Bank One, and more than 2,000 shares of Halliburton.
As Schweizer told MSNBC's Joe Scarborough on November 3, 2005:
PETER SCHWEIZER: Well, Michael Moore has said at least half-a-dozen times, I don`t own a single share of stock, because he considers investing in the stock market to be dirty money.
Well, I guess he is technically correct. He doesn`t own a single share of stock. He owns tens of thousands of shares of stock. And what is interesting is, is looking at the portfolio.
Michael Moore, yes, the same Michael Moore, owns shares in defense contractors like Boeing. He owns...
JOE SCARBOROUGH: No. Well, hold -- hold on. No way. You are telling me...
SCHWEIZER: Yes.
SCARBOROUGH: ... that Mr. "Fahrenheit 9/11" profits off of the war, because Boeing profits off the war, that he despises?
SCHWEIZER: Yes, that`s exactly right. He owns shares in Honeywell.
And, believe it or not, Joe -- it`s on the back cover of the book -- he, in recent years, has owned shares in Halliburton, the Darth Vader of corporate America.
SCARBOROUGH: OK. Hold on. I got to stop you, Peter...
SCARBOROUGH: ... because this guy said that he doesn`t invest on Wall Street. Are you telling me that he just is just lying to us?
SCHWEIZER: It`s a flat, bald-faced lie. When he says that he doesn`t own shares, I pulled IRS forms from a tax shelter of his. And he has hundreds of thousands of dollars on the stock market.
Right now, for example, he is preparing a film on pharmaceutical companies, attacking the health care industry. In recent years, he has owned shares in Tenet Healthcare, which runs HMOs, Pfizer, and Eli Lilly. He is a complete hypocrite on this front.
SCARBOROUGH: And we have got to go to a break, and I want to talk to you on the other side.
But, just before we go to the break, are you telling me again that Michael Moore has owned stock in Halliburton?
SCHWEIZER: Yes. That`s what his IRS forms -- and he signed his own IRS forms.
So Moore's own IRS forms show that one of his tax shelters owns thousands of shares of stock.
But that's not what he wrote Thursday: "I made the decision that I would never buy a share of stock (I didn't understand the casino known as the New York Stock Exchange and I did not believe in investing in a system I did not agree with)."
As such, he's lying again.
Also of note, Moore discussed the $3 million he made from Roger and Me, but he didn't say a word about earnings from subsequent films.
As our friends at Celebrity Net Worth note:
Fahrenheit 911 raked in $230 million in theaters and another $3 million in DVD sales. After the theaters take their traditional 50% cut, that leaves roughly $130 million. Take away marketing, production and distribution expenses and Moore is conservatively left with $80 million. Moore was able to secure a deal from Miramax which guaranteed him 27% of his film's net revenues, or roughly $21.6 million. Michael also was entitled to 50% of the profits of Sicko which are estimated to be $17 million.
Moore didn't discuss any of this in his piece Thursday, nor did he mention his current net worth is $50 million.
I guess he's not interested in telling the whole truth yet.
- Noel Sheppard's blog
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LIberals like this clown are
Submitted by Smartypants on Fri, 10/28/2011 - 2:47pm.
LIberals like this clown are not interested in the truth, except to the extent it helps them in their cause or helps them look better. Moore acts as if what he did with his first movie profits is all that matters. It's also nice that he bought an "American made Honda". Was that made by union workers, Michael? He also does not address the fact that he shuns union employees on his own projects. Paying union wages and benefits is something the other guy does I guess. Is there anything worse than a limousine liberal?
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And the "established" media goes...
Submitted by DumbCanuck on Fri, 10/28/2011 - 2:56pm.
Yes, they've must have seen this song and dance so many times before, that lefty hypocrites aren't even news anymore.
Really now... is it really news when someone on the left is proven to be a lying hypocrite?
I would say that it happens so often, that the lamestream media has developped a built-in auto-defense response to immediately spike. They've done it so often now, it's become second nature to them. A conditional response... kind of like a doctor knocking on your knee with his li'l rubber hammer.
Pavlov's dogs is another example/metaphor that I would use here.
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"The guy who did my 1040"
Submitted by SickofLibs on Fri, 10/28/2011 - 3:01pm.
Oh yeah, that would be Henry over at the local H&R Block I guess.
