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In the example above, this would mean you add 3 to the saving throws made for the unit when it benefits from hard cover. Ignoring the Benefits of Cover Some weapons and models have abilities that ignore the benefit a target might otherwise receive to its saving throws from being in cover, e. Agreeing on Cover The following table provides guidance as to whether a terrain feature is soft cover or hard cover. If a terrain feature does not appear on the table below, players should agree after creating their battlefield whether it is classed as soft or hard cover.
NARRATIVE PLAY MISSION SPECIAL RULES Most narrative play missions use one or more additional special rules to better represent the different tactics and strategies used by Attackers and Defenders. Some of the more in-depth mission special rules are collected below and referenced by the missions that appear later. Concealed Deployment In some battles, commanders have had time to conceal the positions of their forces from their enemy. If a mission uses Concealed Deployment, the Defender will need a set-up marker for each unit in their army that they intend to start the battle deployed on the battlefield. You do not need any markers for units that will start the battle embarked on a TRANSPORT , only a marker for the transport itself. Each marker needs to be distinct for example, by having a different number so it can correspond to a specific unit. The Defender must write down which unit each marker represents and keep this information secret from their opponent. When the Defender deploys their army, they set up the markers instead of their models.
Once the Defender has set up all their markers, the Attacker deploys all their forces. Once this has been done, the Defender then reveals which marker corresponds to which unit, setting up the appropriate models as they do so. Dawn Raid Random Battle Length War is rarely predictable, and the time available to achieve your objectives is never certain. If your mission uses Random Battle Length, at the end of battle round 5, the player who had the first turn must roll a D6. At the end of battle round 6, the player who had the second turn must roll a D6. The battle automatically ends at the end of battle round 7, or when one army has slain all of its foes. Reserves Reserves are forces which are not directly present at the start of battle, but are available as reinforcements. If a mission uses Reserves, it will detail which units in your army start the game in Reserve — these units are not deployed with the rest of your army.
The mission will usually state when the units placed in Reserve arrive on the battlefield — this is typically at the end of a particular Movement phase. If the mission does not specify when units arrive, roll for each unit at the end of your second Movement phase and at the end of each of your Movement phases thereafter — this is called a Reserve roll. Note that if a unit placed into Reserve is embarked within a TRANSPORT , they will arrive when their transport does, not separately if rolling, make a single roll for the transport and the units embarked in it. Cunning commanders may attack under cover of darkness to better conceal their advance from the foe. The mission will explain how and where to set up units when they arrive from Reserve. If your mission uses Dawn Raid, both players must subtract 1 from all hit rolls made in the Shooting phase during the first battle round of the game. In a major offensive, the attacker will often launch a heavy bombardment prior to the main attack.
On a roll of 6, that unit has been hit by a Preliminary Bombardment; that unit suffers D6 mortal wounds. INFANTRY units that are hit by a Preliminary Bombardment can choose to go to ground before the damage is determined — if they do, they only suffer D3 mortal wounds, but cannot take any actions during their first turn. Occasionally, an army will possess overwhelming superiority in numbers. The Attacker can also, at the end of any of their turns, remove any of their units from the battlefield that have a quarter or less of their starting number of models or, in the case of single-model units, a quarter or less of its starting number of wounds.
This unit then counts as having been destroyed for all purposes, and so can be brought back into play later as described above. Use this Stratagem if an INFANTRY unit in your army declares a charge against only one enemy unit in your Charge phase, and that unit is entirely on or within a ruin or Sector Mechanicus structure, but before making the charge roll. After making the charge roll, you can change one of the two dice results to a 6. Use this Stratagem after both sides have deployed, but before the first battle round begins. Pick a terrain feature that is classed as soft cover and is wholly within your deployment zone.
For the remainder of the battle that terrain feature is classed as hard cover instead. HUNKER DOWN Cities of Death Stratagem For troops experienced in city fighting, it becomes second nature to dart behind rubble and take cover in sightobscured spaces at the crack of a rifle shot. Choose a unit from your army that is entirely on or within a ruin or Sector Mechanicus structure. Until the end of the turn, add an additional 1 to saving throws for models in this unit that are receiving the benefit of cover. SIEGE SHELL WRECKER Cities of Death Stratagem These are massive shells that can blast the foe out of cover and render the ruins they hide in unstable. Cities of Death Stratagem Wrecker balls, seismic drills, sophisticated lascutters, or similarly destructive devices can bring an extra level of devastation to city fighting, shattering both ruins and the squads hidden within.
Use this Stratagem in your Shooting phase before making attacks with a MONSTER or VEHICLE from your army. Heavy D6, Heavy 2D6. That weapon can target a single ruin or Sector Mechanicus structure as if it were an enemy unit. Use this Stratagem at the end of your Fight phase if a MONSTER or VEHICLE model from your army is within 1" of a ruin or Sector Mechanicus structure. Cities of Death Stratagem A quick and risky transfusion of refined promethium makes flamer weapons all the more lethal. Select an INFANTRY unit from your army that is within 1" of any Thermic Plasma Regulators or Conduits before it shoots in the Shooting phase, or before it fires Overwatch.
Until the end of this phase, add 1 to the Strength and Damage characteristics of all plasma weapons the unit is equipped with. plasma pistol, plasma gun, plasma rifle, plasma incinerator. Select an INFANTRY unit from your army that is within 1" of any Fuel Pipes before it shoots in the Shooting phase, or before it fires Overwatch. Until the end of this phase, double the range of all flame weapons the squad is equipped with and add 1 to any wound rolls made for these weapons. flamer, heavy flamer, flamestorm gauntlet. PLUNGING FIRE Cities of Death Stratagem When targeting quarry from above, a shooter can pinpoint the weakest part of enemy armour. EXPERT GRENADIER Cities of Death Stratagem Those who survive in the close-quarters hell of urban combat learn to use their grenades to optimal effect. Use this Stratagem when a model from your army throws a Grenade at an enemy unit that is entirely on or within a ruin or Sector Mechanicus structure.
Furthermore, if that Grenade makes a random number of attacks, it always makes the maximum number of attacks instead e. a Grenade D6 profile would instead be treated as a Grenade 6 profile when thrown at a unit that is entirely on or within a ruin or Sector Mechanicus structure. Use this Stratagem before a unit from your army makes its attacks in the Shooting phase. Until the end of the phase, attacks made by models in that unit which have a height advantage over their target are resolved with an additional improvement of 1 to their Armour Penetration characteristic e. LONG BOMB Cities of Death Stratagem Munitions hurled from on high rain down with fury. Use this Stratagem before a unit from your army shoots in the Shooting phase. If a model in that unit has a height advantage, you can double the range of any Grenade weapons it uses this phase. Use this Stratagem at the end of your Movement phase if an INFANTRY unit from your army is within 1" of a Galvanic Servohauler and there are no enemy units within 1" of the same Galvanic Servohauler.
You can move that Galvanic Servohauler in any direction, as if it were a VEHICLE unit in your army with a Move characteristic of 6" it cannot Advance as part of this move, and cannot move within 1" of any enemy model. If the Galvanic Servohauler is towing a crane, both the Servohauler and the crane are moved. SIEGE ARMOUR Cities of Death Stratagem Experienced crews seek to protect their vehicles from plunging fire by adding armour to the tops of their engines of war. Use this Stratagem before the battle. Choose a VEHICLE model from your army: during the battle, enemy attacks do not gain any bonus to their Armour Penetration characteristic for having a height advantage when targeting that vehicle.
OVERLOAD POWER CORE BLOOD IN THE STREETS Cities of Death Stratagem Crudely desecrated, this volatile device makes a potent bomb. Cities of Death Stratagem Cover is the key to survival in urban combat, and those that move out in the open sign their own death warrant. Use this Stratagem before an INFANTRY model from your army that is within 1" of a Plasma Conduit shoots a ranged weapon at a unit within 6". Instead of firing that weapon, that model hurls a power core at the unit. Make a single hit roll; if you hit the target, it suffers D3 mortal wounds. Until the end of the phase, you can re-roll failed wound rolls for attacks made by models in that unit, provided that the target is entirely at street level and is neither obscured nor receiving the benefit of cover.
GRAPPLING HOOKS Cities of Death Stratagem An effective means of claiming the high ground. Use this Stratagem at the start of your Movement phase. Select one of your INFANTRY units. For the duration of your turn, models in that unit can ascend or descend ruins or Sector Mechanicus structures when they move, even without a ladder, wall or girder. Furthermore, for the duration of your turn, do not count any vertical distance that unit moves against the total they can move that turn i. moving vertically is free for those models. Many such acts of sabotage are best resolved through the use of high explosives. Use this Stratagem at the end of your Movement phase. You can only use this Stratagem once per battle. MASTER SNIPERS Cities of Death Stratagem The most skilled marksmen can thread nigh-impossible shots through the densest of terrain to take out enemy officers. RUBBLE AND RUIN Cities of Death Stratagem Years of sustained bombardment have reduced many a sturdy structure to a rubble-strewn deathtrap.
