Blue Cross and Blue Shield and AARP Discussion

Blue Cross and Blue Shield and AARP Discussion
Sample Answer for Blue Cross and Blue Shield and AARP Discussion Included After Question
Description

1 = A number of organizations that may impact the legislative process. Two of these are Blue Cross and Blue Shield and AARP. What are your thoughts on the appropriateness of organizations such as these having an impact on the process? What value do they bring to the process? Or should this type of intervention not be allowed?
2 = Many professional associations work to advance their own policy agendas. One such example is the American Public Health Association http://www.apha.org/advocacy/. As discussed in this chapter, problems lead to the search for solutions. These solutions are many times manifested in the formulation of policy agendas. Locate a policy agenda for two professional healthcare organizations, such as the AMA, AHA, AHIMA, etc. Discuss the types of items that are on their policy agenda. What types of actions do they suggest or support? Who is the intended audience? What are your observations of the way the agenda is presented? Submit a one to two page (double-spaced) summary of your findings.
3 = There has been a great deal of discussion on the type of consent needed by the patient in order to exchange personal health information. The issue is a complicated one, as patients may want to share data with some healthcare providers but may not want to share all information with all providers. The terms opt-in and opt-out are commonly used to describe the environment in which consent may be given for the information exchange. Information on these models, as well as others, may be found in the whitepaper regarding consent models in the Module 5 Resources. Generally, an opt-in model would assume that patients did not authorize the exchange unless they expressly signed a consent to participate. Adversely, opt-out would assume they are participating unless they consent to not have their information shared. While this is a simplistic view and there are alternatives of each type, it brings up a good debate. Which model would you feel is the model of choice to exchange health information?
4 = Review the information on DURSA in the resources section of this module. Provide a critique (double-spaced, Arial 12 font, cover and reference pages using APA 7th Edition formatting rules) of these documents. Do you feel it adequately addresses the areas of privacy and security with respect to the exchange of personally identifiable health information? Are there areas you feel should be in more depth? Items that are unnecessary? Who would execute a DURSA document? At what level would this be beneficial – facility, enterprise, state exchange, national exchange?
A Sample Answer For the Assignment: Blue Cross and Blue Shield and AARP Discussion
Title:  Blue Cross and Blue Shield and AARP Discussion

Restatement I of the Data Use and Reciprocal Support Agreement (DURSA) Version Date: September 30, 2014 Restatement I of the Data Use and Reciprocal Support Agreement Overview Introduction In 2008, as part of the Nationwide Health Information Network Phase II Trial Implementations, a multi-disciplinary team was assembled to develop a comprehensive agreement that would create a legal framework using existing law for the electronic exchange of health data. This agreement, called the Data Use and Reciprocal Support Agreement or DURSA, was first executed by a number of Federal agencies and non-Federal organizations (the “Participants”) beginning in November 2009. The executed DURSA contains a provision describing the creation of a Coordinating Committee that is charged with maintaining and evolving this Agreement. Pursuant to that charge, in 2010, the Coordinating Committee established a Task Group to suggest revisions to the Agreement based on the experience gained with the early implementations and to accommodate new opportunities for the promotion and expansion of health information exchange. This Overview was prepared to facilitate the reader’s understanding of the DURSA, and to place the DURSA into an appropriate context. Why is a Data Use and Reciprocal Support Agreement (DURSA) Needed? The DURSA is a legal agreement created to promote and establish trust among the Participants. It codifies a common set of trust expectations into an enforceable legal framework, and eliminates the need for point-to-point agreements. What is the Data Use and Reciprocal Support Agreement (DURSA)? The DURSA is the legal, multi-party trust agreement that is entered into voluntarily by all entities, organizations and Federal agencies that desire to engage in electronic health information exchange with each other using an agreed upon set of national standards, services and policies developed in coordination with the Office of the National Coordinator for Health