Source: http://www.utsystem.edu/OGC/Newsletter/ForeseeableFutureFall2007.htm
Timestamp: 2016-05-04 07:56:52
Document Index: 373266092

Matched Legal Cases: ['art 2', '§415', '§403', '§3716', '§1395', 'art 2', '§403', '§415', '§3716', '§1320', '§1395', '§1395']

Foreseeable Future Fall 2007
Message from the General Counsel New Attorneys at OGC New UT System Initiative to Maintain Copyright Compliance in the Provision of Electronic Access to Course Materials Data Security Issues in Purchasing and Contracting Part-Time and Shared Use Lease Arrangements in the Health Care Industry Institutional Impact of Federal Administrative Offsets Code Red Task Force Legislative Report - Part 2 Resources from this e-Newsletter Message from the General Counsel
In the 1980s, NBC News Overnight (a late, late night broadcast) anchor, Linda Ellerbee, closed each show with the sign off, "And so it goes." That salutation seems apt as we close out 2007 at OGC. Yes, as always we have seen our share of changes (see, i.e., New Attorneys at OGC below) and challenges (student loan crisis, major acquisition transactions for our institutions, etc.) in 2007, but hopefully we have hit the theme of consistency -- of consistently serving our clients. As we prepare to open 2008, new challenges await -- increasing scrutiny in ethics and conflicts of interest for higher education, doing more with less as government funding of higher education stagnates or declines and more we can't even guess at right now. Nevertheless, I'll borrow another pop-culture phrase to close, "We're here and we will keep the lights on." Peace,
Marty Novak, Business Law Section, Real Estate Practice Group
Dan Sharphorn, Deputy General Counsel Omar Syed, General Law Section <back to top>
New UT System Initiative to Maintain Copyright Compliance in the Provision of Electronic Access to Course Materials by Steve Rosen (Business Law, Intellectual Property Group)
The project's goal is for each campus to implement the task force recommendations to ensure effective and compliant course materials delivery operations.	The Bottom Line: Maintaining the University's commitment to copyright compliance requires an understanding of the new modes of delivering academic course materials, the teaching practices and preferences of UT's faculty, and a familiarity with copyright law and its evolution in the context of higher education. The task force, once constituted, will likely take 6-9 months to complete its work. Expect recommendations to the institutions around Fall 2008.
Data Security Issues in Purchasing and Contracting by Barbara Holthaus (General Law)
As technology deployment and risks have changed, the everyday processes of UT System offices and departments have become more reliant on software and computer technology. This brings new partners for outsourcing, interdependencies and unfortunately, opportunities for data exposures. Even the printers we use everyday involve the transfer of digital data and have the potential to be accessed by unauthorized individuals. As technology deployment and associated risks change, appropriate controls on access to electronic data needs to be established in the form of contract language, required environment changes, audits, and data breach notification requirements. The System-wide policy on data security, UTS165, defines the responsibilities borne by every System office and department for purchasing and contracts that involve data sharing in that office or department, even if the purchase is a "low tech" such as the purchase of new software or a new handheld PDA for the boss. An "Owner" is defined in UTS165 as:
Is your office or department:
Considering buying Hardware? "Hardware" is an actual physical device, such as a desktop computer, hard drive, LAN card or printer.
Hardware purchases should generally be reviewed and approved by your institution's IT department. You may want to contemplate working with your Information Technology Department ("IT") to produce a policy to allow Purchasing, IT and the Owner office or department to accomplish this. Your institution may have exceptions for smaller hardware items. For example, see System Administration exceptions.
Considering buying Software? "Software" is computer instructions or data--anything that can be stored electronically. "Systems software" includes the operating system and all the utilities that enable the computer to function. "Applications software" includes programs that do real work for users. For example, word processors, spreadsheets, and database management systems fall under the category of applications software.
