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First annual report on payments made under the Healthcare (European Economic Area and Switzerland arrangements) Act 2019 for the period 31 December 2020 to 31 March 2021.

The Healthcare European Economic Area and Switzerland Arrangements Act 2019 (HEEASAA) provides the Secretary of State with a legal framework to implement comprehensive reciprocal healthcare agreements with countries in the EEA and with Switzerland following the UKs departure from the European Union.

Under Section 6 of the 2019 act, the Secretary of State has a duty to lay an annual report before Parliament providing details of payments made under the powers conferred by or under the act. The report must be laid before Parliament as soon as practicable after the end of each financial year.

This first annual report covers the period between the end of the EU exit transition period on 31 December 2020 and the end of the financial year on 31 March 2021. Future reports will cover payments made under the 2019 act for subsequent financial years.

For this first report, very limited expenditure took place under the 2019 act due to the lag in receiving claims from member states. All EEA expenditure for the financial year 2020 to 2021 including that incurred under EU law (Regulation 883/04) as well as payments under the 2019 act are covered in the departmental annual report and accounts, published on 31 January 2022.

Reciprocal healthcare agreements with other countries strengthen international healthcare cooperation. They support UK residents to access necessary and emergency healthcare when they travel abroad and can facilitate cooperation on planned treatment and other areas of healthcare policy. They support tourism and short-term business travel and can particularly benefit those with long-term health conditions. The most frequently used element of reciprocal healthcare for UK residents, and the most familiar, is the access to necessary healthcare in other countries.

Following the UKs departure from the European Union, the UK government reached an agreement with the EU to ensure that UK residents will continue to benefit from reciprocal healthcare arrangements when in the EU.

Under the powers in the 2019 act, the government implemented separation agreements with the EU, Switzerland, and the EEA EFTA states (Norway, Iceland and Liechtenstein), namely the UK-EU Withdrawal Agreement [footnote 1], the UK-Switzerland Citizens Rights Agreement [footnote 2] and the UK-EEA EFTA Separation Agreement [footnote 3]. These agreements ensured there was no cliff-edge for citizens rights, including reciprocal healthcare rights, when the UK departed from the EU by protecting those with residence rights.

The government subsequently agreed further comprehensive arrangements with the EU and Switzerland, which have been implemented using HEEASAA powers. These provide reciprocal healthcare coverage to those travelling to the EU and Switzerland. These agreements (The Social Security Coordination Protocol to the UK-EU Trade and Cooperation Agreement [footnote 4] and the UK-Switzerland Convention on Social Security Coordination [footnote 5], respectively) mean continued healthcare support for UK residents when they travel or move to the EU or Switzerland.

Finally, the UK negotiated a memorandum of understanding (MOU) in 2020 with Ireland on reciprocal healthcare, which is also implemented under the powers under the 2019 act. This MOU was negotiated with partners in Ireland to ensure continuity of most elements of reciprocal healthcare in the event of no negotiated outcome with the European Union on a future relationship. It specifically recognises the unique relationship of the UK with Ireland and broader common travel area arrangements. Following the agreement of the EU arrangements, the UK and Ireland have agreed that the provisions in the trade and cooperation agreement will apply for reciprocal healthcare, but with some enhanced elements to support further cooperation.

The UK is currently negotiating a further agreement with the EEA EFTA states of Norway, Iceland and Liechtenstein. Once negotiated, this agreement will also be implemented under the powers under the 2019 act. UK nationals can use their passports to access necessary healthcare in Norway in the meantime.

In summary, the UK has successfully negotiated and implemented 6 agreements under the powers conferred under HEEASAA with countries and blocs in Europe. In the future, it is expected that further agreements will be reached with countries in Europe and outside of Europe. The government has brought forward provisions in the Health and Care Bill to enable the government to implement comprehensive healthcare agreements with countries outside of the EEA and Switzerland.

Where the UK or an EU member state is responsible for the healthcare of an individual, they will be entitled to reciprocal healthcare cover.This includes certain categories of cross-border workers and state pensioners who retire to the EU.

