The California HIPAA Dance

For those who have been following the near-hourly updates on my HIPAA insurance page, the one word I would use to describe the recent activity is--CHAOS.

Anthem Blue Cross initiated what has essentially become a "you-know-what contest" between the two Blues concerning their respective HIPAA portfolios.

The chronology is as follows:

Fall, 2009 - Anthem retires the Share PPO portfolio (retired plans do not need to be offered in the HIPAA mirror of plans)

Jan 11,2010 - Anthem Blue Cross announces a complete HIPAA portfolio overhaul, replacing the 1500 and 2500 Share plans with HMO plan. DOI-registered PPO plans remain the same (5000 and Basic 1000)

Jan 15, 2010 - Anthem closes new enrollments on the 1500/2500 at end of business day

Jan 18, 2010 - Blue Shield CA advises an impending change to the HIPAA products, but cannot comment until 1/22

Jan 22, 2010 - In response to the Anthem HIPAA portfolio change, Blue Shield closes the Spectrum PPO portfolio and eliminates the Spectrum PPO 1500 and 2000 from the HIPAA portfolio. New plans will be available effective Mar 2, 2010 and include an HMO plan, 5500 PPO, 5000 PPO and 4000 HSA-compatible PPO

Jan 25, 2010 - Anthem indicates that a new enrollment requirement applied to the HMO plans will go into effect on Feb 8 in regard to the PPO plans as well (DOI plans). This new requirement will, in effect, guarantee that all Anthem Blue Cross HIPAA enrollees will experience a minimum 30- to 60-day gap in coverage between expiration of group (COBRA/Cal-COBRA) and enrollment in the HIPAA plan.

Please stay tuned to my blog and HIPAA page for further updates as information becomes available.

Dubrovnik in south of Croatia

Dubrovnik is rich in culture and history. Dubrovnik is located on the extreme south of Croatia , the city enjoyed immense growth in trade and naval power in the Middle Ages. The city of Dubrovnik has since relinquished its position as a Mediterranean power player.

Today the city of Dubrovnik is a peaceful and children-friendly haven for tourists and locals. Zagreb , its capital, offers a glimpse of the glory days of the old city of Dubrovnik ; it boasts of well-preserved medieval architectural marvels. As a testament to its ability to masterfully blend the old with the new, the city's capital has established itself as the hub of modern life and is considered the economic, political and scientific center of Croatia .

The city of Dubrovnik takes hospitality on a higher level by offering a wide range of “private accommodations.” Private accommodations are apartments or villas privately owned by locals that have been specially prepared for tourist occupation. These accommodations may be adjacent or separate from the owner's own residence. They are furnished and are most often strategically located to take full advantage of the city's majestic seascapes.

The cuisine of the city of Dubrovnik takes full advantage of the sea's abundance; fresh seafood that is either boiled or grilled and seasoned with herbs and olive oil.

There is a lot to experience in city of Dubrovnik ; charming medieval architecture, spectacular views, fresh food and a host of other activities that will make anyone want to stay.

source: http://www.holidays-in-croatia.info/destinations/dubrovnik

Sigiriya in Sri Lanka

Nothing in Sri Lanka captures the imagination more than a 200 meter lump of granite that rises starkly above the flat central plains about three and a half hours' drive from Colombo. Sigiriya has it all -- a blood-stained history full of intrigue, astonishing frescos of bare-breasted maidens painted 15 centuries ago, a wall covered in graffiti that is more than 1,000 years old and, to top it all, Asia's oldest surviving landscape garden.

All but impregnable to surprise attack and even sustained siege, there are indications that aboriginal hunters first inhabited the great rock more than two millennia ago. It was not until the fifth century AD, however, that Sigiriya entered briefly into a golden age as the seat of Sinhalese power in mediaeval Sri Lanka. The garden city and the palace was built by Kasyapa 477 - 495 AD. Then after Kasyapa's death it was a monastery complex up to about the 14th century. Sigiriya is also the location for Arthur C Clarks novel The Fountains of Paradise. (Jim was avidly re-reading this novel during our long plane ride to Sri Lanka.)