IT (ONC) in the U.S. Department of Health and Human Services. (Those who sign the DURSA are known as “Participants.”) The DURSA builds upon the various legal requirements that Participants are already subject to and describes the mutual responsibilities, obligations and expectations of all Participants under the Agreement. All of these responsibilities, obligations and expectations create a framework for safe and secure health information exchange, and are designed to promote trust among Participants and protect the privacy, confidentiality and security of the health data that is shared. The DURSA is based upon the existing body of law (Federal, state, local) applicable to the privacy and security of health information and is supportive of the current policy framework for Restatement I of the Data Use and Reciprocal Support Agreement -i- FINAL – September 30, 2014 health information exchange. The DURSA is intended to be a legally enforceable contract that represents a framework for broad-based information exchange among a set of trusted entities. The Agreement reflects consensus among the state-level, federal and private entities who were involved in the development of the DURSA regarding the following issues: • Multi-Party Agreement • Participants Actively Engaged in Health Information Exchange • Privacy and Security Obligations • Requests for Information Based on a Permitted Purpose • Duty to Respond • Future Use of Data Received from Another Participant • Respective Duties of Submitting and Receiving Participants • Autonomy Principle for Access • Use of Authorizations to Support Requests for Data • Participant Breach Notification • Mandatory Non-Binding Dispute Resolution • Allocation of Liability Risk Will the DURSA continue to evolve? Yes. An initial group of Participants executed the DURSA in 2009 to support the first set of electronic health information exchange activities in production under the Agreement. Since then, other entities wishing to transact health information electronically using the agreed upon standards, services and policies have executed the DURSA. Additional entities are expected to execute the Agreement over time. (The November 2009 version of the DURSA is available at http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_11673_910332_0_0_18/DURSA_2 009_VersionforProductionPilots_20091123.pdf.) As a living document, the DURSA is being maintained using the process described in the Agreement. An amended and restated version of the DURSA will be available for execution in 2014. When the Department of Health and Human Services issues final regulations addressing governance of the nationwide health information network, the Coordinating Committee will likely convene another Task Group to assess how the DURSA might need to be revised to accommodate the new regulations. Can the DURSA be Used for Other Purposes? The DURSA was developed for a specific purpose – to establish the legal framework and to support the trust framework for health information exchange using an agreed upon set of standards, services and policies. Others may find this document helpful or informative for other purposes, for instance, when addressing practical issues related to other types of information exchange models. The DURSA is not intended to be used, however, for other purposes outside of the purpose for which it has been created. As a result, entities interested in using this Agreement Restatement I of the Data Use and Reciprocal Support Agreement – ii – FINAL – September 30, 2014 for other information exchange purposes are encouraged to seek their own legal counsel regarding the applicability and appropriateness of the DURSA to other settings. Restatement I of the Data Use and Reciprocal Support Agreement – iii – FINAL – September 30, 2014 Data Use and Reciprocal Support Agreement This Restatement I of the Data Use and Reciprocal Support Agreement (“DURSA” or the “Agreement”) is made and entered into by and between the undersigned (hereinafter referred to individually as “Participant” and collectively as “Participants”) as of the Effective Date. WITNESSETH: WHEREAS, the Participants who previously have executed the Data Use and Reciprocal Support Agreement dated November 18, 2009, desire to amend and restate the Agreement in its entirety in order to accommodate developments that have occurred since then for the promotion and expansion of health information exchange; WHEREAS, the Participants desire to electronically Transact, on their own behalf or on behalf of their Participant Users, health information among Participants using the Performance and Service Specifications; WHEREAS, the Participants recognize that the Office of the National Coordinator for Health Information Technology (“ONC”) plans to conduct rule-making to establish a governance mechanism for the Network. This Agreement is not intended to preempt in