United States: Washington Healthcare Update - January 20, 2015

1. Congress

House

Upcoming E&C Health Subcommittee Hearing on Permanent SGR Fix

On Jan. 14, House Energy and Commerce Health Subcommittee Chairman Joe Pitts announced an upcoming two-day hearing to give subcommittee members a chance to discuss how to enact Sustainable Growth Rate (SGR) reform before the current patch expires at the end of March 2015. The current SGR formula, which has been delayed annually since 2010, limits growth in spending for physicians' services by linking updates to target rates of spending growth. The hearing, entitled "A Permanent Solution to the SGR: The Time Is Now," will be held Wednesday, Jan. 21, 2015, at 10:15 a.m. in 2322 Rayburn House Office Building; it is anticipated that the hearing will recess Wednesday, Jan. 21, and will reconvene on Thursday, Jan. 22, at 10:15 a.m. in 2322 Rayburn House Office Building. Last year, the House of Representatives approved bipartisan H.R. 4302, the Protecting Access to Medicare Act, authored by Chairman Pitts. Despite the agreement on policy in the 113th Congress, H.R. 4302, the Protecting Access to Medicare Act, Republicans and Democrats could not agree on how, or even whether, to pay for replacing the formula, which is estimated to cost about $120 billion over a decade. "For too long, the specter of uncertainty has threatened seniors' access to their trusted doctor. Last year we came closer than ever to finally solving SGR — we even passed a bipartisan bill out of committee 51 to zero. In the coming months, we have an opportunity to build upon that momentum in finding a fiscally responsible path to keep the promise to our seniors and put this issue to bed once and for all," commented full committee Chairman Fred Upton (R-MI).

The hearing webcast and witness list will be available at energycommerce.house.gov.

Bipartisan DME Bidding Legislation Introduced in House and Senate; OIG to Perform Study on Effect of DME Competitive Bidding on Patient Access

On Jan. 13, Representatives Pat Tiberi (R-OH) and John Larson (D-CT) and Senators Portman (R-OH) and Ben Cardin (D-MD) introduced bicameral, bipartisan legislation that would help end the speculative bidding that has plagued the Medicare competitive bidding program for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). The Medicare Competitive Bidding Improvement Act (MCBIA), S.148/H.R. 284, would ensure a fair competitive bidding program by disallowing intentional low-ball bidding for Centers for Medicare and Medicaid Services (CMS) contracts. The respective bills would make all bids binding and require proof of licensure for the next rounds of bidding. "Right now, suicide bids have plagued the DME bid process. These are bids some suppliers propose without the capability to actually supply the products if offered a contract. These bids contribute to unsustainable lower overall rates calculated to reimburse those suppliers who do provide products ... [R]equiring binding bids would insert accountability into the bid process, help seniors access high-quality equipment and services, and improve health outcomes," said Rep. Tiberi.

As it stands, officials from CMS does not have the statutory authority to require binding bids, and Congress must authorize CMS to require binding bids.

Also worth noting, the Department of Health and Human Services Office of Inspector General (OIG) announced in a Dec. 22 letter to Rep. Tom Price (R-GA) that the agency plans to look into whether Medicare beneficiaries' access to durable medical equipment has been hurt by the competitive bidding program; Rep. Tom Price (R-GA) and 137 House members wrote a letter in July 2014 asking the agency to review the matter. "We plan to review documents from providers and Medicare claims data for a nationally representative sample of beneficiaries to determine and compare the rates at which beneficiaries successfully obtained needed items subject to competitive bidding," the OIG letter to Price says. If beneficiaries have not received DME they need, the OIG says it will look for the reason behind that, as well. The study will look at both the first and second round of the program.

A press release on the legislation can be found here.

Legislation to Exempt Emergency Volunteers From Employer Mandate Advances

On Jan. 12, the House passed, by a vote of 401-0, legislation that excludes emergency-service volunteers from being considered full-time employees under the ACA employer mandate. According to the bill's author, Rep. Barletta (R-PA), under the ACA, employers with 50 or more employees must provide health insurance or pay penalties. If volunteers were ever considered employees, fire companies could exceed the 50 employee threshold in several different ways: a volunteer department by itself based on size; by being part of a combined, paid-volunteer firefighter department; or by being part of a municipality that has 50 or more public employees in total. Barletta authored the same legislation in the 113th Congress when it passed the U.S. House of Representatives on March 11, 2014, by another unanimous vote of 410-to-0.

