Podcasts about some states

In what will certainly be remembered as a landmark decision, the Supreme Court has overruled a 40-year-old precedent that gave federal agencies, rather than judges, the power to interpret ambiguous laws passed by Congress. Administrative experts say the decision will dramatically change the way key health agencies do business. Also, the court decided not to decide whether a federal law requiring hospitals to provide emergency care overrides Idaho's near-total ban on abortion. Alice Miranda Ollstein of Politico, Victoria Knight of Axios, and Joanne Kenen of Johns Hopkins University and Politico Magazine join KFF Health News chief Washington correspondent Julie Rovner to discuss these stories and more. Plus, for “extra credit,” the panelists suggest health policy stories they read this week they think you should read, too. Julie Rovner: The Washington Post's “Masks Are Going From Mandated to Criminalized in Some States,” by Fenit Nirappil. Victoria Knight: The New York Times' “The Opaque Industry Secretly Inflating Prices for Prescription Drugs,” by Rebecca Robbins and Reed Abelson. Joanne Kenen: The Washington Post's “Social Security To Drop Obsolete Jobs Used To Deny Disability Benefits,” by Lisa Rein. Alice Miranda Ollstein: Politico's “Opioid Deaths Rose 50 Percent During the Pandemic. in These Places, They Fell,” by Ruth Reader. Hosted on Acast. See acast.com/privacy for more information.

Some States still tax Social Security and other retirement income. What happens if you retire in a State that doesn't tax retirement income or pensions? Does it make sense to move in retirement for a more favorable tax situation? What can we learn about taxes from the Shohei Ohtani blockbuster baseball contract with the LA Dodgers?

Some States still tax Social Security and other retirement income. What happens if you retire in a State that doesn't tax retirement income or pensions? Does it make sense to move in retirement for a more favorable tax situation? What can we learn about taxes from the Shohei Ohtani blockbuster baseball contract with the LA Dodgers?

Some States in the US are already looking to exclude Donald Trump from their ballots in 2024; over half of Americans claim they interact with dead relatives, and the Pentagon is ramping up autonomous AI development. Later, we look at a countermovement to the "Gospel-centered" movement. Visit Matthew Pancake's Facebook http://www.facebook.com/matthew.pancake Visit Pastor Gary Held's Facebook http://www.facebook.com/garyheld Visit our Website www.RadicalGraceRadio.com Visit Our Youtube Page RGR Youtube

While you're watching this video, another autistic child is in a clinic to sign papers to get medically or surgically castrated. Possibly scarred and changed for life in an experimental, dangerous procedure. Regret-rate? Unknown. Parents are lied to and told that their child will commit suicide if they say no (there is no data to back that up.)It's borderline insane what's being done to parents and children in schools and gender clinics. No informed consent is the norm. Coercion, negligence, manipulation are common characteristics. Autistic teenagers are coming out as DE-transitioners on Youtube full of regret and anger towards parents and doctors who allowed this to happen before their brains were even fully developed. Meanwhile, some people are trying to turn psychologists, parents and nurses into criminals if they question a 14 year old boy who thinks she's a girl or vice versa. Some States want to take parents out of the mix. Sex change without parental consent here we come. We're Experts NowHi there Future Expert! Stop by our channel to get your education with a comedic twist!Listen on: Apple Podcasts SpotifyHere are 3 ways we can start turning autism symptoms around together, whenever you're ready... 1. Send me a voice message and get my feedback on your most pressing struggles. 2. Check out the free video series "The 5 hidden messages behind autism symptoms" and find your child's unique triggers. 3. Work with me privatelyIf you'd like to work with me directly to turn as many symptoms around as possible in my Autism Turnaround Coaching and implementation group..send me an email with "coaching" in the subject line and tell me how old your child is. I'll get you all the details.

About the Electors | National Archives There is no Constitutional provision or Federal law that requires electors to vote according to the results of the popular vote in their States. Some States, however, require electors to cast their votes according to the popular vote. These pledges fall into two categories—electors bound by State law and those bound by pledges to political parties. The U.S. Supreme Court has held that the Constitution does not require that electors be completely free to act as they choose and therefore, political parties may extract pledges from electors to vote for the parties' nominees. Some State laws provide that so-called "faithless electors" may be subject to fines or may be disqualified for casting an invalid vote and be replaced by a substitute elector. The Supreme Court decided (in 2020) that States can enact requirements on how electors vote. No elector has ever been prosecuted for failing to vote as pledged. However, several electors were disqualified and replaced, and others fined, in 2016 for failing to vote as pledged. Mushrooms PetClub 247 Click Here: https://www.empshield.com/?coupon=ror Save $50 on each unit with coupon code ROR Please consider supporting Right on Radio. Support Right on Radio https://patron.podbean.com/RightonRadio PayPal for Jeff paypal.me/JeffRamsperger Join the movement, make the switch My Liberty Stand – Taking back our country or email rightonjeff@gmail.com Web Site: Right on Radio | a podcast by Right on Radio (podbean.com)  New Rumble Channel Right on Radio (rumble.com) Subscribe Back up Video Channel on Odysee https://lbry.tv/@RightonRadio:9 Right on U Link: https://rightonU.com -Real Estate Investing, use code SAVE800 -Creating Wealth  SAVE $300 USE Coupon Code GETFOR197 -STAR Achievement System Purchase for $17 use coupon "STAR" Get Swag www.rightonmerch.com   Follow on Twitter @JeffRighton Digital Soldiers: Welcome to the SoS Army [Shepherds of Sheeple Army] Web Site https://sosarmy.mailchimpsites.com/  Subscribe:https://rightonradio.podbean.com/​ Follow: https://gab.com/  Right on Radio​ Telegram: https://t.me/right_on_radio [Main Channel] Digs https://t.me/RightonRadioDIGS Chat https://t.me/RightonRadioCHAT Live Right in the Real World! We talk God and Politics, Faith Based Broadcast News, views, Opinions and Attitudes We are Your News Now. Keep the Faith

Illegal Aliens Automatically Registered to Vote in Some States, Analysts Warn

We get this question all the time.  People are told "your income is too high to qualify for Medicaid".  However, their income is WAY less than what it takes to pay for the nursing home.  Some States have what is called an "Income Cap" which means there is a maximum amount that you can make.  However, that limit is much under the amount that facilities cost.Therefore, you have to jump through some hoops to qualify.  That "hoop" is commonly called a Miller Trust.  Today, Todd and Sara talk about the Miller Trust and how you can create it and still qualify for Medicaid even if you have a higher income than allowed.*Note: Not every State has an income cap so don't be surprised if you have never heard of this.Information to help you answer all of your questions about aging.

Questioning Pollsters and Pundits Assumptions That Republicans Will Take the House and the Senate | Changes in Voting Laws Make it Easier to Vote in Some States and Harder in Others | The Need to Prevent the War in Ukraine Escalating Into a Confrontation Between NATO and Russia backgroundbriefing.org/donate twitter.com/ianmastersmedia facebook.com/ianmastersmedia

Morse code transcription: vvv vvv Ukraine war US to ramp up military presence across Europe Ukraine war Putins cousin among inner circle hit by new UK sanctions Kamala Harris breaks silence on 53 Texas migrant deaths, says Abbott went straight to politics Some district attorneys in red states have vowed not to prosecute abortion cases January 6 committee subpoenas Trump White House counsel Pat Cipollone for testimony Charles charity cash donation would not happen again Bruces Beach returned to family nearly a century after seizure Democrats Weigh Paring Biden Tax Hike to Win Over Manchin Bloomberg Xavier Becerra US is backsliding with abortion ruling, says health secretary Airbnb permanently bans parties and events around the world Jackson to take Supreme Court oath Thurs., minutes after Breyer retires Ukraine war Johnson says if Putin were a woman he would not have invaded R. Kelly given 30 years in jail in sex abuse case The future of privacy rights in a post Roe world Nato summit Turkey pushes Finland and Sweden on extradition after deal Paris attacks Surviving suspect Salah Abdeslam found guilty Hershel Williams, a Hero in the Battle for Iwo Jima, Dies at 98 Payment Data Could Become Evidence of Abortion, Now Illegal in Some States Hutchinson stands by her testimony after pushback NATO backs military aid for heroic Ukraine, Russia steps up attacks

Morse code transcription: vvv vvv Democrats Weigh Paring Biden Tax Hike to Win Over Manchin Bloomberg Bruces Beach returned to family nearly a century after seizure Payment Data Could Become Evidence of Abortion, Now Illegal in Some States NATO backs military aid for heroic Ukraine, Russia steps up attacks Hutchinson stands by her testimony after pushback Xavier Becerra US is backsliding with abortion ruling, says health secretary Airbnb permanently bans parties and events around the world Paris attacks Surviving suspect Salah Abdeslam found guilty Charles charity cash donation would not happen again Hershel Williams, a Hero in the Battle for Iwo Jima, Dies at 98 January 6 committee subpoenas Trump White House counsel Pat Cipollone for testimony Kamala Harris breaks silence on 53 Texas migrant deaths, says Abbott went straight to politics Nato summit Turkey pushes Finland and Sweden on extradition after deal Ukraine war US to ramp up military presence across Europe R. Kelly given 30 years in jail in sex abuse case Jackson to take Supreme Court oath Thurs., minutes after Breyer retires The future of privacy rights in a post Roe world Some district attorneys in red states have vowed not to prosecute abortion cases Ukraine war Johnson says if Putin were a woman he would not have invaded Ukraine war Putins cousin among inner circle hit by new UK sanctions

Morse code transcription: vvv vvv Democrats Weigh Paring Biden Tax Hike to Win Over Manchin Bloomberg Ukraine war Johnson says if Putin were a woman he would not have invaded R. Kelly given 30 years in jail in sex abuse case Xavier Becerra US is backsliding with abortion ruling, says health secretary Kamala Harris breaks silence on 53 Texas migrant deaths, says Abbott went straight to politics Ukraine war Putins cousin among inner circle hit by new UK sanctions Hutchinson stands by her testimony after pushback The future of privacy rights in a post Roe world Paris attacks Surviving suspect Salah Abdeslam found guilty January 6 committee subpoenas Trump White House counsel Pat Cipollone for testimony Nato summit Turkey pushes Finland and Sweden on extradition after deal Bruces Beach returned to family nearly a century after seizure Jackson to take Supreme Court oath Thurs., minutes after Breyer retires Hershel Williams, a Hero in the Battle for Iwo Jima, Dies at 98 Some district attorneys in red states have vowed not to prosecute abortion cases NATO backs military aid for heroic Ukraine, Russia steps up attacks Airbnb permanently bans parties and events around the world Payment Data Could Become Evidence of Abortion, Now Illegal in Some States Ukraine war US to ramp up military presence across Europe Charles charity cash donation would not happen again

Monday May 23, 2022 - Foreclosures have not been an issue since the pandemic. One of the first things Government did was to issue a Foreclosure Moratorium. Last August the CDC moratoriums came to and end based on a United States Supreme Court ruling on the issue.. Some States (like Illinois) maintained a foreclosure moratorium thereafter - but no more! “A total of 50,759 U.S. properties started the foreclosure process in the first quarter of 2022, up 67% from the previous quarter and up 188% from a year ago,” Chicago saw over 3,000 foreclosures in the first three months of the year. Attorney Steven A. Leahy reviews the numbers and also talks about the tax implications of losing a home to foreclosure. Did you think the IRS wouldn't be involved? https://www.courthousenews.com/foreclosure-wave-sweeping-us-crests-in-chicago/ https://recentlyheard.com/2022/05/22/foreclosures-and-your-income-tax/ https://propertyonion.com/education/supreme-court-throws-out-the-foreclosure-moratorium/ --- Send in a voice message: https://anchor.fm/steven-leahy1/message

Professor Paul Gragl, European Law at the University of Graz, Austria, gives a talk for the Public International Law seminar series. Abstract: Despite the overwhelming scientific evidence that vaccines are, in general, safe and effective, vaccine hesitancy continues to thrive due to various reasons, such as misinformation, the wish to protect one's personal autonomy, and/or religious or moral beliefs. Vaccine hesitancy therefore endangers attaining and maintaining herd immunity which protects those that cannot be vaccinated due to medical reasons. Some States have consequently implemented compulsory vaccination schemes in order to close this gap in protecting public health, which, however, raises two essential questions in the context of human rights protection: (i) if a State has done so and implemented a compulsory vaccination scheme, does it potentially violate Articles 2,8, and 9 of the ECHR? In other words, are the ECHR Contracting Parties under a negative obligation to abstain from introducing such measures? Or (ii) if a State has not done so (yet), is it actually under a positive obligation to introduce such measures in order not to violate these provisions? On the basis of the ECtHR's recent judgment in Vavřička and others v. the Czech Republic (April 2021), I will discuss these questions and conclude that States are, if specific requirements are met, not prohibited from implementing such measures, whilst they are also not obligated to do so under the ECHR as long as they protect those most vulnerable to infectious diseases through other means. The presentation is based on a paper which will be published in the European Convention on Human Rights Law Review. Paul Gragl is Professor of European Law at the University of Graz, Austria. His research interests include public international law, EU law, human rights law, and legal theory as well as philosophy, which is reflected in his most recent monograph Legal Monism: Law, Philosophy, and Politics (OUP, 2018).

On The Town With Tanya lineup: Some States lessening jail time IF inmates take the vaccine? A 22 year old wins $1Million, for taking the vaccine! Miami Police Chief calling for stiffer gun laws after a drive by shooting? But What about after Columbine, Newtown, Las Vegas, California, Dylan Roof, Kyle R? What did we learn from George Floyds Murder? Later Tanya talks with Comedian for Hire; Tony Viagra on being back on stage after a year! "SketchOphrenia" releases a new improved sketch with "Marjorie Taylor Green-cheese and News Reporter Flash" "Conspiracy Theories from The Senate"

The Gleadhraich guys return as we reflect on our experience of touring on the East Coast of the USA with shows in Alexandria, Asbury Park and New York City. There are many tales to be told here as we reflect on the highs and lows, trials and tribulations and scandalous stories of being on tour together in Some States.

Tick checks are imperative if you have been outside.  I make my kids take showers after being outside. Listen in for what to do if you find a tick crawling on you or if one has bitten you.  Proper tick removal will ensure you aren't letting it inject more toxins into you. If you have been bitten SAVE THE TICK and have it tested. Some States offer free tick testing.  Check with your health department. In Pennsylvania - http://bit.ly/GuudLymePATest   Other labs include:   www.tickchek.com  www.ticknology.com Please share what you are learning with others.  Lyme is in every State in the USA and over 80 Countries world wide.  We need knowledge for prevention.

Press the “play” button at the top left or on the picture to start the show. Call in number:  215 383-3832. Action Radio live shows and podcasts:  BlogTalkRadio.com/citizenaction International calls online - Skype name - GregPenglis Bill writing site:  www.WriteYourLaws.com Patreon sponsors:  https://www.patreon.com/ActionRadio Twitter:  @ActionRadioGP Parler:  @GregPenglis Facebook:  Facebook.com/radiolegislature ***** Action Radio Show Notes:  4/12/21  ***  This was an incredible show, with 4 amazing women telling their story in the second hour. 00:00 - The Rice Report, with Milton City Councilwoman Shannon Rice.  It was just me this half hour so I talked about the appauling "lifeboat ethics" of the Prime Minister of St. Vincent, who, after a volcano, decided only those who had taken the risky Covid mRNA shots were worthy of being rescued.  The naturallly immune were on their own. 7:30 - The National Security Report, with Dr. Peter Vincent Pry.  A whole series of bad news particularly North Korea and Iran, except for the blackout at a nuke plant caused by Israel in self defense. 8:00 - Main Topic, Guests and Callers.  215 383-3832.  This is where we talked about massive health problems, injuries, diseases and deaths, all caused by breast implants.  Some States like Arizona are passing new patient disclosure laws. We need these nationwide. ***** Action Radio is the synergy of radio broadcast technology, the internet, the radio audience, articles, podcasts, news videos, state and federal legislators, the governors, and even the President, in an entirely new way to make our laws.  

Season 2, Episode 3 of SDM- Some NFL Free Agency and the Patriots Signing ALL the Free Agents, Some Golf, Some States and their questionable COVID-19 sports guidelines. Can we get to it all? Jumping right back into the saddle. In our cups this week is an Imperial Brown Ale from Ashland, OR and a…. Kentucky straight bourbon.