Use this Stratagem at the start of the first battle round, but before the first turn begins. Select a ruin or Sector Mechanicus structure on the battlefield — you cannot select one that is currently occupied by any models. That terrain feature is dangerous terrain for the rest of the battle. Cities of Death Stratagem Urban combat is a dirty business. Use this Stratagem when an enemy unit declares a charge against a unit from your army. Instead of firing Overwatch as soon as the enemy unit declares its charge, the enemy unit makes its charge roll as normal. If this is insufficient to end a move within 1" of the target, no Overwatch is fired at the charging unit.
Otherwise, all models in the charging unit are considered to be within line of sight of all models in the unit being charged, and within half range of all of its ranged weapons, when resolving the Overwatch. SEWER RATS Cities of Death Stratagem By squeezing through pipes and wading through filth, these infiltrators have navigated underground sewer systems, using them to attack the foe from an unexpected quarter. Use this Stratagem just before you set up a SWARM or INFANTRY unit during deployment. Instead of setting up that unit on the battlefield, you can place them to one side and say that they are infiltrating a sewer network.
At the end of any of your Movement phases, you can set the unit up anywhere on the battlefield at street level that is more than 9" from any enemy models and is not within a ruin or a Sector Mechanicus structure. RIGGED TO BLOW Cities of Death Stratagem Placing explosive traps where the enemy is sure to set them off is a classic city-fighting tactic. Use this Stratagem at the end of your turn. Secretly pick an objective marker that is not currently controlled by your opponent, and write this down. This Stratagem is used after both sides have deployed, but before the first battle round begins. Secretly pick a single ruin or Sector Mechanicus structure that is not currently occupied by any models, and write it down. The first time any model moves within 1" of that terrain feature, they trigger booby traps and their unit suffers D3 mortal wounds D6 if they Advanced this turn.
PROXIMITY MINES Cities of Death Stratagem Plasma mines rigged to a sensor are set off by nearby movement, heat or any number of different triggers: a nasty surprise for an unsuspecting foe. Use this Stratagem when an enemy unit is set up as reinforcements during the battle. Roll a D6 for each model in the unit: for each 6, that unit suffers 1 mortal wound. These rules allow you to recreate battles that are fought in cityscapes that are even more hostile and hazardous to the combatants than usual. These can be used in addition to, or instead of, any other Battlezone rules. Battlezone: Industrial Worlds Some rules presented in Battlezone: Industrial Worlds printed first in Chapter Approved: Edition also feature as part of the rules found in this book for example, the rules for Height Advantage on page As a result, if you are using Battlezone: Industrial Worlds in conjunction with Cities of Death, the rules published in this book take precedence.
Warriors must contend not only with enemy forces, but bestial hunters that lurk in the shadows of buildings, or that can burst from sewers to claw and savage their prey. Infested City: Before the battle, the players jointly must gather at least four infestation units. These can be any units that have a Power Rating of 10 or less, but we recommend that players select units that do not share Faction keywords with any units from their own armies. In open play and narrative play games, infestation units can be any unit, and players are encouraged to choose forces that best suit their own story, irrespective of their Power Rating. Perhaps a pack of Helbrutes is rampaging through the city slaying all in their path, or an Officio Assassinorum Execution Force lurks in the ruins ready to strike. Your choice is limited only by your miniatures collection. is less than 6, a new infestation unit is set up on the battlefield.
The players roll off and the winner sets up a new, randomly selected infestation unit anywhere on the battlefield at street level that is more than 9" from any other unit and is not within a ruin or a Sector Mechanicus structure. Infestation Units: Infestation units are treated as enemy units by both players. In the Fight phase, infestation units fight after all other units unless they have charged in their turn see below. When resolving attacks or making saving throws, etc. for infestation units, we recommend your opponent rolls the dice. The Command Re-roll Stratagem cannot be used to re-roll dice rolls made for infestation units. Lurking in the Shadows: Before either side deploys, you must first infest the city. To do so, you will need six objective markers: if there are fewer than six objective markers on the battlefield, the players must alternate setting up extra objective markers on different ruins or Sector Mechanicus structures until there are six these extra objective markers have no effect on any victory conditions.
The players then randomly select three different objective markers, setting up a randomly selected infestation unit on each all models in an infestation unit must be set up within 6" of their objective marker. In their Movement phase, each infestation unit will move as far as possible towards the closest objective marker unless they are already within 3" of one , but they will not Fall Back or Advance. If they are a PSYKER , they will attempt to manifest Smite in their Psychic phase they will never attempt to Deny the Witch. In their Shooting phase, each model will shoot at the closest visible unit. If they are within 12" of any unit in their Charge phase they will attempt to charge the closest unit. In their Fight phase, each model will target the closest unit with all of its attacks.
Infested Sewers: Each time a player sets up a unit using the Sewer Rats Stratagem pg 35 , roll a D6 for each model in that unit: for each roll of 1, one model, chosen by the controlling player, was slain by the creatures infesting the sewers. In addition, at the end of each battle round, both players roll a D6. If the combined score In all cases, infestation units will never target other infestation units, and if two units are equally close, randomly select which they will charge or target with their attacks. If any sequencing issues arise, the players roll off and the winner decides the order in which the rules in question are resolved. Troops must battle not only with the enemy, but the fires consuming the city, fighting through flame and smoke to reach their objectives. Only the insane and the foolish can withstand the heat in such a war zone for long. Set Ablaze: After both sides have deployed, and at the end of each battle round thereafter, the players roll off.
The winner then rolls a D6 for each ruin and Sector Mechanicus structure on the battlefield that is not ablaze. Add 1 if there are any other terrain features that are ablaze within 6" of the terrain feature being rolled for. At the start of each battle round, the number on each blaze dice on the battlefield increases by 1 to a maximum of 6. Pillars of Smoke: Models cannot see through or over terrain features that are ablaze. This means that a unit is not visible, and so cannot be targeted, if a terrain feature that is ablaze is in between it and the firing model. Units that are on or within a terrain feature that is ablaze can be seen and targeted normally. Consumed by Fire: At the end of the battle round, after rolling to see if any terrain features are set ablaze, each player must roll a dice for each of their models that is entirely on or within a terrain feature that is ablaze.
Select an INFANTRY unit that is on or within a terrain feature that is ablaze. That unit cannot make any attacks this phase, but immediately decrease the blaze dice of the terrain feature it is on or within by 1 to a minimum of 1. ARSONISTS Conflagration Stratagem Use this Stratagem at the start of your Shooting phase. Select a ruin or Sector Mechanicus structure that is within 6" of a unit from your army. That unit cannot make any attacks this phase. If the terrain feature is ablaze, immediately increase the blaze dice of the terrain feature by 1 to a maximum of 6. If the terrain feature is not ablaze, it is instead set ablaze. Acid rain pours onto the streets below, exposed flesh sizzling and burning in the deluge. Centuries of such pollutants have compromised the integrity of the buildings themselves, their crumbling walls and weakened floors liable to collapse at any moment.
Acid Rain: Subtract 1 from the Toughness characteristic of models unless their unit is entirely on or within a ruin or Sector Mechanicus structure, or they are a MONSTER , or they are a VEHICLE with a Toughness characteristic of 7 or more that does not have the Opentopped ability. Shrouding Smog: Targets are obscured even if they are completely visible to the firing model or they have the Flyer Battlefield Role. In addition, the maximum range of Rapid Fire, Assault and Heavy weapons is halved in this Battlezone. Crumbling City: All ruins and Sector Mechanicus structures are dangerous terrain pg In addition, terrain features that would provide hard cover instead only provide soft cover, unless the Reinforced Position Stratagem pg 32 is used. Rapid Fire, Assault and Heavy weapons fired by this unit this phase can shoot up to their full range, but will only hit targets over half their maximum range on hit rolls of 6, irrespective of any modifiers that may apply.
Rather than stay and fight, they decide to break out in the dead of night before the attacker can tighten the noose. The opposing side must try to prevent them slipping away under the cover of darkness. THE ARMIES FIRST TURN The players must first decide who will be the Attacker and who will be the Defender. Both players then select a Battle-forged army. Neither army can include any Fortifications. This mission works best with ground-based armies that contain few, if any, units that can FLY. After both sides have deployed, the Defender rolls a D6: on a 6 the Defender has the first turn, otherwise the Attacker has the first turn.
