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1.0pt;mso-border-alt:inset #616559 .75pt; padding:0in 0in 0in 0in'> <div align=center> <table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width=500 style='width:375.0pt;mso-cellspacing:0in;mso-yfti-tbllook:1184;mso-padding-alt: 0in 0in 0in 0in'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td style='padding:0in 0in 0in 0in'> <p class=MsoNormal align=center style='text-align:center'><a href="http://www.hallrender.com/" title="&quot;Hall Render Health Law News&quot; t "><span style='mso-fareast-font-family:"Times New Roman";mso-no-proof:yes; text-decoration:none;text-underline:none'><img border=0 width=554 height=97 id="_x0000_i1027" src="http://www.hallrender.com/email/img/health-law-header.jpg" alt="Hall Render Health Law News"></span></a><span style='mso-fareast-font-family: "Times New Roman"'><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:1'> <td style='background:#B5B5A1;padding:2.35pt 2.35pt 2.35pt 2.35pt'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp; &nbsp; &nbsp; <a href="http://www.hallrender.com/?&amp;section=library" title="Hall Render Knowledge Center"><b><span style='font-size:7.0pt; font-family:"Arial","sans-serif";color:white;text-transform:uppercase; text-decoration:none;text-underline:none'>KNOWLEDGE CENTER</span></b></a> &nbsp; <strong><span style='color:#B6121B'>||</span></strong> &nbsp; <a href="mailto:hallrender@hallrender.com" title="Contact Hall Render"><b><span style='font-size:7.0pt;font-family:"Arial","sans-serif";color:white; text-transform:uppercase;text-decoration:none;text-underline:none'>CONTACT</span></b></a> <o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:3'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <div align=center> <table class=MsoNormalTable border=0 cellpadding=0 width="90%" style='width:90.0%;mso-cellspacing:1.5pt;mso-yfti-tbllook:1184;mso-padding-alt: 0in 5.4pt 0in 5.4pt'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes'> <td valign=top style='padding:.75pt .75pt .75pt .75pt'> <div id="previewcell:cell1"> <table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="100%" style='width:100.0%;mso-cellspacing:0in;background:white; mso-yfti-tbllook:1184;mso-padding-alt:3.75pt 3.75pt 3.75pt 3.75pt'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes'> <td style='padding:3.75pt 3.75pt 3.75pt 3.75pt'> <p align=right style='margin:0in;margin-bottom:.0001pt;text-align:right'><strong><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:#616459'>June 3, 2010</span></strong><span style='font-size:10.5pt;font-family:"Arial","sans-serif"; color:#B5121B'><o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:13.5pt;color:#B5121B'>CMS Proposes Rule to Revise Medicare Conditions of Participation Governing Telemedicine Credentialing/Privileging - <span style='mso-spacerun:yes'> </span>A Relaxed Standard</span><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:#616459'><o:p></o:p></span></p> <p style='text-align:justify'><strong><span style='font-size:10.0pt; font-family:"Arial","sans-serif";color:#616459'>Executive Summary</span></strong><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:#616459'><o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>On May 26, 2010, the Centers for Medicare and Medicaid Services (&quot;CMS&quot;) published proposed changes to the credentialing and privileging process applicable to telemedicine practitioners under the Conditions of Participation (&quot;CoPs&quot;) for hospitals and critical access hospitals (&quot;CAHs&quot;) (&quot;Proposed Rule&quot;).&nbsp; Under the Proposed Rule, the governing body of a hospital, or the governing body or responsible individual for a CAH, whose patients are receiving telemedicine services (&quot;Originating Hospital&quot;) would have the option of granting privileges to telemedicine practitioners based <i>on information provided by the &quot;Distant-Site Hospital&quot; providing the telemedicine services</i>.&nbsp; In other words, the Proposed Rule would permit Originating Hospitals to rely on the credentialing and privileging decisions of the Distant-Site Hospital in lieu of conducting duplicative and time-consuming individual appraisals of telemedicine practitioner candidates.&nbsp; Under the current CoPs, hospitals and CAHs must undertake the full privileging function even though telemedicine practitioners have been thoroughly vetted by a Distant-Site Hospital under contract to provide telemedicine services for the Originating Hospital's patients.&nbsp; <o:p></o:p></span></p> <p><span style='font-size:10.0pt;font-family:"Arial","sans-serif"; color:#616459'>The affected CoPs are: 42 C.F.R. §§ 482.12, 482.22, 485.616 and 485.641.