Tampa Bay wins the Superbowl; day 2 of the Impeachment trial for former President Trump as impeachment managers present their arguments to the Senate-Trump was aware of insurrection scheme; Americans are playing in the Australian Open; Schumer, McConnell finalizing deal on Trump impeachment trial; New York to Allow Fans at Madison Square Garden, Barclays Center on Feb. 23; Some States are NOT allowing teachers to get Covid-19 vaccines as “Psaki defends White House's definition of reopening schools amid criticism”; the Biden administration asks Supreme Court to save Obamacare, flipping Trump arguments; “Biden plan to lift refugee cap his least popular executive action” and more, if we can fit it in at 7:15pm, EST.

What should I do with my new DOT medical certification? Link: https://rankingmastery.com/edit_questions.asp?action=info&id=1339&a=9022&p= Answer is: In the state of Florida, in which I reside, they only have two options. You can upload it online or you can take it into the DMV. Every state does require that it be attached to your driver's license so you need to find out what your state regulations are. Some States allow you to fax it in. Some States allow you to put it in online, but others require you to physically take it in.   As the medical examiner, we are required to submit it to FMCSA. If you have any other questions, please contact me at the Drivers' Health Clinic at www.drivershealthclinic.com. Thank you.   Watch on Video: https://www.youtube.com/watch?v=9c2tzHnOTdo We hope you learned something of value from this video. To reach Bethany with Drivers Health Clinic directly go to: https://drivershealthclinic.com or email them at: drdixon@drivershealthclinic.com Do you want to get discovered on the web like all or our Guests RankingMastery Podcast Go to the RankingMastery website at https://rankingmastery.com

The SANTITA JACKSON SHOW Thursday, December 24, 2020 #Headlines; #Vaccines #COVID19 #Racism #Coronavirus; #Stimulus 6:06-6:10aC HEADLINES 6:10-6:15aC #GoodNews Rev. Atty. Janette Wilson Rainbow/PUSH 6:18-6:53aC #COVID19 Q&A Dr. Debra Furr-Holden Associate Dean, Public Health , Michigan State University Dr. Susan Moore Dies of Covid-19 After Complaining of Racism at Indiana Hospital https://www.nytimes.com/2020/12/23/us/susan-moore-black-doctor-indiana.html NYTimes: Questions of Bias in Covid-19 Treatment Add to the Mourning for Black Families https://nyti.ms/2xPIo4Z NYTimes: Black Americans Face Alarming Rates of Coronavirus Infection in Some States https://nyti.ms/3aRc0wZ 6:54-6:58aC #Georgia SENATE Races Atty. Daryl Jones TRANSFORMATIVE JUSTICE COALITION 7:06-7:10aC HEADLINES Shapearl Wells Christmas Food 7:10-7:58aC #Coronavirus #Stimulus Atty. CK Hoffler Atty Robert Patillo Dwight McKee Rev. Todd Yeary

- SUPER TUESDAY! - ERIK SCOTT SMITH: "How the Movie 'EVERYDAY MIRACLES' is Helping Believers Make Peace with Their Past - Starting with the Star of the Film!" - SUPER TUESDAY: "What is 'Ballot Harvesting?' Why is it ACTUALLY LEGAL in Some States but One Leading DEMOCRATIC SENATOR is Calling for Banning This Practice?" - Stefanie Cover of CoverLaw

Some States are Faring Better than Others - Aug 12 by Bureau of Business and Economic Research

Podcast: Raider-Cop Podcast Date: July 22, 2020 Episode #149 Subject: Law Enforcement Officer Safety Act (LEOSA), So What's The Problem ? Host: Al Martinino aka Alpha Mike Word Of The Week: Taste and see that the Lord is good. How happy is the man who takes refuge in Him. Psalms 34:8  Main Topic: LEOSA Law Enforcement Officer Safety Act / HR-218 Enacted July 22, 2004 Amended in 2010 and 2013 Amendment: Extend to those separated after 10 years (Active, Reserve, Auxiliary, Volunteer) Amendment: Extend benefits to active, retired military Department of Defense MP, & Amtrak Police Amendment: Retired LEO's must carry photo ID with authorized under LEOSA Qualify to receive the privilege issued by the State (pass qualification) Problem A. Definition of firearm based on State rules Problem B. Gun free zones Problem C. Some States do not issue a LEOSA authorization ID Problem D. Annual firearms certification per LEOSA, listing of certified instructors LEOSA is not clear on which firearm authorized to carry Reference: LEOSA 18 U.S. Code § 926B.Carrying of concealed firearms by qualified law enforcement officers (Cornell Law School)  LEOSA state by state: Why are retired police officers having problems? Eric Daigle Esq Law Group DLG Aug 6, 2019   Song Of The Week: Tiers on my pillow by Little Anthony Up Next: G-Shock #150 Become a member of the USCCA by hitting the link below or text "Raider" to 87222  @RaiderCopNews @TestEvery1521 Test Everything 5 minutes on the Power of God Instagram @day_with_milo Co-host of Raider-Cop Tube coming 2021 @raidercoppodcast Parler: @RaiderCopNation Facebook  Twitter iTunes  Spotify   Stitcher  Google Play  PodBean  YouTube TuneInJoin the Raider-Cop NATION Pistol Pete the Gunsmith Kilo Sierra’s Firearms Training or Investigation: Sepulveda inc #EmpanadaLadiesOfGeorgia #MoxieMatron @TanTenacity74 Twitter Manifest Your Dreams With Moxie Matron #JailsLASD #CACorrections #MDCR #NYPD #LAPD #LASD #MDPD #MPD #NYSP #NJSP #LVPD #Security #HCSO #PBSO #BSO #OCSO #PCSO #SFPD #DPD #HPD #SAPD #LCSO #FMPD #CCSO #NYC #NYCDOC #NJDOC #PPD #SLPD #CPD #TestEverything @RaiderCopNation #RaiderCopNation #TrainUp #o9TG #WiseGuySeries #TrainUpSeries #RollCallSeries #ThinkOuttaDaBox #SideBarSeries #BeLikeJack #Corrections Twitter @RaiderCopNation, Parler @RaiderCopNation, FaceBook @RaiderCopNation, Instrgram @DayWithMilo, Tik Tok @RaiderCopNation, Linkedin @raider-cop-podcast-ao12b96b/  Youtube Free Music: Triumph by Yung Logos, Rodeo Show by The Green Orbs, Minor Blues for Booker E’s Jammy Jams, Happy Birthday Mambo, by E’s Jammy James. The Awakening Patrick jazz Space, The Current Blues, Blue Infusion, Front Porch Blues, Crazy Blues, Midnight Special, Super Blues, Bright Eyed Blues, Bleeker Street Blues, Olde Salooner Blues, Miles BeyondPatrikiosMusic: I'm Back by Eye of the beholder.This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.   

Some States are pushing false stats when it comes to the Corona Virus, so how do you know what to believe?

With more Americans out of work than any time in recorded history, whether or not they will be able to earn a living is top of mind for many people. All too often, however, courts turn a blind eye to laws and rules that arbitrarily and unnecessarily shut people out of work. Recent state supreme… The post Can the Government Throw You Out of Work? (Not in Some States!) appeared first on Institute for Justice.

With more Americans out of work than any time in recorded history, whether or not they will be able to earn a living is top […] The post Can the Government Throw You Out of Work? (Not in Some States!) appeared first on Institute for Justice.

Some States have decided to fully open even though there is still a lack of testing & overcrowding in hospitals. Just because they have decided to open does NOT mean you need to be going out & mingling. A fresh set of nails is NOT worth your life or anybody in your intermediate family. 

Some States and Local Governments "Do the Reich Thing" in shutting down Churches to protect the people, while YouVersion tells us that Bible reading is way up!. Also Pastor Gary reveals the Biblical Principles for Surviving the Coronavirus Quarantine. Visit Matthew Pancake's Facebook http://www.facebook.com/matthew.pancake Visit Pastor Gary Held's Facebook http://www.facebook.com/garyheld Visit our Website www.RadicalGraceRadio.com Visit Our Youtube Page Risen Savior's Youtube Channel

Looming over this 22nd episode of our daily coverage of COVID-19 is the question of whether the lockdown will be extended nationally and what strategy may be followed for a calibrated exit in some sectors. Some States have gone ahead and announced an extension (as we publish, Telangana is the latest to do so, joining Odisha and Punjab). We discuss that as well as the mathematical graph put out by the Health Ministry which claims that India would have had over 8 lakh infections without the lockdown. We also get an update on India's exports of hydroxychloroquine to the world — a story that seems to take on larger dimensions by the day. (Recorded on April 11, 2020) Write to us with comments and feedback at socmed4@thehindu.co.in