DAWN RAID This mission uses the Dawn Raid rules pg Any units that do so have escaped the ambush — they are removed from the battlefield and take no further part in the battle. BATTLE LENGTH The players should use the Random Battle Length rules pg 31 to determine how long the battle lasts. Any other result is a major victory for the Attacker. The attacker is under orders to locate and destroy this haven, and is fully prepared to flatten the entire block to accomplish their mission. The players roll off and the winner chooses who has the first turn. After reinforcing their positions, the Defender must secretly pick one objective marker to denote their strongpoint. Create a battlefield using the deployment map below and then set up terrain as described on page After terrain has been set up, the Defender must set up 6 objective markers. Each must be set up on or within a different ruin or Sector Mechanicus structure.
After terrain has been set up, the Defender sets up their army using the Concealed Deployment rules pg 31 and then the Attacker sets up their army. The Attacker can use the Demolitions Stratagem pg 34 for free i. it costs 0 CPs and can do so any number of times during the battle. Any other result is a major victory for the Defender. They have held out for days against several waves of attackers, but now the odds stacked against them seem insurmountable. A relief force has been sent to secure the building and save the garrison before the enemy overwhelms their position.
The Attacker has the first turn. Neither player can use the Demolitions Stratagem pg 34 on the Vital Building objective marker. Ensure that there is at least one ruins or Sector Mechanicus structure wholly within 12" of the centre of the battlefield to be the Vital Building. After terrain has been set up, the Defender sets up 1 objective marker on or within the Vital Building. The Attacker then sets up their army wholly within their deployment zone. VITAL BUILDING BATTLE LENGTH The players should use the Random Battle Length rules pg 31 to determine how long the battle lasts.
The Defender has the first turn. Note that whilst the Attacker continues to control the objective marker, the unit itself does not. After terrain has been set up, the Defender must set up 6 objective markers in their deployment zone. The players should use the Random Battle Length rules pg 31 to determine how long the battle lasts. The Attacker uses the Sustained Assault rules pg On a 6, set up the unit wholly within 6" of any battlefield edge. THE ARMIES LET THEM SEE OUR ADVANCE, LET THEM TREMBLE The players must first decide who will be the Attacker and who will be the Defender. The Attacker cannot use any abilities or Stratagems that allow their Thunder Run units to be set up off the battlefield and arrive as reinforcements later.
Thunder Run units cannot move into ruins or Sector Mechanicus structures for any reason. Ensure that the two short edges of the battlefield are connected by a street or road that is sparsely littered with obstacles. Thunder Run units must be set up on streets or roads. Any units that do so have successfully completed their Thunder Run — they are removed from the battlefield and take no further part in the battle. Their mission is to destroy the enemy command structure and swiftly exfiltrate the battlefield, severing the head of the opposing army and leaving their foes reeling in confusion. THE ARMIES TIMED STRIKE The players must first decide who will be the Attacker and who will be the Defender. At the start of the first battle round, the Attacker chooses whether or not the Dawn Raid rules pg 31 will be used in the battle.
FIRST TURN After both sides have deployed, the Defender rolls a D6: on a 6 the Defender has the first turn, otherwise the Attacker has the first turn. TARGET SIGHTED In this mission, the Attacker can use the Master Snipers Stratagem pg 34 for free i. it costs 0 CPs. ONLY THROUGH HIS DIVINE WEAPONRY MAY OUR SALVATION BE OBTAINED. Victory will go to the commander who has fortune, strategy and cunning on their side, and each new mission you play is an opportunity to master all three. The matched play missions available in the Warhammer 40, rulebook give players a wide range of strategic challenges, from the tightly controlled scenarios of Eternal War, to the rapidly shifting battlefield challenges of Maelstrom of War. Every warlord worth their name relishes new strategic challenges, however. Tried and tested tactics must be revised, or whole new routes to victory found. Units that seemed, at first glance, to lack the utility you desired suddenly come into their own as their abilities on the tabletop are proved invaluable.
On the following pages you will find just such a range of exciting new opportunities to crush your foes. PLAYING NEW MISSIONS This section includes twelve new matched play missions: six Eternal War missions and six Maelstrom of War missions. You can agree with your opponent which set of matched play missions to use, or you can roll off, and whoever rolls highest can choose which set to use, be it one from this book or the Warhammer 40, rulebook. Having decided the set you wish to use, you can either select one of its six missions, or roll a D6 to randomly select one using the appropriate table. The table for the matched play missions in this book is below. D6 MISSION MISSION 1 Vital Intelligence pg 48 Disruptive Signals pg 54 2 Narrow the Search pg 49 Decapitation Strike pg 55 3 Cut Off the Head pg 50 Strategic Gamble pg 56 4 The Four Pillars pg 51 Tactical Cascade pg 57 5 Supplies from Above pg 52 Visions of Victory pg 58 6 Beachhead pg 53 Scars of Battle pg 59 MATCHED PLAY MISSION RULES MATCHED PLAY MISSION RULES Strategic Discipline The following rules apply to all matched play games: The same Stratagem cannot be used by the same player more than once during any single phase.
Battle Brothers All of the units in each Detachment in your Battleforged army must have at least one Faction keyword in common. In addition, this keyword cannot be CHAOS , IMPERIUM, AELDARI , YNNARI or TYRANIDS, unless the Detachment in question is a Fortification Network. This has no effect on your Army Faction. Targeting Characters An enemy CHARACTER with a Wounds characteristic of less than 10 can only be chosen as a target in the Shooting phase if it is both visible to the firing model and it is the closest enemy unit to the firing model. Understrength Support Boots on the Ground When determining which player controls an objective marker, exclude all units that have the Flyer Battlefield Role — these units can never control objective markers.
Limits of Command You cannot use the Command Re-roll Stratagem to affect Mission dice rolls. Mission dice rolls include any dice rolls that are made before the battle begins such as those that determine who chooses deployment zones or who gets the first turn , those that must be made at the end of a battle round such as rolls that determine if the battle ends or any rolls that determine how many victory points are awarded to a player. Psychic Focus With the exception of Smite, each psychic power can be attempted only once per turn, rather than once per psyker per turn. In addition, unless the psyker attempting to manifest Smite has either the Brotherhood of Psykers see Codex: Grey Knights or the Brotherhood of Sorcerers ability see Codex: Thousand Sons , you must add 1 to the warp charge value of Smite for each attempt whether successful or not that has been made to manifest Smite during a given Psychic phase, to a maximum warp charge value of Understrength units can only be included in Auxiliary Support Detachments.
Several key data-terminals have been detected, but they have been damaged in the fighting and you cannot reliably tell when each will be processing the intelligence you need. THE ARMIES BATTLE LENGTH Each player selects a Battle-forged army to an agreed points limit. At the end of battle round 5, the player who had the first turn rolls a D6. At the end of battle round 6, the player who had the second turn rolls a D6. The battle automatically ends at the end of battle round 7. Next, four imaginary lines are drawn between the centre of the battlefield and each corner of the battlefield: another objective marker is placed halfway along each of these lines, until there are five objective markers on the battlefield in total. The players then roll off and the winner individually numbers the objective markers 1 through 5. Their opponent uses the other deployment zone. The player who did not pick their deployment zone then deploys their entire army first. Their opponent then deploys their entire army.
If both players have the same, the game is a draw. Victory points are scored for the following: Capture the Data: At the start of each battle round, the player who had the first turn rolls a D6 this cannot be re-rolled for any reason. On a 6, all objective markers are active for that battle round. On any other result, the objective marker which corresponds to the number rolled is active for that battle round. At the end of the battle round, each player scores a number of victory points equal to the number of objective markers they control. Each objective marker is worth 1 victory point; active objective markers are worth 2 victory points instead. In this mission, a player controls an active objective marker if they have more models within 3" of it than their opponent does.
Slay the Warlord: If the enemy Warlord has been slain during the battle, you score 1 victory point. The player who finished setting up their army first chooses who takes the first turn. If they decide to take the first turn, their opponent can roll a dice: on a 6 they seize the initiative, and they get the first turn instead. The matched play rules for Sudden Death are not in use in this mission. You must secure the area while they narrow their scans to its exact location, for it is hidden by a disruptive null field. The enemy is hunting it too, however, and must be driven away from the final location.
At the end of the game, the player with the most victory points is the winner. The players then place one objective marker in the centre of the battlefield. FIRST TURN The player who finished setting up their army first chooses who takes the first turn. If they decide to take the first turn, their opponent can roll a dice: on a 6, they seize the initiative, and they get the first turn instead. A player controls the objective marker if they have more models within the specified distance of it than their opponent does. At the end of battle round 1, this distance is 18", and it shrinks by 3" at the end of each battle round, to a minimum of 3".