Platform – If the institution is hosting the Software, it is important to know how the software interacts with the software. For example, System Administration's expertise is in Microsoft products. Ease of integration/access to system data – Can vendor support web services to access and update their information?
Authentication – Does IT require use of the institution's local credential to authenticate users? System Administration prefers a SAML compliant solution. Its fallback is an eproxy service that we manage. We do not share passwords.
How often do they upgrade their software? What is the process? Is there a cost associated with that or is it covered by the maintenance agreement? When do they expect a new version? Will the transfer to the new version be covered by the maintenance cost?
Accessible – All products purchased above a certain threshold must comply with the state requirement for accessibility of the software.
Security – The vendor must comply with the UTS165 and INT124 security policy. You should share these with the vendor pointing particularly to change management, security of data, backup and recovery and other points of quality control.
Stability of the vendor – evaluate history and the market. Make sure that vendor is willing to escrow the software that will become available to us if they default or go out of business. Keep in mind that ongoing maintenance for a robust business application will average 20% of the software purchase price and budget for it.
What hardware is necessary for the system to be installed? Remember, that if the system is critical to your operation, needing to have high availability and integrity, all hardware costs for a simple installation laid out by the vendor will need to be doubled to provide redundancy. If this is not a general application for the institution this will be part of the cost of the system and will need to replaced every 3-5 years.
Considering Outsourcing/Hosted Solutions where institutional employees will be accessing a vendor's Software on the vendor's site?
Can the vendor ensure adequate uptime, redundancy and other sections of UTS165?
If data must be sent to the vendor can they support secure data transfer (sFTP)?
Can the vendor comply with your records retention and destruction requirements? Is this process automated or will it require customization?
Can you accept the software As Is? If you can't, will the vendor do the customizations and what will it cost? If IT must do it, is the technology a core skill-set or will the IT department need training?
For All IT Related Purchases, Consider:
Actual vs. Promised capabilities. Make sure you see the required functionality work before a contract is signed.
Are IT resources available to meet your timeline for integrating the software, customizing the software or purchasing and configuring new hardware to run the software? What is the process for customer support? Who will do the training on the software and is there a cost? Will it be done at your institution?
What technical support is available when problems arise?
What is the vendor's process for making enhancements to the product? Do you get input to that process? How will changing needs be handled?
Based on the requirements, make note of the changes that will be needed within your institution to use the product correctly.
It is important not to simply select a product and then try and justify the purchase. Instead,you can use a product you like as the basis of the requirements list. Don't become attached to a solution before you examine all of the options and make sure that the vendor can comply with the institution's unique environmental requirements.
Finally, as always, remember that the Office of General Counsel will be happy to assist you with any purchasing or contracting issues involving such purchases and acquisitions.
The Bottom Line: Make friends with your ISO or CISO. Think about IT and data security aspects BEFORE you begin any purchasing process and get your IT folks involved early and often! <back to top>
Part-Time and Shared Use Lease Arrangements in the Health Care Industry by Marty Novak (Business Law, Real Estate Group)
Regardless of whether the parties involved are health care providers, any lease involving the part-time or shared use of facilities and equipment should expressly allocate between the lessor and the lessee the right and duty during their respective periods of control to, among other matters, (i) insure against damage to property and injury or death of persons; (ii) maintain, repair, and replace the facility and equipment; (iii) alter or modify the facility and equipment; (iv) control access and other security arrangements for the facility; and (v) use or install telephone, computer, and other telecommunication services in the facility. If the lessor is subleasing premises that it holds as a tenant under a base lease, then the underlying base lease can create additional issues, such as a requirement that the base landlord consent to the sublease or the extent of the sublessee's right to order special services (such as after-hours HVAC or additional janitorial services) that the base landlord will charge to the sublessor under the base lease.