The traditional telling of Sigiriya's rise and the King Kasyapa who built the city was described by our guide. Dark deeds led to the establishment of Sigiriya as the center of the ancient Sinhalese Kingdom for a period of 18 years. The reign of King Dhatusena came to an abrupt end in 477 A.D. when his throne was seized by Kasyapa, his son by a wife of unequal birth. Kasyapa's action was prompted by the fear that his younger half-brother Mogallan, who was born of the anointed queen, would take over the throne. Kasyapa was convinced that his father was hiding a cache of treasure from him, and demanded that the King reveal where this wealth was hidden. Dhatusena took the young usurper to the bund of the Kalawewa, the greatest of his irrigation works, below which lived a venerable monk who had been his teacher and companion of many years. There, the old King pointed, was the sum of all his wealth. In a fit of pique, Kasyapa ordered the old man to be walled up alive and naked in his own tomb. Meanwhile, Mogallan survived an assassination attempt by his brother and fled to India to raise an army. Paranoia, arrogance and delusions of divinity drove Kasyapa to leave the traditional Sinhalese capital of Anuradhapura and construct his palace on the peak of Sigiriya Rock, a perfect lookout which could be easily defended; a huge lion was carved out of the rock. Seven years after ascending the throne, he moved into his new home.

According to research after our return from Sri Lanka, some historians have recently found evidence of a slightly different version of King Kasyapa and how he came to the throne. Though not quite as fraught with intrigue it still has all the markings of family murder and mayhem. You can read a brief version of this online by Nadhira Lawrence via Sri Lanka Library site. Also, there is one archaeologist who offers a completely different (some say radical) theory of Sigiriya. Read a summary of the theory of Dr. Raja de Silva in a newspaper article in 2001.

Sigiriya is approached from the west over a moat that encloses an elaborate water garden that runs up to the foot of the rock. The picture here is of the second moat. There was evidently a moat previous to this one but it is no longer available. It is said that the King kept alligators or crocodiles in the moat to make it very difficult to cross.

Directly after the moat is the beginnings of the excavated water gardens, or pleasure gardens, that lead up to the foot of the fortress. Only the southern side of the garden has been excavated, leaving the identical northern half for the archaeologist of the future.

The water gardens of the western precinct are symmetrically planned, while the boulder garden at a higher level is asymmetrically planned. The water garden displays one of the worlds most sophisticated hydraulic technologies, dating from the Early Historic Period.

The pleasure gardens are studded with ponds, islets, promenades and pavilions. Some underground and surface drainage systems have been discovered during excavations. We were visiting during the dry season, so very little water remained in these pools. However, our guide assured us (and we have seen pictures) that during the normal part of the year, this pools are filled with water and the fountains still bubble.

This shows an interconnection of macro- and micro-hydraulics to provide for domestic horticultural and agricultural needs, surface drainage and erosion control, ornamental and recreational water courses and retaining structures and also cooling systems.

The Macro system consisted of the Sigiri Maha weva, the manmade lake with a 12 km dam, running south from the base of the rock, a series of moats, two on the west and one on the east fed from the lake. At micro level are, the water control and the water retaining systems at the summit of the rock and at various levels with horizontal and vertical drains cut in to the rock and underground conduits made of cylindrical terracotta pipes.

It amazing to realize that all of this was built and engineered over 1,600 years ago!

The fountain garden is a narrow precinct on two levels. Western half has two long and deep pools, with shallow serpentine streams draining into the pools. These had been paved with marble slabs. These streams display the fountains, which have been made from circular limestone plates with symmetrical perforations, which are fed by underground water conduits and operate by gravity and pressure. There are two shallow limestone cisterns which would have served as storage and pressure chambers for the fountains.