any manner or presume any part of that rule-making process. Rather, the Participants enter into this Agreement to enable their voluntary participation in health information exchange activities, as set forth below; WHEREAS, the Participants are organizations that oversee and conduct, on their own behalf and/or on behalf of their Participant Users, electronic transactions or exchanges of health information among groups of persons or organizations; have the technical ability to meet the Performance and Service Specifications to electronically transact health information on their own behalf or on behalf of their Participant Users; have the organizational infrastructure and legal authority to comply with the obligations in this Agreement and to require their Participant Users to comply with applicable requirements in this Agreement; and have each individually been accepted by the Coordinating Committee as a Participant; WHEREAS, the relationship between the Participant and the individuals whose records are available within or through their respective Systems varies from Participant to Participant and, in some cases, there is no relationship at all; WHEREAS, as a condition of Transacting information with other Participants, each Participant must enter into this Data Use and Reciprocal Support Agreement and has agreed to do so by executing this Agreement or the Joinder Agreement; NOW, THEREFORE, for and in consideration of the mutual covenants herein contained, the Participants hereto mutually agree as follows: Restatement I of the Data Use and Reciprocal Support Agreement Page 1 of 41 FINAL – September 30, 2014 1. Definitions. For the purposes of this Agreement, the following terms shall have the meaning ascribed to them below. All defined terms are capitalized throughout this Agreement. a. Applicable Law shall mean: (i) for the Participants that are not Federal Participants, all applicable statutes and regulations of the State(s) or jurisdiction(s) in which the Participant operates, as well as all applicable Federal statutes, regulations, standards and policy requirements; (ii) for the Federal Participants, all applicable Federal statutes, regulations, standards and policy requirements. b. Authorization shall have the meaning and include the requirements set forth at 45 CFR § 164.508 of the HIPAA Regulations and include any similar but additional requirements under Applicable Law. c. Breach shall mean the unauthorized acquisition, access, disclosure, or use of Message Content while Transacting such Message Content pursuant to this Agreement. The term ‘‘Breach’’ does not include the following: (i) any unintentional acquisition, access, disclosure, or use of Message Content by an employee or individual acting under the authority of a Participant or Participant User if— (I) such acquisition, access, disclosure, or use was made in good faith and within the course and scope of the employment or other professional relationship of such employee or individual, respectively, with the Participant or Participant User; and (II) such Message Content is not further acquired, accessed, disclosed or used by such employee or individual; or (ii) any acquisition, access, disclosure or use of information contained in or available through the Participant’s System where such acquisition, access, disclosure or use was not directly related to Transacting Message Content. d. Business Associate shall have the meaning set forth at 45 C.F.R. § 160.103 of the HIPAA Regulations. e. Common Participant Resources shall mean software, utilities and automated tools made available for use in connection with the Transaction of Message Content pursuant to this Agreement and which have been designated as “Common Participant Resources” by the Coordinating Committee pursuant to the Operating Policies and Procedures. f. Confidential Participant Information, for the purposes of this Agreement, shall mean proprietary or confidential materials or information of a Discloser in any medium or format that a Discloser labels as such upon disclosure. Confidential Participant Information includes, but is not limited to: (i) the Discloser’s designs, drawings, procedures, trade secrets, processes, specifications, source code, System architecture, security measures, research and development, including, but not limited to, research protocols and findings, Restatement I of the Data Use and Reciprocal Support Agreement Page 2 of 41 FINAL – September 30, 2014 passwords and identifiers, new products, and marketing plans; (ii) proprietary financial and business information of a Discloser; and (iii) information or reports provided by a Discloser to a Receiving Party pursuant to this Agreement. Notwithstanding any label to the contrary, Confidential Participant Information does not include Message Content; any information which is or becomes known publicly through no fault of a