In summary, the agreements in place during the report period cover:

the healthcare costs of UK-insured state pensioners and their dependants living in the EEA and Switzerland around 201,000 [footnote 6] in total. These are known as S1 arrangements

individuals exporting benefits to the EEA and Switzerland (and their dependants) whose healthcare is funded via the S1 form around 7,200 [footnote 7] in total

around 42,000 [footnote 8] workers from the UK who are on a temporary posting in the EU and access healthcare using their EHIC and GHIC [footnote 9]. There are also around 2,100 [footnote 10] S1 certificates issued to workers or their dependants to access healthcare in the EEA and Switzerland, although there may be overlap between these 2 groups

The cost of necessary healthcare (EHIC and GHIC) of UK-insureds of approximately 67 million visits to member states each year once travelling patterns return to their long-term trend [footnote 11]. UK nationals can also use their passports to access necessary healthcare in Norway

We also fund around 1,300 to 1,500 UK residents per year to travel overseas to receive planned treatment in member states (such as, for procedures unavailable in the UK within a medically justifiable timescale or returning home to give birth) [footnote 12]. These are known as S2 provisions

Prior to EU exit, the UK was obliged to reimburse healthcare costs for which we were liable under Regulation (EC) No 883/2004 and in accordance with procedures set out in Regulation (EC) No 987/2009. Treatment in the EEA and Switzerland incurred since 31 December 2020, for which the UK is liable, is now mainly reimbursable under the 2019 act.

For the reporting period of this report, the UK has been responsible for funding those covered by the separation agreements and the social security coordination protocol to the UK-EU trade and cooperation agreement [footnote 13] (including the MOU with Ireland). The UK-Switzerland social security convention came into force in November 2021 and therefore no payments have been made under this agreement during this reporting period.

Different reimbursement mechanisms are in place for the different reciprocal healthcare provisions and vary by member states. Table 1 below outlines the specific detail for each member state.

For necessary healthcare, our reciprocal healthcare arrangements enable the UK to charge EEA and Swiss states based on the actual costs for the use of NHS services or to agree an alternative form of charging, such as cost-waiver agreements (where each country underwrites the healthcare costs of the services used by people of the other state) or formula agreements (where a model is agreed between the UK and a member state based on factors such as travel numbers).

The UK has formula agreements in place to estimate the value of NHS services used in the UK by temporary visitors from Spain, France, Portugal, Belgium, Sweden and Ireland, and the UK has opted to enter into cost waiver agreements with some of the smaller member states, such as Norway and Malta, where the total flow of people between the UK and these states is broadly similar in both directions.

The UK pays the actual costs for all those receiving planned treatment (S2).

Pensioner healthcare (S1) is charged at an average cost in Cyprus, Portugal, Spain, Ireland and Sweden, and actual cost (or through the waiver) for all other member states and Switzerland. Workers eligible for an S1 are all charged at actual cost.

Table 1: EEA Switzerland reciprocal healthcare payment arrangements

In terms of the payments, all EEA healthcare payments (including those under the 2019 act) are made in arrears, usually between 1 to 3 years after the event.

If, for example, a UK national were to injure themselves on a holiday in Germany, they would present their GHIC at the German hospital and receive the necessary treatment. The hospital would then raise an invoice for the treatment with their liaison body. In the case of the UK, this liaison body is the NHS Business Services Authority (NHS BSA). The German liaison body would then submit a claim for the cost of that treatment to the UK based on receipts of the invoice from the hospital. Once the UK is satisfied that the claim is accurate and valid, the UK would release the payment to Germany. This process takes at least one year.

Routine payments for treatments covered under the 2019 act are therefore unlikely to begin until early 2022, one year after the agreement came into force.

For the reasons outlined above, the only payments made under the HEEASAA legislation for the period between 11pm on 31 December 2020 and 31 March 2021 were for discretionary planned treatment care. These payments are made outside of the regular payments process and are therefore paid in a shorter time frame. Expenditure is outlined in Table 2 below.

Payments for discretionary planned treatment are made to support the healthcare needs of British residents when they are abroad in circumstances which fall outside of a reciprocal healthcare agreement. They are most likely to be used when the refusal to fund healthcare treatment would result in unjustifiably harsh consequences for the individual.

Table 2: Payments made by the UK government under HEEASAA for financial year

Alongside payments under HEEASAA, EEA payments have also been made for reciprocal healthcare claims from member states, which took place whilst the UK was still a member of the EU, during the 2020 to 2021 financial year. These payments do not fall under the 2019 act and are outlined in the DHSC annual report and accounts: 2020 to 2021

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FOR IMMEDIATE RELEASE:April 11, 2022Contact: Press_Paul@paul.senate.gov, 202-224-4343