The fountains were not bubbling when we visited as it was the dry season. However, this picture shows the fountain location. These fountains are evidently still active during the rainy season from November to January.

This overhead view of the gardens seen from about half-way up the rock, shows the extent of the development and planning. The moat is the dark line you see in the upper 1/3 of the picture.

The miniature water garden just inside the inner wall of the western precinct, consists of water pavilions, pools, cisterns, courtyards, conduits and water courses. The pebbled or marbled water-surrounds covered by shallow slowly moving water would have served as cooling devices with an aesthetic appeal with visual and sound effects, which could be visualised by a visitor who could spend a little time.

The water is in four L-shaped pools, connected by underground water conduits at varying depths, to provide different water levels. The pool on the south-west, is divided into a large bathing pool, with a corbelled tunnel and steps leading down into it. The other pool is smaller with a central boulder on which was a brick-built pavilion.

On either side of the fountains are four large moated islands , oriented north-south, cutting across the central axis of the water garden. This too shows the symmetrical repetition. The flattened surfaces of the islands were meant for the Summer Palaces or ‘water pavilions’. Access to the pavilions were across bridges cut into the surface rock.

The climb to the top of the rock is made via 1200 stairs. The first 800-900 are on steep stone stairs like those in this picture. It is a very steep climb that should be taken without hurry. The stairway takes visitors past caves and hollows, places where guards watched for intruders, a number of carved symbols, and remnants of places where early Buddhist monks (coming after the reign of the King) lived and worshipped.

Maggie did not make it to the top as she was suffering from a little sun-poisoning from the previous days snorkeling in Hikkaduwa. However, Jim made it to the Lion's mouth entrance (see later), so we are fortunate to have his pictures of that portion of the trip.

Carving directly into the stone rock was the means of creating stairs, justice chambers, sleeping chambers, baths, and art work. A fine examples of granite sculpture from the rock is this cobra head, known as Cobra Hood Cave. Its painted ceiling is dated back to the period of King Kasyapa (5th Century AD). It is however believed, that Buddhist monks from as early as the 3rd Century BC used this cave.

It is believed that the cave below the hood of a cobra had the paintings of Kasyapa's biography which were eventually erased by his brother Moggallana

About one third of the way up the stairs, just beyond the cobra hood is a raised granite platform where a long bench has been carved out of the rock. It is believed that this may have been the council chambers. A place where the King, or his appointee, would sit at certain timse of the day or week and settle disputes among the subjects. People would likely bring their issues to this spot and await the pronouncement of the King.

Our guide indicated that the King did not have to deal with the long climbs up or down from the top of the rock. Rather he was always carried on a bed from one location to another

Just below the council chamber raised platform, was a seat carved out of the rock and aligned with the footpath and stairs. This is thought to be a soldiers seat, where the soldier would watch for intruders or manage the line of people awaiting an audience at the council.

Directly above this seat (about 20 feet up) we could see four square holes carved out of the rock, two on each side. It is likely that some sort of wooden posts and material covered this section to shade the soldier from the sun as he performed his duties.

Also, near this same area was the King's resting chamber. When the heat was particularly difficult at the top of Sigiriya, he would be carried down to this chamber on his bed or platform then laid on this stone bed. This chamber would have been nice and cool and we could see evidence of water being fed into this chamber for washing or cooling.

The primary reason most tourists visit Sigiriya is to see the "Sigiriya Maidens. These paintings are found up a spiral staircase about 14 meters above the Mirror Wall gallery in a natural pocket in the rock which has been protected for centuries from the rain by an overhang. Epigraphic evidence refers to the existence of 500 such portraits, but only 12 remain today. John Still in 1907 had observed that; "The whole face of the hill appears to have been a gigantic picture gallery... the largest picture in the world perhaps". The paintings would have covered most of the western face of the rock, covering an area 140 meters long and 40 meters high.