Live from my personal Facebook page, I welcome Dr. Mark Milligan, PT, DPT from Anytime.Healthcare as he discussing how we can implement telehealth services into our physical therapy practice.  In this episode we discuss:  * How to set up a telehealth platform * How to perform an initial eval and follow sessions * How to bill (at least what we know right now) * The paperwork you need to start seeing patients today * And so much more!  Resources:  Anytime.healthcare Doxy.me Connected Health Policy/Telehealth Coverage Policies State Survey of telehealth Commercial Payers Telehealth Paperwork   For more information on Mark:  Dr. Mark Milligan, PT, DPT, is a board certified, fellowship-trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions. He is a full-time clinician with multiple patient populations and is the Founder of Revolution Human Health, a non-profit physical therapy network. Helping others create the best patient experience and outcomes through his continuing education company specializing in micro-education is also a passion. His latest venture is creating the easiest pathway to access healthcare for providers and patients with Anywhere Healthcare, a tele-health platform. He is an active member of the TPTA, APTA, and AAOMPT and has a great interest in the pain epidemic, public health, population health, and governmental affairs. Read the full transcript below:  Karen: (00:07): Welcome to the healthy, wealthy and smart podcast. Each week we interview the best and brightest in physical therapy, wellness, and entrepreneurship. We give you cutting edge information you need to live your best life, healthy, wealthy, and smart. The information in this podcast is for entertainment purposes only and should not be used as personalized medical advice. And now here's your host, dr Karen. Let's see. Hey everybody. Welcome back to the podcast. I am your host, Karen Litzy and in Karen  (00:40): Day's episode. I am sort of re airing a Facebook and Instagram live that I did last Wednesday with dr Mark Milligan all about telehealth. So a little bit more about Mark. He is a board certified fellowship trained orthopedic physical therapist. He specializes in the intelligent prevention and treatment of all human movement conditions. He's fulltime clinician with multiple patient populations and is the founder of revolution human health, a nonprofit physical therapy network, helping others create the best patient experience and outcomes through his continuing education company specializes specializing in micro education is also a passion. His latest venture is creating an easy pathway to access healthcare for providers and patients with anywhere. Dot. Healthcare. This is a telehealth platform. He is an active member of the Texas PTA, P T a and a amped and has great interest in pain epidemic, public health, population health and government, governmental affairs. Karen  (01:41): I should also mention that he is also on the PPS coven task force. So if you want to get the most up to date information on how the coven pandemic is affecting physical therapists in private practice, you can find that at the private practice sections website. It's all free even for non-members. All right, now onto today's podcast. Like I said, this is a recording from the Facebook live that we did last week. And in it we talk about what is telehealth. We talk about how to set up telehealth, how to implement telehealth, how to conduct a telehealth session for an initial eval or for a followup. We talk about how to get paid for telehealth and this is the information that we knew at the time. That was last Wednesday. Like I said, things are moving really, really quickly here. So the best thing to do in Mark says this is to check with your individual insurance providers, check with your state things are moving really, really fast. Karen  (02:45): And of course finally we talk about answer a lot of viewer questions. So a big thanks to Mark and I think this is really timely and I hope that all physical therapists that if you're listening to this, that you can set up an implement your telehealth practice ASAP. Thanks for listening. So today we're talking about how to implement telehealth into your physical therapy practice. As we all know, the COBIT 19 virus is causing a lot of disruption in healthcare and we're hoping that telehealth can help at least mitigate some of that interruption for the sake of our patients, for the sake of our own practices and for our businesses and for our profession. So Mark, what I would love for you to do is can you just talk a little bit more about yourself, where you're coming from and why we're doing this interview. Mark  (03:34): So Mark Milligan, Austin, Texas physical therapists board certified fellowship trained, but also for the last few years have stepped into a telehealth space and have anywhere healthcare, which is a digital platform for delivering healthcare. It's agnostic to provide her, so PTs, mental health providers, anybody that needs a HIPAA compliant platform to connect with patients. So the current situation is it's pretty mind blowing, right? We're seeing a, a world changing epidemic that will change the landscape of healthcare as we know it today. For several reasons. One is that people will be now exposed to a delivery of care method that they weren't otherwise are supposed to before. So telehealth and tele PT and tele medicine had been out there for a long time. Teladoc started in, in 1987, somewhere in there. So it's been around for a long time, but a rapid adoption of telehealth has really occurring right now for physical therapists. Mark  (04:30): What we need to know and what are the most important things right now are how it applies to us in this landscape. How can we be the best providers to meet our patients? Demand to help quell fear, doubt and an anxiety for our patients as well as, as providers and our businesses. And so stepping into this space is, it's been a little bit overwhelming. It's been a nonstop 70, 96 hours really. And so everything that I say today may or may not be true and four hours or smart [inaudible] because of how fast things are changing. So yeah, I think that tees it up. You want to kick it off? Yeah, Karen  (05:10): No, I think that's, that's great. That's perfect. So let's start out with, we got a number of questions from people from different therapists from around the country. And I think let's start with the number one question is how do you actually set it up? Totally basic one Oh one. So let's start with that, Mark  (05:33): Right? So the first thing you have to make sure is that you have patients that want this. And right now everybody wants that, right? So patient adoption of technology can be challenging, especially especially generational. So the issue with in, yeah. Pre COBIT has been adoption by, by therapists and by patients just because of ease of use. Now it's a, it's a forced adoption. So now we're in a set up where we, where are going to want this regardless of whether or not they want it. So first thing is patient population. Second thing is you need to look at your business, right? You need to look at your patient workflow and your business flow. So you need to have the appropriate from a business standpoint, you need to have a liability to make sure that you're covered in the telehealth space. So in my experience over the past few years, almost every liability insurance cover, it doesn't see telehealth as a, is a different delivery mode for physical therapy. Mark  (06:26): But with everything changing rapidly, it would be real. It would be highly advised that you contact your liability insurance provider and make sure that tele-health is approved as, as in your cupboard. All right? So that's logistics. Secondly, you need paperwork, you need onboarding paperwork for digital visits. You'll need a telehealth consent form and you'll need the digital release form. And if you're recording visits, you need to have a very specific form that that allows you to record patient visits. Some States don't allow recording some. And so you have to be very mindful of that. So onboarding paperwork, it's, it's good to have in fillable PDFs so that a patient can fill it out and then send it back to you digitally. Making sure that that transmission is is secure. You can also have E faxes, right? So they can electronically fax to you over a secure portal as well. So just basic things that we haven't really thought about as providers we need to adopt as mobile providers. Right. So, Oh, go ahead. Karen  (07:24): I know, I was going to say, so when we're talking about who is the best, what is the easiest way for us as a clinician to get that paperwork Mark  (07:32): Right? So they can email me. I've gotten a tele-health consent. I've got I've got that. So they can just email me at market anywhere. Dot. Healthcare. And I can send 'em I'm been sending that out over Facebook. I'm happy to share that with people. And of course you need to make sure and adapt it for your state in your practice. It's a word doc so you can switch out the logos and everything, but I'm happy to provide that for people. They can pass that that step. Karen  (07:57): And then one more question on paperwork and things like that. So when we are calling our insurance, our liability insurance carriers, aren't there specific questions we need to ask them or like what is the best way to have that conversation with our liability insurance providers? Mark (08:16): Right. Just say in this facing time that we're starting to provide care digitally. Am I covered for providing telehealth as a physical therapist? Simple. Straightforward. Karen (08:25): Okay. And so you may already be covered in your current policy, it might be part of your current policy, you just don't know it and then you're not, is that then added as a rider to your yes. Mark (08:38): Typically it's a very inexpensive writer. Okay.  Karen (08:41): All right. So before we set everything up, we get our liability coverage covered and we get consent forms, which can email to you or you can share them on under this post. It's whatever you feel more, most comfortable with or what might be easiest. And then we do what we got the paperwork covered. Now what? Mark (09:06): So you're sending that out to the patient. So they need to agree to be treated digitally. Right now it's really an interesting space. The CMS has waived temporarily a HIPAA privacy with when it comes to digital communication. I'm can't stress this enough that this is a temporary wave in, in the absence of mass abilities to communicate or HIPAA compliant platforms that patient that people are able to communicate via other means of non HIPPA compliant video software. So right now Skype and FaceTime are considered and what's the other one? Zoom and zoom and those well-known platforms are, are open, enable all those zooms just increased their prices yesterday. Yeah, so I would argue that you could use the, what's free and what's available right now in preparation as you prepare after this is over, you'll need to go back to HIPAA compliance. So in the immediacy video platforms are readily available across all. You cannot use public facing video platforms like tick talk or other things that mass put out your video. Okay. Karen (10:22): Instagram live or Facebook live. You can have your patient video, you can have your patient treatment sessions over live video, Mark (10:30): Right. That it means sounds, it sounds obvious, but you never know where people will do right by a group session. You can just do a giant group session. I'm going to train everybody on the East coast of America on a Facebook live. Karen (10:42): Yeah. Okay. All right, so good to know. So no one social media lives like we're doing right now, but for the time being during this outbreak, we can use face time, we can use zoom, we can use Facebook, zoom, Skype, Mark (10:59): Right. Totally. And you need to make sure that in your notes and documentation for your intake software or your intake paperwork, that you are waiting, that the patient is waiving their HIPAA rights during this time due to the COBIT outbreak and you are using this unsecured software and you will return to it as soon as possible. Right. Okay. This is a window. This isn't something that will last. And you need to note for your own CYA that you are, you acknowledged the existing coven scenario and that you will prepare for post that with, with my platform. Yeah. Yep. So technology on the technology side, it's really easy because you can plug and play as long as you get someone's if they have an iPhone or if they have Skype, easy set up, you can connect technology there. So once you get the form signed, you have the informed consent, the HIPAA, the HIPAA included waiver as well to sure that they understand that they are on an, they have to understand and agree to an unsecured network. Mark (11:58): Even though you can provide it, some people may not want it because FaceTime, that's all easily hackable. Right? So so they may not, or may, they may, they may not want to agree to that. So just have to be transparent with them in the, in your services. Right. So once you get that, I mean, it's really a matter of getting the patients, depending on your system, everybody's so different. So if you're, if you are a concierge PT and you're practicing out there for a fee for service cash base, you handle all your own scheduling when it comes for their time, you just flip them and you just call them on FaceTime, right? You collect their face, their number and you connect that way and you do your treatment, which we'll talk about in a bit, some other scheduling systems. You may have to, you know, type in a telehealth visit and your scheduling system or have some type of a demarkation for a telehealth visit versus an in person visit. Mark (12:47): And so work with your scheduling software, work with who you work with in order to make sure that that's appropriate so you can have the right amount of, or the right type of scheduling so you know where to go and what to do and how to bounce it. A billing, again, for the concierge practices out there, this is fee for service. Tele-Health doesn't take as long as normal to as normal PT. So I have my hourly rate broken down into 15 minute increments because it's roughly about 15 to 30 minutes. Is it an average tele-health followup evaluations in the last 40 to 50 minutes? But it just completely depends. So fee for service, it's really straight forward. You just charge per time, per minute, dollar, dollar, dollar, $52 a minute to 15 minute depending on your price point. Karen (13:29): Okay. All right. So now let's get into, so knowing how to actually set it up. So we've got a lot of these different things. What are some other platforms? I know anywhere. Dot. Health care. Doxy.Me. Mark  (13:46): Yup. Doxy.Me co view. So anywhere. Dot. Healthcare is the platform that I created. It's straight forward. Right now I'm offering you a $10 a month, unlimited use for anybody for three months while onboarding everybody. So to, to help people get to see patients doxy dot. Me actually has a free version where that's a, a room where people meet. So you can actually sign up. The patient is sent a link, they click on a link and it drops them right in a meeting room. Super convenient, super easy. There's no bells and whistles and it's free right now. So you can do that. I think a couple of other platforms I've seen throughout the Facebook live of Facebook groups that I'm in a few platforms are pushing out a free entry level software right now. So it's everywhere. So I think Karen  (14:31): We'll use G suite Mark  (14:32): D suite, right? So G suite, if you have a BA with, with Google, you can use Google meet. Right now actually with the, with the HIPAA waiver that's happening right now, you can actually use Google hangout. That would be another appropriate thing to use as long as the other person has the G suite or Google doc, a Google suite downloaded on their computer. So there are lots of, there's literally lots of options now there, there are other companies that offer other features, right? As you get into anywhere that healthcare, not only as a platform, but also as a billing feature and a scheduling feature. Doxy dot. Me if you upgrade to the higher levels, has a scheduling feature, a messaging feature, all types of stuff. So it really looking for different platforms. You need to be, do your due diligence and test them out to see what fits your practice best. I mean, some, some have exercises that are completely a part of the package that you can just have an HTP that sends right out from the program. Some have an actual, a range of motion measuring system so people can move their arm or their body in front of them. The then they can actually measure range of motion live on camera, which is pretty cool. So it just really depends on the need for your, your practice and also the practice size. Karen  (15:44): Got it. Yeah. Okay. So that's a lot of options for people going from free to low priced too. Mark  (15:52): $200 a month for co for HIPAA compliance zoom. Karen  (15:55): Right, right. Yeah. Yeah. Okay. So lots of options there for people. So we know we need some onboarding paperwork and we need to call our liability insurance carriers to see if they cover telehealth. Presently. And if they don't, then we need to ask them to put an addendum on and you can, they can do that immediately. It doesn't take like 30 days for that to happen. Right. Should be immediate. Okay. And so once we have all of the right paperwork and everything we decide what platform we're going to use and you just gave a whole bunch of different platforms that people can use. So all of those platforms are pretty easy to set up. And like you said, you send a link to the patient, they'd drop in and boom, there you go. And at this time we can use Facebook and Skype and, and not Facebook, sorry, Facebook. We can use Skype, regular zoom face time, all that. Okay. All right. Now Mark  (16:58): You may need other equipment though. You may, depending on the situation you may need. So some people, a desktop versus a computer are versus a tablet versus a phone all matter, right? So a desktop computer tends to be really well for you to have good communication and see the patient really well. But it's also very challenging for me to move my desktop to show somebody how to get on the floor and exercise, right? So the part of being a a digital physical therapist is that you have to be able to move and your equipment has to move with you. So some people use, I, you know, some people use a selfie stick to demonstrate exercises, right? Some people have one of those little iPhone holders that can be multiple or wrap around something so they can have different angles or show people at different places. Mark  (17:41): So understand that desktop can be good for this face to face interaction and the, and the immediate subjective interview. But maybe moving towards the objective exam or, or showing the exercise parts you may want to find or have a different device that's more mobile. So just thoughts for that. And you also need to think about your area or your headphones, your microphone and your lighting that can all add or take away from the experience of the digital experience. So making sure that you have those things. I use, I'm old school. I just use the old wired ear buds. They, when you're on the computer a long time, the wireless can die, right? And then all of a sudden you don't have new headphones. So I'm always a fan of just good old fashioned things that won't die on you after a long day of work. Mark  (18:26): So something to think about. You also may want to get a tripod to hold up your computer or you can get a standing desk. So there's lots of options in that space. But also you have to be considered for your backdrop. I love your backdrop that you have there in New York here and with the, with the cherry tree, that's all. It's very Boston's. That's awesome. I just have a plain white wall. Just be mindful of the environment that you're delivering this care in, right? You don't want you to be distracted. You don't want the patient to be distracted. You need to connect with the patient. Some of the key things that you need to think about are the connection that you're going to have with a patient. Something you can do easier face to face. It's challenging to get the connection and to have the emotional connection with the patient by a digital care. So setting up the environment for not only you to feel safe and, and that you feel comfortable that you're, no one's going to bust in, but also your patient needs to feel safe in that space too, so they can communicate to you in a free way that their patient information isn't being broadcasted to other people as well. So backdrops, microphones, computers, tablets, all have to be taken into consideration while you're doing this, while you're doing this intervention. Karen  (19:32): Okay, thank you. Those are great tips. How about cats that could, that could help or hurt you. Right? People love a cat. Great. If not, it can be a problem Mark  (19:44): Or at least they're not allergic to it. They're alerted to it. It doesn't matter. Right? So Karen  (19:47): Right. So pets can help or hinder, just kind of depends. Okay. So we've got, let's say now everyone has a better idea of how to set it up. And then the next question I got was how, Oh, they said this is great. Sound isn't great. I don't know why this sounds not great on, on Instagram, but, well, I mean it's going to be out on it as a podcast as well. So we'll, you'll be able to hear full sound tomorrow. At any rate, I dunno what to do. I could get my earbuds, but as we just said, what if they time out on me? Yeah. Okay. So let's talk about let's talk about how do you, what was it? How did, Oh, how do you actually execute a session? Mark  (20:40): Yeah. So once you've got somebody on the line, once you've got a patient in front of you, right? We know from our PT and our PT exam that about 80 to 90% of your differential diagnosis occurs in the subjective. So you go back to your old way of being, you shut up and you listen to the patient. Right? So, you know, so this is also assuming that you're doing an evaluation via telehealth, right? So most people at this space have patients that they'll flip from brick and mortar or in person into telehealth. So that's a different beast, right? So that's followup. That's exercise progression. Those are obvious things, right? That you're going to show them. You're going to talk them through their progression and talk to them about what they need to do next. Maybe show them a few new exercises when you're, we're, we're going to get, what we're talking about right now is the new patient that you'd never met before and what, how do you gain information to get them treated? Mark  (21:33): So subjective is key, right? You need to have your differential diagnosis hat on. You need to ask the next best questions, their intake form. You should have looked over, created your hypothesis list and make sure that you have a good idea of what you're trying to discover. It's your responsibility as a provider. I know it's written in the Texas legislation that if you, if the patient is not appropriate for digital care, you have to get them to an in-person provider, right? So doing your, you still have to do your red flag screens, you still have to do your due diligence and your differential diagnosis and make sure the patient's appropriate. Right? This is, you have to consider a digital visit to be no different than an in person visit. You have to take every precaution that you would take. I'm minus taking vitals unless the patient has their own, you know, portable, vital kit. You're gonna have them do that. But you have to take every precaution you would from an initial evaluation perspective as you would in a digital space. So going back to forms, you also have to have your intake form and consent to treat in there as well. That needs to be signed off as well. Karen  (22:31): So the, the same sort of forms that someone would have if they were coming to you or if you're like a mobile practice like me, you have them sign that initial paperwork regardless of whether you're seeing them in their home, in your clinic or, or via telehealth completely. Mark  (22:48): This is, you cannot be this any differently. Right? So take it, having all the consent to treat forms, signed all your intake paperwork done, differential diagnosis, red flags, you know, your three tiers. Are they appropriate for physical therapy or are they a treat and refer or they refer. You have to have that, you have to have that hat on. And so if they're presenting with sub with symptoms that aren't musculoskeletal and presentation, you need to be mindful of that and get them to the approved provider, right? So you have to be a triage at this point. So once you get through and determine their appropriate for intervention, you have to get your thinking hat on, right? This is where, this is where things change. And as a mobile PTM, I know that you have walked into somebody's house and been like, huh, how are we going to do PT in here today? Mark  (23:32): Or you have to completely be a problem solver. Think about being a problem solver on steroids when it comes to digital health. Right? Because you didn't have, at least in someone's physical environment, you can see what they have available. Right? If you treating me right now, all you would know is I'd have a white wall behind me. You don't know what chairs I have. You don't know what equipment I have. You don't know anything that I have. So asking them about what equipment's available is important. I take all my patients, depending on what they have, if they have, my most common thing I treat is, is back pain. So most commonly about 20 to 40% of patients, that's 20 to 30% of patients will fit into some type of directional preference when it comes to low back pain. So I take them through an active range of motion our digital active range of motion to see what exacerbates or relieves their symptoms. And if, and if repeated extensions and standing it relieves their symptoms, I go why? Clear out other things, but I go right into treatment. Right. So you can use progressive movements, repeated motions right in your treatment from the get go the same way you would do in the clinic. Mark  (24:35): Some of them prior, Karen  (24:36): It's New York. I don't even literally grown even here at anymore. It's just did with something there. Is there the engine going up, I don't even hear it. Anyway. Mark  (24:46): White noise. White noise. Yeah. So you have to go through your objective range of motion in your objective measurements just like you would in home or in the clinic at home. So knowing your physical exam and having a musculoskeletal screen is super important. So if I have somebody with radiating arm pain that I'm treating, where's my arm on my camera? If I have somebody with radiating right arm pain, I'm going to take them through cervical active range of motion. I've actually even had people do over pressure to themselves. Right. To see, I've had somebody to do their own spurlings to see if it's ridic. So you have to get really creative teaching someone how to do a UNL TT a on camera is because you have to back up. Right? That's another thing. You have to have visibility and you have to have the ability to see what the patient's doing and also correct them while they're doing their motion. So I take my patients, do as many physical exams that they can do on their own without, without me being present to do it. Karen  (25:45): Yeah. So I think it's important to note cause my good friend Amy Samala said, can you do this for brand new patients in your practice or is this just to be used for existing patients? So I think Amy, I think we're covering that right now, that yes, Mark is sort of taking us through how he might do an initial evaluation with someone via telehealth. Mark  (26:05): Totally. Totally. Now I think we should probably circle back to billing again and payment. I think we, we've, Karen  (26:12): Yeah, yeah, yeah, yeah. Let's definitely talk about that. And one other thing that I, I want to make people aware of, Mark, is how using you want to have space. So not only you want to make sure that not only your patient has space or depth, but that you do as well as a therapist because you may need to step back to show them something and then come closer. Mark  (26:33): Right. And I've I often, so I have a flat couch in the back, so I have this couch that's right behind me so I actually use that. I pushed my chair of the way and I show repeated extensions and prone. It's a six or seven foot long couch and I show double needs to test and I sh if I mirror exercises for patients. So you cannot do everything verbally, you can't. Could you imagine telling somebody, okay, I'm going to walk you through a double a single knee to chest with words only. It becomes extremely challenging. So you get up and you move. I just hop on the couch. I'm like, all right, so you're going to lay on your back. You'll grab both knees. You see my hands on the outside of my knees. Knees are slightly apart. We're going to pull that all the way up until you feel a big stretch in your back and I show them. Mark  (27:13): I walked through the exercises with them. Same thing with, same thing with nerve glides, right? If