Senate

Bipartisan Legislation Introduced in the Senate to Allow Importation of Rx Drugs from Canada

On Jan. 8, Senators John McCain (R-AZ) and Amy Klobuchar (D-MN) reintroduced bipartisan legislation , the Safe and Affordable Drugs from Canada Act, which would allow individuals to safely import prescription drugs from Canada. S.122 is a measure they hope will create savings for consumers and bring greater competition into the pharmaceutical market. "Minnesotans know that, just on the other side of the border, Canadians often pay much less for the exact same prescription drugs. These cheaper alternatives come with the same safety standards and are the same dosages sold in the United States, but current law prevents Americans from importing them and benefitting from the savings. That just doesn't make sense. This bipartisan bill would allow for the safe import of these drugs from Canada, let competition in from over the border, and bring down costs for American families," Sen. Klobuchar said in a press release. Under the legislation, imported prescription drugs would have to be purchased from an approved Canadian pharmacy and dispensed by a licensed pharmacist. Drugs imported under this bill would be the same dosage, form and potency as drugs in the U.S., but at a significant savings to U.S. consumers. The U.S. spent a total of more than $271 billion on prescription drugs in 2013 alone, and we spend an average of almost $1,000 per person per year on pharmaceuticals — roughly 40 percent more than the next highest country. Senators McCain and Klobuchar first introduced this bill in July 2014.

Senator Grassley Sends Letter to CMS Concerning Failing Iowa Insurance Co-Op

Sen. Grassley (R-IA) sent a letter to the Centers for Medicare & Medicaid Services (CMS) Administrator Marilyn Tavenner on Jan. 13 inquiring about the role of CMS in the financial collapse of CoOportunity Health, a co-op in Iowa and Nebraska formed through the implementation of the Affordable Care Act (ACA). As it stands, the co-op enrolled over 100,000 members and charged premiums that proved to be too low to support the co-op's operations. Iowa insurance regulators took over control of the co-op after CMS refused to meet its request for more funding in order to continue to offer coverage. New beneficiary enrollments were stopped, and members were instructed to find insurance elsewhere. "While CoOportunity was facing financial challenges, if CMS had informed it earlier that it would not receive additional funds it could have taken steps to potentially avoid failure," Grassley wrote in the letter. He asked several questions of CMS to explain how the agency made its loan decisions for co-ops and requested all communications between the agency and the co-op concerning the amount of funding that would be available. In a response letter from CMS, the agency said the co-op's last request for funding was greater than all of the resources CMS had available to loan to co-ops. CoOpportunity was one of 23 health insurance co-ops set up nationally under the Affordable Care Act, and which was set up to bring new choices in areas, such as Iowa, where there was little competition in the insurance market.

2. Administration

Administrator Tavenner to Leave CMS Next Month

On Jan. 16, CMS Administrator Marilyn Tavenner announced that she will step down from her post at the end of February. Tavenner had served as acting administrator since 2011, but with strong bipartisan relationships in Congress, she became the first Senate-confirmed CMS Administrator in almost six years in May 2013 by a vote of 91-7. Despite her working relationship with Capitol Hill, Tavenner oversaw the rocky rollout of HealthCare.gov, the federal health insurance marketplace created by the ACA, and had recently drawn negative attention for over-reporting the number of individuals enrolled in ACA insurance plans. According to HHS Secretary Burwell, CMS principal deputy administrator Andy Slavitt will become acting administrator of CMS.

OMB Reviewing CMS Rule on Mental and Behavioral Health Parity for Medicaid, CHIP and Expanded Medicaid Populations

The White House Office of Management and Budget (OMB) is currently reviewing a proposed Department of Health and Human Services (HHS) rule, released in November 2013, that addresses the requirements under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and applies them to Medicaid Alternative Benefit Plans (ABPs), Children's Health Insurance Program (CHIP) and Medicaid managed care organizations (MCOs) related to beneficiary expansion through measures within the Affordable Care Act. The final rule defines intermediate service and creates an intersection between medical care and behavioral health services, requiring that they be handled in a "comparable fashion" relative to cost sharing/duration limits. While the rule doesn't require that residential services be covered, it says that if MCOs or health insurers offer "post-acute care services," then they must cover residential treatment and other intermediate services on the behavioral health side. CMS finished a rule in November 2013 that applies the mental health parity to commercial plans and plans covered by the Employee Retirement Income Security Act. That rule, which HHS wrote with the Department of Labor and the Department of Treasury, did not apply to plans in Medicaid managed care, CHIP or Medicaid-expansion plans.