Health Care Lease Issues
Other significant legal issues arise when at least one of the parties to a part-time lease provides health care services to patients insured under state or federal health care insurance programs such as CHIP, Medicare, Medicaid, or CHAMPUS and patients are referred to that party by the other party to the lease. The primary areas of legal concern in such situations are (i) the federal and state fraud and abuse statutes regulating charges for health care services, and (ii) the confidentiality of patient medical information.
Fraud and Abuse Concerns. The public policy underlying federal and state "fraud and abuse" statutes such as the federal Medicare and Medicaid Fraud and Abuse Act, the federal Ethics in Patient Referral Act (commonly known as the Stark statute), the Texas Patient Solicitation Act and various Texas worker's compensation statutes and regulations (see, e.g., Texas Labor Code §415.003) presumes that any compensation paid by a health care provider for the referral of patients will ultimately result in higher health care costs to the public, private insurers and governmental insurers. Accordingly, these statutes generally prohibit paying or receiving any compensation for the referral of patients insured under state or federal insurance programs and collectively establish both civil and criminal penalties for violations. Experience has shown that some health care providers have attempted to evade the prohibitions against patient referral fees by entering into leases of facilities, equipment and/or personnel that seek to disguise the payment of the referral fees as payments owing under the lease. Accordingly, federal and state regulatory agencies regularly scrutinize health care provider lease arrangements for illicit compensation schemes, and the federal government has declared as "suspect" lease arrangements that involve:
payments of rent for space that traditionally has been provided for free or for a nominal charge as an accommodation between the parties for the benefit of the provider's patients (for example, payments for rent of consignment closets in physicians' offices are generally suspect);
rental amounts in excess of amounts paid for comparable property rented in arms-length transactions between persons not in a position to refer business;
rental amounts for subleases that exceed the rental amounts per square foot in the primary lease;
rental amounts that are subject to modification more often than annually;
rental amounts that vary with the number of patients or referrals;
rental arrangements that set a fixed rental fee per hour, but do not fix the number of hours or the schedule of usage in advance (that is, "as needed" arrangements);
rental amounts that are only paid if there are a certain number of federal health care program beneficiaries referred each month;
rental amounts that are conditioned upon the supplier's receipt of payments from a federal health care program;
rental amounts for space that is unnecessary or not used (for example, where the lessee subleases the entire provider office for one afternoon a week and pays rent on the entire office on the grounds that it is the only occupant during that time, but in fact the lessee only needs the use of one examination room.);
rent is paid for time when the rented space is not in use by the lessee (for example, a lessee has enough business to support the use of one examination room for only four hours each week, but rents the space for an amount equivalent to eight hours per week); and
non-exclusive occupancy of the rented portion of space (for example, a physical therapist does not rent space in a physician's office, but rather moves from examination room to examination room treating patients after they have been seen by the physician. Since no particular space is rented, the government will closely scrutinize the proration of time and space used to calculate the therapist's "rent").
To assist health care providers in structuring leases that comply with the complex federal fraud and abuse statutes, the federal government has issued "safe harbor" guidelines for such leases in an effort to ameliorate the concerns of parties to such leases. (See, 42 CFR 1001.952(b), as amended.) Under these safe harbor guidelines, a lease must (i) be in writing and be signed by the parties; (ii) specify the premises/equipment covered by the lease; (iii) cover all of the premises/equipment leased between the parties for the term of the lease; (iv) be for a term of not less than one year; (v) have an aggregate rental charge set in advance that is consistent with fair market value in an arm's-length transactions and is not determined in a manner that takes into account the volume or value of any referrals or business otherwise generated between the parties for which payment may be made in whole or in part under Medicare, Medicaid, or other federal health care programs; and (vi) be limited in aggregate to the amount of space/equipment that does not exceed that which is reasonably necessary to accomplish the commercially reasonable business purpose of the rental. If the arrangement provides the lessee with access to the premises/equipment for only part-time or periodic intervals of time, then the lease agreement must also specify exactly the schedule of such intervals, the precise length of the intervals, and the exact rent for such intervals.