&nbsp; Comments on the Proposed Rule are due to CMS no later than 5 p.m. on July 26, 2010 and may be submitted electronically (<a href="http://www.regulations.gov" title="http://www.regulations.gov" alias="http://www.regulations.gov" conversion=false>http://www.regulations.gov</a>), by regular mail, by express or overnight mail, or by hand delivery or courier.&nbsp; Commenters must reference file code CMS-3227-P.&nbsp; See: <a href="http://edocket.access.gpo.gov/2010/2010-12647.htm" title="http://edocket.access.gpo.gov/2010/2010-12647.htm" alias="http://edocket.access.gpo.gov/2010/2010-12647.htm" conversion=false>http://edocket.access.gpo.gov/2010/2010-12647.htm</a> (.pdf version may be found here <a href="http://edocket.access.gpo.gov/2010/pdf/2010-12647.pdf">http://edocket.access.gpo.gov/2010/pdf/2010-12647.pdf</a>) for details.&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><strong><span style='font-size:10.0pt; font-family:"Arial","sans-serif";color:#616459'>Background</span></strong><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:#616459'>&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>The hospital CoPs and CAH CoPs set forth specific requirements for participating in the Medicare and Medicaid programs.&nbsp; In the hospital CoPs, the governing body of the hospital is responsible for making all decisions regarding privileging, and it bases these decisions upon recommendations from its medical staff's examination of the credentials and qualifications of the practitioners.&nbsp; Under the CAH CoPs, the CAH is required to have its privileging decisions made by either the governing body or the person responsible for the CAH.&nbsp; Every CAH that is a member of a rural health network must have an agreement to review and evaluate practitioners seeking privileges at the CAH with a hospital that is a member of the network, a Medicare Quality Improvement Organization, or another qualified entity identified in the State's rural health plan.&nbsp; These requirements for hospitals and CAHs apply to all practitioners providing patient services, whether the services are in-person and on-site or through a telecommunications system.&nbsp; Therefore, a practitioner who only provides telemedicine services for an Originating Hospital must still undergo a <i>complete</i> privileging process by the Originating Hospital.&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>Hospitals and CAHs accredited by The Joint Commission (&quot;TJC&quot;) are able to avoid having to carry out a complete privileging process for telemedicine practitioners through a process known as &quot;Privileging by Proxy.&quot;&nbsp; TJC allows a hospital or CAH seeking telemedicine services of a practitioner to accept the privileging decisions of the Distant-Site Hospital for that practitioner if the Distant-Site Hospital also is accredited by TJC.&nbsp; Currently, hospitals and CAHs accredited by TJC are deemed to meet the Medicare CoPs.&nbsp; While Privileging by Proxy technically does not meet the CoPs, the hospital or CAH currently is &quot;deemed to have met&quot; the CoPs through its TJC accreditation.&nbsp; However, the Medicare Improvements for Patients and Providers Act (Pub. L. 110-275, July 15, 2008) (&quot;MIPPA&quot;) terminates the statutory recognition of TJC's hospital accreditation program, which includes the &quot;deemed to have met&quot; language.&nbsp; Effective July 15, 2010, TJC will be required to enforce the CoP requirements regarding the privileging of telemedicine practitioners in TJC-accredited hospitals.<sup>1</sup>&nbsp;&nbsp;&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>In light of the upcoming effective date of MIPPA and the expressions of concern voiced by industry stakeholders, CMS has proposed to revise the CoPs to allow a more flexible telemedicine practitioner privileging process while eliminating &quot;unnecessary and duplicative regulatory impediments.&quot;<o:p></o:p></span></p> <p style='text-align:justify'><strong><span style='font-size:10.0pt; font-family:"Arial","sans-serif";color:#616459'>Proposed Changes</span></strong><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:#616459'>&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>Under the proposed changes to the hospital CoPs, Originating Hospitals would have a second option for completing the privileging requirements for telemedicine practitioners.