HHS Reports 6.8 Million Enrolled in ACA Health Plans

On Jan. 14, HHS announced, in the first weekly snapshot that provides an estimate of plan selections for each state in the federally facilitated marketplace (FFM), that since Open Enrollment began on Nov. 15, nearly 6.8 million consumers selected a plan or were automatically re-enrolled in the FFM. "Nearly 6.8 million Americans have access to quality, affordable health coverage for 2015 through the Federally Facilitated Health Insurance Marketplace," HHS Secretary Sylvia Burwell said. "There are just over four weeks before the Feb. 15 deadline and the end of Open Enrollment. For those who are thinking about getting health coverage, take a look at your options on HealthCare.gov or contact the call center. If you don't enroll by Feb. 15, then you may have to wait until next year to sign up for affordable coverage. In the first month, 87 percent of consumers got financial assistance to help lower the cost of premiums." The Open Enrollment snapshots for the Federally Facilitated Marketplace provide point-in-time estimates for weekly data. These are preliminary numbers and could fluctuate based on consumers' changing or canceling plans or having a change in status such as new job or marriage. The snapshots also include totals from the beginning of the 2015 Open Enrollment period, which started Nov. 15, 2014. Note that data revisions may mean that the weekly totals do not sum to the cumulative numbers.

POTUS Expands Parental Leave for Federal Workers

In a fact sheet published Jan. 15, President Barack Obama announced a new executive action , entitled "Modernizing Federal Leave Policies for Childbirth, Adoption and Foster Care to Recruit and Retain Talent and Improve Productivity," that gives federal employees up to six weeks of paid family leave after the birth, adoption or foster placement of a new child, even if they have not accrued that much time off yet; the measure would also grant federal employees an additional six weeks of unpaid administrative leave for the same purposes. The Administration will also propose using more than $2 billion in new funds to encourage states to develop paid family and medical leave programs as part of its upcoming budget; moreover, the Administration announced that the Department of Labor will use $1 million in existing funds to help state and local governments conduct feasibility studies on the issue. In addition, the President called on Congress to expand these medical leave benefits further by passing the Healthy Families Act, which would grant Americans seven days a year of paid sick time. "The fact is this is not a partisan issue. It's a family issue, and it's an economic issue," said Valerie Jarrett, Senior Advisor to the President. "Adopting policies that are good for working families is both good for business and good for workers." Under the Family and Medical Leave Act (FMLA), many workers may take up to 12 weeks of unpaid time off without losing their job to care for a new child, recover from a serious illness or care for an ill family member (roughly 60 percent of workers are eligible for the law's protections). However, employers are not required to provide paid leave for these purposes and often choose to make it unpaid.

FDA 2015 Regulatory Agenda Released

On Jan. 6 the Food and Drug Administration (FDA) released its list of 90 guidance documents the drug center plans to publish in 2015. The agenda list, "Guidance Agenda: New & Revised Draft Guidances CDER is Planning to Publish During Calendar Year 2015," is published annually by FDA and is meant to outline FDA's regulatory itinerary as it relates to pharmaceutical and biological products. The latest Guidance Agenda contains several guidances of particular note, including four biosimilar guidance documents, including how biosimilar products should be labeled. With regard to marketing guidance FDA expects to finalize six advertising guidance documents, including one on the use of health care economic information, and another one on how companies can use third-party links on social media. Other topics with high priority include manufacturing, with planned guidances on how to "modernize the pharmaceutical manufacturing base" using emerging technologies, another on "quality metrics and risk-based inspections," and another one focused on data integrity — a particular issue for foreign-based inspections. Guidance on several congressional priorities include six guidance documents on track and trace as part of the Drug Supply Chain Security Act (DSCSA) and new guidance on the Sunscreen Innovation Act (SIA), a law passed in late 2014 that aims to speed up the pace at which new sunscreen ingredients can come to market. Unexpectedly off the list was FDA's anticipated final guidance on evaluation and labeling of abuse-deterrent opioids, particularly noteworthy as Congress' FY 2016 budget withheld $20 million in salaries and expenses for the FDA commissioner's office pending finalization of the guidance.