BS. I am positive Lardass pays a top CPA firm more to do his taxes than the average shlub earns in a year.
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Well, the corpulent creep
Submitted by killa37 on Fri, 10/28/2011 - 3:04pm.
Well, the corpulent creep doesn't 'feel' like a 'one-percenter', so that's all that really matters, right??? I mean..........he 'looks like half the country', he wears a baseball cap to prove he's a homeboy, his personal hygiene appears to be suspect, and he goes around to these rallies to further his phony-ass image as a 'working class hero'..........so how could anyone possibly think that he is part of the EVIL 1%???
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he also has spent many of his $$$$-
Submitted by JIMMY1660 on Fri, 10/28/2011 - 3:09pm.
on meals-
shame on him.
what a joke.
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Michael Moore is a lying
Submitted by ThePickle on Fri, 10/28/2011 - 3:17pm.
Michael Moore is a lying D-Bag.
(please notice the lack of an exclamation point as this is not "news" to me)
HOWEVER, this and a multitude of other cases, wherein prominent Liberals are shown to be utter and complete liars, will mean as little a a fart in a windstorm to the mindless hoards of libs that slaver over each pronouncement from these lying POS's. They talk the talk and provide much needed "affirmations" to the little people on the front lines.
Meanwhile they adjourn to their life of luxury secure in the knowledge that they have appeased the masses by saying the right words and that as such it will be only their "minions" that truly suffer when they establish their "utopia".
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He set up a foundation with
Submitted by inquiringmind on Fri, 10/28/2011 - 3:23pm.
He set up a foundation with one million, Hmmm that allowed him to defer about 500,000 in income.
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Even if his blog post were
Submitted by SPCOlympics on Fri, 10/28/2011 - 3:37pm.
Even if his blog post were true he still ignores the hypocrisy.
While he didn't claim all his deductions, he did claim his mortgage which probably was his biggest deduction allowed.
He paid his required taxes but his didn't volunteer more than that to the Feds.
Sure he gave away more than a third to charity, but HE decided where the money went, not some bureaucrat in Washington.
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Moore hasn't figured out
Submitted by celator on Fri, 10/28/2011 - 3:47pm.
Moore hasn't figured out that, while he routinely lies on "national TV". and is never corrected by the MSM, we have Al Gore's Amazing Internet and will catch him every time. He's made a fortune making movies which lie from the opening scene to the last.
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Michael Moore is not lying...
Submitted by dbo on Fri, 10/28/2011 - 3:54pm.
...he is not a one percenter. $350,000/yr makes you a one percenter. Moore is closer to a 0.01 percenter.
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Big Fat Problem For The Left
Submitted by rammingspeed on Fri, 10/28/2011 - 3:59pm.
Lefties will never publicly admit it, but Michael Moore as been a big fat detriment to the cause. He's a gaffe-a-minute machine and a laughing stock. But he does help with fund raising, so they have to put up with him. Have a ball, lefties!
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Then there is this.
Submitted by Par for the Course on Fri, 10/28/2011 - 4:28pm.
Filmmaker Michael Moore Takes Michigan Film Tax Credits After Criticizing Program
January 29, 2010
The Mackinac Center in Michigan has this video describing more saga with Michigan's film tax incentive program, where Michael Moore has criticized corporate welfare but will receive it for the making of his recent film, "Capitalism: A Love Story."
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Submitted by bkeyser on Fri, 10/28/2011 - 4:32pm.
Right off the bat he's comfortable and proud to pay a 33% tax rate as a multimillionaire. I'm pretty sure the tax rate is higher than that now. Then, being the proud, big-government American that he is, he gives another million to charity. That's respectable, but why not the IRS, Mikey? I'm also a little concerned about the number of union friends who apparently rob banks.
The problem with liars is that they are rarely able to remember all of their lies. Sicko.
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I'll tell ya,
Submitted by killa37 on Fri, 10/28/2011 - 4:45pm.
I'll tell ya, BK...............I was looking at that list of 'charities' that the corpulent commie, the rotund re-distributionist, and the stout socialist lays claim to having done............and I've got to believe that some of it has got to be 'urban legend', or some figment of his cholesterol-addled mind. I mean - just read it - it's PERFECT!!!
And he only bought his parents a new refridgerator???? Cheapskate................
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I recommend clicking on the Moore blog link...