I'm doing a U L T T a I'm going to say, I'll bring your a shoulder all the way up. Like you're going to put those little, or you CC that you're going to put the little ion right and then you're gonna lift your elbow up and see if that changes it. Right. And so you have to walk them through. It's easier for them to mirror you than it is to say, okay, you need maximum shoulder flection with external rotation. NOLA deviate. Like you can't do that. Karen  (27:39): Yeah, we know jargon doesn't work. Yes. You can never say that in an NPR. If you are face to face them, you would never just sit there with your arms folded and be like, okay, flex your arm to hear externally. Like if you just want to do that, you wouldn't do it. I think it's important to know that we can still certainly in well versed in strong verbal communication in this space. Oh, that's nice. From work. Yes. Or there was a delay. Oh, okay. So I think we're good. So Amy said, yes, sorry, there's a delay. She's all the way in New Jersey, so forgive the Jersey part. Yeah, New Jersey. Okay. all right. So I think people get an idea that yes, this is how you can set this up. You just want to make sure that each of you have enough physical space to do everything that you want to do. That yes, you can do your initial evaluation. It's all about the subjective, in my opinion, in that initial evaluation anyway. Definitely. and then once you see them for the initial evaluation, as you start progressing them, like you said, it would be like any other exercise progression you're just not putting hands on, but it can be done. Mark  (28:51): Definitely. Definitely. If you think about the interventions that we do in the clinic that you can apply to home. So I work with people that you know, that don't, they may not have good balance. So safety is a, is a concern in that space. Right? So I talk people in a corner, I show them what it looks like to get into a corner with a chair in front of me or in front of my couch or the chair in front of me and teach them how to do single leg stance while having my fingertips on the chair. Right eye. You have to physically show people what to do so they understand that better. And so like you said, it's about being able to show and speak at the same time, right? Because a lot of the field like nerve tension testing, a lot of times it's, you can feel the tension before the symptoms ever get there. Mark (29:34): So you have to educate somebody that has a really angry nerve that's a, it's a hot nerve and say, look, we're just going to take this up until you barely feel it. Right. We're just going to touch it. And then if you feel it there, just bring it back down. Right. You, you can't rely on your hands to feel that tension anymore. Not that we can reliably feel it anyway, but we want to make sure that we prime the patient for success. Right? Communicate expectations. Like we're going to do some discovery today. We're going to walk through a lot of different movements to see what's happening with your body. See if we can figure out ways that we can help you feel better through movement. Cause that's what ideally what we're going to do, right? We need to make sure that we enable patients and make them feel safe and comfortable that we're going to help them. We're going to take them through this. We just need to, we need to communicate to that. This is going to be something that I should be completely comfortable with. Yeah. Karen  (30:24): Perfect. All right. Now let's get to the part that everybody really wants to know about billing. Someone. let's see. Oh, Mark Rubenstein also New Jersey. He had kinda some of the same questions. No, I have nothing against New Jersey, New Jersey. So he kind of had the same question I had before we went live. He said but Medicare will only pay now for existing patients as per info yesterday. So this is the info, I guess on that evisit versus tele-health. So can you kind of give us, cause I know just for background, Mark is a part of a PPS task force and he is really being updated a lot. And I'll let you kind of talk a little bit more about that and, and how you are helping to work the billing aspect of things and the difference between an evisit and tele-health. Mark  (31:20): Right. I'd like to first shout out to the PPS members, Allie shoes and the I and alpha are our lobbyist for the APA. We are meeting for hours daily and we are, so everyday we have scheduled calls on this task who have a task force. We're pushing out content on the APA plus the PPS site. So there are 18 to 20 people that are hard at work to get, to gather information, to interpret it and then to question it and then make sure that it's legal. Right. Because there's information that comes out that it's great information, but it may not be legal for us to do based on practice act. So there's, there's a federal level, then there's the, then there's the PTA level, then there's the state level, then there's your individual insurance levels. So there's a, there's so many different paradigms. It's not just a cut and dry situation. Mark  (32:06): So right now, some of the biggest things that we're working on behind the scenes with this PPS task force are really are defining out what it means from Medicare as it relates to the visit ruling. So E visits technically are not telehealth. Medicare is not calling these eVisits tele-health. They're calling them eVisits because they derive them from the medical, from the MD coding as, as a bra, a brief and abrupt follow up to a situation where the patient is in an engaged patient. So imagine somebody who may not be feeling well after seeing, having a doctor's appointment just to follow up to touch. So the visit codes right now can only be billed based on time, so their cumulative time and there are three levels. The max level is 21 minutes to be billed one time over a week. And so you add all the time for one week and over 21 minutes is the third code. Mark  (32:59): And that can only be a build a once every, well in seven one time in seven days. There is a question right now about whether or not that code can be repeated the next seven days. That information has not been gotten yet. We have not had a clear answer on that. So please be patient while we investigate whether or not that code can be repeated the next week. So right now, currently we are still working on whether or not now that these eVisits have come out, the question is now whether or not CMS sees us as telehealth providers, which upfront does it look like they do. But we still haven't gotten for Bay. We still haven't gotten the, the appropriate word from CMS whether or not we are. We are providing tele-health, which they said we're not. So we can assume we can assume anything. Mark  (33:49): But so they said we're not providing tele-health, but we think they will. They won't include us in the, as a telehealth provider, which is extremely important because if they don't consider us Medicare providers, then we can, well, I'll wait about Medicare billing Medicare patients, we'll, we'll wait to hear what happens. I'll have to have an update on that. And so right now we are not approved providers for telehealth, for Medicare. And we can build he visits with an established patient that has to make contact through a patient portal to the provider to request their evisit. Now it's been clarified that you can notify a patient that they have the option of that type of care. You can tell the patient, Hey, you know, we're not treating people in person, but you do have the option for an evisit. Here's how you do it. If you choose, if you were to choose to have an E visit, you would go to this part of our website to our port, your patient portal and request a visit so you can prime patients to go utilize that service. Whether or not you can only do that for one week or multiple weeks, that's in question. Karen  (34:52): Okay. And a patient portal is not Skype zoom face time or any of the telehealth platforms that is not a patient yet. Mark  (35:04): Well, some platforms have a portal, some, so it has to be a patient portal. So it has to be a place where a patient can log in and request a visit. And so we're still also waiting for a clear definition of a patient portal. But for our understanding the patient, it's a place where the patient goes to get their information or connect or message their provider. Right. So right now that's still being clarified through CMS on the other private payer front and medicate well, so Medicaid is being rapidly adopted by payers all across the country. Right. So we've seen, I know Louisiana is about to release a wording today at some point. I know that I think Minnesota, I think that a few others have already, Medicaid has already blasted that inflammation and that are, that are, that there are approving and paying for telehealth or physical therapists, payers on a national level are all over the place. Mark  (36:00): So if you are a, in the work provider, you need to call your payers and ask very specific questions and we have people working on this across the country. You have to ask them if your patient has tele-health benefits, you need to ask them if those benefits are payable to a physical therapist. So if a therapist is a PT, a paid as a payable provider of telehealth services, if they need any modification codes, right? So like an Oh two location code modifier, right? That needs to be asked and then what CPT codes they reimburse for. Okay. Right. So manual therapy is not going to be one, but neuro, our neuro they're ex their acts home care, self care, all of those codes should be available. And it just depends on the, on the payer and the carrier. Okay. I have a Google doc that we can link that I'm trying to collect that data from across the country. Mark  (36:58): So people can have open access to it that I can send you that link here and it's on a couple of Facebook pages. But we're trying to collect that data so people can see because, and you don't put any reimbursable fees, don't breach your contracts, don't talk about a fee per schedule, but where you're scheduling fees or your fee schedule. But I'm just put whether or not they pay if it's parody, right? Some States out parody. So here's the kicker. Parody States doesn't miss it necessarily mean payment, right? And this is a, this is a very confusing, a very confusing thing. So somebody says, Oh, we have parody in the state so that, and then we are going to get paid equal in person as we do digitally. Just because you have parody doesn't mean to pay your pace for telehealth, right? They may pay for physical therapy, but they may not pay for tele rehab, right? Yes. Check. Karen  (37:47): Why can they just not make this easy? Mark  (37:50): Right? So you can have parody in a state and you could have a parody law and then the payer not even pay for telehealth. Right? So there's nuances upon nuance, on nuance. And in some States, some carriers have contracts with larger telemedicine providers and their members can only have telehealth through that tele provider and they may not have tele, they might not have tele PT. So then they had no tele-health, physical therapy option for that payer. Does that make sense? Karen  (38:28): Okay, so I'm going to just do this. So for example, I'm just going to take a for example, and tell me if I heard you correctly. Oh one more thing. So Rina said, we're talking about the visits, that's all specifically for Medicare patients only the egoist. Yes, yes. Mark  (38:46): As of now we have, we are unaware. I am unaware. I'll say that of any payer that's adopted the evisit policy and that's as of our Medicare Copa. Our coven call ended at noon today. So I don't know. That may change. Karen  (39:02): Okay. So let's talk about your individual. Let's talk. Oh, somebody said, Oh Mark, can you bring your microphone closer to your mouth? But you've got the ear buds in, Mark  (39:13): Right? So I have my phone a lot. Loose ear buds are going to the computer, but now you see if you can bring the microphone closer to your mouth, then they see my giant fivehead here and I'm like, I mean, how about if I go, that's fine. We'll do that. Karen  (39:32): We'll do that. It's fine. It's fine. Okay. Oh, so here, let me just ask some, get some of the questions. So Kim wants to know, she's in New Jersey also. He lives in New Jersey, but her practice is in Brooklyn. How do we find out if our state has parody? Mark  (39:51): So again, I, the, I will link you guys to the center for connected health policy and I also have a link to the parody in the different States. So I have links to both of those that I can give you, that we can add to this. Karen  (40:07): Yeah, we can put that in the comments under this Facebook under the live here. Mark  (40:12): So where, and so the, the commercial parody book is only 150 pages of nice, easy light reading. Where should I go for Facebook live? Karen  (40:23): Just go, if you go to my page, just go to me and then you can put it in. You'll see, you'll see us. You can put it in the comment section or we could put it in the comments section. When we're done with the live, we can add it in as well. Mark  (40:35): Oh, there we are. All right. So I'm dropping it in the, yeah, Karen  (40:37): You can drop it in right now too. Mark  (40:38): There's the parody laws. Here is the fact sheet on the UpToDate. This is a live document on what's happening in the world right now. As far as tele-health policies and procedures across the country. So those two documents should have a lot of information. But here's the kicker. Just because the state has a parody law doesn't mean that, that, that the payers have a policy that reimburses tele PT, Karen  (41:08): Right? So parody and, and just to be very clear parody means because you, you can do tele-health because you see them in person. So it's like Mark  (41:20): No. So parody only means parody only means payment. So parody means if they have a parody law and they both reimburse for inpatient physical therapy and for telehealth benefits, they paid equal. Karen  (41:32): Say again Mark (41:33): If the, if the, if a payer say let's let's say blue cross blue shield, if that, if that patient has a blue cross blue shield policy and they have a physical therapy benefits and they have tele-health benefits that a physical therapist can provide, they pay equal. Right. Okay. So it's the same face to face as the say. So because a lot of insurances will the 75% or 50% of impersonal versus digital. So it's literally a payment equality clause. Karen (42:02): I see. Okay. Okay. But you have to call blue cross blue shield because they may not actually, that patient's policy might not include tele-health. Mark (42:13): Right. And then even if they have a parity law, you're not getting paid for it. Karen (42:17): Got it. Right. I got it right. It's okay. Kim. I hope that my inability to understand help you. Dah, dah, dah, dah, dah. Can hear Mark fine. I'm physic. Oh, Deborah joy Sheldon. She said, is there a particular language that needs to be included in the documentation? So when we document the visit, how, so? Let's say we know how to set it up. We have the visit, how do we document it? Mark (42:47): Right? So you typically documented as a telehealth visit. So there's no you, your billing will coat it with an OTU location modifier, but you need to denote specifically that it was a digital visit. Okay. Yeah, that's the, Karen  (43:02): Because we just got a question on what's the location coding for telehealth and you just answered it. So Abby, I hope that that helps you. And [inaudible] can we skip insurance and just bill cash or has this new E health stuff messed that up? Mark  (43:26): So that's unsure right now. So the visit has, it's not considered telehealth by early information. That's not considered to be telehealth. We are still not telehealth providers by Medicare. So that should not impact that. That's my, that's my personal uninformed or relatively informed opinion. Please don't take that to anybody else. We're still discovering that. And private payers still do not, are not adopting that yet. That we've heard of. And so you should, Mark  (44:01): If you are currently billing or having people pay cash in there and they do not have coverage, then you should be able to continue doing that. Does that make sense? Okay. Right. I mean, you need to check your contract language. Where we get sticky is, is this considered a non-covered service by a policy? Right. So this is where the sticky sticky comes in. Okay. Is tele-health considered physical therapy just delivered in a different manner, not a non-covered service, right? Yeah. Yeah. Well that V that opinion varies. And so if it's a non-covered service for Medicare, you can, they can, you can charge cash for that service. Right? And so, and that also applies to other payers. Correct. So if, if your payer has a policy that considers telehealth to be reimbursable by PTs, you wouldn't be able to pay, have them pay cash. But if Karen  (45:03): Your individual patient's insurance does not cover telehealth right, then can you charge the patient cash? Mark (45:12): I'm not a healthcare attorney. But we're doing that. Karen  (45:16): Where the heck, I know she's on here somewhere here in Jackson. I know she's watching, I saw her log on, Karen  (45:23): Come on or Jackson answer that question for me Karen  (45:25): Or an answer that question please in the comment section if you're still watching if not, maybe we can ask her or care Gaynor through the APA might be able to answer that question. So again, that question is if Aaron's still watching is if your patient's specific policy does not cover telehealth, again we'll use blue cross blue shield. So they have blue cross blue shield, they do not cover telehealth. Can you charge cash to that patient if they don't have it covered on their policy? Mark (46:02): That is a good question. Yeah, that's a great question. And I think, I mean I, I think I know what my answer would be but I cannot speak as Karen (46:12): Brought any information to anyone or misleading information. So maybe that's something we can ask Cara Gaynor on Twitter. Maybe she can answer that or if Aaron is still listening, maybe she can pop that into the comment section at some point. So Mark (46:28): And having amazing people that are listening that can help. Yeah, exactly. Taking, cause this is a, this is a mad house right now when it comes to legislation and information. So it's all over the place and apparently so yeah, it's just all over the place. We can't information that was [inaudible] I did hear that. Some of the bigger things for Rhode Island and for Pennsylvania this morning, that the governor, the governor assigned legislation that would massively require all payers to pay all providers for telehealth. All right. Yeah. Yeah, yeah. Okay. One other big question that comes up is location for these for, for billing. Right. And so the word from CMS is the, the, the POS code is the location of the billing practitioner. So in the case where remote services are rendered it does not matter where the corporate address of the billing provider is either, nor does it matter what the beneficiary's address, it matters where the services was rendered. That is where the biller is located. Okay. All right. So when that happened, Karen (47:43): Put that into like example. Mark  (47:45): So when that happens, let's say yes. So if you are, New York has parody, right? Or you got to know you guys have compact revolution, right? Correct. I thought you did. So let's say you're a large provider and you have multiple States that you are in charge over that or multiple States. You treat patients and you're billing Medicare that the, the, the service in the, in the billing, in the service location code is the place where the provider is located. Karen  (48:18): I see. So like for example, if we use something like Athletico like a big gigantic company or maybe someone like, I think Michelle Kali has some places in Rhode Island. I think she just went to Massachusetts, but the headquarters is in Rhode Island. So if you're a therapist in their Massachusetts office, you're using Massachusetts. Mark  (48:40): No, you're using wherever you are and delivering the code. Deliver. Karen (48:43): Where do you get where you are? Okay. Mark  (48:45): Okay. Yup. Karen  (48:46): Okay. and then Michelle Townshend said, how does this work with EHR? Ours? Mark (48:55): Yeah. So eeh Karen  (48:57): So she is looking at a separate telehealth provider from our EHR who also does our billing. Mark  (49:04): Right. So EHR is, there's only a handful of the HRS in the physical therapy space that offer tele-health as a part of the platform. I think PT everywhere is a platform that has that has it built in. And self doc is another ER EHR that'll be live and in the next couple of weeks they'll have a platform within six weeks. But most of them are stand alone freestanding. So you just have to find the best system that are set up that can work simultaneously with your other systems. There's really no way to unless the company has an integration with your EHR, which the HRS don't like to integrate with people because that's patient data and it's a, it's a whole hot mess. So most of these are just freestanding side by side. So you'll have your EHR on one side and you're in your camera on the other. So you just do, and that's what I did with anywhere healthcare, it's just basic connection so you can document everything ever somewhere else. Okay. Karen  (50:03): All right. And then Debra says, Mark, my state has parody related to my hospital being F, Q, H C I do not know what that means. Any insight on that? So what does FQHC mean? Any thoughts if not, maybe Mark  (50:25): It's a federally qualified health center federally. Okay. So they have parody. I don't think I understand the question. Karen  (50:33): Yeah. In my S my state has parody related to my hospital being FQHC. Any insight on that? Mark  (50:40): Oh good. So she Oh, she said they have parody. Karen  (50:43): Yeah, they have PR has parody. Yeah. Mark  (50:46): I'm unsure on that. That has to parody is I've, I linked that doc into the live on Facebook. I can look up parody by state and by organization. Okay. Yeah. Karen  (50:59): Okay. Let's see. Let me we already touched, so I'm just kind of, what paperwork do we need? We talked about that. Oh, what if you're not a Medicare provider? Gosh, all right. Dah, dah, dah. Oh, we are usingG suite and doxy.me. This is from,uKelly Dougan, I think. Yeah. But haven't started officially yet. We have an ABN and I wanted to have liability form as well. So those liability forms, that's something that we can, that you can maybe share also on this link here and people can make it their own. Is that by liability? Like the patient has to sign off on saying yes, I'm okay with having telehealth. Mark  (51:51): Is that of course for me. Yeah, I would assume that what she's saying. Yeah. So I'll, I'll create a, I'll create a Google drive folder and drop a link in to the chat Karen  (52:05): And then one other, we've got two other questions. So to clarify for service location code, so that you said that, is that like the OTU code? Right. Okay. If I or any of my PTs are in their own home while tele-health with patient, is she using her home address? Mark  (52:28): Oh, that I can't answer that I haven't gotten, yeah, that would be a billing question. That hasn't been brought up, but I, we have a meeting tomorrow morning and I'll ask that question. Karen  (52:39): All right, Kimmy, we will get to that. Mark  (52:43): We're saying the PTs can just stay home and bill from there. But Medicare has specific guidelines on origination sites. And I know if origination sites apply to eVisits versus telehealth. That very question. Do origination, do originations, I'm writing it down so we can ask this to origination sites. Apply to eVisits. Yeah, cause that's, that's a game changer too. Karen  (53:11): Yeah, yeah. Oh, sorry. She said, sorry, I meant to say service location. Did you clarify for service location address? If I or any of my PTs are in their home while doing telehealth, do they use their home address or does she use her address? So Kim, like lives in New Jersey, her practice in Brooklyn. So that's a really good question. So, Kim, maybe we can get back to you with that answer. Mark  (53:33): And is she a Medicare provider? Karen  (53:35): Kim, are you a Medicare provider? I think so. We'll see. We're on like a 22nd delay. Mark  (53:43): Yeah. So I'll ask, I'll ask service location for employees versus brick and mortar versus mobile provider. Karen  (53:52): Perfect. And then Sarah Catman says, if you are licensed in more than one state, but only practice, may single state, can you only do telehealth in the state you practice in or can you do, hello, hello, hello. Telehealth and States you are licensed in. Mark  (54:12): Yeah. So that's where it comes to state rules and regs and yeah. So everywhere that you have a practice reciprocity or you have a licensed in other States, as long as they, you are allowed legally to practice tele-health in that state. Yes, you can practice telehealth in that state. I mean it's, but you have to sit, you have to make sure to abide by the rules and regs when it comes to our the licensure compact of the rules and regs of the state that the patient abides in or they live in. Right. Cause that's just compact language. So like I can do tele-health and Missouri, but they don't have direct access. So I would still have to have direct access or I'd have to have a referral for that patient if I want to open Missouri. Right. So like example. Yeah. so I think, yeah, so we have to make sure that you abide by the laws of the state that the patient resides in. But yes, you can do tele-health across the country. That's the beautiful thing about the compact, right. Compact allows for us to practice across this country with with little, with, without a lot of that a lot of restraint or not restraint, but a lot of challenge. Karen  (55:20): Okay, perfect. All right, so we're at about an hour, which is as long as I think people's attention spans are, and I think we have an apparently as long as Instagram will go live. So if anyone has any other questions, please you can keep adding them into this feed here and we'll try and get to them as, as best we can. Thank you Mark for dropping that stuff into dropping those links in here. And again, we'll get some of the, the onboarding paperwork from you and maybe can drop it in here as well, or you can point us to maybe where it's been put in other Facebook Facebook links. But yeah, everybody, you're welcome. You're welcome. And Mark, thank you so much. This was above and beyond. I think what you had to do but I think we all appreciate you so much because we're in a time where there's a lot of uncertainty and tele-health is at least a way to one, keep our patients healthy and moving and to kind of keep our practices going as best we can in these times because we don't know. Mark (56:38): Yeah. We don't know. Karen  (56:41): Okay. Mark  (56:43): Yeah, I think, I think, I think as a profession we need to remain calm and PT on, right? Like there's a lot of things happening right now. There's to be the, the future is unknown for us as a healthcare profession. All I do know is that it's going to be changed on the other end. This will no longer be an exception to the rule. This will be an expected method of care. People will, will now grow to understand that digital health is a real opportunity in every aspect, not just in, in telemedicine. So I think if I can say one final thing is just be prepared to adopt this and, and, and set up your systems for the long game. Not for this short, immediate, even though the immediate needs to happen. We have things in place like the waiver for using different platforms just to make it happen while it is, but set your practice up, set your systems up for a long game to provide digital care to your patients. Because that's where we're going to go. Part of it is so yeah, but be patient with each other, love each other be kind and wash your hands, Karen  (57:49): Wash your hands and don't touch your face. Yeah. And be mindful of the people if you are still, if your offices are still open, be mindful of the people coming into your office. If you are a home health therapist, be mindful of the people that you're that you're going to be treating because they may be in that vulnerable population. And because we, there's so much that we don't know, just be very mindful of how you're doing that and utilizing telehealth is a great way to have that extension of care for our patients, so. Mark  (58:27): Right. And feel free to reach out to me market anywhere. Dot. Health care. I'm here as a resource. I'm trying to be as available as I can. I have to go to the bathroom occasionally or drink some water, eat some food, but I'm trying to be as available as I can in order to help help us transition and get through this, navigate this time. Karen  (58:45): All right, well Mark, thank you so much. Got it. You've got everything there. Check out. Also, check out Mark's platform anywhere. Dot healthcare. I'll be happy to give a plug for that of course. And thank you so much. I really appreciate it. This is everyone else on this, on this call, so thank you. Mark  (59:01): Beautiful. Thank you. Karen  (59:04): Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