CMS Allows Medicaid Reimbursement for Schools for Some Free Health Services

In a letter to state Medicaid directors, the Centers for Medicare & Medicaid Services (CMS) announced a change in its "free care rule," which bars Medicaid from reimbursing schools for health services offered to students for free. Many advocacy groups asked CMS to change its 17-year-old rule because it discouraged schools from providing health services such as vaccinations, health screenings and asthma care. The previous rule included two exemptions: Services provided to students as part of their individual plans created under the Individuals with Disabilities Education Act and services provided under the Maternal and Child Health Services Block Grant. School eligibility for the updated federal financing program (FFP) policy requires that the student is a Medicaid beneficiary, that the service is covered by Medicaid including the Periodic Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefit and that third-party liability (TPL) requirements are met, among others. CMS issued the guidance after several school districts, including San Francisco Unified, successfully challenged their state programs in court to not provide Medicaid payment under the previous rule and utilizing CMS' administrative appeals process.

3. State Activities

CA Exchange Board Implements Adjustments for New Insurance Market Entrants

The Covered California board of directors adopted a new policy Jan. 15 that will allow more health insurance carriers to sell in areas of the state where patients have few options for coverage. Previously, the exchange had instated a rule not to allow new insurers into the market until 2017, barring a few exceptions. The new policy will allow health insurance companies that are already established in the state to apply to sell individual coverage in underserved areas, which includes Northern California, the Central Coast, the Central Valley and Mono and Inyo counties. As it stands, almost 30,000 covered California subscribers in more than 22 counties have only one insurer option in the state exchange. Worth noting, the state-based exchange will still be giving priority to the existing 2015 insurers to expand coverage into those regions. Covered California Executive Director Peter Lee said large, well-established insurers should not be able to enter the individual exchange immediately because otherwise they would undercut competitors who joined the state exchange when it first opened. However, California Insurance Commissioner Dave Jones (D) criticized the board's new policy, saying it favors the exchange's existing insurers and limits coverage options for beneficiaries. Both UnitedHealthcare and Oscar Insurance Corporation pushed back on the decision in hopes they could offer plans for the first time in 2016.

4. Regulations Open for Comment

Medicare and Medicaid Program; Revisions to Certain Patient's Rights Conditions of Participation and Conditions for Coverage Overview

On Dec. 11, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to revise selected conditions of participation (CoPs) for providers, conditions for coverage (CfCs) for suppliers, and requirements for long-term care facilities, by proposing to clarify that where state law or facility policy provides or allows certain rights or privileges to a patient's opposite-sex spouse under certain provisions, a patient's same-sex spouse must be afforded equal treatment if the marriage is valid in the jurisdiction in which it was celebrated. The proposal was made in response to a Supreme Court decision, United States v. Windsor, which held that Section 3 of the Defense of Marriage Act (DOMA) is unconstitutional because it violates the Fifth Amendment. Section 3 of DOMA provided that in determining the meaning of any Act of the Congress, or of any ruling, regulation or interpretation of the various administrative bureaus and agencies of the United States, the word "marriage" meant only a legal union between one man and one woman as husband and wife, and the word "spouse" could refer only to a person of the opposite sex who was a husband or a wife. To be assured consideration, comments must be received no later than 5 p.m. on Feb. 10, 2015.

CMS Releases Proposed Rule Aimed to Strengthen ACOs

In a Dec. 1 press release, the Centers for Medicare & Medicaid Services (CMS) announced a new proposed rule looking to improve the Shared Savings Program (SSP) for Accountable Care Organizations (ACOs) through a greater emphasis on primary care services and promoting transitions to performance-based risk arrangements. Through the Affordable Care Act (ACA), ACOs encourage doctors, hospitals and other health care providers to work together to better coordinate care when people are sick and keep people healthy, which helps to reduce growth in health care costs and improve outcomes. CMS Administrator Marilyn Tavenner said, "This proposed rule is part of our continued commitment to rewarding value and care coordination -- rather than volume and care duplication. We look forward to partnering with providers and stakeholders to continuously refine and improve the Medicare Shared Savings program." Other goals of the rule include providing more flexibility for ACOs seeking to renew their participation in the program, encouraging ACOs to take on greater performance-based risk and reward, creating alternative methodologies for benchmarks, and streamlining data sharing and reducing administrative burden. The SSSP now includes more than 330 ACOs in 47 states, providing care to more than 4.9 million beneficiaries in Medicare fee for service. Recently, CMS announced first-year SSP results, finding that 58 SSP ACOs held spending below their benchmarks by a total of $705 million and earned shared savings payments of more than $315 million, and that another 60 ACOs had expenditures below their benchmark, but not by a sufficient amount to earn shared savings. Comments on the proposed rule are due by Feb. 6. A fact sheet accompanying the proposed rule can be found here.