WASHINGTON, D.C. Today, U.S. Senator Rand Paul (R-KY) announced that he saved more than $480,000 from his official fiscal year 2021 operating budget, bringing the total amount Dr. Paul has returned to the taxpayers to over $5.7 million since taking office in January 2011.Its easy to picture Washingtons out-of-control spending as a massive, untamable beast, said Dr. Paul. Im determined to show change is possible by starting in the area under my control, while working everywhere else I can to stop business as usual. When I ran for office, I promised Kentuckians I would stand for smaller, more efficient government, balanced budgets, and spending restraint. Im proud my staff and I have kept that pledge while operating one of the most active federal offices.Dr. Paul has achieved the savings by asking his staff to do more with less.While most congressional offices remained closed under the guise of the COVID pandemic, Dr. Pauls office stayed open. This past year, Dr. Paul and his staff have assisted thousands of Kentuckians with casework all across the Commonwealth of Kentucky, fielding over 18,000 calls and over 14,000 letters, emails, and faxes to Kentuckians in need of assistance. They were among the first on the ground and have continued to assist local and state officials in the aftermath of the December tornadoes across Kentucky. They have also traveled and met with Kentuckians in all 120 counties over this past year.In Washington, D.C., Dr. Paul and his staff continue working for all Kentuckians and taxpayers by fighting for commonsense, fiscally conservative solutions to bureaucratic problems and waste. Dr. Paul has led the way for reform by introducing a five-year balanced budget, and shining a spotlight on reckless federal spending. Dr. Paul and his staff continue to defend the liberties and rights of every American, and are committed to doing so while also preserving your tax dollars.

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Dr. Rand Paul Returns Over $5.7 Million to US Taxpayers | Senator Rand Paul - Senator Rand Paul

FOR IMMEDIATE RELEASE:April 8, 2022Contact: Press_Paul@paul.senate.gov, 202-224-4343

WASHINGTON, D.C. Recently, U.S. Senator Rand Paul (R-KY) Ranking Member of the U.S. Senate Committee on Small Business and Entrepreneurship, recognized Total Equine Services of Falmouth, Kentucky, as the Senate Small Business of the Week.

Dr. Paul entered the following into the Congressional Record:

The breeding, training, and of course racing of horses is an integral component in the history and culture of our beautiful state. Many refer to Lexington, Kentucky as the Horse Capital of the World, with their 1,200 acre Kentucky Horse Park in addition to the hundreds of horse farms operating in the area. Moreover, as of 2019, the Kentucky equine industry had an economic impact of $3.4 billion and supplied 80,000 direct and indirect jobs. Needless to say its a leading industry in our state. For that reason I am delighted to honor a business so involved in that iconic industry, Total Equine Services, founded by Steve Thomas and his wife Patti Thomas.

When it comes to raising Quarter horses, Steve Thomas is a seasoned veteran. He and his wife founded Total Equine Services fifteen years ago, but he has over twenty years experience caring for this breed under his belt. Together they opened the business which initially offered only an arena where one could come and ride horses. They quickly expanded to provide a variety of services ranging from boarding, breeding, and training horses. In addition to that same arena, the Thomas constructed a Foaling Barn and sixteen enclosed stalls where owners can board their horses. The Thomas also offer nutrition and feed balancing services as well as a full tack shop where one can satisfy all their riding equipment needs. When it comes to the care and maintenance of horses, Total Equine Services offers a full package.

With parents like Steve and Patti, it is no wonder that their son Jason Thomas grew up with a love for horses. He and his wife Nikki Thomas have joined the team at Total Equine Services. Nikki was a natural addition to the team since, just like her in-laws, she has an extensive background in raising Quarter horses. Moreover Nikki is seasoned in training horses in the art of barrel racing and pole bending. Pole bending is a timed event where a rider must direct their horse in a speedy serpentine path around six poles arranged in a line. Meanwhile barrel racing is an event where the horse and rider must attempt to run a cloverleaf pattern around preset barrels in the fastest time possible. Needless to say training of this sort requires meticulous repetition and a keen eye for detail, which Nikki gladly brings to the arena. And with all the exercise and activity that their stock see, the Thomas make sure to keep their horses properly shod, with Jason being a certified farrier, a blacksmith that creates horseshoes, who keeps their fleet equipped with the proper horseshoes they need.

The Thomas have developed a reputation for covering every need a horse owner or rider might have, but they are also highly regarded for their breeding services. Their current stud horse, Redneck Jettin Down, has not only won several local shows, he has placed at national competitions held through the American Quarter Horse Association. In 2014, Redneck Jettin Down placed 4th at the All American Quarter Horse Congress, placed 6th at the AQHA World show in Jr Pole Bending, and placed 5th at the North American Live Stock Show. It goes without saying that Redneck Jettin Down is an asset to Total Equine Services.