For today's topic we're going to talk about how you can calm your divorce overwhelmed. So, virtually everyone who either decides to get a divorce or their spouse throws it on them has that moment of panic when they realize that they don't understand the legal system. They don't know how they are going to go about their divorce, and they want their legal bases covered. If they have children, they want to make sure they're protected, but really just feel paralyzed in fear. So, this podcast episode is really for the people that are just starting the process and need a little extra support along the way. I always tell people when you are trying to figure out where to start, start with you. Reach out to your support system or even build a new one. It could be as simple as joining a Facebook group for divorcing people or an online support group through DivorceForce or Meetup. When you're determining how to do divorce, I have a few tips for you. So, first of all, you're going to want to take the process step-by-step. You're going to need to learn to get comfortable in transition, because the process is a marathon, not a sprint. Unless there's an emergency, virtually nothing happens overnight. It takes a while to get through your divorce, even if it's uncontested, and so I want you to take it step-by-step. I also want you to take a deep breath and know that you have time to wrap your head around this and get through it in the best way possible. The next thing that I usually tell people who are feeling overwhelmed is to educate yourself about the divorce process and how it works in your state. If you're in California, head over to Hello Divorce. You can take a look or download our California divorce flow chart. It breaks down divorce start to finish. Also, check the Hello Divorce site regularly if you live in Texas or Arizona, where we're going to be launching quite soon. Then I want you to consider your options. There's so many ways to work through the process. At Hello Divorce, you can use our divorce navigator. Erin Levine: It's kind of like a TurboTax for a divorce, where you work through all the forms step-by-step on your own. We also have do it for you options and we have legal coaches on standby, so if you don't want to lawyer up in the traditional sense of the word, where you pay a big retainer and potentially freak your spouse out, then using a illegal coach, either through Hello Divorce with our Levine family law group lawyers or someone in your locale, can be a really great option if your case is mildly contested, uncontested, or you're working with a mediator. Another great option if you and your spouse expect to have some conflict, but really are determined to work things out on your own, is to use a mediator. A third party, neutral mediator is going to help you with all the issues that might come up in your divorce, kids, support, property and debt division and help you come to a full agreement on all those issues. A couple of other things that seem to come up for our clients in terms of their overwhelm is whether or not you'll have to go to court, and my legal answer is it depends. Some States require you to go to court to actually formalize and finalize your divorce, but in those cases, assuming you have a full agreement, it's really more of a formality, and it's kind of a pain, in that you have to schedule it, show up for court, wait to be called, and have the judge ask you a bunch of questions, but fortunately it's not a contentious hearing.... Find out more infomation and schedule your free 15 min phone call at hellodivorce.com