HIPAA Concerns. Whenever a person outside a health care provider's employ (such as a subtenant, the building landlord, or an outside janitorial service) has access to the offices of the health care provider, appropriate steps must be taken to ensure the protection of protected health care information under the Health Insurance Portability & Accountability Act of 1996. Under this statute, the Department of Human Services has adopted the "HIPAA Privacy Rule" (45 CFR 164.501), which establishes security requirements for all "protected health information" ("PHI"). PHI is defined as all "individually identifiable health information" held or transmitted by a covered entity or its business associate, in any form or media, whether electronic, paper, or oral. HIPAA encompasses both the transmission of protected health information by covered providers and, under appropriate circumstances, non-care provider parties who, because of their job duties, might have access to protected health information. (For example, the subtenant that occupies the provider's premises on a part time basis, the building janitor who might read medical results thrown in a wastebasket, the building maintenance personnel who might rummage through patient files during after-hours maintenance work, etc.) Accordingly, both parties to any lease (whether full or part time) or other agreement allowing access to the covered provider's premises will want HIPAA-oriented provisions in the lease acknowledging the applicability of HIPAA to the arrangement and setting forth appropriate agreements concerning: (i) the respective obligations of the parties to implement appropriate administrative, technical and physical safeguards to protect the privacy of protected health information held by each; (ii) the conduct expected of a party in the event of a disclosure of protected health information to unauthorized persons; and (iii) as appropriate, the affirmation or denial of any "business associate" relationship between the parties, as that term is defined by the HIPAA Privacy Standards. From the covered provider's perspective, such agreements have the additional advantage of establishing a contract action for damages and/or contribution against the party what violated the agreement, which is significant since any suit by the patient for breach of the patient's PHI protections will be against the health care provider. Additionally, the regulations indicate that if an agreement allowing access to a covered provider's premises does not address HIPAA concerns, then the provider has a responsibility to terminate such agreement immediately. The Bottom Line: The trend towards part-time subleases of facilities, equipment and personnel in the health care industry involves significant pit-falls for the unwary under applicable state and federal law. Inasmuch as the applicable statutes provide both civil and criminal penalties for violation, health care providers should undertake such arrangements only with a full appreciation and understanding of the application of law to the particular circumstances of their proposed transaction.
Institutional Impact of Federal Administrative Offsets by Traci Cotton (Claims & Bankruptcy) The Spring 2006 issue of The Foreseeable Future included an article about the state's warrant hold, or offset rights, under §403.055 of the Texas Government Code ("Use of the Warrant Hold as a Collection Tool"). The federal government has similar rights as provided in 31 U.S.C. §3716.
Within UT System, we have felt the impact of this right to offset as it relates to our group health plan, which provides coverage to our employees and retirees, and the plan's relationship with Medicare. Under 42 U.S.C. §1395y(b)(2)(B), several entities, including self-insured health plans and employers that contribute to or sponsor group health plans, may be required to reimburse Medicare in situations where Medicare "believes" it has paid for medical services in error. The current situations tend to revolve around medical services provided to employees who retire, but then return to work in some capacity. Depending on the number of hours the employee is appointed, Medicare may not be the primary coverage, even though the employee is Medicare eligible. Instead, the System health plan may have primary responsibility. Regardless, for various reasons, Medicare will sometimes pay in these situations.
Unfortunately, the offset may be made against federal funds owed to a department within the employing institution that has no involvement with the benefits process. Because of the impact of such an offset, it is imperative that all institutions treat these CMS notices with special care. If a CMS demand for reimbursement is received, OEB should be contacted immediately to assist with a response. If a Notice of Intent to Refer is received, the Office of General Counsel, Claims & Bankruptcy Section, should be contacted immediately. The Bottom Line: Any demand for payment from CMS should be handled with care, and System OEB or OGC should be contacted for assistance.