Submitted by MightyMouth on Fri, 10/28/2011 - 4:57pm.
some of the comments are pure gems of moronic Micheal Moore leg humping. How people can be so deeelusional is beyond me! One guy was arguing that Moore was not in the top 1% even though his networth is a paltry 50 million buckaroos. Ha Ha Ha!
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M.M. is...
Submitted by Bhaal on Fri, 10/28/2011 - 5:25pm.
so full of crap he has to wipe his face with toilet paper each time he speaks.
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Submitted by telecaster on Fri, 10/28/2011 - 6:42pm.
Michael Moore is a liar and a hypocrite. Now there's a news flash!
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Most of the liberal Democrat masses...
Submitted by shooter on Fri, 10/28/2011 - 6:45pm.
Most of the liberal Democrat masses and voters are so ignorant, they probably have no idea what a "hypocrite" is, nor do they care.
All they care about is getting that "gummint" check each month...and they will vote for anyone who will either continue that or give them more.
They are the true "zombies"...
"An armed society is a polite society" -- Robert A. Heinlein
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mike the tank
Submitted by D'saredumbpeople on Fri, 10/28/2011 - 7:45pm.
he meant he eats 99% of the world's twinkies.
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What, Me Greedy?
Submitted by IrateNate on Fri, 10/28/2011 - 8:16pm.
Let us not forget the lawsuit he brought against the producers of "Fahrenheit 9/11" thinking the $20 million they gave him wasn't quite enough.
But, to be fair, Mr. Moore was no doubt planning on using the additional funds to buy more toys for children, movie cameras to the Iraqis, or perhaps a string of "Krispy Kreme" franchises...for the needy, of course.
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Don't forget about those
Submitted by killa37 on Sat, 10/29/2011 - 1:47am.
Don't forget about those 'black' churches that were burned to the ground - by white conservative TEA party members.
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i guess we can call him...
Submitted by OldJoe on Sat, 10/29/2011 - 2:22am.
Millionaire Moore.. say often enough, it should stick.
Maybe he'll run out for a triple quarter pounder and super size the fries..
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Michel Moore...alias.....
Submitted by thescoots on Sat, 10/29/2011 - 9:21am.
"PorkChop".....has hutzpa....give him that much.....as for the rest.....pure, unadulterated hypocracy.
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Heh, I have run out of things to say about Michael Moore
Submitted by Dave. on Sat, 10/29/2011 - 10:47am.
I just wish he would go away - even if he goes away mad.
Vote for the American in November
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name all of them
Submitted by jimtrees on Sat, 10/29/2011 - 1:14pm.
Every time someone starts to talk about a rich democrat, they should start with the word millionaire. Like millionaire Mike, millionaire Nancy Pelosi, millionaire Bill Maher, millionaire Barak Obama, millionaire Harry Reid, millionaire John Kerry and so on.Every time one of these little piss-ant owsers open their mouths, throw it right back at them. When a republican begins a speech, start off by reminding the puplic of all the rich democrats.Elephants could jump through Kerry's tax loop-holes.
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In his contribution to Gifts and Interests (Morality and the Meaning of Life) , Jacques Godbout suggests that the freedoms of modernity are "founded on the immediate and permanent liquidation of debt." In the market, all debts are immediately canceled: You give me goods over the counter, I give you money; we both leave without owing anything to each other (25).
This enables him to specify the difference between gift and commodity:
'"A debt voluntarily entered into is essential to the gift . . . The partners in a gift system are in a positive or negative state of debt. If it is a positive state, this means that each person believes he owes a great deal to the others." In short, "the market is founded on the liquidation of debt" while "the gift . . . is founded on debt" (30-31).
The two "systems" are not commensurate. Godbout thinks that it is a flaw of social science to assume that human beings act according to a linear means-ends calculus, and gifts prove that this is inadequate. Gifts are not necessarily unilateral, but "one makes a gift, one often receives something more in return, but the relationship between the two is much more complex than the linear model of instrumental rationality is capable of explaining" (30). Trying to explain gifts in terms of market exchanges (e.g., he received after giving, therefore he gave to receive; the end is receiving and the means is giving) is simply an imposition of market logic on exchanges that operate by a different logic.
Godbout thinks that the market logic is no more "natural" than the other. He suggests instead that there is a "natural" instinct to give - at least, this is as plausible as saying that we have a natural tendency to truck and barter. This upends the study of gifts: Instead of investigating why people give (as if giving were a strange anomaly among creatures who seek only self-interested ends), he wants to ask, Why not give? What inhibits giving?