    Don West and Shawn Vincent explore two home invasion cases, with a focus on the choices the defenders made that justified their use of force, and the decisions that could have increased their legal jeopardy.   TRANSCRIPT: Shawn Vincent: Hey, Don. Good to see you again. Don West: Shawn, as always, nice to see you. Shawn Vincent: So, I’ve got to ask some questions. You're, as most people know by now, a career criminal defense attorney. Don West: Right, that's actually all I've ever done. I started my legal career at the public defender's office and have never prosecuted, so I understand and respect that job and there are lots of criminal defense lawyers that used to be prosecutors, but not me. Shawn Vincent: Sure. And so I'm a litigation consultant, which is less straightforward, so I don't get to represent people. I don't try cases, I don't pick juries, I don't take depositions. But I have had a great opportunity to work with a lot of interesting lawyers on theme and theory aspects of the case. I've gotten into the legal mind even though I'm not a lawyer. Shawn Vincent: I bring this all up because I want to see if you share the same problem that I have. Today, I took my kids to see Spider-Man, in the movie theaters, and this movie, like so many other action-type movies, I can't help but to count up all the felonies and misdemeanors that are committed throughout the course of the film, or tally up the civil liability that's being assessed while all this violence is going on. I'm just curious if this has ever crossed your mind watching a film, where you're like, "That's a felony, you can't do that." Don West: You have to suspend disbelief and I suppose suspend any notion of accountability either. Otherwise, every scene has something that would land somebody in hot water of some sort. Shawn Vincent: Right. Don West: Either go to jail or get sued. Well, the stuff that you go see with your kids the superhero stuff. Shawn Vincent: Sure. But even a classic car chase, how there are at least 20 lawsuits, civil lawsuits that would come out of that, plus multiple criminal violations. Don West: Good point, I had a client one time charged with DUI. Left the roadway and hit a utility pole, bent the light pole. Got the criminal charges resolved favorably but she still got sued by the city to fix the light pole. Shawn Vincent: So not a criminal, but out of pocket. Don West: Had to pay for it, yes. Had to pay for it. Shawn Vincent: That's not unlike what self-defense shooters sometimes face. Don West: Sure. Shawn Vincent: Right. That's what our podcast is about. We look at real life self-defense shootings, things that we've seen in the news. Sometimes, things that we've had an opportunity to be involved with from a legal perspective. We dissect those to look at how did these facts, as they played out, as we know them, as they are reported sometimes, contribute to what Mike Darter likes to call the fight after the fight. You've had this first fight, this self-defense scenario. Now there's potentially a legal fight afterwards and that legal fight could be first criminal liability and potentially civil liability. Don West: No matter what, there's going to be a lot of cleanup of some sort. There's going to be the literal cleanup of the scene. We've had cases where the shooting took place inside a home, and several thousand dollars spent just to clean the place up from the event that took place. And there's the criminal process cleanup, the cost of hiring counsel and investigators and experts to sort all of that out. And then the cleanup, if there's a civil claim filed. Don West: The so-called aftermath can be measured not just in a legal liability. It can be measured in dollars and cents. It can be measured in emotional cost. I think if there's any one theme that runs throughout our discussions of this, is that the first fight is only the first one and there may be at least one big one and several others to address after a self-defense incident. Shawn Vincent: I remember one of the cases that we looked at deeply was the Markus Kaarma case, from Missoula Montana. And I follow up on these cases and the last bit of research I did on it, we know that what happened in that case is that Markus had been robbed previously. Someone had broken into his garage, not really broken in, he had his garage door open so they came into the garage and took some things of value. He had been monitoring it with a baby monitor thinking that some burglar might come back and try it again. Shawn Vincent: One night, after midnight, or right around midnight, he sees a shadow in his garage. He gets a shotgun and goes around up front of the garage, which was opened. Then he fires in and he kills a 16-year-old foreign exchange student who is most likely trying to steal beer from his refrigerator. Garage hopping. Shawn Vincent: We know that he was convicted after a trial and he's in jail for I believe the rest of his life. But also, that family, from all the way in Germany, came to the States and sued his wife, his common law wife, and the property and the estate. What hey got is undisclosed, but I assume a pretty big civil settlement that ended up resolving that side of things. So we hear about the criminal stuff a lot. We don't always hear about the civil stuff. Don West: From our member's standpoint, we are so aggressive so early in the case defending the members, with the risk of criminal prosecution, that we get investigators and experts involved early, get lawyers involved. We have a critical response team that is dispatched to the scene immediately, for a couple of reasons. Don West: One, to do the very best we can at that moment to make our members' chances the best they can be at successfully navigating the criminal investigation. But I think in hindsight, having gone through a few of these cases, we also realize that the more effort you put up front, the better the chances are of not only perhaps discouraging what might have been a close call on the criminal case, but also setting the stage not to be sued down the road. Shawn Vincent: Sure. Understanding and identifying the mitigating factors and bringing down the risk and the liability. Don West: Sure. Shawn Vincent: That's interesting. One of the reasons I brought up the Markus Kaarma case is that was one of three burglary/home invasion cases that we looked at. One reason I thought it was originally interesting was because we feel that we know about the castle doctrine, right. Our home and our sanctuary, and you've said it's a special place. There's nowhere in the world where we're more justified in defending ourselves than when we are in our home. Shawn Vincent: And then here you have a guy, Markus Kaarma, someone was in fact trespassing at least, in his garage, and because of some extraordinary circumstances, because of the fact that it was pretty well established that he was trying to lure someone back in to catch these burglars. Don West: Yeah, I think that we really talk about that case, not because we think Markus Kaarma got a raw deal or was in some way unjustly prosecuted, but to point out so many mistakes that he made, so many avoidable mistakes that he made that ... That changed what might have been on its face protecting one's castle from an intruder, to what the jury and everyone else ultimately concluded was simply murder. Shawn Vincent: Right. And that's what I want to explore today, is that fine line between self-defense and murder when it comes to home invasions or burglaries that you catch in the act. Because we'll talk about a case from Cincinnati, Ohio, where we know we have this mother of five, she lives in a home that she owns with the five children, her estranged ex, she has a restraining order against him. She herself has a concealed carry permit, even though she wouldn't necessarily need that in her home. Shawn Vincent: He comes over, is causing a ruckus. He wants to get in the house. He eventually rips the air conditioning unit out of a window. Don West: It's a window unit- Shawn Vincent: A window unit. Don West: That's mounted and the window is closed on top of it. So if you pull the air conditioner out, you have a big hole you can crawl through? Shawn Vincent: Once he pulled that air conditioning out, he had essentially gained entry to the home, and that's when it looks like she shot him multiple times. He ended up getting taken to the hospital, survived those injuries and her children are safe. The police looked at it for not very long at all. And even the district attorney for Cincinnati, a guy named Joe Deters, he said afterwards that, "Thank goodness she had a concealed carry permit and was able to defend herself and her five children. It's hard to imagine what might have happened to her or her children if she had not been able to protect herself and her family." Shawn Vincent: This is one of those scenarios where just like Joe Dieter says, the prosecutor, thank God she was able to protect herself and her children. And it seems like here she pretty much did everything right. She certainly, she didn't need to have a concealed carry to have a gun at her home. Don West: Let's break that down, let's take a look at that. Don West: That's the prosecutor not endorsing what happened because a life was nearly lost, but at the same time acknowledging that she acted lawfully and that as a result she was not going to be prosecuted. So, if we break that down, we know a few things just by those limited facts that are available on this. One, that she had attempted to use the legal process, the legal system to get some safety from this guy. A protective order is going to be issued upon application, claiming fear, threats, indicating prior incidents of violence likely. Shawn Vincent: You have to go before a judge and make a case for it. Don West: Yeah, there's typically a temporary order issued upon the application of one of the parties, and then that's served on the other party. and there's an opportunity for the parties to go to court, explain their situation to the judge, and then the judge makes a decision whether the protective order should be issued. And apparently based upon the information available, the judge said "Yes," and that order is going to require the person to stay away. Shawn Vincent: He's legally required to stay away. And she's established, she's afraid of this guy. Whatever it was that convinced the judge to give the order. Don West: Sure. Yeah. I think that that is the threshold that she did before she resorted to self-help the first time there was a problem, she took the steps necessary to use the judicial system and it didn't work. That's unfortunate. Sometimes it doesn't work and there's more violence and somebody dies. In this case, fortunately, as the prosecutor suggested, she was prepared and capable to defend herself as it turned out to be necessary. Shawn Vincent: And her children. Don West: So what we also know is that she herself is a law abiding citizen, because she wouldn't have a carry permit if she had a significant criminal history. Shawn Vincent: Sure. Don West: For whatever that's worth, that she lawfully possessed the weapon, that she took the steps to be able to lawfully carry it outside the home. I think all suggests that this is a responsible person who's trying to follow the law, dealing with someone who clearly isn't. We don't know what the relationship was like, but we know it had to have been volatile and we knew that he was ordered to stay away because of the protective order in place and that didn't work, and he went to the house. Obviously would not be deterred to gain entry if he went so as to pull the AC unit out of the window and then go through. Don West: We also know it was her house, we also know that protective order made him a trespasser, if not worse, just by being on the property. So when the prosecutor looks at the equities in this case, he doesn't have to take her word for much of anything frankly. She's got the protective order in place. Shawn Vincent: It's her home. Don West: The air conditioner is on the ground, and he's incapacitated, having been shot. Now, no question that she had good reason to believe that he intended her harm. And I suspect with all of those circumstances and the factors at play, the law favored that and may very well under Ohio law, presumed that her fear of serious bodily harm or death was justified. Shawn Vincent: Yeah. One thing I want to point out here too is, unlike Markus Kaarma, she doesn't run outside the house to shoot this guy. She doesn't try to engage him until he's gained access to the house. Don West: She doesn't leave the door open and dare him to come in. Shawn Vincent: Right. She doesn't go outside to meet the threat. She waits there. It seems to me, and this isn't explicit in the article that we've found about this, the reporting about this, but it seems to me that he was out there for a while, probably yelling before he got to the point where he was trying to rip the air conditioner out. I'm sure he was banging on the door or pounding on some windows at some point. Don West: Sure, she didn't shoot him through the wall as he was trying to remove the air conditioner or through the window. Shawn Vincent: Yeah. It doesn't say here, but I suspect she's the type of person who would have called the police while he's out there raging in her yard. And it was only when he had gone through the extraordinary circumstance of actually breaking into the house, and now had entry that she fired, and eliminated the threat. Don West: And of course she would have known who it was. This wasn't a stranger to her. She couldn't write it off as a mistake, or that it was someone lost. She knew by virtue of what he did and how he was doing it in the face of the protective order and their history, judicial and otherwise, that- Shawn Vincent: Sure, so you bring up whether she knew who it was, she did obviously. That has echoes of the Ted Wafer case. We reference that a lot when we have these discussions. Because that one was a real heartbreaking case. That's Ted Wafer up in Dearborn, Michigan outside of Detroit. It's very early in the morning, around four o'clock in the morning. He lives alone. He's in a rough neighborhood now and there's violent banging on the door, on the front door, moves to the side door, comes back around the, the floorboards are shaking, the pounding's so loud he gets his shotgun, goes to the front door during a lull and the knocking opens it up and he's surprised by a figure there. Shawn Vincent: He doesn't know that it's a 19 year old girl named Renisha McBride. She tries to push through the screen. It seems like from the facts a shot is fired from a shotgun, it blows her head off. He claimed later that it was an accidental shot. I think you and I both agree that it was probably a twitch. He was scared, he was frightened, he was startled and he pulled the trigger and he didn't mean to shoot her, but it seemed like she was trying to break in. That was the case they made at trial. Don West: And that may have been exactly what actually happened. That makes life really complicated though when you then claim self-defense, which by definition is an intentional act. Shawn Vincent: Right, it's an affirmative defense, you meant to do it. Don West: A justified intentional act. Shawn Vincent: You can't accidentally shoot somebody in self-defense was what we've said before. And so the difference there, when you've got someone attempting to intrude your home, what you know about them becomes very important. If it's somebody that you've got a negative history with, that you suspect will do you harm, like this woman's ex-husband, who she had a restraining order against, you're in a more justified position. Shawn Vincent: If it's somebody, if it happens to be the pest control guy or someone who -- the mailman, someone who has a reason that you found suspicious for some extraordinary circumstance, you're in a much worse position. And then if you don't know who it is, that you don't know, there is no ... That has an effect on the reasonableness of your fear. Don West: Of course. Shawn Vincent: Is that true? Don West: Sure. One comment I wanted to make it in these facts, like we've always talked about if you just tweak one little aspect of it, you can take a legitimate self-defense shooting and turn it very quickly into a criminal act, perhaps murder. Can you imagine how emotional this whole thing must have been between these two people? Shawn Vincent: We're talking the woman and her estranged husband? Don West: Yeah. That he is willing to do all of that in the face of the court order, so he's not to be deterred. Apparently nothing is going to stop him until eventually some bullets did. And her, they've got this relationship. It's in the worst possible shape it could be in because she had to get a protective order. My guess is that their lives together and particularly hers have been a living hell for a long time. Don West: She finally feels she's got the judicial process in place and she's safe and he winds up coming over, yanking the air conditioner out and going inside to face her with a gun. Can you imagine how much self-restraint and emotional control she must have had? Because we know he didn't die on the scene. Shawn Vincent: To actually stop shooting once she had taken him down? Don West: To actually stop shooting and not say to herself, if not out loud, you will never do this to me again and fire that last, that one final round. Shawn Vincent: She didn't come around and shoot him in the head while he was on the ground and finish him off. Don West: And we've seen those cases. We've seen those cases where all of a sudden self-defense becomes a murder. No prosecutor is going to defend that. The prosecutor would not let her off the hook for that if that's in fact what the facts turned out to be. You need to keep shooting until the threat is neutralized. But once the threat is neutralized and you are no longer facing that threat, you can't put one more round in for good measure. Shawn Vincent: Well, and we call that every shot counts. Every shot fired will be judged on its own. And that first shot can be self-defense, the second shot could be self-defense. That last shot could be and sometimes is murder. Don West: Other people have said every bullet comes with a lawyer. Shawn Vincent: I also remember the Gyrell Lee case we talked about, and that's a guy who watched his cousin get shot in the stomach right in front of him, and then he had a gun- Don West: And the gun turned on him. Shawn Vincent: Then turned on him, and then he fired on the shooter, killed the shooter. He made a mistake of running away. But one of the things that we know really affected his trial, because the jury asked for the evidence of this was a suggestion that that last bullet was fired through his body that was laying on the ground and struck the pavement underneath him. Don West: Yeah, they made a big deal about the forensic evidence. There was a divot in the pavement that the prosecutor wanted the jury to interpret that evidence as if it was the, what's the French term coup de grace. Shawn Vincent: Is that it? Don West: I think that's it, the one final shot for good measure and that ... Now in the Lee case, if I'm not mistaken, he was convicted. Shawn Vincent: Yeah. Don West: And then wound up with a successful appeal but had to face the whole thing over again. Shawn Vincent: Right. Yeah, but I don't think he's faced it over again yet. I'm not sure the status of that case, but just proof of how those things can drag on for years and years. Don West: Regardless of what the final outcome is, he spent the past several years in prison trying to get it sorted out. Shawn Vincent: Yeah. Let's talk about another home invasion case. I think it's fair to call this a home invasion case. The difference between burglary and home invasion, Mr. Lawyer, counselor is what? Don West: A lot of people confuse burglary with robbery. It's pretty hard to rob a house because a robbery contemplates a face to face encounter, accompanied by violence or threat of violence. So you can't legally rob an occupied house. Shawn Vincent: Okay. Don West: You burglarize a house. A burglary could turn into a robbery- Shawn Vincent: If someone happens to be home. Don West: Yes. And those are more often characterized as burglary, then with an assault. And that's a much more serious offense than just illegal breaking and entering. A home invasion is typically considered as forcible breaking knowing there are people inside with the intent of confronting them and robbing them, or terrorizing them, doing something, knowing that you're going to be face to face with another human being. Shawn Vincent: Sure. So we talked about the Zack Peters case out of Oklahoma, and there we have three people dressed all in black, break in through the back door. They'd actually burglarized the guest house of this property in the recent past, and here they are at noon on a weekday, they break in through some glass, gain access to the house and then are surprised to find Zach Peters is there, armed with an AR 15. That was a burglary turned into something else. Don West: Right. That would not be viewed as a home invasion robbery to start with. I tell you what, what commonly happens out there, and that's often common as home invasion robberies is when there is design to go inside and rob the people valuables or jewelery. But you see that kind of stuff all the time when people go into drug houses. Often other gangs will go into drug houses and rob the individuals there of their drugs. The goal is to go in and control and confront and take whatever they have of value, may very well be targeting their stash of drugs. Shawn Vincent: Okay. That's interesting. So we're looking at this case out of Wichita where the homeowner there, he's a young guy, 18 years old, and two people that he knows, they're both 20 years old, come over in the middle of the afternoon, 2:45 PM on a Saturday. And according to police, they're trying to recover some property that's in dispute, that the 18 year old, the homeowner has. They've got a bad history, these three. These two guys are out there trying to get in the house. Don West: The 18 year old is the homeowner or occupant. The other guys that he knows want something that they believe he has in his house, they claim is theirs. As I understand what you're saying and what I saw in the article is, they went there to recover some property of some sort. Shawn Vincent: That's right. Don West: It's never really been identified or described other than that particular property wasn't stolen unless they thought it was stolen from them perhaps. Shawn Vincent: Sure. I think of this as the OJ Simpson scenario where he's going, he wants his trophy back. I don't know what it was that they were after. Don West: That's a robbery. It wasn't like he broke into the place or the hotel room to steal the Heisman trophy back, confronted people, by force and threat, and that's what made him into a robber. That was, what'd he get? 15 years? Something for that? Shawn Vincent: Yeah. I can't remember exactly, but ... Well, he's on Twitter now, so he's out, OJ. Don West: Another day, another conversation. Shawn Vincent: Yeah. Here, you got two guys that you know that you have something they want and now they're outside your door at 2:45 PM on a Saturday, trying to force their way in. Here's what the homeowner does. He fires through the door and kills them both, one of them shot in the back. Now from everything we've read in this report, it looks like he was not charged for these homicides. He was later charged because he had stolen property in his house. It wasn't the property that these guys were there after, so he's got his own legal problems. Well, one of them isn't apparently murder. Shawn Vincent: And I bring this one up because I think we take a pretty conservative look at a lot of these cases and our mantra is, you never shoot until you absolutely have to. And usually that's when there is imminent threat of great bodily injury or death. And I think we would almost never recommend shooting people through a closed locked door. I feel like that's a recipe for some real trouble afterwards. Don West: Yeah, I agree. That can be extremely hard to justify, although under certain circumstances, either legal or close enough, since you're protecting your home that you wind up not being prosecuted. Shawn Vincent: Sure. Don West: And that's typically a call that you don't want to make unless you're absolutely forced to and you can't make that decision whether you in fact are justified and feel the absolute need to do that until you're right there in the middle of it and can assess your own situation. What you think the odds are against you, and in this case he knew who these guys were. I assume he knew what they are capable of. He probably felt he knew what they intended, if they were able to get inside, and may very reasonably have felt that he couldn't have protected himself adequately if they got in -- that he would have been overwhelmed. Shawn Vincent: So it's two against one. Maybe he believes that they're armed, maybe they got shotguns, I don't know. But once that door's down, he's at the disadvantage is the idea. Don West: And we have some other things going and that is not only did he know them, but that it seemed pretty clear that law enforcement accepted the explanation that they intended to break their way in. They were trying to force their way in as opposed to other cases we've talked about where some crazed person or drunk person or lost person isn't necessarily trying to commit a home invasion robbery, but rather get some attention, maybe even in their mind get some help, but they raise a hell of a ruckus outside banging on the door, the Renisha McBride case. Shawn Vincent: She was probably looking for help and her actions were interpreted as an attempt to break in, but they were actually an attempt to get help. She was confused and disoriented Don West: Whereas these guys apparently we're not going to stop until they got in and there were two of them. And yeah whether there could have been some ... Could have exercised better judgment or different judgment hindsight may tell, but at this point any way from the initial investigation, apparently law enforcement decided it was justified and it was his house, let's not forget that. Like you said before, that is your sanctuary. It's a sacred place. It's highly protected. And if the law is ever going to favor your use of force. . . Shawn Vincent: Give you the benefit of any doubt, right? Don West: Yeah. You remember our other conversations that we've had where I use this phrase that struck me, it's subjective forgiveability. Shawn Vincent: Yeah, right. Don West: The idea that even if you don't do it 100% right, unless it's clear you're doing it wrong, or you aren't justified, then as the homeowner who is being subjected to criminals breaking in or some other kind of threat, then you're going to be given the benefit of the doubt in your house. Shawn Vincent: Right. So our mother of five, with all of these things that we know about her, the protective order that she's a law abiding citizen, she owns a house. She's got the children, she has a concealed carry permit. She waited for the air conditioner to be ripped out before she fired. All those things, anywhere where we might've had a subjective look at whether she was right or wrong, we're forgiving her, because she's got everything lined up on her side. Don West: Right. Shawn Vincent: This guy in Wichita, he doesn't have five kids in there and he doesn't have a restraining order against these two guys, but apparently there was enough of a documented history between them that it seems like, he seems reasonable to fear them. And then we get into this other thing I wanted to talk to you about is, a lot of self-defense statutes and they're a little bit different in every state, but a lot of self-defense statutes are, you're allowed to use deadly force when there's an imminent threat of great bodily harm or death to you, right? Don West: Yes. Shawn Vincent: And sometimes. . . Don West: That's the law in all 50 States. Some States still require a duty to retreat, so you can't use that force unless you've exhausted a way to avoid using it safely. And stand your ground states, you don't have to retreat first, but nowhere can you respond with deadly force other than a threat to yourself of deadly force, except in very rare circumstances, and that happens to be in the house. Shawn Vincent: Right, in order to prevent a forcible felony is often what the statute reads. And some of them, I've read like in Colorado for example, I remember reading that that includes specifically your house. They'll address specifically that someone breaking into your home, there's this presumption that. . . Don West: Yeah, you bring up a good point, we should try to make that a little more clear. Andrew Branca, that we think the world of who wrote the book, The Law of Self-Defense and blogs, and offers a lot of content for gun owners who want to know the law of the jurisdiction, where they live and where the boundaries are. So we encourage people to take advantage of his vast knowledge to improve their own. He calls the home the highly defensible property. So, that's where you're going ... That's the most defendable place you can be on earth is your house. Don West: Now, what you were talking about was another aspect of self-defense that doesn't necessarily require the actual threat to you, before you can use, in this instance, deadly force, and that is a lot of places including Florida in particular, allow for the use of deadly force to prevent the commission of an aggravated felony. And there's a list of those in most statutes. What is an aggravated felony, robbery, murder, rape, kidnapping, those kinds of things. Don West: And you can use force to prevent someone from committing an aggravated felony in most places. And that doesn't necessarily require the specific threat, life-threatening event to you, but you do have to be right, and you have to be able to perceive the circumstances correctly. And if so, you have the right to protect someone from being raped or robbed or kidnapped. Shawn Vincent: Right. Or from breaking into your house. Don West: Yes. We talked about Florida a little bit. The Florida statute provides that not only can you use deadly force to defend against, a threat, a threat against your life, but in Florida, if someone is breaking into your house, forcibly entering your house, the element of reasonable fear is presumed just by virtue of those circumstances, it's your house, they're trying to force their way in, your use of deadly force is presumed to be reasonable. Shawn Vincent: You're allowed to assume that they're going to do you harm if they come in and you're there. They've broken into your house. Now here's where the conversation gets interesting, because we've got this great letter from a CCW Safe member, we're going to talk about it anonymously to protect the identity, but we can share the story. And the story is that this man lived on a small ranch with his wife and two children. Shawn Vincent: And it's just before midnight out here on this ranch, a rural, desolate area, and this guy comes up on his porch wearing nothing but blue jeans. He's a little bloodied, he's clearly been in a fight, he's either intoxicated or in some way otherwise out of his mind. And he started yelling that he wants to entry to the house. He's banging on the door over the course of 20 minutes. He tries to steal their ATV. He tries to use the swing bench on the porch as a ramrod to get into the house. He pulls up bushes and throws them at the windows. Shawn Vincent: All this time, the homeowner had a pistol and a flashlight, I think, out. That you can see through the windows this guy, he lets him know that if he comes in the house, he's going to shoot him. Meanwhile, his wife's on the phone with 911, in a locked room in the back of the house with the children. It's going to take 911 out here in his ranch 20 minutes to get out there, and during that time, he keeps his cool and there's one confrontation at a backdoor, which was a big pane glass in it where he was face to face with this guy. Shawn Vincent: And he wrote to let us know that he was remembering the Ted Wafer story that we wrote about. Don't open the door, don't go outside. This man decided that he was going to wait for this person to cross his threshold before we fired, that he would resolve to shoot him if he did, and he told him so. And as fate would have it, the police arrived in time, they take the guy down, nobody’s shot; nobody's killed. There's no legal inquiry, at least for the homeowner at this point, and there was the best possible resolution of a terrifying situation. Shawn Vincent: And I would suggest that, especially at a point where maybe this guy is using a swing bench to try to ram down his front door. He may have been justified like this guy in Wichita who someone was trying to forcibly enter his house. I suspect the right police department and the right prosecutors would look at that and say, you're all right here. But you're in gray area or you're in a grayer area than if you are to wait for that threshold -- for the window to be broken, for the air conditioning unit to be ripped out. Don West: One of the things that Andrew Branca talks about is managing your risk and of course with training and experience and such, you manage your risk by being better prepared to defend yourself if and when necessary. But you also can manage your risk in the legal context. And what you're saying may in fact have been true under those circumstances. He may very well have been legally justified to fire and shoot this guy under some of the circumstances you've described. But at a very minimum, we know that his legal risk skyrocketed at that point. Shawn Vincent: Sure. Don West: And it went from zero to something unnecessarily, and the guy had enough. He thought it through. He realized that he wasn't actually in danger. His family wasn't actually in danger at that moment. And if his level of physical risk increased, he was prepared. But he wasn't going to do anything to make himself more vulnerable, or frankly, to increase his legal risk. Shawn Vincent: Yeah. In this case, this is a guy who seems unarmed, just crazy and he had established a threshold that he was comfortable with. You talked one time about, and maybe this is a Andrew Branca thing, about buying yourself time in these critical decisions, right? Don West: That's important to me, and I don't claim to be any kind of expert whatsoever on the tactics side of it. It just makes sense that a lot of what goes on is trying to figure out what's going on. What does this person intend? How much of a comfort zone do I have before I have to take decisive action? And the more you do to give yourself the opportunity to assess it, I think the better decision you're going to make. Don West: And you may not have any time whatsoever and you have to react, but if you can get away a little bit and give yourself another chance to see what's going on, that's more helpful than not. And if you can get completely away then ... Shawn Vincent: Sure. Well, and then Zach Peters, after he shot those guys, he didn't know if he had killed them or ... He retreated his room locked the door and called the police. So even though he knew he had people still in the house, he knew he was home alone and he went to a safer place in the house. This guy on the ranch we talked about sent his family to a safer place in the house. I just have to think, when I look at these cases, I see thresholds all along the way. Shawn Vincent: And if somebody trips in alarm and still continues to try to get in, they've crossed that threshold. Our mother of five waited for a threshold to be opened before she shot. Ted Wafer made the mistake of opening that threshold himself, forcing the conflict. And so I guess we might have 10 thresholds and somewhere on the first one, we might be unjustified or have what you talked about this high legal risk, but the more thresholds that get crossed, more likely you have more time to consider your options. Shawn Vincent: Your legal risk depending on the circumstances might go down and if you're forced at last after having allowed those thresholds, recognize and allowed it, I mean the, there's ... We talked about reasonableness in all of these shootings that the reasonableness becomes greater and greater I think as known thresholds are crossed. Don West: That's an excellent point because that's what the case will hinge on eventually. No matter what happens, the prosecutor and then ultimately the jury will have to decide did you act reasonably under the circumstances? Another point that Andrew Branca makes, which I think is so important for people to know and that is, when you're talking about a stand your ground state, meaning that there is no legal duty to retreat, just as a brief refresher, if there's a legal duty to retreat, that means you have to try to get away if you can do so safely before you use deadly force- Shawn Vincent: Before you're justified of it. Don West: While facing a threat of serious bodily harm or death. Stand your ground basically means is you don't have to retreat, but you can if otherwise justified, you can meet force with force. But Andrew points out brilliantly that depending on where you are, there are certain stand your ground states that he calls hard stand your ground states, and other states that he calls soft stand your ground States. Both stand your ground, but the difference being in a hard stand your ground state, the opportunity to retreat or the failure to retreat isn't admissible on the question of whether you acted justifiably. Shawn Vincent: The prosecutor can't suggest that because you didn't retreat in this hard stand your ground state, that that somehow reflects on your judgment or your fear. Don West: Yes. And that your conduct was unreasonable. In the soft states though, even though you had the legal right to stand your ground, the prosecutor may very well get away with arguing that sure he didn't legally have to get away, but he had these clear opportunities to avoid this and to get safe. And no reasonable person, no one who really was trying to defend themselves would not have taken advantage of that. So this was a guy looking for a fight. This was a guy trying to be aggressive. This was a guy who, who just missed any opportunity to avoid the confrontation. Therefore, ladies and gentlemen, when you look at the totality of the circumstances and what this person did, it's unreasonable. Shawn Vincent: And we know in the Gyrell Lee case, that's the guy whose cousin was shot and he shot back, the prosecutor in that case made that argument in court, that a reasonable person would've gotten out of there. Don West: Yeah, so the jury could very well find all of the other elements of self-defense to be satisfied except the reasonableness one. Shawn Vincent: Right. So in the stand your ground state, the duty to retreat is removed, but that's just for that first threshold for whether you're justified or not. I think that if you can try to retreat safely, then you become more reasonable. Don West: Yeah, I don't know any advisor or instructor for that matter, any trainer that ever says don't retreat if you can, don't avoid the confrontation if you can, because you can't control the outcome. All of a sudden your risk is then gone up and the risk of killing somebody, the risk of being killed, the risk of going to prison for the rest of your life is just infinitely greater than if you were able to get away. Shawn Vincent: Well, I think about this rancher and what he was able to do, take everything else off the table. He was able to turn this into, for his kids: “I remember that night, that crazy guy was banging on our door,” kept it from being, “Remember that night that daddy killed somebody on our porch,” justifiable or not. The trauma on his family is so different because he had that judgment, and that he established those thresholds. I think that's the lesson, whenever we had these conversations, we're looking for the lessons for the concealed carrier, to be ... Everyone who has got a concealed carrier permit is there, because they are interested in their own, they're taking responsibility for their own protection. Don West: Yes. The protection of themselves, the protection of their loved ones, of their home. Shawn Vincent: And a lot of people who carry, I believe responsible people, will have gone through scenarios. They're trained for scenarios often of where this might happen so that they can survive it, their family will survive it. And then what we talk about are what happens after that. And we talked about Bob O'Connor all the time and his “warrior mindset.” His mindset and his judgment where if, if beyond just thinking about the tactical scenarios where you might need to use your weapon, thinking about the ... We're talking about the legal scenarios here and when you can safely, if you have the judgment and the mindset, and can safely buy yourself that time and recognize the thresholds of where the threat is and when it becomes critical. Shawn Vincent: And, we're talking about split second decisions here, but recognizing those thresholds allows you more choices than just that one choice, whether to pull the trigger or not. And that can be the difference between killing somebody or not, being killed or not. Don West: Yeah, we know statistically it's highly statistically unlikely, but we also know what happens and it happens fairly frequently. But as you take that responsibility, I think the better you can train your brain to react appropriately under that high stress moment of having to make those decisions. You can also train your brain to know the boundaries better. That helps define your own conduct, and all of that together helps you avoid what could turn out to be a lethal confrontation. Shawn Vincent: We started this conversation now talking about watching movies like Spider-Man and chalking it up all the felonies and misdemeanors and civil liability that happens. But I think when we talked about that mindset, if you're a concealed carrier, you end up when you choose to carry, walking around needing to contemplate what is my liability in these situations? What's my responsibility as a carrier? What's the risk I have? Shawn Vincent: And this, call it tactical awareness, if you will, on adding the legal aspect of it, it's understanding, I'm in a parking lot at night now, at the convenience store at 2:00 AM, this is a place where people get shot. This is where things happen. I'm at risk and I'm armed and right now my liability is high. I'm at home, I've got a security system, I have lights in my yard, I'm where I'm meant to be, my liability and my risk is low. I think these are things that we need to think about all the time when we choose to carry- Don West: Yeah, and I think the experts would say, if you're in a high risk situation by choice, don't do it. Go someplace else. If you have to be, then of course everything else has to kick in, but you also keep yourself safe by understanding what a high risk situation is and taking steps simply to avoid making yourself vulnerable or increasing the odds that there's going to be some problem. What's that App that Mike has, Mike Darter, he's got an App on his phone. It's, shoot, I wish I knew the name of it, crime something. Shawn Vincent: Crime maps, that shows how at risk you are? Don West: Yeah. It's find you and basically tell you what kind of spots you're at, what the crime rates are. Is it relatively safe or relatively dangerous? Shawn Vincent: That's interesting. I like to take very long walks and sometimes it's behind the building or someplace on a route to go somewhere. And other places I'm more comfortable than others. And there's some places where I've mapped out a long walk in advance and like, you know what, I don't think right there, I'd be comfortable unless I had a gun with me. And then I stop and think, well, if I'm not comfortable there without a gun, and I don't have to go there, then I just don't need to go there. Don West: Yeah. Shawn Vincent: And that's the mindset. Don West: That's what we're talking about, isn't it?. Thinking it through. Making some decisions with the goal of being safe and reducing your risk. Don't be a victim. Shawn Vincent: Yeah. Don't be a victim, and sometimes walking away or avoiding the aggressor is how you avoid being the victim of the bigger system, the victim with a legal system. Don West: There you go. Shawn Vincent: Or of your own temper or of a mistaken identity. All those things. Don West: So many things that could go wrong. Shawn Vincent: Well there we did it, it's another episode in the can, and a real pleasure to talk with you. Don West: Thanks as always, look forward to the next time and be good, be safe. Shawn Vincent: Be good, be safe. Take care.