So the player with the most models within 15" of the centre of the objective marker at the end of battle round 2, within 12" at the end of battle round 3, and so on, controls the objective marker. NULL FIELD Invulnerable saving throws cannot be made for units that are within 12" of the objective marker. BATTLE LENGTH At the end of battle round 5, the player who had the first turn rolls a D6. FOR THE EMPEROR SEEKS MOST THEY WHO OBEY WITHOUT QUESTION. Your leaders must survive to preserve the information they carry, or else transmit it back to headquarters, whilst preventing the enemy commanders from doing so. THE ARMIES Each player selects a Battle-forged army to an agreed points limit. Victory points are scored for the following: Crucial Intel: At the end of the third battle round, and at the end of each battle round thereafter, each player adds up the number of Intel Points allocated to models from their army that are currently on the battlefield, or that are currently embarked within a TRANSPORT that is on the battlefield; this is the number of victory points that player scores.
Transmit Intel: Starting from the second battle round, a player scores 1 victory point if they control the objective marker at the start of their turn. ETERNAL WAR THE FOUR PILLARS THE FOUR PILLARS Strange and ancient alien pillars dominate this battlefield. While these are in your possession, their energies can be siphoned off and stored to power weapons of unimaginable destruction. Draw imaginary lines from the centre of the battlefield towards each corner of the battlefield and place an objective marker 15" from the centre of the battlefield along each of these lines. Once all the objective markers have been placed, the players then create the rest of the battlefield and set up terrain.
Victory points are scored for the following: Siphon Power: At the end of each battle round, if one player controls more objective markers than their opponent, they score 1 victory point. If they control all four objective markers, they score 3 victory points instead. A player controls an objective marker if they have more models with the Troops Battlefield Role within 3" of it than their opponent does other units cannot control objective markers; ignore them when determining who controls each objective marker in this mission.
You must secure the landing sites, although these are hard to judge from the ground, so your forces must be ready to react and secure them while driving the enemy away from these locations. The players then roll off and, starting with the winner, alternate placing objective markers until four have been placed. Each objective marker can be placed anywhere on the battlefield, as long as each is more than 12" from any other objective marker and more than 6" from the edge of the battlefield. DRIFTING ON THE WIND At the start of each battle round, starting with the player who has the first turn, alternate picking objective markers; for each objective marker, each player rolls a D6. The player who scores highest can move that objective marker up to 3" they can be moved over models and terrain, but they cannot end the move on top of models, and cannot leave the battlefield — if they would, reduce the distance they are moved by the minimum amount necessary.
If the results are tied, that marker is not moved this battle round. The players should then repeat this process for each of the other objective markers. Victory points are scored for the following: Secure Supplies: Starting from the second battle round, each player scores 1 victory point for each objective marker they control at the start of their turn. However, if only one player has models that can FLY excluding those with the Flyer Battlefield Role within 3" of the objective marker, they control it, regardless of the number of nearby enemy models. ETERNAL WAR BEACHHEAD BEACHHEAD You must capture a key point in enemy territory while securing your own borders against their attacks.
Next, the players place one objective marker in the centre of the battlefield. Their opponent uses the other deployment zone, and likewise sets up an additional objective marker within it. Neither of these objective markers can be set up within 8" of any battlefield edge or within 12" of any other objective marker. Victory points are scored for the following: Push Them Back: Starting from the second battle round, each player scores a number of victory points for each objective marker they control at the start of their turn. GLORY IS ACHIEVED THROUGH METAL. The players place six objective markers, as detailed in the Tactical Objectives section of the Warhammer 40, rulebook.
REFINED STRATEGY Before the battle begins, each player selects up to 6 of their Tactical Objectives inform your opponent of your choice. If they are using Tactical Objective cards, remove the selected cards from their deck; otherwise, if that player generates one of the selected Tactical Objectives during the battle by rolling dice, they must immediately generate a new Tactical Objective to replace it. STRATAGEM Players can use the following Stratagem: SIGNAL INTERRUPT Maelstrom of War Stratagem Use this Stratagem after your opponent generates Tactical Objectives. In addition to achieving Tactical Objectives, victory points are scored for the following: Slay the Warlord: If the enemy Warlord has been slain during the battle, you score 1 victory point.
A player cannot have more than 6 active Tactical Objectives at any one time stop generating new Tactical Objectives if a player reaches this limit. HIGH VALUE TARGETS Each time a CHARACTER is slain, the controlling player must randomly select one of their active Tactical Objectives and discard it. If a Warlord is slain, the controlling player must instead randomly select D3 of their active Tactical Objectives and discard all of them. THE ARMIES TAKE A CHANCE Each player selects a Battle-forged army to an agreed points limit. Create the battlefield and set up terrain. If that player is able to achieve the newly generated Tactical Objective by the end of this turn, they score double the number of victory points for that Tactical Objective. This mission uses Tactical Objectives. MAELSTROM OF WAR TACTICAL CASCADE TACTICAL CASCADE Victories can often lead to overconfidence.
For every success, more responsibility will be placed upon your shoulders. You will need to adapt to this greater responsibility, or be buried by it. Otherwise, at the end of battle round 5, the player who had the first turn rolls a D6. The players roll off and the winner determines which of the standard deployment maps is used in the battle see the Warhammer 40, rulebook and picks one of the deployment zones for their army. At the start of each of their turns after their first, The matched play rules for Sudden Death are not in use in this mission. In addition to achieving Tactical Objectives, victory points are scored for the following: Burden of Command: Each player loses 1 victory point for every 3 active Tactical Objectives they still have rounding down at the end of the battle. Unable to reach any higher authority, you must rely on the advice of your ambitious subordinates to best direct your forces.
You can only hope that their advice is well informed. Whenever a player is required to generate a Tactical Objective, they must instead generate two Tactical Objectives and their opponent selects which one they must keep. The other one is discarded, but can potentially be generated again later in the battle. IN AN AGE OF INSANITY LOOK TO THE MADMAN TO SHOW THE WAY. REFINED STRATEGY Before the battle begins, each player selects up to 6 of their Tactical Objectives. MAELSTROM OF WAR SCARS OF BATTLE SCARS OF BATTLE The battle has raged long and hard. Your communications are unreliable, vital equipment has been lost and even the warriors under your command are fatigued beyond measure.
Despite this, a vital opportunity to defeat the foe has arisen. Seize it! On a 1, that player cannot generate Tactical Objectives numbered in this mission, on a 2 that player cannot generate Tactical Objectives numbered , and so on. If a player is using Tactical Objective cards, remove these cards from their deck; otherwise, if that player generates one of the selected Tactical Objectives during the battle by rolling dice, immediately generate a new Tactical Objective to replace it. Battlefield Terrain This section provides rules for a range of terrain pieces that can be used to transform your gaming table into an interactive, thematic battlefield. Rules for Sector Mechanicus and Sector Imperialis terrain allow you to lace your battlefields with thrumming wonders of arcane technology, while those for Death World Forests enable you to add sprawling thickets of lethal plant life to your games, forcing warriors to battle their way through grasping tendrils and weather salvoes of toxic spines as they do battle with one another.
Within this section you will find all the datasheets needed to forge your Adepta Sororitas Citadel Miniatures into an army, alongside a suite of Detachment rules such as Stratagems, Warlord Traits and relics. You will also find points values for fielding a Sisters of Battle army in your matched play games. Index: Renegade Knights Containing background, datasheets and Detachment rules — including Stratagems, a Relic and a Warlord Trait — this section allows you to field the terrifyingly devastating walkers known as Renegade Knights on the battlefields of the 41st Millennium. The Eight This section describes the most famed heroes of the Farsight Enclaves — the Eight — and provides you with rules for using them in your battles. Battle-forged Armies Updated Points Values In this section of the Appendix, you will find useful tools to help you keep track of the details of your Battle-forged armies.
The points values we give to each unit allow players to organise their armies based on the strength of each element, and are a great tool when collecting a force for the tabletop. Once you have a suitably impressive collection of Citadel Miniatures, it is always satisfying to add up their points as an army, either simply to figure out how much your army is worth, or to fine-tune it to a specific points value ready to play games with other hobbyists. The Detachment and army rosters in the Appendix allow you to do just this, with space to record details of each of your units — including their wargear options, Battlefield Role and points values — as well as each Detachment in your army, for easy reference in your games. With each new publication, we review the points values we have given to each unit, and update them if necessary.
Here you will find lists of all the updated points values for such units, including several from the Forge World range. Updated Datasheets Datasheets are essential to playing games of Warhammer 40,, describing the characteristics, wargear and abilities of the models in a unit. Since those publications, several new model kits have been released with new options not accounted for by the current datasheet. There have also been a few instances where rules have changed for a datasheet following extensive feedback from the community. As a result, this final section contains several updated datasheets that reflect the latest rules and options for such units.