5. Reports

MedPAC January 2015 Public Meeting

On Jan. 15-16, the Medicare Payment Advisory Commission (MedPAC) met to discuss Medicare payment policy issues, including upcoming recommendations the commission will issue to Congress in March. Specifically, MedPAC Commissioners voted unanimously to approve site-neutral payments for inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs) for selected conditions, consistent with previous recommendations to Congress. Commissioners also voted on a recommendation to replace the existing bonus for primary care doctors with a per-beneficiary payment method. A full list of topics covered includes:

  • Per-beneficiary payment for primary care
  • Post-acute care: Trends in Medicare's payments across sectors and ways to rationalize payments
  • Assessing payment adequacy and updating payments: Ambulatory surgical centers, dialysis facilities, hospice, inpatient rehabilitation facilities and long-term care hospitals
  • The relative cost of Medicare Advantage, Accountable Care Organizations and fee-for-service Medicare
  • Status report on Part D
  • Hospital short stay policy issues
  • Next steps in measuring quality of care in Medicare

For more information, please visit www.medpac.gov.

OIG: Medicare Hospices Have Financial Incentives to Provide Care in Assisted Living Facilities

According to a recent report issued by the HHS Office of the Inspector General (OIG), Medicare payments for hospice care in Assisted Living Facilities (ALFs) more than doubled in five years, totaling $2.1 billion in 2012. Hospices provided care much longer and received much higher Medicare payments for beneficiaries in ALFs than for beneficiaries in other settings. In addition, hospice beneficiaries in ALFs often had diagnoses that usually require less complex care. OIG found that hospices typically provided fewer than five hours of visits and were paid about $1,100 per week for each beneficiary receiving routine home care in ALFs. Also, for-profit hospices received much higher Medicare payments per beneficiary than nonprofit hospices. This report raises concerns about the financial incentives created by the current payment system and the potential for hospices to target beneficiaries in ALFs because they may offer the hospices the greatest financial gain. Together, the findings in this and previous OIG reports show that payment reform and more accountability are needed to reduce incentives for hospices to focus solely on certain types of diagnoses or settings. OIG based its study on an analysis of all Medicare hospice claims from 2007 through 2012. OIG used Certification and Survey Provider Enhanced Reports data and Healthcare Cost Report Information System reports for information on hospice characteristics.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
 
In association with
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration
Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:
  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.
  • Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.
    If you do not want us to provide your name and email address you may opt out by clicking here
    If you do not wish to receive any future announcements of products and services offered by Mondaq you may opt out by clicking here

    Terms & Conditions and Privacy Statement

    Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

    Use of www.mondaq.com

    You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about Mondaq.com’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.

    Disclaimer

    Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

    The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.

    Registration

    Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

    • To allow you to personalize the Mondaq websites you are visiting.
    • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
    • To produce demographic feedback for our information providers who provide information free for your use.

    Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

    Information Collection and Use

    We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

    We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to unsubscribe@mondaq.com with “no disclosure” in the subject heading

    Mondaq News Alerts

    In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.

    Cookies

    A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

    Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

    Log Files

    We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.

    Links

    This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

    Surveys & Contests

    From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.

    Mail-A-Friend

    If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.

    Emails

    From time to time Mondaq may send you emails promoting Mondaq services including new services. You may opt out of receiving such emails by clicking below.

    *** If you do not wish to receive any future announcements of services offered by Mondaq you may opt out by clicking here .

    Security

    This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to webmaster@mondaq.com.

    Correcting/Updating Personal Information

    If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

    Notification of Changes

    If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

    How to contact Mondaq

    You can contact us with comments or queries at enquiries@mondaq.com.

    If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at problems@mondaq.com and we will use commercially reasonable efforts to determine and correct the problem promptly.

    By clicking Register you state you have read and agree to our Terms and Conditions