Diane Gardner is a Certified Tax Coach and best-selling author whose proactive planning approach helps clients dodge the tax bullet. Her tax coaching sessions have resulted in a combined savings of over $1,767,928 to-date. Diane has authored several books including, Stop Overpaying Your Taxes! Diane Gardner Vroom Veer Stories GOOD:  Changes to the Alternative Minimum Tax Mixed:  Changes to the Itemized deductions Good:  Some States are trying to work out a charitable contribution credit for the money that’s paid in for taxes. Congress is not happy with that. Good:  I have a sole proprietorship, that makes me a pass through business, What's new with pass-through business treatment? Ugly:  meals in? and entertainment out? Good:  Hire-your-kids strategy!  YAY! Mixed:  Standard deduction was raised, most folks won't itemize. Good:  Families with younger children; Congress doubled the child tax credit. Explain the difference between a tax deduction and a tax credit? Good:  We have a new family tax credit for people taking care of elderly parents or other adults. Good:  Wonderful score in the business world under depreciation. Diane Gardner Connections Tax Coach 4 You  

Official website: http://www.lawabidingbiker.com Podcast-This episode was a direct result of Patreon Member Russell Roberts. He gave me the topic idea some time ago and he happened to be in town, so we grabbed the mics and spit this episode for you. Lurch was also in the studio and weighed in. Russell Roberts is like many law abiding bikers out there and exercises his 2nd Amendment Rights to carry a firearm while riding his motorcycle when he legally can. He wants to follow the rules, but that can be confusing, especially when traveling across State lines. Different States have different rules. Some States have reciprocity agreements and may recognize another State's concealed carry permit. Other States don't recognize any permit except their own. In some States, you can open carry and in others, you can't. It gets just plain confusing for most. Lurch and I are full-time Law Enforcement Officers and can carry across all State lines and in places others can't. We forget all the rules regular citizens have to try and navigate.  This is why it was great to have Russell in the studio to give the perspective of a regular citizen and what he's learned. He gives some great advice and some great resources for bikers who want to carry a concealed weapon (see below resources).  You really must listen to this entire episode if you are a motorcycle enthusiast and also exercise your right to carry a concealed firearm.   SUPPORT US AND SHOP IN THE OFFICIAL LAW ABIDING BIKER STORE! Book Mentioned:  The Law of Self-Defense: The Indispensable Guide to the Armed Citizen Amazon Affiliate Link Smartphone App Mentioned:  This application is about empowering the CCW (concealed or open carry permit) holder (or anyone who wishes to lawfully transport a firearm in any state.) It gives you the direct information that you need to follow the maze of arcane, complicated, and dissimilar gun laws in each state and in each situation. It provides all this information with an easy-to-use User Interface. Laws updated monthly or more frequently! (We are not affiliated with this app or company) IOS/Apple CCW – Concealed Carry 50 State Guide Android/Google Play CCW – Concealed Carry 50 State CHECK OUT OUR HUNDREDS OF FREE HELPFUL VIDEOS ON OUR YOUTUBE CHANNEL AND SUBSCRIBE! Insurance Mentioned: USCCA membership arms you with the education, training, and self-defense insurance you need to protect your family with confidence. (We are not affiliated with USCAA) US Concealed Carry Self-Defense  Insurance For Gun Owners Website IOS App Android App NEW FREE VIDEO: Harley Wireless Headset Interface Module-WHIM-Boom Box-What You Must Know-PROBLEMS? Sponsor-Ciro 3D CLICK HERE! Innovative products for Harley-Davidson Affordable chrome, lighting, and comfort products Ciro 3D has a passion for design and innovation New Patrons: John Fischer of Halthorpe, MD Guy Gorney of Manhattan, IL James Rajacich of Apple Valley, CA James McKinley of BANNING, CA ROBERT BORNHEIMER Cecil Hoskinson of Muskogee, OK If you appreciate the content we put out and want to make sure it keeps on coming your way then become a Patron too! There are benefits and there is no risk. Thanks to the following bikers for supporting us via a flat donation: Randy Gerdon of Santa Clara, CA Steven Stratton James Spruance Jim Dimitrious of Cadiz, KY I.M.E. STITCHING of Farmington Hills, MI Barry Darnell of Morgantown, WV

Latest Insights, Trends, Polls and Thoughts ... "There is currently a lack of clarity in the tax code about how Direct Primary Care (DPC) agreements should be treated vis-à-vis Health Savings Accounts (HSAs). The Internal Revenue Code (IRC) clearly states that HSAs must be paired with a high deductible health plan (HDHP). Section 223(c) of the IRC also prohibits individuals with HSAs from having a second health plan to cover services not covered by the HDHP. Current Treasury Department interpretation of the IRC treats DPC monthly fee arrangements like a second health plan, rather than a payment for a medical service. As such, under current policy, individuals with HSAs are effectively barred from having a relationship with a DPC provider, because the DPC agreement makes the individual ineligible to fund the HSA. However, 23 states have passed laws defining DPC as a medical service outside of health plan or insurance regulation." ~DPC Coalition; www.dpcare.org By Michael Tetreault, Editor-in-Chief | The DPC Journal November 15, 2017 | Run Time: 31:35 Listen in as Jay Keese, Executive Director of The Direct Primary Care Coalition (DPCare.org) and Michael Tetreault, Editor of The DPC Journal ...  Discuss a Variety of the The Federal and Statewide Efforts Happening Across The U.S. To Clarify Private, Direct Pay Healthcare Language. We talk about the following issues: + Who should pay for the private, direct pay subscription fees; + Defining DPC in Pennsylvania, Arizona, Oregon, Florida, South Carolina, Georgia, West Virginia and Virginia Updates; + Missouri Medicaid Pilot; + 2017 action items accomplished; + DPC, HSAs and 2016 Year-End Devenir HSA Research Report Key Findings + HSA accounts now exceed 20 million. The number of HSA accounts rose to 20 million, holding almost $37 billion in assets, a year over year increase of 22% for HSA assets and 20% for accounts for the period of December 31st, 2015 to December 31st, 2016. HSA investments see continued growth. HSA investment assets reached an estimated $5.5 billion in December, up 29% year over year. The average investment account holder has a $14,971 average total balance (deposit and investment account). Health plans remain the largest driver of account growth. Health plan partnerships continued as the leading driver of new account growth, accounting for 37% of new accounts opened in 2016. + Michigan Medicaid Pilot; + Employers and Tax Treatment of Direct Primary Care & Concierge Medicine with Health Savings Accounts (HSAs) ; + Lack of Definitions in Some States; + The Primary Care Enhancement Act (H.R. 365 and S. 1358) + 2017 & 2018 challenges; + 2018 solutions proposed in 2017; + 2018 policy questions still need to be answered and addressed in the space; + The ACA; + Medicare; + initiatives that may help moonlighting and financially challenged DPC Physicians across the U.S. to add more revenue to their practice; + what still needs to be done legislatively in certain states; + how flexible should the DPC model be to match existing state or federal laws; + who should and should not consider DPC; + What will practicing as a DPC Physician Look Like in the next 2-3 years? and more. (c) 2017 The Direct Primary Care Journal (The DPC Journal) The Direct Primary Care Coalition's mission is to support DPC, an innovative, non-partisan approach to better primary care. The central tenets of this movement are based on a culture of service, patient empowerment, trusting relationships supported by unrushed care, rejection of FFS insurance incentives, excellence of medical care and promotion of health. To learn more, participate or become part of the the DPC Coalition policy activities, visit https://www.dpcare.org/join Learn More ... www.DirectPrimaryCare.com | www.ConciergeMedicineToday.com

Françoise Hampson, Emeritus Professor of Law, University of Essex Making rules and adhering to them has underpinned the course of the United Nations and international relations more generally since 1945. Some States have not respected these and situations have arisen where adherence to these rules were dismissed but this had limited impact on the rules themselves. They were a violation of the rules, rather than a challenge to them. But some argue that they must now fight for the rules themselves, a cause they never anticipated (continued below). Françoise Hampson was an independent expert member of the UN Sub-Commission on the Promotion and Protection of Human Rights (1998-2007) and acted as a consultant on humanitarian law to the International Committee of the Red Cross. She is currently working on autonomous weapons, investigations into alleged violations in situations of armed conflict and on the use of an individual petition system to address what are widespread or systematic human rights violations. So why should we be worried? Because of the evidence. Three states have announced their intention to withdraw from the jurisdiction of the International Criminal Court; progress in world trade at a global level appears to be frozen; there is an increasing tendency to reach regional trade agreements that privilege international corporate interests over those of the populations of sovereign States; the use of torture by US and UK agents in Iraq and Afghanistan disregarded both human rights law and the law of armed conflict; and, in the UK, threats by the government to withdraw from the European Convention on Human Rights. Is an expression of concern dangerous, even risking generating a self-fulfilling prophecy, or is it well-founded?