If rules for a terrain feature that has rules in the Warhammer 40, rulebook appear here, they update and replace those in the rulebook. CRATERS Many worlds bear the scars of heavy, sustained bombardment. INFANTRY units that are entirely within a crater receive the benefit of cover. Models are slowed when charging across craters. When a model targets an enemy INFANTRY unit that has all of its models within 1" of a barricade, the target unit receives the benefit of cover if the shooting model is closer to the barricade than it is to the target and the target is at least partially obscured from the point of view of the shooting model.
In addition, enemy units can Fight across a barricade, even though the physical distance is sometimes more than 1". When resolving Fights between units on opposite sides of a barricade, units can be chosen to Fight and can make their attacks if the enemy is within 2" instead of the normal 1". When a model targets an enemy INFANTRY unit that has all of its models within 3" of a Galvanic Servohauler, the target unit receives the benefit of cover if the shooting model is closer to the Galvanic Servohauler than it is to the target and the target is at least partially obscured from the point of view of the shooting model.
WOODS Twisted woodlands grow on many a corpsestrewn battlefield. INFANTRY units that are entirely on the base of a wood receive the benefit of cover. If your wood is not on a base, discuss with your opponent what the boundary of the wood is before the battle begins. Models are slowed when charging through woods. RUINS The galaxy is littered with the remains of onceproud cities. Only INFANTRY , BEASTS, SWARMS and units that can FLY can be set up or end their move on the upper floors of ruins any unit can do so on the ground floor.
INFANTRY are assumed to be able to scale walls and traverse through windows, doors and portals readily. These models can therefore move through the floors and walls of a ruin without further impediment. INFANTRY units that are entirely on or within a ruin receive the benefit of cover. Units do not receive the benefit of cover when they are on top of a Munitorum Armoured Container — their position is too exposed. If an INFANTRY unit is on top of a Munitorum Armoured Container that has one or more storm bolters, up to two models in that unit can each fire them each time their unit shoots instead of firing any of their own weapons. Storm bolters are Rapid Fire 2 weapons, with a Range of 24", a Strength of 4, AP0 and Damage 1. THERMIC PLASMA CONDUITS These conduits channel hot plasma and make for dangerous cover.
Thermic Plasma Conduits follow all the rules for Barricades, but they also have the Hazardous Cover ability see Haemotrope Reactors. OBSTACLES The advance of many armies has been thwarted by obstacles. There are two kinds of obstacles: tank traps, which are obstacles to VEHICLES and MONSTERS, and tanglewire, which is an obstacle to everything else. Units are slowed when they attempt to move over obstacles. TITANIC models are not slowed by obstacles. Sector Mechanicus structures follow all the rules for ruins with the following difference: Unless they can FLY , INFANTRY, BEASTS and SWARMS must scale ladders, girders or walls to ascend or descend between the different levels of a Sector Mechanicus structure.
INFANTRY are also assumed to be able to traverse around girders, buttresses and hanging chains, and so move through them without impediment. IMPERIAL STATUARY The heroes of the Imperium are immortalised in stone effigies. When a model targets an enemy INFANTRY unit that has all of its models within 3" of Imperial Statuary, the target unit receives the benefit of cover if the shooting model is closer to the Imperial Statuary than it is to the target and the target is at least partially obscured from the point of view of the shooting model. In addition, IMPERIUM units add 1 to their Leadership characteristic whilst they are within 3" of any Imperial Statuary. Thermic Plasma Regulators follow all the rules for Sector Mechanicus structures, but they also have the Hazardous Cover ability see Haemotrope Reactors. A Death World Forest consists of one or more of the following terrain pieces in any combination: Shardwrack Spines, Eldritch Ruins, Barbed Venomgorse or Grapple Weeds.
Each piece of Death World Forest terrain is a separate model. When a model targets an enemy INFANTRY unit that has all of its models within 1" of a Death World Forest terrain piece, the target unit receives the benefit of cover if the shooting model is closer to the terrain piece than it is to the target and the target is at least partially obscured from the point of view of the shooting model. In addition, subtract 1 from hit rolls for models that make close combat attacks within 3" of a Death World Forest terrain piece — this represents limbs being entangled by sentient roots or minds being fogged by eldritch energies. Each of the four Death World Forest terrain pieces has an additional ability, as described opposite. GRAPPLE WEED These lethal plants uproot themselves to seek out their prey. In addition, at the start of each battle round, each Grapple Weed terrain piece moves 2D6" in a straight line towards the nearest visible unit, provided there are any within 12".
If two or more units are equidistant, roll off to see which one it moves towards. When moving a Grapple Weed terrain piece, it will stop 1" away from any units or any other battlefield terrain. After all Grapple Weed terrain pieces have moved, roll a D6 for each unit within 3" of one or more of them. The throttling limbs of barbed venomgorse are swift and strong. ELDRITCH RUIN An aura of arcane power surrounds these ancient ruins. You can add 1 to Psychic tests and Deny the Witch tests you make for PSYKERS that are within 3" of any Eldritch Ruin terrain pieces. It also provides you with the rules required to assemble your collection of Adepta Sororitas miniatures into a powerful army in your games of Warhammer 40, The Adepta Sororitas, also known as the Sisters of Battle, are an elite sisterhood of warriors raised from infancy to believe unquestioningly in the supreme power of the Emperor of Mankind.
The perfervid, unshakeable nature of their faith is a potent weapon indeed, manifesting as divine inspiration that drives the Sisters of Battle to incredible feats of martial prowess. Their fanatical devotion and unwavering purity are a bulwark against corruption, heresy and alien attack, and once battle has been joined they will stop at nothing until their enemies are utterly crushed. BETA CODEX This section of Chapter Approved forms what we are calling a beta codex. At time of writing, we are busy sculpting a new range for the Adepta Sororitas and are in the initial stages of writing a new Codex: Adepta Sororitas.
This beta codex is therefore designed to provide Sisters of Battle players with a set of these rules that they can make use of until the full Codex: Adepta Sororitas is released alongside the new miniatures range. As this is a beta codex, we want to take this opportunity to invite players to give us feedback on the rules found within. What worked well? What could be improved? What points values should be changed and to what? This feedback will then help to inform the final rules in the full Codex: Adepta Sororitas. It is worth highlighting that we have made some changes for the Adepta Sororitas in this beta codex from the rules within Index: Imperium 2.
Mostly these take the form of small changes to characteristics or abilities, but more significantly we have completely overhauled the Acts of Faith ability that is common to much of the army. We are particularly interested to hear your feedback on this rule in comparison to that presented in Index: Imperium 2. We have also removed Imagifiers as a unit — instead, models within certain Adepta Sororitas units can now carry a Simulacrum Imperialis, and this ties in to how the proposed new Acts of Faith ability works. Finally, whilst this beta codex has been designed to be used in all types of games, including matched play games, if you intend to use them at organised events then it is ultimately up to the event organiser as to whether these rules will be allowed or not as is the case with all our beta rules. We will errata this profile in all our other books wherever it appears.
Burn the heretic! The biggest difference between the two arises from the revised Acts of Faith ability. Individuals with employer-sponsored or other types of private health insurance also face challenges with prescription drug costs. As noted above, in response to increasing costs across all sectors of health care, insurance companies have raised deductibles, increased monthly premiums, imposed or increased copays and coinsurance, and transferred high-cost drugs to more expensive formulary tiers Claxton et al. Among employer-sponsored plans, deductibles grew from 4 percent of cost-sharing payments in to 24 percent in ; coinsurance increased from 3 to 20 percent over that same period Cox, Private health insurance plans have been moving to three- or four-tier coinsurance or copayment structures that require a smaller degree of cost sharing for generics and a greater degree for higher-cost drugs especially when there are therapeutically equivalent options KFF, However, every plan, whether Part D or an employer-sponsored pharmacy benefit, has an exception process that permits coverage of a drug not on formulary or reduce out-of-pocket cost if a physician provides information about side effects the patient has experienced from a lower-tiered drug or offers another medical reason for switching.
As noted in Box , most large employers self-finance their health insurance contributions for their employees and hence have a direct and significant interest in controlling health care costs. The ubiquity of such plans can influence how much individuals cov-. The average coinsurance was 17 percent for first-tier drugs and 38 percent for third-tier drugs. In addition to copayments and coinsurance, health plans can apply an additional deductible to drugs that is separate from the general annual deductible. These plans require a higher deductible than most health plans, in exchange for a lower monthly premium. High-deductible health plans require consumers to cover percent of their health care costs up to a certain amount—the deductible—at which point their insurance coverage and other cost-sharing arrangements begin. In , nearly 30 percent of individuals in employer-sponsored plans were enrolled in a high-deductible health plan Claxton et al.