&nbsp; Under this second option, hospital medical staff would be able to rely on credentialing and privileging decisions of the Distant-Site Hospital as part of its recommendation to the Originating Hospital's governing body to grant the telemedicine practitioner privileges.&nbsp; The Originating Hospital still would be able to utilize the traditional credentialing and privileging process at its discretion, but this second option would help avoid duplicative information-gathering and evaluations by both the Originating Hospital and Distant-Site Hospital.&nbsp;&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>The agreement between the Originating Hospital and the Distant-Site Hospital must specify that it is the responsibility of the Distant-Site Hospital's governing body to meet the existing requirements of the hospital CoPs.&nbsp; In addition, CMS recognizes that this second option is less burdensome and is requiring additional accountability measures.&nbsp; Specifically, in order to utilize this second option, the Originating Hospital must ensure that:&nbsp;<o:p></o:p></span></p> <div> <ol start=1 type=1> <li class=MsoNormal style='color:#616459;mso-margin-top-alt:auto; mso-margin-bottom-alt:auto;text-align:justify;mso-list:l4 level1 lfo3; tab-stops:list .5in'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";mso-fareast-font-family:"Times New Roman"'>The Distant-Site Hospital is a Medicare-participating hospital;<o:p></o:p></span></li> </ol> </div> <div> <ol start=2 type=1> <li class=MsoNormal style='color:#616459;mso-margin-top-alt:auto; mso-margin-bottom-alt:auto;text-align:justify;mso-list:l4 level1 lfo3; tab-stops:list .5in'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";mso-fareast-font-family:"Times New Roman"'>The practitioner who will provide telemedicine services must be privileged at the Distant-Site;<o:p></o:p></span></li> </ol> </div> <div> <ol start=3 type=1> <li class=MsoNormal style='color:#616459;mso-margin-top-alt:auto; mso-margin-bottom-alt:auto;text-align:justify;mso-list:l4 level1 lfo3; tab-stops:list .5in'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";mso-fareast-font-family:"Times New Roman"'>The practitioner's current list of privileges is provided by the Distant-Site Hospital;<o:p></o:p></span></li> </ol> </div> <div> <ol start=4 type=1> <li class=MsoNormal style='color:#616459;mso-margin-top-alt:auto; mso-margin-bottom-alt:auto;text-align:justify;mso-list:l4 level1 lfo3; tab-stops:list .5in'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";mso-fareast-font-family:"Times New Roman"'>The practitioner holds a license in the state, or one recognized by the state, in which the telemedicine services will be provided; and<o:p></o:p></span></li> </ol> </div> <div> <ol start=5 type=1> <li class=MsoNormal style='color:#616459;mso-margin-top-alt:auto; mso-margin-bottom-alt:auto;text-align:justify;mso-list:l4 level1 lfo3; tab-stops:list .5in'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";mso-fareast-font-family:"Times New Roman"'>The Originating Hospital utilizing telemedicine services has evidence of an internal review of the practitioner's performance of his/her privileges, including, at a minimum, all adverse events resulting from telemedicine services and all complaints received by the Originating Hospital about the practitioner; the Originating Hospital must send the Distant-Site Hospital this information for use in the Distant-Site Hospital's periodic appraisal of the practitioner.&nbsp;<o:p></o:p></span></li> </ol> </div> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>CMS also is proposing that additional language be added to the CoPs requiring that the hospital's medical staff bylaws include criteria for determining privileges and a procedure for applying the criteria to individuals requesting privileges.&nbsp;&nbsp;&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>Modeled after the proposed changes to the hospital CoPs, the proposed changes to the CAH CoPs are very similar.&nbsp; However, since the current CAH CoPs only provide that the governing body has the responsibility to grant surgical privileges to practitioners, the proposed changes include adding language similar to the hospital CoPs regarding the governing body's responsibilities regarding the staff privileging process.&nbsp; In addition, the proposed changes would add a new requirement that would allow the Distant-Site Hospital to evaluate the quality and appropriateness of the diagnosis and treatment furnished by its own staff when providing telemedicine services to the CAH.