Today's host(s): Scot Landry and Fr. Chris O'Connor Links from today's show: Today's topics: The Obama administration's assault on religious liberty Summary of today's show:Scot Landry and Fr. Chris O'Connor go in-depth on the Obama administration's recent ruling that Catholic institutions must violate their religious beliefs and conscience in providing healthcare to employees. They consider Cardinal-designate Timothy Dolan's forthright remarks that show how extreme the administration's policies on religious freedom are; the three key points highlighted by the US bishops that define this issue; a series of common questions and answers to clarify what's at stake; the USCCB's point-by-point rebuttal of the White House's response; and a particularly egregious column by the Boston Globe's Joan Venocchi. 1st segment: Scot Landry and Fr. Chris O'Connor caught up with their activities of the past week and discussed today's topic. Fr. Chris said it's outrageous what the Obama administration has done with Health and Human Services regulations on the contraception mandate for health insurance coverage. Scot said they will get behind the soundbites and slogan and examine the issue in-depth. 2nd segment: Scot said Cardinal-designate Timothy Dolan has been on the forefront of this issue and read from his recent op-ed: Religious freedom is the lifeblood of the American people, the cornerstone of American government. When the Founding Fathers determined that the innate rights of men and women should be enshrined in our Constitution, they so esteemed religious liberty that they made it the first freedom in the Bill of Rights. In particular, the Founding Fathers fiercely defended the right of conscience. George Washington himself declared: “The conscientious scruples of all men should be treated with great delicacy and tenderness; and it is my wish and desire, that the laws may always be extensively accommodated to them.” James Madison, a key defender of religious freedom and author of the First Amendment, said: “Conscience is the most sacred of all property.” Scarcely two weeks ago, in its Hosanna-Tabor decision upholding the right of churches to make ministerial hiring decisions, the Supreme Court unanimously and enthusiastically reaffirmed these longstanding and foundational principles of religious freedom. The court made clear that they include the right of religious institutions to control their internal affairs. Yet the Obama administration has veered in the opposite direction. It has refused to exempt religious institutions that serve the common good—including Catholic schools, charities and hospitals—from its sweeping new health-care mandate that requires employers to purchase contraception, including abortion-producing drugs, and sterilization coverage for their employees. He played the Cardinal's video statement from the USCCB website on this issue. Scot further explained the Cardinal-designate's point about recent Supreme Court cases and how even justices appointed by Obama are saying the administration's interpretation of the first amendment is getting more and more extreme. Fr. Chris said he hears priests refer to it as the persecution of faith. He said this isn't the Church's war on Obama, but the Church calling for the protection of the freedom of conscience. Scot and Fr. Chris pointed out that our rights do not come from the will of the government, but that they are ours by right of our birth and given to us by God himself and this has been emphasized by Pope Benedict XVI, quoting our own Declaration of Independence. Scot said the contraceptive mandate imposed on health plans by the Department of Health and Human Services (HHS) violates freedom of conscience, which is guaranteed by the First Amendment and several federal laws. The Bill of Rights says we are free to live by our religious beliefs. Forcing all of us to buy coverage for sterilization and contraceptives, including drugs that induce abortion, is a radical incursion into freedom of conscience. Never before in U.S. history has the federal government forced citizens to directly purchase what violates their beliefs. The Supreme Court recently declared in the Hosanna-Tabor case that the Constitution gives a priority place to Freedom of Religion. Scot and Fr. Chris discussed how this isn't just a Catholic issue. The first amendment protects, for example, Jewish nursing homes from having to serve pork in meals to non-Jewish residents. The government cannot force them to under the Constitution. Scot said HHS created this mandate after Congress asked it to develop a list of services all health plans should provide without co-pay. Instead of keeping with the prevention of diseases like breast cancer, sexually transmitted diseases and gestational diabetes, HHS took it upon itself to include sterilizations, contraceptives and abortion-inducing drugs. It treats pregnancy as an illness like breast cancer. Fr. Chris said we should talk about ensuring life, not discarding it. Obama is asking Catholics to support something that is radically against what we believe at the core of our faith. Scot said the US Conference of Catholic Bishops have been publishing numerous documents to help us understand this issue. One of the key points is that the mandate treats a healthy pregnancy as a disease in need of “prevention,” like breast cancer or AIDS (which other “preventive services” on HHS's list do legitimately seek to prevent). In reality, some of the mandated contraceptives are associated with an increased risk of AIDS, blood clots leading to stroke, and other ailments. Inclusion of these drugs places HHS's effort to prevent disease at war with itself. Militant pro-abortion people in the administration is trying to stick it to the Church. Fr. Chris said this is why he's so glad the USCCB is mobilizing and people are hearing what this is called for. Scot said the second point they make is that HHS wants abortifacient drugs to be required in every health plan. These drugs cause abortions and employers must subsidize abortion and individual Catholics must pay as part of their general premiums for everyone else's abortion drugs. Fr. Chris said the Church will not support this. Scot said the third point is that the rule violates religious freedom and rights of conscience. The rule has an incredibly narrow religious exemption for “religious employers” (not insurers, schools with student health plans, or families purchasing insurance). Even religious employers are exempt only if their purpose is to inculcate religious doctrine, they hire and serve mainly people of their own faith, and they qualify as a church or religious order in a very narrow part of the tax code. Most religious institutions providing health, educational or charitable services to others have no protection. The head of Catholic Charities USA said even Jesus wouldn't qualify for the exemption because he healed everyone regardless of their belief. Fr. Chris said the bill protects individual churches. Scot said it would not include churches if they have a food pantry that serves non-Catholics. It would force the Church to stop providing public services. Fr. Chris said institutions that don't buy in are threatened with fines and those fines could bankrupt them. It's as if the Obama administration wants to put Catholic charitable organizations out of business. 3rd segment: Scot and Fr. Chris discussed a list of questions and answer put out by the USCCB. the first question is “How important is the right of conscience in American tradition?” Scot quoted Thomas Jefferson: “No provision in our Constitution ought to be dearer to man than that which protects the rights of conscience against the enterprises of the civil authority”. In the past, has the federal government respected conscientious objections to procedures such as sterilization that may violate religious beliefs or moral convictions? Yes. For example, a law in effect since 1973 says that no individual is required to take part in “any part of a health service program or research activity funded in whole or in part under a program administered by the Secretary of Health and Human Services” if it is “contrary to his religious beliefs or moral convictions” (42 USC 300a-7 (d)). Even the Federal Employees Health Benefits Program, which requires most of its health plans to cover contraception, exempts religiously affiliated plans and protects the conscience rights of health professionals in the other plans. Currently no federal law requires anyone to purchase, sell, sponsor, or be covered by a private health plan that violates his or her conscience. How has the Department of Health and Human Services departed from this policy? By issuing a mandate for coverage of sterilization and contraceptives (including long-lasting injections and implants, and “morning-after pills” that may cause an early abortion) in virtually all private health plans. In August 2011 HHS included these procedures in a list of “preventive services for women” to be required in health plans issued on or after August 1, 2012. On January 20, 2012, HHS reaffirmed its mandate while deferring enforcement against some religious employers until August 2013. Scot noted that the timing means President Obama won't have to stand for re-election with this issue hanging over him. Fr. Chris noted Mitt Romney's recall of how Catholic Charities in Boston had to get out of the adoption business because of this kind of overreach into religious liberty. Scot noted that many Catholics who supported Obama in 2008 who have said how they are disappointed by this ruling and that they won't be supporting Obama in 2012 unless this changes. Obama won in 2008 with a greater portion of the Catholic vote than John McCain. They discussed prominent Catholic Doug Kmiec who supported Obama in 2008 and later was named Ambassador to Malta by Obama has said this has gone too far. Isn't this an aspect of the Administration's drive for broader access to health care for all? Whether or not it was intended that way, it has the opposite effect. People will not be free to keep the coverage they have now that respects their convictions. Organizations with many employees will have to violate their consciences or stop offering health benefits altogether. And resources needed to provide basic health care to the uninsured will be used instead to facilitate IUDs and Depo-Provera for those who already had ample coverage. This is a diversion away from universal health care. Scot said the bishops weren't very strong opposing the initial mandate in the law because they expected the religious exemption to be included and now the only provision was giving the Church an extra year to figure out how to violate our consciences or drop health care coverage for employees and face massive fines. Fr. Chris said Dolan met with Obama in November and came out of that meeting confident of this conscience clause so this is a real shock to the Catholic bishops. Fr. Chris said the media has reported first that the administration was reconsidering, but then said only that they would listen to concerns. What solution to this dispute would be acceptable? Ideally, HHS can leave the law the way it has always been, so those who provide, sponsor and purchase health coverage can make their own decisions about whether to include these procedures without the federal government imposing one answer on everyone. If HHS refuses, it will be especially urgent for Congress to pass the “Respect for Rights of Conscience Act” (HR 1179/S. 1467), to prevent health care reform act from being used to violate insurers' and purchasers' moral and religious beliefs. 4th segment: Scot said the USCCB issued a response to the White House's contradictory statements on its own contraceptive mandate. The Obama administration, to justify its widely criticized mandate for contraception and sterilization coverage in private health plans, has posted a set of false and misleading claims on the White House blog (“Health Reform, Preventive Services, and Religious Institutions,” February 1). In what follows, each White House claim is quoted with a response. Claim: “Churches are exempt from the new rules: Churches and other houses of worship will be exempt from the requirement to offer insurance that covers contraception.” Response: This is not entirely true. To be eligible, even churches and houses of worship must show the government that they hire and serve primarily people of their own faith and have the inculcation of religious values as their purpose. Some churches may have service to the broader community as a major focus, for example, by providing direct service to the poor regardless of faith. Such churches would be denied an exemption precisely because their service to the common good is so great. More importantly, the vast array of other religious organizations – schools, hospitals, universities, charitable institutions – will clearly not be exempt. Most religious organizations, not just Catholic, would be forced to provide such services. Claim: “No individual health care provider will be forced to prescribe contraception: The President and this Administration have previously and continue to express strong support for existing conscience protections. For example, no Catholic doctor is forced to write a prescription for contraception.” Response: It is true that these rules directly apply to employers and insurers, not providers, but this is beside the point: The Administration is forcing individuals and institutions, including religious employers, to sponsor and subsidize what they consider immoral. Less directly, the classification of these drugs and procedures as basic “preventive services” will increase pressures on doctors, nurses and pharmacists to provide them in order to participate in private health plans – and no current federal conscience law prevents that from happening. Finally, because the mandate includes abortifacient drugs, it violates one of the “existing conscience protections” (the Weldon amendment) for which the Administration expresses “strong support.” Scot said this is about forcing insurers to include them in their plans and individual Catholics must then subsidize those immoral acts. This isn't about directly providing the drugs. Claim: “No individual will be forced to buy or use contraception: This rule only applies to what insurance companies cover. Under this policy, women who want contraception will have access to it through their insurance without paying a co-pay or deductible. But no one will be forced to buy or use contraception.” Response: The statement that no one will be forced to buy it is false. Women who want contraception will be able to obtain it without co-pay or deductible precisely because women who do not want contraception will be forced to help pay for it through their premiums. This mandate passes costs from those who want the service, to those who object to it. Claim: “Drugs that cause abortion are not covered by this policy: Drugs like RU486 are not covered by this policy, and nothing about this policy changes the President's firm commitment to maintaining strict limitations on Federal funding for abortions. No Federal tax dollars are used for elective abortions.” Response: False. The policy already requires coverage of Ulipristal (HRP 2000 or “Ella”), a drug that is a close analogue to RU-486 (mifepristone) and has the same effects.1 RU-486 itself is also being tested for possible use as an “emergency contraceptive” – and if the FDA approves it for that purpose, it will automatically be mandated as well. Scot said the White House is trying to pivot from an unfavorable question to a more favorable. This isn't about a particular drug, but a class of drugs. Claim:“Over half of Americans already live in the 28 States that require insurance companies cover contraception: Several of these States like North Carolina, New York, and California have identical religious employer exemptions. Some States like Colorado, Georgia and Wisconsin have no exemption at all.” Response: This misleads by ignoring important facts, and some of it is simply false. All the state mandates, even those without religious exemptions, may be avoided by self- insuring prescription drug coverage, by dropping that particular coverage altogether, or by taking refuge in a federal law that pre-empts any state mandates (ERISA). None of these havens is available under the federal mandate. It is also false to claim that North Carolina has an identical exemption. It is broader: It does not require a religious organization to serve primarily people of its own faith, or to fulfill the federal rule's narrow tax code criterion. Moreover, the North Carolina law, unlike the federal mandate, completely excludes abortifacient drugs like Ella and RU-486 as well as “emergency contraceptives” like Preven. Scot said some states have policies on this, but they would be overridden by federal law. The state laws don't affect religious employers because federal exemptions sweep them away,but those exemptions would be done away by this. Fr. Chris said the White House is comparing apples and oranges. Claim: “Contraception is used by most women: According to a study by the Guttmacher Institute, most women, including 98 percent of Catholic women, have used contraception.” Response: This is irrelevant, and it is presented in a misleading way. If a survey found that 98% of people had lied, cheated on their taxes, or had sex outside of marriage, would the government claim it can force everyone to do so? But this claim also mangles the data to create a false impression. The study actually says this is true of 98% of “sexually experienced” women. The more relevant statistic is that the drugs and devices subject to this mandate (sterilization, hormonal prescription contraceptives and IUDs) are used by 69% of those women who are “sexually active” and “do not want to become pregnant.” Surely that is a minority of the general public, yet every man and woman who needs health insurance will have to pay for this coverage. The drugs that the mandate's supporters say will be most advanced by the new rule, because they have the highest co-pays and deductibles now, are powerful but risky injectable and implantable hormonal contraceptives, now used by perhaps 5% of women. The mandate is intended to change women's reproductive behavior, not only reflect it. Fr. Chris went back to Pope Benedict who said that the Church's teaching is not based on popularity. It is based on the truth communicated by Jesus Christ. Claim: “The Obama Administration is committed to both respecting religious beliefs and increasing access to important preventive services. And as we move forward, our strong partnerships with religious organizations will continue.”  Response: False. There is no “balance” in the final HHS rule—one side has prevailed entirely, as the mandate and exemption remain entirely unchanged from August 2011, despite many thousands of comments filed since then indicating intense opposition. Indeed, the White House Press Secretary declared on January 31, “I don't believe there are any constitutional rights issues here,” so little was placed on that side of the scale. The Administration's stance on religious liberty has also been shown in other ways. Recently it argued before the Supreme Court that religious organizations have no greater right under the First amendment to hire or fire their own ministers than secular organizations have over their leaders– a claim that was unanimously rejected by the Supreme Court as “extreme” and “untenable.” The Administration recently denied a human trafficking grant to a Catholic service provider with high objective scores, and gave part of that grant instead to a provider with not just lower, but failing, objective scores, all because the Catholic provider refused in conscience to compromise the same moral and religious beliefs at issue here. Such action violates not only federal conscience laws, but President Obama's executive order assuring “faith-based” organizations that they will be able to serve the public in federal programs without compromising their faith. Scot said the bishops are encouraging everyone to contact their Senators and Representatives to ask them to support proposed legislation to protect religious liberty. 5th segment: Scot and Fr. Chris turned to discuss a recent op-ed in the Boston Globe by columnist Joan Venocchi. But not all employees of Catholic institutions are Catholics. Why should their employers impose their religious beliefs on them and deny coverage for birth control and other medical care? As long as those Catholic institutions are getting taxpayer money, they should follow secular rules. That's the Obama administration's argument, and it makes sense. Scot said Venocchi doesn't remember that it's the taxpayers who provide the money that the government disburses to provide services to people. Fr. Chris said the majority of Americans are religious believers, so she forgets that the majority of the people paying the taxes are believers in God who want to protect their conscience. On the larger health care reform issue, this president has the moral high ground, if only he would take it. A church that is supposedly dedicated to feeding the hungry and clothing the naked wouldn't want to leave it to insurance companies and free markets to decide who gets to see a doctor and who gets care - would it? Fr. Chris said he's doesn't understand her point. It's a red herring. People have been receiving health care all along. All the Church is saying is that we cannot support contraception, sterilization, and abortion. Scot said the argument is that if you support universal healthcare, you have to support this mandate. Obama isn't trying to regulate religion or undermine Catholicism. He's telling Catholic leaders they can't regulate the beliefs of those of other faiths. That's fitting in a country that treasures religious freedom, but also values separation of church and state. Scot said Obama is indeed telling Catholics that they can't regular their own beliefs. He said separation of church and state is also misrepresented. It only means the government can't name a particular religion as official. Fr. Chris said this is exactly what the Church wants: freedom from the interference of the state. Scot ended by reciting the First Amendment: Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances. Freedom of religion is not just how we pray in Church on Sunday, but we live our whole lives every day. This law prohibits the free exercise thereof.