Receiving Party; is learned of by a Receiving Party from a third party entitled to disclose it; is already known to a Receiving Party before receipt from a Discloser as documented by Receiving Party’s written records; or, is independently developed by Receiving Party without reference to, reliance on, or use of, Discloser’s Confidential Participant Information. Message Content is excluded from the definition of Confidential Participant Information because other provisions of the DURSA address the appropriate protections for Message Content. g. Covered Entity shall have the meaning set forth at 45 C.F.R. § 160.103 of the HIPAA Regulations. h. Digital Credentials shall mean a mechanism that enables Participants to electronically prove their identity and their right to Transact Message Content with other Participants. i. Discloser shall mean a Participant that discloses Confidential Participant Information to a Receiving Party. j. Dispute shall mean any controversy, dispute, or disagreement arising out of or relating to this Agreement. k. Dispute Resolution Subcommittee shall mean the standing subcommittee of the Coordinating Committee that is established pursuant to, and performs the tasks described in, Attachment 6 of this Agreement. l. Effective Date shall mean the date specified in Section 23.12 of this Agreement. m. Emergent Specifications shall mean the technical specifications that a group of existing and/or potential Participants are prepared to implement to test the feasibility of the specifications, to identify whether the specifications reflect an appropriate capability for the Participants, and assess whether the specifications are sufficiently mature to add as a production capability that is available to the Participants. n. Federal Participants shall mean those Participants that are Federal agencies. o. Governmental Participants shall mean collectively those Participants that are local, state or Federal agencies. p. Health Care Operations shall have the meaning set forth at 45 C.F.R. § 164.501 of the HIPAA Regulations. Restatement I of the Data Use and Reciprocal Support Agreement Page 3 of 41 FINAL – September 30, 2014 q. Health Care Provider shall have the meaning set forth at 45 C.F.R. § 160.103 of the HIPAA Regulations. r. Health Information Service Provider or HSP shall mean a company or other organization that will support one or more Participants by providing them with operational, technical, or health information exchange services. s. Health Plan shall have the meaning set forth at 45 C.F.R. § 160.103 of the HIPAA Regulations. t. HIPAA Regulations shall mean the Standards for Privacy of Individually Identifiable Health Information and the Security Standards for the Protection of Electronic Protected Health Information (45 C.F.R. Parts 160 and 164) promulgated by the U.S. Department of Health and Human Services under the Health Insurance Portability and Accountability Act (HIPAA) of 1996, as in effect on the Effective Date of this Agreement and as may be amended, modified, or renumbered. u. Joinder Agreement shall mean the agreement that each New Participant signs pursuant to which the New Participant agrees to be bound by this Agreement. The form of the Joinder Agreement is attached hereto as Attachment 7. v. Message shall mean an electronic transmission of Message Content Transacted between Participants using the Specifications. Messages are intended to include all types of electronic transactions as specified in the Performance and Service Specifications, including the data or records transmitted with those transactions. w. Message Content shall mean that information contained within a Message or accompanying a Message using the Specifications. This information includes, but is not limited to, Protected Health Information (PHI), de-identified data (as defined in the HIPAA Regulations at 45 C.F.R. § 164.514), individually identifiable information, pseudonymized data, metadata, Digital Credentials, and schema. x. Network shall mean the all of the standards, services and policies identified by ONC that enables secure health information exchange over the Internet. As of December 2010, the group of ONC identified standards, services and policies is called the Nationwide Health Information Network, but may be renamed by ONC. y. New Participant shall mean an organization or agency that is approved as a Participant by the Coordinating Committee pursuant to the Operating Policies and Procedures and Section 23.03 of this Agreement. z. Non-Federal Participants shall mean collectively those Participants which are not Federal Participants. aa. Non-Governmental Participants shall mean collectively those Participants which are not Governmental Participants. Restatement I of the Data Use and Reciprocal Support Agreement Page 4 of 41 FINAL – September 30, 2014 bb. Notice or Notification shall mean a written