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Reduction will begin the first day of the next month and remain in effect until an acceptable MA-11 is filed with the Department. b ; If a nursing facility fails to file a timely final MA-11 and outstanding annual MA-11s: 1 ; The net operating components of the nursing facility's per diem rate will be determined on the basis of the nursing facility's peer group medians, prior to the percent of median adjustment in accordance with 1187.96 relating to price and rate setting computations ; , for the last fiscal period for which the nursing facility has an acceptable MA-11 on file. 2 ; The capital component of the nursing facility's per diem rate will be set at ##TEXT##. Subchapter G. RATE SETTING 1187.91. Database. The Department will set rates for the case-mix payment system based on the following data: 1 ; Net operating costs. i ; The net operating prices for year 1 of implementation will be established based on the most recent audited nursing facility cost report adjusted for inflation, for those nursing facilities receiving audit reports issued by the Department on or before March 31, 1995. ii ; If an Intergovernmental Transfer Agreement has been executed on or before January 15, 1996, and the State Plan Amendment with sufficient funds to carry out the terms of this subparagraph has been approved by the Health Care Financing Administration HCFA ; , the net operating prices for year 2 of implementation will be established based on the following: A ; Audited nursing facility costs for the 2 most recent years available in the NIS database adjusted for inflation. This database includes audited MA-11 cost reports that are issued by the Department on or before March 31, 1996, of the July 1 price setting period. B ; If a nursing facility that has participated in the MA Program for 3 or more consecutive years has fewer than two audited cost reports in the NIS database that are issued by the Department on or before March 31, 1996, of the July 1 price setting period, the Department will use reported costs, as adjusted to conform to this title, for those years not audited within 15 months of the date of acceptance, until audits have been completed and are available in the NIS database for price setting. C ; If a nursing facility, that has not participated in the MA Program for 2 consecutive years, has fewer than two audited cost reports in the NIS database that are issued by the Department on or before March 31, 1996, of the July 1 price setting period, the Department will use all available audited cost reports in the NIS database. iii ; If an Intergovernmental Transfer Agreement has not been executed on or before January 15, 1996, and the State Plan Amendment with sufficient funds to carry out the terms of subparagraph ii ; has not been approved by HCFA, the net operating prices in year 2 of implementation will be established based on the provisions contained in subparagraph iv ; . iv ; The net operating prices for year 3 of implementation and thereafter will be established based on the following: A ; Audited nursing facility costs for the 3 most recent years available in the NIS database adjusted for inflation. This database includes audited MA-11 cost reports that.

But I tell you of a truth, many widows were in Israel in the days of * Helias, when heaven was shut three years and six months, when great famishment was through out all the land, and unto none of them was * Helias sent, save in to Sarepta besides Sidon unto a woman that was a widow. And many lepers were in Israel in the time of * Heliseus the Prophet: and yet none of them was healed, saving Naaman of Syria. And as many as were in the synagogue when they heard that, were filled with wrath: and rose up, and thrust him out of the city, and led him even unto the edge of the hill, where on their city was built, to cast him down headlong. But he went his way even through the midst of them: and came into Capernaum a city of Galile, and there taught them on the Saboth days. And they were astonied at his doctrine: for his preaching was with power. And in the synagogue there was a man which had a spirit of an unclean devil, and cried with a loud voice saying: let me alone, what hast thou to do with us, thou Jesus of Nazareth? Art thou come to destroy us? I know thee what thou art, even the holy of God. And Jesus rebuked him saying: hold thy peace, and come out of him. And the devil threw him in the midst of them and came out of him, and hurt him not. And fear came on them all, and they spake among themselves saying: what manner a thing is this? For with authority and power he commandeth the foul spirits, and they come out? And the fame of him spread abroad through all places of the country round about. And he rose up and came out of the synagogue, and entered into Simons house. And Simons mother in law was taken with a great fever, and they made intercession to him for her. And he stood over her, and rebuked the fever: and it left her. And immediately she arose and ministered unto them. When the * son was down, all they that had sick taken with.