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via nimg.sulekha.com
Fuck you. Fuck you Price. We came to your ballpark and fucking dominated you for two games, and we were somewhat respectful to your awful crowd. Then you come to our ballpark and yeah you win two games. You wanna mock our fans, though? Maybe you weren't mocking. Maybe you just felt bad that you and your fans don't have that same connection. I mean if your fans wanted to do the claw and antlers, they'd need to get over that arthritis they got. Most of them don't even know they're at a baseball game. The bus just took them to your stadium because the bingo house was full. B 07 does not get you the blackout on your card. It's just your starting pitcher who is starting the game. Maybe you could do a new thing with him, you know instead of stealing ours. Maybe you could do the cane tip. Here is an illustration.
As you see you just kind of point your cane to the field. Used for when someone gets a good hit or something. Which won't happen much considering Cliff Lee is on the mound for us. I didn't believe we could win this game, but this has got me fired up. Looking through google pictures and seeing every idiotic face Price gives, and their manager who thinks he's in the beatles. I know their fans will say "Get off our lawn" to our rangers, but the fact is they can't! It's not even a fucking lawn. So get ready Yankees the Rangers are coming for you, antlers and all.


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Villa player on emergency loan to Forest
Aston Villa player Alan Hutton has joined Nottingham Forest on an emergency loan.
The 27-year-old is committed to Nottingham Forest until 2nd January, available for nine games.
Chairman Omar Al Hasawi said:
– Chairman Omar Al Hasawi
"Like most of the signings we have made, Alan brings great experience to our squad.
"He has played at the very highest level and will be a big asset to us over the next six weeks."


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CATEGORIES Classics, Comedy, Drama, Gay & Lesbian, Horror, Music & Musicals, Sci-Fi & Fantasy, Casting, RumorMonger, Celebrities and Controversy, 20th Century Fox, Remakes and Sequels, CinematicalHoly sweet transvestite, Janet. Rumors are swirling around the internet about the possibility that Fox may finally be making some progress on that Rocky Horror Picture Show remake and/or possible sequel we've been hearing about since 2002 (c'mon, guys, this can't be that hard -- it's just a jump to the left, and then a step to the right ... right?) The remake was supposed to have happened to coincide with the show's 30th anniversary, but that came and went a year ago (not that anyone's counting). The more interesting rumor du jour is that shock-rocker/artistic genius Marilyn Manson supposedly let slip in an interview with E! that Fox has approached him about the possibility of taking on the role of Dr. Frank-N-Furter, originated by Tim Curry.
Before we go any further here, folks, I want to make it abundantly clear: All these stories out there -- every single one I've found thus far -- references a single piece on bloodydisgusting.com that's based on a single report from a reader that he or she heard Manson say on an interview with E! that Fox had approached him about the role. I haven't seen the interview myself, I can't find a copy of it online, and even the E! Online website, fount of truth and knowledge, makes nary a mention of this news. Manson's official website, while visually very cool, is either not navigable at the moment, or I'm not artsy enough to figure out where to click to get anywhere. The Heirophant, the official Manson fansite, also has no news about Manson potentially taking on Frank , nor even a mention about the supposed E! interview -- although you can find all kinds of fascinating stuff about Manson there, including this interview in which Manson talks about the film we do know is really underway, Phantasmagoria: The Visions of Lewis Carroll, which, in addition to being written and directed by Manson, will also star him in the role of Carroll. That's one I can't wait to see. The site does list Manson as being on Leno -- on Halloween, shockingly enough -- so perhaps he'll let something more substantial slip there. Even the official RHPS Fan Site doesn't make mention of this rumor, and if anyone would be on the ball about any and all things RHPS, you'd think it would be those guys.
It's kind of interesting that so many sites are reporting this as if it's gospel truth based on one unsubstantiated source, but such is the nature of the internet. Personally, I'm always suspicious of rumors that propagate across the internet like wildfire with no factual back-up, so at this point I'm taking the whole thing with a generous portion of salt (and perhaps a generous portion of Meatloaf). And yet -- I'm strangely intrigued by the idea of Manson as Frank. I mean, who else could you possibly imagine taking on that role and bringing it back to the big screen, except perhaps Curry himself? Well, maybe Johnny Depp could pull it off, but other than that?