Whether they grew up in the heart of our big cities or in our smallest of towns, every Kentucky citizen has heard about the glamour of Keeneland and Churchill Downs. The equine industry plays an active part of the Kentucky identity, and it is businesses like Total Equine Services that retain the respect and renown of that industry by taking special care of their breeds. Moreover the Thomas and families like them play a vital role in our states economy, as they support commerce within our more rural communities. Congratulations to Steve, Patti, Jason, and Nikki Thomas and the rest of the team at Total Equine Services. I wish them the best of luck and look forward to watching their continued growth and success in Kentucky.

As Ranking Member of the Senate Committee on Small Business and Entrepreneurship, Dr. Paul continues the tradition of honoring Americas small businesses and entrepreneurs. The Senate Committee on Small Business and Entrepreneurship oversees proposed legislation on matters relating to the Small Business Administration and investigates all problems relating to Americas small businesses.

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Dr. Rand Paul Honors Total Equine Services of Falmouth, Kentucky, as the Senate Small Business of the Week | Senator Rand Paul - Senator Rand Paul

The federal government legalized agricultural hemp in 2018 after its prohibition nearly 50 years earlier. Cannabis is still considered a Schedule 1 drug by the Drug Enforcement Agency along with heroin and LSD, which is defined as not having any accepted medical use and a high potential for abuse.

The conflicting legal status of hemp creates a problem for producers, who need to navigate the byzantine rules placed on them.

"We're constantly researching and trying to make sure that we're up to date with all of the regulations that there are from state to state, not just in the state of Oregon; we follow the Department of Agriculture's rules and regulations we'll work really close with them," said Violet Robles, co-founder of Rooted Hemp Co., a Bend-based CBD and hemp company.

Some bills have passed through the house attempting to reform how hemp is designated. In May 2021 Senators Ron Wyden, Jeff Merkley and Rand Paul proposed a bill that would make the Food and Drug Administration regulate hemp and CBD products like it would other dietary ingredients, foods and beverages.

"CBD products are legally being used and produced across the nation. Yet because the FDA has failed to update its regulations, consumers and producers remain in a regulatory gray zone," Wyden said in a press release. "It's been more than two years since I worked with colleagues to have Congress legalize hemp and hemp-derived products. It's long past time for the FDA to get with the program, for the sake of American consumers and farmers."

The FDA hasn't issued formal regulations for the CBD industry, and says it's keeping an open mind while awaiting more evidence before making a solid judgement.

"FDA recognizes the potential opportunities that cannabis or cannabis-derived compounds may offer and acknowledges the significant interest in these possibilities," the agency states on its website. "However, FDA is aware that some companies are marketing products containing cannabis and cannabis-derived compounds in ways that violate the Federal Food, Drug and Cosmetic Act (FD&C Act) and that may put the health and safety of consumers at risk."

The FDA says THC and CBD products can't be sold as dietary substances, but plenty of CBD companies advertise and sell cannabis-derived food products.

"They do come in and they slap people's hands, and they send cease and desist orders if someone makes any health claims," said Jack Robson, owner of High Desert Pure, a local cannabis company. "There's all these FDA requirements that you have to put on the label of each of those in order to be compliant. You have to specifically say, 'Warning, the FDA has not reviewed and approved this.'"

In November 2019 the FDA issued a warning letter to a local hemp company, Apex Superfoods, over advertising animal feed pellets as CBD products that the FDA claimed were adulterated. Apex's owner, JT Taylor, says his way of processing hemp is different from how many others in the industry do it. He cold presses hemp seed and bud to create an oil and doesn't isolate CBD like some other companies.

"Isolation itself is adulteration, and anything used with chemicals and processing agents is an adulterant. It is exactly what the FDA has licensed in the pharmaceutical company and the food world," he said. "So is it CBD oil or is it hemp oil? How do you get the cannabinoids out of the hemp without adulterating it? It's a natural compound found in hemp."

Taylor avoided any enforcement actions from the FDA, which range from seizure of property to criminal prosecution, by changing labeling and removing claims of CBD's benefits in social media posts. After corresponding with FDA agents, Taylor sought to become GRAS (Generally Recognized as Safe) certified, but the barriers aren't scalable for someone without a massive amount of capital.

"It's extensive. You've got to do case studies. It's hundreds of thousands of dollars to get anything passed through them. And if you don't have that threshold of income, then you're not going to be able to compete with the big boys," Taylor said.