Code Red Task Force Legislative Report - Part 2 by Lannis Temple (Health Law)
Nineteen Task Force members, including four from University of Texas health facilities, as well as representatives from other academic health centers, small and large businesses, insurers, consumers, and non-academic health care providers, deliberated for 18 months and released their final report, "Code Red: The Critical Condition of Health in Texas" on April 17, 2006.
Recommendation Six: Health Care institutions and other providers must contribute to increasing community based ambulatory care, which includes integrating the latest developments in disease management and other cost effective models of health care delivery that seek to to improve the quality of patient care while decreasing the cost of care. Behavioral health (both mental health and substance abuse) services should be accessible to all Texans with mental illness and additional public funding should be appropriated.
HB 1 expands STAR+PLUS, in which Medicaid clients, their family and providers work together to help clients coordinate traditional health care (regular doctor visits), long-term care and community support services, and provides increased Medicaid funding for a projected caseload growth. As noted previously, SB 10 extensively reformed Medicaid.
Recommendation Seven: Texas must increase investment in the education and training of health professionals who will provide a significant amount of care to the uninsured and underinsured. HB 1 increased funding in graduate medical education, the professional nursing shortage program, and the Joint Admission Medical Program.
SB 156 and 138 enhanced programs for nursing and allied health, while SB 138 also established incentive programs for nursing student retention and graduation. HB 3443 established a program for hospital based nursing education partnerships. SB 139 authorizes a study to improve nursing curricula. SB 10 directs the Texas Healthcare Policy Council to study increasing the numbers for medical residents and the medical residency programs.
Recommendation Eight: Implementation of an integrated approach to school health including an emphasis on nutrition, exercise, dental health and disease management of such problems as asthma. Expansion of the School Breakfast Program, increase of physical activity requirements to 60 minutes a day in Texas schools, and adoption of asthma management education for affected school children and support staff will improve the health of Texans.
SB 530 increases the requirements for student physical activity and physical assessments. HB 3618 coordinates health programs for ISDs (independent school districts) in the border region.
Recommendation Nine: Academic health institutions, state and local governments, and communities, foundations, and the private sector should support the development of health science center research programs to study cost effective health care and other characteristics of a high quality and efficient health system.
HB 14 details the most comprehensive and ambitious cancer research plan in the nation in the Cancer Prevention and Research Institute of Texas. HB 14 will only take effect if voters approve constitutional amendment HJR 90, which authorizes general obligation bond issuance.
Recommendation Ten: Texas should adequately invest in public health programs, including research and community health, at the state and local level.
SB 10 incentivizes healthy lifestyle choices for Medicaid recipients. Several other bills noted in this article also relate to this recommendation.
HB 1 provided funding for Schools of Public Health expansion and special items to address public health issues and Governor Perry deleted those sections with line-item vetos. The Bottom Line: Dr. Shine of the UT System states: "The Task Force for Access to Healthcare in Texas can point to a number of legislative achievements in the 80th Texas Legislature which take effect immediately. As for the future, the pilot programs and feasibility studies under SB 10 will hopefully result in permanent future programs. Further, SB 10 maintains the Medicaid Reform Legislative Oversight Committee and creates a Health and Human Services Transition Legislative Oversight Committee, which will recommend additional future legislation to address these recommendations." <back to top>
Resources from this e-Newsletter Code of Federal Regulations
42 CFR 1001.952(b)
45 CFR 164.501 Health Insurance Portability & Accountability Act of 1996 (Public Law 104-191)
§403.055
§415.003
Chapter 102 (Texas Patient Solicitation Act) The Foreseeable Future e-Newsletter Summer 2007 Issue Spring 2006 Issue United States Code 31 U.S.C. §3716
42 U.S.C. §1320a-7b (Medicare and Medicaid Fraud and Abuse Act) 42 U.S.C. §1395nn (Ethics in Patient Referral Act, aka Stark statute) 42 U.S.C. §1395y(b)(2)(B)
UTS107 UTS165