It's not as if other folks haven't played the part of Frank-N-Furter. The live stage version, The Rocky Horror Show, has been touring since the '90s with various actors in the lead role, and every town from San Francisco to New York City and thousands of points in between has had live actors -- both men and women -- playing the role during screenings of the film with local casts ranging from the maudlin to the hard-core, practically professional troupes that rehearse weekly and spend thousands on sets and costumes, but a big screen remake is another kettle of fish.
Now I know all you Frank-N-Fans out there fall into one of two camps on this rumor. So speak up, current RHPS fans -- and yeah, all you old folks (and I include myself in this category, so don't take offense) who used to run around theaters in lingerie in your glory days, shouting out audience lines at the movie screen and tossing your toast in the air. Do you love Marilyn Manson and think that he could do an awesome job taking over the reins from the Curry, or do you get all hot and flustered at the mere thought of Fox even considering handing the role of Frank over to another performer? And are you content to occasionally wander out to a midnight screening of RHPS, or are you looking forward to a remake with antici ... pation?
More stories on Marilyn Manson and Rocky Horror:
Manson Wants Depp for New Film
Manson Takes a Dip Down the Rabbit Hole
Vintage Image of the Day: Oh, Rocky ...
Vintage Image of the Day: Shock Treatment


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Financial Daily from THE HINDU group of publications
Friday, Sep 02, 2005
Agri-Biz & Commodities
Industry & Economy - Metals
Non-ferrous metals prices increased
Our Bureau
Mumbai , Sept. 1
FOLLOWING a firm trend in the international market, all major non-ferrous metal producers including Nalco, Hindustan Zinc, Sterlite, Birla Copper and Hindustan Copper have increased the prices of their metal products from Thursday, trade sources said.
Major copper producers, including Hindustan Copper Ltd, Sterlite and Birla Copper Ltd, have increased the prices by Rs 9,600 to 1,96,849 a tonne (Rs 1,87,234) of copper cathode (full) and Rs 2,01,855 a tonne (Rs 1,92,228) for CC rod category.
National Aluminium Co has also increased sale prices by Rs 1,400 to 1,02,700 a tonne for aluminium ingot and by Rs 1,650 to 1,04,550 a tonne for aluminium wire rod.
Hindustan Zinc has raised its prices by Rs 7,100 a tonne for zinc products and Rs 2,600 a tonne for lead metal.
The company has increased prices to Rs 75,100 a tonne (Rs 68,000) for special high grade (SHG) zinc and Rs 74,900 per tonne (Rs 67,800) for high grade (HG) zinc.
In lead metal category, the company has increased to Rs 49,300 a tonne (Rs 46,700) for the current month.
The Bombay Metals Exchange (BME) has also revised its benchmark price of copper wire bar upward by Rs 9,640 to Rs 2,07,611 a tonne (Rs 1,97,971) in line with the firm LME trend.
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You think your kid's school is bad…
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Length 18:52


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Hello everybody,
Yes I'm new and none of you know me, but I'm a long time follower of this site and have noticed a few Madden players around and though a tourney might be a fun idea given the lack of any true football news or action currently. I'm on Xbox and hoping that represents the majority, but if not we could have separate PS3/Xbox tournaments. The idea would be for interested parties to leave a comment including their gamertag to show their intent, then I would draw names at random to determine the initial pairings and bracket. I would hope it goes without saying that fairplay(i.e. no nano blitzing) would be expected by all. Being that most of us are going to want the Broncos(I would hope anyways) that's fine, just make sure to have different colored uniforms for your own sakes.
My Xbox tag is "BeansOverFrank" and I look forward to meeting you all. Also as a side note, if anyone either runs or is in a solid sim league I'm looking for a new one as declining interest and a commish who nano's constantly has kind of killed my enthusiasm for the one I'm in.


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Garry Boytos, UTHSCSA, Panelist, Print 13 In-Plant Panel: Success Stories from the Field
Print 13 In-plant track session R18, "In-Plant Panel: Success Stories from the Field" Monday 9/9.
In-plants panelist, Garry Boytos, The University of Texas Health Science Center at San Antonio (UTHSCSA) reveals his success secrets.