&nbsp;&nbsp;&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><strong><span style='font-size:10.0pt; font-family:"Arial","sans-serif";color:#616459'>Analysis and Recommendations</span></strong><span style='font-size:10.0pt; font-family:"Arial","sans-serif";color:#616459'>&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>The Proposed Rule, if finalized and adopted, will ease the burden on Originating Hospitals that do not have the resources and/or clinical expertise to carry out the traditional credentialing and privileging process for remote and highly-specialized telemedicine practitioners.&nbsp; All Originating Hospitals will benefit to the extent the Distant-Site Hospital provides services of a large number of telemedicine practitioners.<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>While the Proposed Rule makes significant headway toward eliminating barriers to the use of telemedicine, it does not address all possible concerns.&nbsp; For example, does the Proposed Rule apply to teleinterpretive services where the telemedicine practitioner interprets a radiology study but does not offer any recommendations for follow-up treatment?&nbsp; With respect to Originating Hospitals using non-hospital based teleradiology services (e.g., &quot;Nighthawk&quot; services) or contracting with non-Medicare participating hospitals for telemedicine services, there is no mechanism through which Originating Hospitals can rely on the credentialing and performance appraisal information provided by such entities.&nbsp; We expect a flurry of comments addressing these issues.&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>TJC hospitals, in particular, may be well advised to offer comments on the Proposed Rule since the Final Rule will affect TJC standards/EPs and impact TJC hospitals with telemedicine agreements.&nbsp;&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>Finally, depending on how the Proposed Rule is finalized, hospitals and CAHs will need to amend their Medical Staff Bylaws and/or Rules and Regulations as they apply to the credentialing and privileging of telemedicine providers.&nbsp;<o:p></o:p></span></p> <p style='text-align:justify'><span style='font-size:10.0pt;font-family: "Arial","sans-serif";color:#616459'>If you have any questions, please do not hesitate to contact Cody Lawson (317-977-1590 or <a href="mailto:clawson@hallrender.com" alias="clawson@ hallrender.com" conversion=undefined>clawson@hallrender.com</a>), Adele Merenstein (317-752-4427 or <a href="mailto:amerenst@hallrender.com" title="amerenst@hallrender.com" alias="amerenst@hallrender.com" conversion=undefined>amerenst@hallrender.com</a>) or your regular Hall Render attorney.<o:p></o:p></span></p> <div> <div> <div class=MsoNormal><span style='font-size:10.0pt;font-family:"Arial","sans-serif"; mso-fareast-font-family:"Times New Roman";color:#616459'> <hr size=1 width="33%" align=left> </span></div> </div> </div> <p style='text-align:justify'><sup><span style='font-size:7.5pt; font-family:"Arial","sans-serif";color:#616459'>1</span></sup><span style='font-size:7.5pt;font-family:"Arial","sans-serif";color:#616459'>&nbsp;In preparation for the July 15, 2010 deadline, TJC submitted to CMS for approval revised standards elements of performance (&quot;EPs&quot;) requiring all telemedicine practitioners providing patient care, treatment and services to be credentialed and privileged at the originating site.&nbsp; CMS approved the revised EPs (see 74 Fed. Reg. 62333) but in view of the Proposed Rule under consideration, extended the effective date for implementation of the revised EPs to March 1, 2011.&nbsp; The revised implementation date, currently, is under review by TJC but has not yet been adopted by TJC.&nbsp; </span><span style='font-size:10.0pt;font-family:"Arial","sans-serif";color:#616459'><o:p></o:p></span></p> </td> </tr> </table> </div> </td> </tr> </table> </div> </td> </tr> <tr style='mso-yfti-irow:4'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:5'> <td valign=top style='padding:0in 0in 0in 0in'> <p class=MsoNormal align=center style='text-align:center'><span style='mso-fareast-font-family:"Times New Roman";mso-no-proof:yes'><img border=0 width=554 height=70 id="_x0000_i1026" src="http://www.hallrender.com/email/img/health-law-separator.jpg" alt="http://www.hallrender.com/email/img/health-law-separator.jpg"></span><span style='mso-fareast-font-family:"Times New Roman"'><o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:6'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:7'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <div align=center> <table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0 width="80%" style='width:80.0%;mso-cellspacing:0in;mso-yfti-tbllook:1184;mso-padding-alt: 0in 0in 0in 