It's also annoying to producers that they're barred from making claims of therapeutic benefit when it's both the main appeal of their product and there's a growing amount of research supporting some health benefits to taking CBD. The National Academies of Science, Engineering and Medicine reported that cannabis or cannabinoids can significantly reduce chronic pain symptoms and reduce chemotherapy-induced nausea, reduce multiple sclerosis-related spasticity. A study out of Oregon State University found hemp compounds can block COVID-19 from causing an infection. Most recently, a study out of Kansas State University found hemp decreased stress in cows.

"Most people simply at that point just go remove those claims even though the claims are valid, and this even extends to customer testimonials," Robson said.

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What the FDA? - The Source Weekly

Each week well run through the sublime, the trivial and profound issues, decisions and goings on that strike us as Hits or Misses. you can join in, too, by emailing your Hits & Misses to editboard@theunion.com.

HIT (from reader Marsha Lewis): To the return of garden tours to Empire Mine State Historic Park after a pandemic hiatus at 10:30 a.m. Saturdays and Wednesdays May through September.

HIT (from reader Shanti Emerson): To the Nisenan tribe continuing to get important recognitions. The latest is the Native American Heritage Commission contact/tribal consultation list, which enables them to consult on any project in their area, such as the Idaho-Maryland Mine. The commission identifies, catalogs and protects Native American cultural resources ancient places of special religious or social significance to Native Americans and known ancient graves and cemeteries of Native Americans on private and public lands in California.

HIT (from Emerson): To Sierra Stages for yet another wonderful musical performance.

MISS (from reader George Carter): To Waste Management. With major property work completed in September, I canceled our rental of two large Waste Management yard waste bins and was assured that they would be removed. Another phone call and assurance in October, and then November all with the bins sitting roadside in front of our property. In my 11th call on March 14 came more assurance of action. Then something new happened! A Waste Management email arrived giving April 5 as the date certain for pickup. Yay! But no. The bins still sit lonely by the roadside. My wife says my idea to post a Free sign likely would prompt action, but the bins dont belong to us. So we wait in hope.

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HIT (from reader Ray Bryars): To the Green Waste Disposal Program that has allowed hundreds of property owners to reduce the storm debris on their properties. Also to the staff and volunteers who made it such a well-managed, efficient process. Can we do it again next year? Maybe four times would help some of us get ahead of the vegetation growth.

MISS (from reader Phil Reinheimer): To the Republican senators who got up and walked out as Ketanji Brown Jackson was confirmed to the Supreme Court. What an insult and disgrace!

HIT (from Editorial Board member Ed Beckenbach): To those with the fortitude to continue reading long articles and commentareis for or, mostly, against reopening the Idaho-Maryland Mine with the faint hope that there will be some new fact, some so-far unused argument, that will make them consider possibly changing their position on the subject. Or maybe that should be a MISS.

MISS (from Editorial Board member Jo Ann Rebane): To The Union editorial cartoon of April 8 that depicted a wild-eyed GOP elephant resuscitating Hunter Bidens laptop. Its obvious that the news media, including this paper, still fear the harbinger of scandals coming out of the laptops emails and other contents.

HIT (from Rebane): To celebrations this week of Easter and Passover. These observances in our community help maintain our culture and remind us of our countrys Judeo-Christian roots.

HIT (from Editorial Board member Tom Durkin): To Republican senators Mitt Romney, Susan Collins and Lisa Murkowski broke ranks with the Party of No to confirm Supreme Court Justice Ketanji Brown Jackson to replace retiring Justice Stephen G. Breyer.

MISS (from Durkin): To Republican Sens. Lindsey Graham and Rand Paul, who in a show of petty disrespect refused to come to the floor of the Senate for the historic vote to confirm Justice Jackson. They cast their no votes from the Senate cloakroom.

HIT (from Publisher Don Rogers): To the start this week of the local candidate forum season for the June 7 primary elections at the Nevada County Association of Realtors. On Tuesday, candidates for the contested Board of Supervisors and county clerk/registrar of voters races got in their first reps on questions theyll be answering over and over again. The key question for supervisor is the one they cant answer and be able to vote on later, if elected: What do you think of the bid to reopen the Idaho-Maryland Mine? The contest for registrar of voters (no one cares so much about the county clerk part, it seems) mainly is a political referendum of sorts on the the offices ability to run clean elections not that theres been much of a question about that locally.

HIT (from Rogers): To the candidates. There is a spread in their points of view and they offer choices about the future of the offices they are running for. This is a good thing. Theres also a little mystery around the the big question, that elephant in the room, for the supervisor candidates, those who havent naively tipped their hands and rendered themselves essentially ineligible to vote on the mine, should that issue reach them.

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Hits & Misses: The return of garden tours at Empire Mine are a HIT - The Union