More info and registration: http://bit.ly/panel13


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Leyton Orient start new signing Chris Dagnall on bench at Crewe (From This Is Local London)
Report news now! Text pictures & video to 80360, starting message with WITNESS then leave a space
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New signing Chris Dagnall starts on bench for Leyton Orient at Crewe
2:26pm Saturday 18th January 2014 in Latest Sport By Simon Mail
Leyton Orient could give a debut to new signing Chris Dagnall from off the bench at Crewe this afternoon.
Former Barnsley and Rochdale striker Dagnall signed on Thursday and he is on the bench along with fit again midfielder Romain Vincelot.
Jamie Ness makes his first league start in midfield with Marvin Bartley ruled out due to his hamstring injury.
Leyton Orient: Jakupovic; Omozusi, Clarke, Baudry, Cuthbert; Cox, James, Ness, Odubajo; Lisbie, Simpson
Subs: Sawyer, Lasimant, Larkins, Vincelot, Loza, Dagnall, Coulthirst
Comments are closed on this article.


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By STEPHANIE BEECKEN6 News Reporter
SEVIERVILLE (WATE) - Over the past month several people have come together to save the life of a dog who'd been shot.
The thin, injured dog was found roaming in Sevierville when a family took her to the vet. The dog is older and one leg has been amputated but one woman stepped up to give the injured dog a home just in time for Christmas.
As an early Christmas gift for herself and her foster child, Kay Hodge adopted a pooch named Lady.
"She's very sweet and it surprises me how trusting she is. She is very trusting," said Hodge.
Lady had been shot. A family in Sevierville found her, fed her and tried to gain her trust.
"It's incredible. She wouldn't have made it if it hadn't been for that couple. They are the heroes here," said Hodge.
The couple was eventually able to take the dog to the vet where she underwent surgery.
"The vet had to amputate her leg, but you're doing really good aren't you, Lady?" said Hodge.
The couple who rescued Lady had nine pets already and couldn't keep her. So, on Monday Hodge stepped in to help give the older, injured dog a forever home.
"She needs love and attention just like any other dog, and I've just got a heart for the neglected and abused," said Hodge.
Lady may only have three legs, but that doesn't slow her down. Hodge says while she has given Lady a home, Lady will give her family back much more in return. Hodge hopes more people consider adopting rescue animals.
"It's very rewarding. It just feels good to help, and the dogs just have unconditional love for you, they really do," said Hodge.
"Do you consider your animals a part of your family?" 6 News asked. "Oh yeah," said Hodge. Hodge says Lady is a new member of the family for life.
As far as medical treatment, Lady is still on antibiotics. Her stitches come out Saturday. Hodge says she's looking forward to giving her new dog a bath.
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Comment: Re:What's wrong with Gmail? (Score 1) 121
I didn't read TFA, let alone finish reading TFS... After all, and I'm assuming the service is hosted in the US, the White House has access to any keys which are transmitted to and from Silent Circle's systems.
From TFA: "Silent Circle stresses that their product offers secure communications within the networks and only uses Canadian servers that are outside of U.S. government control."


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Two things need to happen in order for the Zags to share the WCC regular season title with St. Mary's and get an auto bid into the semi-finals in Vegas. 1. Win our remaining two games vs BYU and San Diego. 2. We also need St. Mary's to lose another game.
I believe we can do this. We play extremely well at home {see: recent thumpdowns of SMC & LMU}. BYU does not play as well on the road as they do in the Merriot Center. Also, unfortunately, BYU also comes in having suffered a significant player injury.
The injury news on the BYU front: They are going to come into the Kennel with their top scoring player, Noah Hartsock, either unable to play, or in most likelihood not able to contribute anywhere near 100%. He went down this Saturday with what initially appeared to be a severe knee injury. Turns out it is not as bad as first thought, but he is unable to practice fully as of today.
And on the SMC front: St. Mary's will be without their star guard, Stephen Holt, who is done for the season with a knee injury. SMC has lost 3 of it's last 4 and look to be taking quite the nose-dive since his injury.
Not very long ago it looked like the historic streak of consecutive WCC Titles was lost. We receievd a reprieve when we performed spectacularly in a two win weekend over SMC and LMU, coupled with a loss by SMC to LMU, we suddenly were not only alive but controlled our own destiny. But then, before losing the high of this fortuitous turn of events...we choked at USF on Saturday and that pretty much dashed our hopes for once and all. Or did it? With this sudden rash of injuries we have extra hope. But, should there be an asterisk after such a streak if aided along by them?