Just before the frescoes and past them are what used to be a wall of mirrors. It is said that the King wanted it this way, so when visitors came to see him they would be surrounded by these paintings. Large sections of the so-called Mirror Wall are still intact, and it is here that graffiti artists have inscribed their neat messages, many of them more than ten centuries old.

Most of the ancient graffiti are notse or poems referring to the Sigiriya Maidens. Nobody knows who painted these amazing frescoes, but the Maidens testify to a highly advanced Sinhalese civilization at a time when Europe was in the Dark Ages.

The frescoes are generally considered to be representations of the beauties in Kasyapa's court. An inscription on the nearby Mirror Wall speaks of "Five Hundred Golden Ones", but at the time of their rediscovery in 1889 only 22 survived. Some, loosely designated viju-lata or "lightning princesses", are light-skinned, whilst others, known as megha-lata or "cloud maidens", are of darker hue. The sensuous nature of these paints has evidently aroused conflicting emotions in visitors to Sigiriya down the years. Thus, a male admirer incising his thoughts on the Mirror Wall a thousand years ago was moved to write:

"The ladies who wear golden chains on their breasts beckon to me. Now I have seen these resplendent ladies, heaven has lost its appeal for me."

A contemporary female, clearly less enamoured with the frescoes, records different, if equally passionate emotions:

"A deer-eyed maiden of the mountain side arouses anger in my mind. In her hand she holds a string or pearls, and in her eyes she assumes rivalry with me."

This worldly sensuality may explain early damage to the Sigiriya nymphs, for it is speculated that disapproving Buddhist monks may have destroyed those frescoes within reach long centuries before their rediscovery. Certainly misplaced puritanism seems the most likely explanation of a vicious night attack during October, 1967, when all but one of the surviving frescoes were daubed and disfigured with paint by persons unknown. So serious was the damage that specialists had to be called in from Italy to restore the frescoes, which are now officially recognised as a national treasure and protected as a part of an UNESCO World Heritage Site. Unfortunately during the attack three of the maidens were damaged beyond repair, so security at the Lion Rock is pretty tight today. Flash photography is forbidden, and people are permanently on hand to keep an eye on visitors.

Beyond the frescoes, a second ascent continues to the Lions Paw entry. Here is Jim standing at the stairs that begin the final ascent to the top of the rock and the King's palace. Visitors to the palace entered via a stone stairway that took them into the lion's mouth and through its throat -- hence Sigiriya's alternative name, "Lion Rock." Only the lion's massive paws remain today, but they indicate how gigantic the rest of the carving must have been.

Due to the lateness in the day and the exhausting climb, Jim did not continue to the top of the rock -- another 300-400 steps (see picture below). .

A stairway has been attached to the side of the rock to allow access to the summit, enabling visitors to stroll around the ruins of the palace and gasp at the panoramic views. These are the final stairs to the top. After three hours already of climbing, and with me waiting several stairs below even the Lion's Paw, Jim decided to turn back and let us all get down the rock before dark.

However, I have placed two pictures below that show the ruins that are found at the top. The first picture is a close up of the the Lions Paw entrance at the bottom of the picture and the climb remaining to get to the top (courtesy of Lonely Planet publications). The second one is an aerial view of the entire complex on the top. Archaeologists say that two water tanks, used for bathing and drinking, still fill with rain water in the top ruins, but in Kasyapa's day a sophisticated pumping system was used to fill the tanks from a lake at the foot of the rock.

The summit of the rock is nearly three acres in extent. The outer wall of the palace, which is the main building, was constructed on the very brink of the precipice. There were gardens; cisterns and ponds layed out attractively.