communication, unless otherwise specified in this Agreement, sent to the appropriate Participant’s representative at the address listed in Attachment 4 or the Coordinating Committee in accordance with Section 22. cc. ONC shall mean the Office of the National Coordinator for Health Information Technology in the Office of the Secretary, U.S. Department of Health and Human Services. dd. Operating Policies and Procedures shall mean the policies and procedures adopted by the Coordinating Committee that describe (i) management, operation and maintenance of the Performance and Service Specifications; (ii) qualifications, requirements and activities of Participants when Transacting Message Content with other Participants; and (iii) support of the Participants who wish to Transact Message Content with other Participants. The Operating Policies and Procedures are attached hereto as Attachment 3, as amended from time to time in accordance with Section 11.03. ee. Participant shall mean any organization that (i) meets the requirements for participation as contained in the Operating Policies and Procedures; (ii) is provided with Digital Credentials; and (iii) is a signatory to this Agreement or a Joinder Agreement. Participants may act as either a Submitter, Recipient or both when Transacting Message Content. ff. Participant Access Policies shall mean those policies and procedures of a Participant that govern the Participant Users’ ability to transact information using the Participant’s system including, but not limited to, the Transaction of Message Content. gg. Participant User shall mean any person who has been authorized to Transact Message Content through the respective Participant’s System in a manner defined by the respective Participant. “Participant Users” may include, but are not limited to, Health Care Providers; Health Plans; individuals whose health information is contained within, or available through, a Participant’s System; and employees, contractors, or agents of a Participant. A Participant User may act as either a Submitter, Recipient or both when Transacting Message Content. hh. Payment shall have the meaning set forth at 45 C.F.R. § 164.501 of the HIPAA Regulations. ii. Performance and Service Specifications shall mean the Validation Plan and the Specifications, as well as any implementation guidance, migration plans and other technical materials and resources approved by the Coordinating Committee in accordance with Section 10.03 of this Agreement. jj. Permitted Purpose shall mean one of the following reasons for which Participants or Participant Users may legitimately Transact Message Content: 1. Treatment of the individual who is the subject of the Message; Restatement I of the Data Use and Reciprocal Support Agreement Page 5 of 41 FINAL – September 30, 2014 2. Payment activities of the Health Care Provider for the individual who is the subject of the Message which includes, but is not limited to, Transacting Message Content in response to or to support a claim for reimbursement submitted by a Health Care Provider to a Health Plan. 3. Health Care Operations of either .01. the Submitter if the Submitter is a Covered Entity; .02. a Covered Entity if the Submitter is Transacting Message Content on behalf of such Covered Entity; or .03. the Recipient if (i) the Recipient is a Health Care Provider who has an established Treatment relationship with the individual who is the subject of the Message or the Recipient is Transacting Message Content on behalf of such Health Care Provider; and (ii) the purpose of the Transaction is for those Health Care Operations listed in paragraphs (1) or (2) of the definition of Health Care Operations in 45 C.F.R. § 164.501 or health care fraud and abuse detection or compliance of such Health Care Provider; 4. Public health activities and reporting as permitted by Applicable Law, including the HIPAA Regulations at 45 C.F.R. § 164.512(b) or 164.514(e); 5. Any purpose to demonstrate meaningful use of certified electronic health record technology by the (i) Submitter, (ii) Recipient or (iii) Covered Entity on whose behalf the Submitter or the Recipient may properly Transact Message Content under this Agreement, provided that the purpose is not otherwise described in subsections 1-4 of this definition and the purpose is permitted by Applicable Law, including but not limited to the HIPAA regulations. “Meaningful use of certified electronic health record technology” shall have the meaning assigned to it in the regulations promulgated by the Department of Health and Human Services under the American Recovery and Reinvestment Act, Sections 4101 and 4102; and 6. Uses and disclosures pursuant to an Authorization provided by the individual who is the subject of the Message or such individual’s personal representative as described in 45 C.F.R. § 164.502(g) of the HIPAA Regulations. kk. Protected Health