0in'> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'> <td width="35%" valign=top style='width:35.0%;padding:0in 0in 0in 3.95pt'> <p class=MsoNormal><strong><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'>Indiana Offices</span></strong><span style='font-size:8.0pt;mso-fareast-font-family:"Times New Roman"; color:#616459'><br> Suite 2000, Box 82064<br> One American Square<br> Indianapolis, IN 46282 <br> (317) 633-4884<o:p></o:p></span></p> </td> <td width="33%" valign=top style='width:33.0%;padding:0in 0in 0in 0in'> <p class=MsoNormal><strong><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'>Michigan Offices</span></strong><span style='font-size:8.0pt;mso-fareast-font-family:"Times New Roman"; color:#616459'><br> Columbia Center, Suite 1200<br> 201 West Big Beaver Road<br> Troy, MI 48084<br> (248) 740-7505<o:p></o:p></span></p> </td> <td width="32%" valign=top style='width:32.0%;padding:0in 0in 0in 0in'> <p class=MsoNormal><strong><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'>Kentucky</span></strong><span style='font-size:8.0pt;mso-fareast-font-family:"Times New Roman"; color:#616459'><br> 614 West Main Street<br> Suite 4000<br> Louisville, KY 40202<br> (502) 568-1890<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:1'> <td colspan=3 style='padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:2;mso-yfti-lastrow:yes'> <td width="35%" valign=top style='width:35.0%;padding:0in 0in 0in 3.95pt'> <p class=MsoNormal><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'><br> 8402 Harcourt Road<br> Suite 820<br> Indianapolis, IN 46260<br> (317) 871-6222<o:p></o:p></span></p> </td> <td valign=top style='padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'><br> 2390 Woodlake Drive <br> Suite 380 <br> Okemos, MI 48864<br> (517) 706-0920<o:p></o:p></span></p> </td> <td valign=top style='padding:0in 0in 0in 0in'> <p class=MsoNormal><strong><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'>Wisconsin</span></strong><span style='font-size:8.0pt;mso-fareast-font-family:"Times New Roman"; color:#616459'><br> 111 East Kilbourn Avenue<br> Suite 1300 <br> Milwaukee, WI 53202<br> (414) 721-0442<o:p></o:p></span></p> </td> </tr> </table> </div> </td> </tr> <tr style='mso-yfti-irow:8'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:9'> <td valign=top style='background:white;padding:0in 7.9pt 0in 0in'> <p class=MsoNormal align=right style='text-align:right'><span style='mso-fareast-font-family:"Times New Roman"'><a href="http://www.hallrender.com/" target="_blank"><b><span style='color:#B6121B;text-decoration:none;text-underline:none'>hallrender.com</span></b></a>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:10'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:11'> <td valign=top style='padding:0in 3.95pt 0in 15.8pt'> <p class=MsoNormal><span style='font-size:8.0pt;mso-fareast-font-family: "Times New Roman";color:#616459'>This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader must consult with legal counsel to determine how laws or decisions discussed herein apply to the reader's specific circumstances. &nbsp;<o:p></o:p></span></p> </td> </tr> <tr style='mso-yfti-irow:12;mso-yfti-lastrow:yes'> <td valign=top style='background:white;padding:0in 0in 0in 0in'> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'>&nbsp;<o:p></o:p></span></p> </td> </tr> </table> </div> </td> </tr> </table> </div> <p class=MsoNormal><span style='mso-fareast-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p> <custom name="opencounter" type="tracking"></div> </body> <table cellpadding="2" cellspacing="0" width="600" align="center"> <tr> <td> <font face="verdana" size="1" color="#777777"> This email was sent to: <b>%%emailaddr%%</b><br><br> <table cellpadding="2" cellspacing="0" width="450" ID="Table1" Border=0> <tr> <td> <font face="verdana" size="1" color="#777777"> This email was sent by: %%Member_Busname%%<br> %%Member_Addr%% %%Member_City%%, %%Member_State%% %%Member_PostalCode%% %%Member_Country%% </font> </td> </tr> </table><br><br> We respect your right to privacy - <a href="http://email.exacttarget.com/Company/Policies/PrivacyPolicy.html?linkid=View+Privacy+Policy" alias="View Privacy Policy" style="color: #0000ff">view our policy</a> </font> </td> </tr> <tr> <td colspan="2" align="center"> <font face="verdana" size="1" color="#777777"> <br> <a href="%%subscription_center_url%%" alias="Manage Subscriptions">Manage Subscriptions</a> | <a href="%%profile_center_url%%" alias="Update Profile">Update Profile</a> | <a href="%%unsub_center_url%%" alias="Unsubscribe">One-Click Unsubscribe</a> </font> </td> </tr> </table> </html>