After all this work and building, this palace only served the King for 14 years. He came to a sticky end, perhaps deservedly. In 495, his brother Mogallan at last returned from India with an army of combined Chola and Sinhalese troops behind him and Kasyapa descended from his impregnable stronghold to meet him in battle. At a crucial stage in the battle, the King's elephant balked at a hidden swamp before him and momentarily turned aside, making his troops believe he was retreating. His army broke in confusion, leaving Kasyapa defenseless. Flamboyant to the last, he drew his dagger, slashed his own throat, raised the blade high in the air and sheathed it again before falling down dead.

Sigiriya's halcyon days ended with Kasyapa's death. But the grandeur of this astonishing rock lives on. Sigiriya dates back from over 7,000 years ago, through Pre-Historic to Proto-Historic to Early Historic times, then as a rock-shelter mountain monastery from about the 3rd century BC, with caves prepared and donated by devotees to the sangha.

Source: http://web.pdx.edu/~mmlynch/srilanka/trip2002/sigiriya.htm

Harbin Ice Lantern Party in china

Welcome to... a performance of Disney on Ice? No, this is the “Harbin Ice Lantern Party” - a slight name the event that takes place every year in Harbin’s Zhaolin Park, in this Chinese city’s Russian district.

This is the traditional ice festival in Harbin; it used to be the big winter event here before the spectacular Ice and Snow World started up in the year 2000. Here, a couple approaches the bottom of an ice slide after passing through an ice castle.

A side view of the ice slide shown earlier, as visitors begins to enter the park. During the Ice Lantern Party, Zhaolin Park closes for an hour in the late afternoon to get the 20-yuan daytime ticket holders out of the park before letting in the 40-yuan (5$) evening ticket holders. The evening ticket price here is a quarter of that at the Ice and Snow World, which is fairly proportional to the entertainment value one receives.

These days, there are only two reasons for visitors to see the Ice Lantern Party. The first is to see what the Harbin winter festival was like before the arrival of the Ice and Snow World, as this festival in Zhaolin Park has changed little over the years. One could have seen something quite similar to this view years ago.

The second reason is to see the results of Harbin’s ice sculpture competition - this year called “The 21st Harbin International Ice Sculpture Competition” - and that, it turns out, is a pretty good reason to visit. This photograph is of a competition sculpture called “Harmony”, created by a Chinese team. The lights in the competition area of Zhaolin Park had not yet been turned on, and I wanted a shot before the last light of day faded, so in desperation I used a flash to see what would happen. This was the result - a happy accident that turned out to be one of my favorite photographs of the trip. As you’ll see below, this sculpture looks pretty nice when lit as well.

When the lights in the ice sculpture competition area of Zhaolin Park finally came on, this is how they looked. The closest, a jazzy Russian sculpture of a musician playing stand-up bass, is entitled “Composer”. The competition this year completed on January 8th; that, along with the snow sculpture competition across the river in Sun Island Park completing about a week later, makes waiting to visit Harbin until mid January a good idea.

A delicate French sculpture entitled “New Season”. Over a hundred competitors from nearly a dozen countries participated in the competition this year. Unlike the large ice structures lit from within, both here at the Ice Lantern Party and over at the Harbin Ice and Snow World, these ice competition sculptures were all lit from underneath by lights within the base of ice blocks. Despite the unusually mild weather in Harbin this winter, the ice sculptures in late January seemed to show no ill effects, as evidenced by the fine detail in this sculpture.

This horse ice sculpture, from a Russian team, seems rather simple...

...until one notices the clever design of the horse’s head. It’s a Trojan horse, with soldiers ready for battle hidden within the horse’s very design.

Arches of ice over a walkway, lit from within by colored incandescent light bulbs, not unlike ones I photographed here during my visit two years ago.

An awning with many traditional lanterns underneath, near the south entrance to Zhaolin Park. Two years ago, a large and gaudily colored rooster appeared near this spot to celebrate the Chinese New Year - the Year of the Rooster then. No similar sculpture appeared this year to celebrate the upcoming Year of the Pig, but another large and blocky ice sculpture of somewhat in determinant shape did. I found these lanterns more compelling.