I do not want to win the WCC title because our opponents suffered injuries. I hate to even think about it but, the unthinkable has happened. I remember a few years ago that SMC had a very good team, argueably better than this years version. We played them in a defining game at the Kennel where they led us at halftime. Unfortunately, their star guard Patty Mills, broke his wrist just before the half and we went on to win the game and keep our streak alive. I bring this up becaue there are those who suggest if Mills had played the whole game we would not be taking about a steak right now.
If we play very well, win out, and even win the WCC Tourney, there will be questions. Of course, I do like it that we are still alive and in a position to reach our season goals. I do not like it that we may be able to get there partially, because of our opponents terrible luck.
Yes, I know injuries are a part of the game. We have had players with injuries this season too and who's to say we would not have won the first meeting at SMC if Robert Sacre's thumb was not injured or how much the loss of Ryan Spangler has cost us? I guess we will never know...But if we win out and SMC falls flat...there will be questions.
What do you think about our chances now, and about the recent injuries to our two best competitors players?


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The California Assembly voted 52-21 to approve SB1172, a bill restricting therapists from offering ex-gay therapy to minors. As Jim Burroway notes, the bill's language has been watered down to eliminate fines, as well as informed consent requirements for adults seeking therapy. During the debate, some Assembly members spoke out against the bill, such as Linda Halderman (R), who suggested the Assembly should focus on priorities like "taking perverts out of the classroom," and Shannon Grove (R), who insisted that, "It's my job as a parent to protect my children," even if that means harmful therapy. The bill now returns to the Senate for a concurring vote on the amendments.
California Assembly Advances Bill Limiting Ex-Gay Therapy To Minors
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"There is little glamour at the Division of Health and Welfare as we try to undo the flaws and wrongs in people's lives left by living second-best. On every possible occasion the League spoke out forcefully against all forms of racism that infect our society. On every possible occasion we testified on government policies as they affect black and poor people...
Through the Urban League doors in South Providence walk the thousands of jobless, the disenchanted, those who are grievous with the quality of healthcare, with the quality of city services…, the aged, and the dropouts, the dislocated veterans…, all looking for the understanding and healing of a friend."
What would you say if I told you these words appeared in the Urban League of Rhode Island 1975 Annual Report: In Quest for Community? Would you say that it seems as though it were written yesterday? With all of our advances in technology, our reforms in government and public policy our society is still plagued by many of the tribulations of our past. Societal disparities still exist and that is why the Urban League of Rhode Island is still here.
Each year we speak to you about the issues directly affecting you—our constituents, supporters and partners. Each year we see both great strides and disappointing setbacks. This year and in the coming year, we are establishing our recommitment to our mission and to you. We will redouble our efforts in the face of dwindling funding, economic recession and overwhelming demand for services.
The causes we champion may not always be popular; but they are the causes most closely touching our community. Housing and homelessness, community re-entry, family reunification, child welfare and education, adult education and job training, prevention referral and counseling, basic needs assistance; these are the areas that shape our society. These are the areas that require social service attention. We will continue to be there.
I ask that you join me in applauding the leadership of the Board and staff; who are also vigilant to the changes in our society and dedicated to ensuring that our organization remains in step with the times. The agency owes its thanks to these individuals, as well as to the members of the Guild and Young Professionals who carry our intentions to the community through their service projects.


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Shippensburg, PA (PRWEB) January 21, 2014
Destiny Image is proud to announce the release of founder, Don Nori, Sr.'s, latest book, "The God Watchers."
What is God's will for my life? Christians have asked this question for centuries. In recent years, the desperate have flooded conferences, attended events, and traveled to the latest, greatest seminars in hope of answering this nagging question and bring true peace to their seeking souls.
Nori's latest book proposes that maybe we are looking for purpose in all the wrong places?
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Interviews, review copies and giveaway copies are available upon request.
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Kristen Adams
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Jackson Police say man in white van kidnapped the manager at the Dollar General store at 1214 W. Capitol St. around 4:30 p.m.
They say it may have been a disgruntled customer. A shot was fired, but it is unclear if the manager was hit.
We'll have more on this developing story on News Channel 12 at 6.
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