Recent work has begun to explore the clinical and economic benefits of high-deductible plans in the long run Fronstin et al. Many oral drugs used to treat complex conditions such as HIV, multiple sclerosis, rheumatoid arthritis, cancer, and hepatitis C are costly, and the increasing use of deductibles and coinsurance in the pharmacy benefit offered by insurance plans may lead to significant financial hardship for patients needing treatment. Medicare beneficiaries are exposed to high costs in two primary ways. After enrollees reach the catastrophic coverage threshold, Medicare pays for most 80 percent of their drug costs, plans pay 15 percent, and enrollees pay 5 percent of total drug costs. Second, even patients who reach the catastrophic coverage threshold of Medicare Part D can be exposed to high costs because the threshold is not a hard cap on out-of-pocket costs.
For medications costing tens of thousands of dollars or more per year, patients can spend more out of pocket during the catastrophic phase than in the other benefit phases combined Hoadley, A recent analysis found that 3. To mitigate the concern that pharmaceutical companies might respond by simply raising their list prices, one strategy might be to increase the share of total costs that Part D plan sponsors pay in the catastrophic coverage phase of the benefit up from the current 15 percent , giving them a stronger financial incentive to negotiate larger rebates for higher-priced drugs and to take more steps to manage the use of these drugs by their enrollees, which could produce savings for enrollees, Medicare, and the plans themselves. This practice may bring the price that patients pay for branded medications closer to—and in some cases lower than—the price of generic alternatives, but it does not change the cost to the insurer. In fact, such practices serve to increase costs to insurers and therefore, the premiums charged by the insurer.
The popularity of patient assistance programs among both patients and manufacturers has increased over time Daubresse et al. Assistance programs are delivered through a variety of mechanisms, including coupons, drug savings cards, manufacturer assistance programs provided through the drug maker , access networks that create disease-specific funds, and disease-focused foundation programs. Support can include providing medications or payments directly to individuals. Eligibility for support from these sources varies by insurance status and income. Some types of copayment assistance are not allowed, including the use of manufacturer coupons to pay for drugs obtained through Medicare Part D benefits.
While helpful in some ways, patient assistance programs encourage patients to use higher-cost branded products, since generic manufacturers do not typically offer assistance programs. Patients with very high deductibles or with high coinsurance requirements may find it difficult to pay the out-of-pocket costs to obtain high-priced drugs. In such cases, patients may need to access assistance programs in order to offset the out-of-pocket costs of starting and adhering to therapy, regardless of their insurance status. Each program is a unique, unregulated, private offering by a pharmaceutical company for an individual product. The application process can be onerous for patients and clinicians, with a high probability of rejection, commonly based on patient income level and insurance coverage.
There is little information available to evaluate the impact of patient assistance programs so few studies have examined the proportion of patients served, the extent of aid provided, the criteria for qualifying for aid, and the estimated financial cost to society Felder et al. Drug manufacturers tend to use coupons to promote the use of branded expensive products when less expensive alternatives are available Dafny. One analysis estimated that copay coupons increased branded drug sales by 60 percent or more, almost entirely by reducing the sales of generic competitors, and that they had the potential to undermine the efforts of prescription drug insurance plans Dafny et al. Federal policies prohibit the use of manufacturer coupons in paying for medications paid for by Medicare Part D because it is considered a violation of anti-kickback statues and it raises costs to the government OIG, Congress created the Medicaid Drug Rebate Program MDRP , which went into effect in , resulting from the Omnibus Budget Reconciliation Act of in an attempt to address the rising cost of prescription drugs in the Medicaid program.
In the MDRP, the drug manufacturer enters into a rebate agreement with the HHS secretary in return for Medicaid coverage of all products made by this manufacturer, as well as payments for covered outpatient drugs provided through Medicare Part B. This has essentially created an open formulary in Medicaid. Unlike most rebates for prescription drug spending, the rebates obtained through the MDRP are not negotiated, but are defined by statute. However, many components used to calculate the rebate are proprietary, and as a result, it is difficult to calculate exactly how much Medicaid spends on a particular drug. This contributes to the lack of transparency surrounding drug pricing. Statutory rebates are set by the U.
Congress and enacted into law, and there have been changes over time. States are free to negotiate supplemental rebates on top of the statutory rebates. The basic rebate calculation for single-source drugs and innovator multiple-source drugs 8 is set by statute and is set separately for non-innovator, multiple-source drugs. For single-source and innovator multiple-source drugs, the unit rebate amount is equal to the greater of either the product of Average Manufacturer Price AMP times Statute sets different rebate percentages for certain types of single-source and innovator multiple-source drugs: clotting factors and drugs approved by the FDA exclusively for pediatric indications.
For non-innovator, multiple-source drugs, the unit rebate amount is equal to the product of AMP times 0. The rebate on innovator drugs includes an adjustment to account for price inflation; however, this adjustment is not included in the rebates for non-innovator drugs. Department of Veterans Affairs, the U. Rebates are paid by drug manufacturers on a quarterly basis to states and are shared between the states and the federal government. Under the ACA, drugs provided in managed care settings are also eligible for rebates and as a result, states have increasingly been providing the Medicaid prescription drug benefit through managed care.
States have been left vulnerable to the high costs of branded drugs that have little competition McConnell and Chernew, Recently, Massachusetts submitted an amendment to its demonstration waiver to CMS that would allow the state to have a closed formulary. Prior to the implementation of the MDRP in , manufacturers often provided discounts on their drugs to safety net providers. The waiver request is pending as of November Congress addressed this potential unintended effect of the MDRP with the B program, a drug discount program named after the section 10 in the law that created it Health Affairs , a. Covered entities can seek additional rebates on top of the B discount. The law instructs the HHS to enter into a pharmaceutical pricing agreement PPA with drug manufacturers as a stipulation for their drugs to be covered under Medicaid.
If a drug manufacturer signs a PPA, it agrees that the prices charged for covered outpatient drugs to covered entities will not exceed B ceiling prices as defined by statute. Drugs included in the B program generally consist of outpatient prescription drugs and drugs administered by clinicians in an outpatient setting, excluding vaccines. HRSA administers the B program and is responsible for the oversight of various stakeholders, including covered entities and pharmaceutical companies. The ACA expanded the types of covered entities eligible to participate in the B program, including critical-access hospitals, rural referral centers, sole community hospitals, and freestanding cancer centers. Furthermore, in , HRSA allowed B entities to sign agreements with more than one outside pharmacy—known as contract pharmacies—to provide the covered drugs.
Contract pharmacies are employed by some hospitals and clinics to expand services outside of hospital walls HRSA, By design, B program participation provides qualified entities the opportunity to generate revenue from administering and dispensing prescription drugs, financed by pharmaceutical manufacturers, insurers, and paying patients Conti and Bach, The program does not require enti-. It also does not require these entities to limit the patients who receive the discounted drugs to those who are uninsured or underinsured. These exemptions in turn influence the costs of drug therapies among fee-for-service Medicare beneficiaries and the commercially insured. Patient deductibles and coinsurance payments associated with prescription drugs reflect the reimbursement set by the insurer to the pharmacy or the clinic; these are unaffected by B discounts. Debate about the program has intensified recently, due in part to the large number and the significant diversity of providers receiving the discounts and their safety net roles GAO, ; OIG, ; von Oehsen et al.
Outpatient clinics participating in B are, by definition, serving vulnerable patient populations. In , these standalone safety-net clinics were outnumbered by hospitals, their affiliated outpatient clinics, and contract pharmacies participating in B OIG, Particular scrutiny has focused on acute care nonprofit hospitals. In , roughly one-third of all acute-care not-for-profit hospitals in the United States qualified as covered entities under the B program Conti and Bach, , and they are thought to have accounted for approximately 48 percent of the national outpatient hospital visits Mulcahy et al. In contrast to the clinics, acute care, nonprofit hospitals and their affiliated outpatient clinics participating in the B program are not required to demonstrate that they provide community benefits in the outpatient setting.
To be eligible for B discounts, HRSA requires only that hospitals provide inpatient services to Medicaid and low-income Medicare beneficiaries to the degree that their Medicare disproportionate share patient percentage 11 exceeds the eligibility threshold of The disproportionate patient percentage is equal to the sum of the percentage of. Evidence about the impact of B revenue on safety net and community need engagement among qualifying hospitals is largely anecdotal B Health, ; Kantarjian and Chapman, ; Wallack and Herzog, GAO conducted a cross-sectional comparison of B-qualified Medicare disproportionate share hospitals with nonB hospitals in using publicly available data from Medicare hospital cost reports GAO, The report found that B hospitals provided more uncompensated care than did nonB hospitals and also had lower profit margins than nonB hospitals, in part because they provided more uncompensated and charity care.