A walkway through ice structures at the Harbin Ice Lantern Party. Visitors intending to see both this festival and the Harbin Ice and Snow World might consider visiting this one first, because it’s certainly impressive if one has never visited a major ice festival before, and because its modest structures serve as good apetizers for the much larger ones at the Ice and Snow World.

A view from atop the festival’s ice slide in Zhaolin Park; through the trees on the left is the ice sculpture competition area. Five yuan - about seventy cents - gets one a ride down the slide, complete with a choice among old plastic sacks to sit on for the ride.

A final look at the stunning competition sculpture “Harmony”, now lit up. As mentioned earlier, the home of this competition and the Ice Lantern Party, Zhaolin Park, is in Harbin’s Russian district - Daoliqu - where there's more to see both before and after a visit to this festival.

Source: http://www.rtoddking.com/chinawin2007_hb_zp.htm

Children Foot Problem

Even though a lot of people of all ages and sex are experiencing several foot problems (toe nail fungus, athlete's foot, plantar warts, etc), it is still undeniable that children are the ones who are mostly affected by these. To help you in preventing and curing these problems of the younger children you are taking care of at home, this article will enumerate the most common types.

The first among the list of foot problems (toe nail fungus, athlete's foot, plantar warts, etc) among children are the different injuries acquired from different physical activities like sports. When your kids join different sports and activities from several sports clinics and summer camps, it is just normal for them to at least once experience an injury. Make sure that you tell your children that whenever they feel something painful, they should immediately tell it to you; the reason for this is because you will be able to get these foot pains treated right away. The best thing that you can do is to continuously remind your children that these activities should always be fun and should not reach the point of putting their health at risk.

It is very rare for children to experience heel pain, but if among all the available foot problems (toe nail fungus, athlete's foot, plantar warts, etc) this one occurs, you should know that it is caused by what is known as Calcaneal Apophysitis. This is commonly known as the Severs disease. It is also important for you to be aware that the children who usually get this problem are aged from 10 up to 14 years of age. When your children already start to experience pain on the heel area, make sure to stop them from jumping and running to avoid further agitating the pain; avoiding going barefoot and putting icepack on the affected area are some of the things you should do. If on the other hand the condition has gotten worse, the best thing for you to do is to escort your child to a podiatrist so that the proper treatment can be made.

The last among all the foot problems (toe nail fungus, athlete's foot, plantar warts, etc) available is the ingrown toenail that almost always makes children suffer because of the excruciating pain that it gives. Remember that in the cases of these ingrown toenails, infection can develop if they are not treated immediately after feeling the pain that it brings. The ingrown will be eliminated by means of cutting the corner of the nail; there are also cases where the edge of the toenails is removed up to the point of the cuticle. You have to know that you will be able to teach your kids to avoid experiencing this painful problem by telling them to cut the toenails straight across and not on a specific angle. It will also be helpful if you immediately replace shoes that are already too tight on your child's feet.

Knowing these foot problems (toe nail fungus, athlete's foot, plantar warts, etc) will help you in making your children feel better most especially if they experience the ones mentioned above. Even if your children experience something that is not listed above, you will at least be assured because you know that there is a specific cure for it.

Source: http://ezinearticles.com/?Common-Foot-Problems-of-Children&id=4978974

Cal-COBRA Subsidy Change?

I have the current word on the applicability of ARRA extension in regards to Cal-COBRA.

As it stands currently, the state of California has not amended the applicable law nor signed off on this change. If you remember, when the first ARRA came out, California had to amend existing law to allow for subsidy on Cal-COBRA.

Until such time as the state agrees to amend and sign off, there is NO extension of subsidy for Cal-COBRA to 15 months and no eligibility for subsidy for any beneficiaries going onto state continuation after 12/31/09.

I will update the blog if there are any changes forthcoming. In the meantime, it is 9 months subsidy with a sunset of Dec 31 2009.