6. Are there any issues of competency which ACC needs to refer to the relevant professional body and the Health and Disability Commissioner for investigation? No The contemporaneous clinical records and subsequent reports indicate that [Mr A] was treated appropriately following his presentation to [the hospital's] A&E on 31 3 [Dr B] has taken an appropriate history and examined the patient according to an acceptable standard. Advice to be detained overnight for neurological observation was correct despite reluctance of the patient ; on account of the lack of clear competence of the patient to take his own discharge. There is clinical evidence that [Mr A] was under the influence of alcohol and post mortem examination of his blood identified residual amounts of alcohol 8mg per 100 ml ; . In the absence of brain CT a period of 4 hours neurological observations is generally recommended following head injury with return of normal consciousness. This is complicated by the presence of alcohol and overnight observation is generally regarded as the appropriate level of care when minor head injury co-exists with alcohol intoxication. The neurological observations remained stable overnight as reported in the nursing record. Note has been made by the complainant that no ECG was taken on arrival. In the light of the presentation and lack of complaint of chest pain this was not unreasonable. There is no documented evidence of seizure and in the light of his subsequent neurological recovery following a period of unconsciousness on the evening of 31 3 and lack of brain injury on post mortem ; it can be assumed that [Mr A] suffered a period of concussion following a fall complicated by alcohol intake. His incontinence of urine can be attributed to his altered neurological state and intoxication. On presentation he was noted to have a GCS of 14 indicating mild neurological impairment. By 22.50hrs his pulse was 92 and his oxygen saturation was 92%. He declined further recordings. The following morning, although short of breath he was able to eat breakfast. There is no evidence that [Mr A] collapsed or died from Myocardial Infarction. 7. If the claim meets the criteria for medical misadventure, does it raise any issues that in the public interest ACC should report to the appropriate authority? No and formoterol.

Mr. Terrence Thompson Robert Hagan Dr Salik Govind Dr B.Altanzagas Dr. Enkhjargal Gombajov Liduvina M.Gonzales Badamkhorloo Lkhamsuren Dorjgotov Tsendsuren Khasha B.Batbayar Tsendsuren Chimedtseren Mr Tsegmid Bold Mr Gombosuren Munkhbayar Ms Narantuya Ms Oyunchimig Mr. Enkhsaikhan Nyamjav Sumberzul Dr Yameen Mazumder Tuya Mungun Saijaa Nagnii Ms J Altantuya Dr I Bolormaa Mr. Mr Gamboldt Mr. A. Orgilt Mr Dr Jiang Regional Adviser, Environmental Health, WHO Western Pacific Regional Office, Manila Manager WHO, Ulaanbaatar office UB ; Program Management Officer, WHO, UB Lecturer at School of Public Health, UB Research Officer, Ministry of Health, UB Communicable diseases surveillance and Response Officer, WHO, UB Director World Bank Ulaanbaatar, UB Manager and Engineer, World Bank, UB Nurse Health department, Darkhan-Uul Aimag Governor of Orkhon soum Governor of Darkhan Soum and Vice governor of Darkhan-Uul Aimag Head of the City Maintenance and Public Utilities Division, UB General Manager of City and Chief of the Mayor's office, UB Officer at international department, Ministry of Health, UB Officer in charge of Water and Sanitation, Ministry of Urban Construction and Development, UB Head of the Health Department, Mandalgobi Dean, School of Public Health, UB Program Coordinator, UNICEF, UB National Officer Health &Nutrition, UNICEF, UB Director, Public Health Institute, UB Division Director, Ministry of Health, UB Scientific secretary, Public Health Institute, UB Governor, Delgerkhanjai Soum Governor, Erdenedalai Soum Sanitary Engineer, Sub Depart Services, UB city School of Engineering, UB WHO, Beijing and forteo.