A more recent report found that hospitals participating in B in exhibited widely varying financial stability and safety net care provision Nikpay et al. Some B disproportionate share hospital DSH program participants operated at a substantial loss, but at least one-quarter of participants operated with a comfortable margin. Many of the hospitals with the highest operating margins were also those that provided the least uncompensated care, while the hospitals that provided the most uncompensated care had the lowest operating margins. Furthermore, there was little correlation between county-level uninsured rates and the adjusted DSH patient percentage. Finally, some B hospitals and clinics built large networks of contract pharmacies after HRSA released its guidance.
As contract pharmacy arrangements have proliferated, especially with national chains including Walgreens, Rite Aid, CVS, and Walmart, these agreements have come under scrutiny. They are not subject to routine independent audits like other B program providers and manufacturers. Furthermore, contract pharmacies are not required to demonstrate that they serve vulnerable populations at all, nor are they required to show that they meet the core program objectives to qualify for discounts. The report noted that covered entities using contract pharmacies do not always offer the discounted B price. Medicare inpatient days attributable to patients eligible for both Medicare Part A and the Supplemental Security Income plus the percentage of total inpatient days attributable to patients eligible for Medicaid but not Medicare Part A.
Under current statute, neither HRSA nor CMS collects information from qualifying entities or drug manufacturers regarding which drugs are being purchased through the B program, the amount of B-derived revenue generated by qualifying entities, or how revenues are used to benefit vulnerable patient populations. Reports from several pharmaceutical manufacturers suggest that sizable proportions of national product sales 10 to 20 percent are currently subject to B discounts. GAO also analyzed spending on oncology drugs covered under Medicare Part B in , comparing hospitals that were or were not qualified to participate in the B program GAO, Part B spending on those drugs was substantially higher at B hospitals than at nonB hospitals.
Stakeholders have expressed concern that the scale of the program has increased without a subsequent correlation in resources dedicated to oversight. Of particular concern has been the strengthening of oversight by HRSA and CMS to adequately enforce existing prohibitions on diversion and duplicate discounts among covered entities and contract pharmacies GAO, Diversion is when a B drug is given to an ineligible patient or resold by the covered entity. Under current statute, eligible patients are defined as those who receive regular medical care at covered entities or who participate in an AIDS drug-purchasing assistance program and who are not insured by Medicaid, although there are some exceptions. While manufacturers can audit covered entities for suspected unauthorized use of B drugs, covered entities do not have any audit authority and they must petition HRSA to investigate manufacturers or turn to the judicial system when purported violations in B pricing occur; therefore, another focus of these efforts has been to strengthen oversight of possible manufacturer overcharges.
The ACA required a new dispute resolution process and greater pricing transparency by establishing a B. This change will also result in reduced out-of-pocket payments for Part B beneficiaries undergoing outpatient drug-based treatment HHS, The special protections afforded to drugs that prevent or treat rare diseases also influence their availability and may have an impact on their affordability as well. The European Union identifies a rare disease as a condition affecting no more than 5 in 10, people Gammie et al. Fewer than 10 such industry-sponsored products entered the market in the decade preceding the act FDA, e.
Over the past 5 years, orphan drug approvals have increased exponentially Evaluate Pharma, In , nearly half of the new medications approved were orphan drugs, including two that are indicated for diseases with no approved treatments FDA, e. The program provides a number of benefits to the sponsors of FDA-designated products for rare diseases FDA, e , including an additional 7 years of market exclusivity. Participating firms also benefit from more open study protocols with fewer eligibility criteria , which are intended to increase access of affected patients to the medications, and these firms may also receive modest FDA grant support to investigate treatments for rare diseases. The regulatory review process for orphan drugs is expedited, and clinical trials can enroll smaller numbers of patients than would otherwise be acceptable in registration trials. The manufacturers of orphan drugs can.
Furthermore, the act allows manufacturers to claim a tax credit 13 in the taxable year of up to 50 percent for expenses paid or incurred by the sponsor on human clinical trials required to obtain FDA approval FDA, c. These factors tend to substantially reduce the development costs for orphan drugs compared with what traditional drugs cost to develop HHS, However, sponsors are required to request orphan drug designation from the FDA before filing a new drug application FDA, e. Drugs for rare diseases often have higher prices because of the small size of the eligible patient population and because there are generally few if any competitors to address what is most often a high unmet need. Orphan drugs are also more likely to be biologics, which tend to be less susceptible to generic competition Thomson Reuters, The median cost per patient is 5. From to , orphan drug sales increased These include Vioxx, Cialis, and Botox.
Hu PDF - 1. Collective links are provided in 2 or 3 Different Clouds at the end of Each Post. Fill out, securely sign, print or email your nurses notes templates form instantly with SignNow. Both items are free. Identify common formats of the medical record. Pages: These notes are of Made Easy coaching institute, New Delhi. October 8, by Dr. If you don't see an OpenOffice Template design or category that you want, please take a moment to let us know what you are looking for. XXX X The second segment Product Code can be 3 or 4 digits in length, and it represents the product strength, dosage form, and formulation. I really like that I can freely move the notes anywhere on top of the PDF, annotate with gesture, move annotations around, share notes across different PDF files, look up words in the dictionary, keyword search in PDF, etc.
Arshad Bangash Leave a Comment. These exam notes also represented a defining moment for me as a student, because they proved to me that I was stubborn enough to write a set of exam notes even if it was a complete waste of time. In order to ensure that user-safety is not compromised and you enjoy faster downloads, we have used trusted 3rd-party repository Nursing Notes Pdf. About Us. See image of free textbook below. Download Free Medical Notes. So we have brought all 1st-year MBBS book in pdf form. Size: B. Fun Stuff. Feel free to contact us , be our team member to promote us and helping others. A short summary of this paper. University of Basrah. Our digital library saves in fused countries, allowing you to acquire the most less latency times to download any of our books gone this one.
File Count 1. These notes are required whenever a student or employee is expected to disappear from school or office on medical grounds. The study setting was the bed medical center of the Denver Health and Hospital Authority, an integrated, urban safety-net system. Achalasia is a medical condition that affects the way food can pass through your oesophagus into your stomach. If you use my log sheets in your geocache, add a link to http Health and Medical Templates in OpenOffice format. Merely said, the toronto notes for medical students pvaz is universally compatible gone any devices to read.
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA. Home current Explore. Home Chapter Approved Chapter Approved Uploaded by: Jocke 0 0 November PDF Bookmark Embed Share Print Download. Words: 59, Pages: All Rights Reserved. This is a work of fiction. All the characters and events portrayed in this book are fictional, and any resemblance to real people or incidents is purely coincidental. British Cataloguing-in-Publication Data. A catalogue record for this book is available from the British Library. Pictures used for illustrative purposes only. Certain Citadel products may be dangerous if used incorrectly and Games Workshop does not recommend them for use by children under the age of 16 without adult supervision.
Whatever your age, be careful when using glues, bladed equipment and sprays and make sure that you read and follow the instructions on the packaging. ISBN: Games Workshop Ltd, Willow Rd, Lenton, Nottingham, NG7 2WS games-workshop. In the grim darkness of the far future, there is only war. Marked by glory and lurid scars, veteran squads win renown through their deeds upon the field of battle. Great champions and leaders arise, living legends who inspire their followers and strike fear into the hearts of their enemies. Armies clash amidst the urban confines of continent-spanning cities, while skirmish forces engage in brief and bloody conflicts, the outcome of their battles affecting the balance of power in the larger theatre of war.
This is a galaxy filled with uncountable factions, each ever ready for war. Ork hordes swell their planet-crushing numbers with salvaged vehicles, and the greatest living heroes of the Farsight Enclaves enter the fray to turn the tide. Meanwhile, the Orders Militant of the Adepta Sororitas seek to purify the million worlds of the Imperium with bolt and flame. Included here are rules for Ork players to add looted vehicles to their armies, as well as rules for all players to use in creating their own bespoke special characters with unique abilities.
NARRATIVE PLAY: This style of gaming aims to make the 41st Millennium truly come alive on the tabletop. Players will find a Battle Honours system to add a new level of progression to their campaigns, as well as an expansion, Cities of Death, which is designed to recreate the unremittingly harsh urban conflicts of the far future. MATCHED PLAY: This section is packed with new Eternal War and Maelstrom of War missions, available for use in your matched play games. APPENDIX: Here we have collected updated rules for battlefield terrain, updated datasheets and updated points values. You will also find a beta codex for the Adepta Sororitas, an index containing datasheets and Detachment abilities for Renegade Knights, and rules for fielding the legendary warriors of the Farsight Enclaves known as the Eight in your games of Warhammer 40, To make full use of the contents in this book you will need a copy of the Warhammer 40, rulebook.
To find out more about Warhammer 40,, visit warhammer WAYS TO PLAY WAYS TO PLAY WARHAMMER 40, WARHAMMER 40, Warhammer 40, offers three distinct styles of game for players to choose from, depending upon their preferences, the collections they have available, and what they want to get out of the game. These styles are open play, narrative play and matched play, and each has its own strengths. OPEN PLAY For those who simply want to gather part or all of their miniatures collection, get it onto the tabletop and start rolling dice, open play is the perfect way to game. As its name would suggest, open play has few restrictions. Force sizes are not limited, and do not need to be in any way balanced against the army they are facing.
Players are free to invent whatever storyline or framework for the battle they wish, whether that involves using the Only War mission provided in the core rules, or simply inventing their own scenario based upon the sort of game they feel like playing. In this section of Chapter Approved, we present ways in which you can make your games of open play even more exciting. Starting with Looted Wagons pg , Ork players will find rules allowing them to use kustomised vehicles in their armies. From transports to battle tanks and even super-heavy vehicles, open play gives you the flexibility to try units such as these in games of all sizes.
Also included in this section is a set of guidelines for creating your own unique champions and leaders pg These provide you with the opportunity to field completely new characters — such as the Chapter Master of a Space Marine Chapter of your own devising — or to recreate famous figures from the 41st Millennium, such as Black Library favourites Ibram Gaunt and Uriel Ventris, and even the infamous Doomrider. These are just some examples of the kind of things you can do when playing open play games. The only limits to open play gaming are the models in your collection, the gaming space you have available, and your imagination.
NARRATIVE PLAY Games inspired, driven and regulated by a particular pre-generated storyline are usually known as narrative play battles. Chapter Approved provides a range of new content for use with this sort of gaming. First up is Battle Honours pg The Battle Honours rules can be applied to any campaign system, and they enable players to accrue experience points for their units when they perform certain deeds in battle. After each battle these units can gain new ranks, and with them, new abilities. These rules also accommodate using Battle Honours in one-off battles. The section that follows, Cities of Death pg , contains missions and rules that allow players to fight exciting close-quarters battles in the depths of ruined Imperial hives. MATCHED PLAY Utilising points values and Battleforged armies, matched play adds an element of competitive balance to games of Warhammer 40, In this section of Chapter Approved, you will find the latest matched play rules alongside new missions to play — choose from Eternal War missions pg , in which both players compete to achieve the same objective, and Maelstrom of War missions pg , in which random Tactical Objectives can change the face of the game in a heartbeat.
AND MORE! To make your games even more varied and exciting, you can use the rules provided in the rest of the book. They work with any style of gaming: open, narrative and matched. The terrain rules on pages can be used to represent all manner of otherworldly landscapes, from deadly alien jungles and city-sized manufactorums to the ruins of urban hive worlds. This edition of Chapter Approved includes a beta codex for the Adepta Sororitas pg , an elite sisterhood of warriors. This includes background, datasheets and army-wide rules such as Acts of Faith, Warlord Traits, Stratagems and a set of Order Convictions that allow you to represent these iconic forces on the tabletop.
This is a beta codex that we are inviting you, the player, to try out and give us feedback on as we start development of a full Adepta Sororitas codex, which will coincide with the release of a suite of new Sisters of Battle Citadel Miniatures. Following the Adepta Sororitas codex is Index: Renegade Knights pg The datasheets and Detachment rules in this section allow you to field the corrupted walkers of those Nobles turned traitor in all their dark majesty, and include a unique Warlord Trait, Relic and Stratagems. On pages of the appendix you will find background for the Eight, the greatest living legends of the Farsight Enclaves, along with rules on how to field these mighty, battlesuit-clad champions on the battlefields of the 41st Millennium. Lastly, we have included updated datasheets for several units, and updated points values that can be used in your points-based games, including some from the Forge World range pg There has been no peace with this alien race, nor will there ever be, for they understand but one thing: war!
They are savage in victory, unrepentant in defeat. Look to your weapons, for they are your only hope. They provide greenskins of all clans with a wider range of mechanised support, and besides, Orks think there is something inherently funny about blowing foes up with their own weapons. You can convert models to tie them to a story you have read, or simply to make them stand out even more on the tabletop. Looted Wagons present a wealth of opportunities for this sort of thing, being converted from almost any other Citadel kit you like. On the following pages you will find a guide on how to build and convert a Looted Wagon from a Leman Russ Battle Tank, but the same idea can be applied to almost any kit from the Citadel range, from the humble Rhino to the massive Baneblade!
We also include some example datasheets you can use in your open play games for three broad categories of Looted Wagons; Karts, Wagons and Battle Fortresses. Orks have a knack for salvaging, and nothing is more valuable to them than weaponry. Scrap teams haul off damaged or abandoned enemy vehicles, often not even waiting until a battle is over. Ork Mekboyz pay many mouthfuls of teef for the recovered wrecks, and they delight in patching up and kustomising them to improve upon their speed, dakka, and general design. While Looted Wagon is a catch-all term, and can cover any number of modified vehicles, there are three basic categories. Karts are Mek-tinkered transport vehicles. Most often these are made using a chassis from an Astra Militarum Chimera, Goliath Truck or Space Marine Rhino. They are ideal for getting Ork Boyz to the front lines of combat as quickly as possible. Most often the base of a Looted Wagon is Imperial in nature.
A few anti-grav xenos skiffs withstand the brutal modification process, but most are quickly destroyed by Meks who regularly fix complex mechanisms by applying heavy blows from blunt instruments. The second category of looted vehicles, Wagons, sacrifices transport capacity in favour of a larger weapon and thicker armour. Leman Russ Battle Tanks are the most common core for Wagons, but Orks will try out almost anything. The largest pilfered vehicles are Battle Fortresses, mobile strongholds that bristle with weaponry, gun turrets, and additional armour plates. They are frequently based on Imperial super-heavy tanks such as the Baneblade or Shadowsword. WEAPON RANGE Big shoota Shoota Skorcha Stikkbomb launcha 36" Assault 3 5 0 1 18" Assault 2 4 0 1 8" Assault D6 5 -1 1 This weapon automatically hits its target. Explodes: If this model is reduced to 0 wounds, Big Red Button: Once per battle, at the start of the roll a D6 before removing it from the battlefield Shooting phase, the driver of the Kart can hit the and before any embarked models disembark.
On inviting and mysterious red button mounted on his a 6 it explodes, and each unit within 6" suffers D3 dashboard. When he does, roll a D3 on the table below mortal wounds. to see what happens. WARGEAR OPTIONS ABILITIES TYPE D Dakka! In addition, immediately make an additional hit roll against the same target using the same weapon. These additional hit rolls cannot themselves generate any further hit rolls. When firing a weapon with randomly determined characteristics e. a bubblechukka , any additional hit rolls use the same characteristics as the hit roll that generated the additional hit roll. This ability does not affect weapons that automatically hit their target. ABILITIES D3 1 2 3 Result Boosta: Immediately move this model 6" as if it were your Movement phase models cannot disembark from the vehicle before doing so.
Auto-welder: This model regains D3 lost wounds. TRANSPORT This model can transport 10 FLASH GITZ or INFANTRY models. Each MEGA ARMOUR or JUMP PACK model takes the space of two other models.
Chapter Approved 2018,The Latest Rumors and Leaks
WebWARHAER 40, – CHAPTER APPROVED 1 WARHAMMER 40, CHAPTER APPROVED: EDITION Official Update Version Although we strive to ensure WebChapter approved pdf download mega Subscriptions are specific to an individual user and access to the platform requires a redemption code, which will be provided via email WebChapter Approved - Free download as Excel Spreadsheet .xls /.xlsx), PDF File .pdf), Text File .txt) or read online for free. Chapter Approved Open navigation menu WebDec 15, · Published on December 15, blogger.com - Warhammer 40, Chapter Approved Edition By Games Workshop PDF Free WebFeb 6, · Download Here - blogger.com chapter approved pdf download free WebChapter approved pdf download You're Reading a Free Preview Page 2 is not shown in this preview. An official website of the United States government Official websites use ... read more
The ubiquity of such plans can influence how much individuals cov-. If they control all four objective markers, they score 3 victory points instead. Form 2 focuses on the developing level of funds from the issue age premium basis and compares this to the active life reserve. In a Cities of Death mission, the battlefields are characterised by the increased density of the terrain. The only limits to open play gaming are the models in your collection, the gaming space you have available, and your imagination.
The player who did not pick their deployment zone then deploys their entire army first. The regulatory review process for orphan drugs is expedited, and clinical trials can enroll smaller numbers of patients than would otherwise be acceptable in registration trials. The enemy is hunting it too, however, and must be driven away from the final location. These warriors — the Sisters Repentia — band together to seek redemption in battle,
chapter approved 2018 pdf download. Identify common formats of the medical record. Thunder Run units cannot move into ruins or Sector Mechanicus structures for any reason.