Information or PHI shall have the meaning set forth at 45 C.F.R. § 160.103 of the HIPAA Regulations. ll. Receiving Party shall mean a Participant that receives Confidential Participant Information in any capacity including, but not limited to, as a member of the Coordinating Committee, from a Discloser. mm. Recipient shall mean the Participant(s) or Participant User(s) that receives Message Content through a Message from a Submitter for a Permitted Purpose. Restatement I of the Data Use and Reciprocal Support Agreement Page 6 of 41 FINAL – September 30, 2014 For purposes of illustration only, Recipients include, but are not limited to, Participants or Participant Users who receive queries, responses, subscriptions, publications or unsolicited Messages. nn. Specifications shall mean the specifications adopted by the Coordinating Committee pursuant to this Agreement to prescribe the data content, technical, and security requirements to enable the Participants to Transact Message Content. Specifications may include, but are not limited to, specific Network standards, services and policies. The Specifications are attached hereto as Attachment 1, and may be amended from time to time in accordance with Sections 10.02 and 10.03. oo. Submitter shall mean the Participant(s) or Participant User(s) who submits Message Content through a Message to a Recipient for a Permitted Purpose. For purposes of illustration only, Submitters include, but are not limited to, Participants or Participant Users who push Messages with Message Content, send Messages seeking Message Content, send Messages in response to a request, send subscription Messages, or publish Messages with Message Content in response to subscription Messages. pp. System shall mean software, portal, platform, or other electronic medium controlled by a Participant through which the Participant conducts its health information exchange related activities. For purposes of this definition, it shall not matter whether the Participant controls the software, portal, platform, or medium through ownership, lease, license, or otherwise. qq. Testing shall mean the tests and demonstrations of a Participant’s System and processes used for interoperable health information exchange, to assess conformity with the Specifications and Validation Plan. rr. Transact shall mean to send, request, receive, assert, respond to, submit, route, subscribe to, or publish Message Content using the Performance and Service Specifications. ss. Transaction Pattern shall mean a type of information exchange service(s) enabled by the Specifications. The Operating Policies and Procedures will identify the Transaction Pattern(s) and the Specifications required to implement each Transaction Pattern. As of December 2010, the Transaction Patterns are submission, query and respond, publish and subscribe, and routing. The Transaction Patterns may be amended from time to time through amendment of the Specifications and the Operating Policies and Procedures. tt. Treatment shall have the meaning set forth at 45 C.F.R. § 164.501 of the HIPAA Regulations. uu. Validation Plan shall mean the framework for Testing and demonstrations for parties seeking to become Participants. The Validation Plan is attached hereto as Restatement I of the Data Use and Reciprocal Support Agreement Page 7 of 41 FINAL – September 30, 2014 Attachment 2, and as amended from time to time in accordance with Sections 10.02 and 10.03. 2. Incorporation of Recitals. The Recitals set forth above are hereby incorporated into this Agreement in their entirety and shall be given full force and effect as if set forth in the body of this Agreement. 3. Purpose of the DURSA. 3.01. The purpose of this Agreement is to provide a legal framework that will enable Participants to Transact Message Content with other Participants using the Performance and Service Specifications. 3.02. This Agreement hereby amends the November 18, 2009 Data Use and Reciprocal Support Agreement in its entirety, which has been entered into by some of the Participants. 4. Coordinating Committee. 4.01. Formation of the Coordinating Committee. To support the Participants who wish to Transact Message Content with other Participants, there shall be a Coordinating Committee. 4.02. Composition of the Coordinating Committee. The Coordinating Committee shall be composed primarily of representatives of the Participants. To allow for future flexibility in response to the evolving health information exchange environment, the exact composition of the Coordinating Committee shall be set forth in Operating Policies and Procedures adopted pursuant to the process in Section 11.03, Operating Policies and Procedures Change Process.” 4.03. Grant of Authority. The Participants hereby grant to the Coordinating Committee the right to provide oversight, facilitation and support for the Participants who Transact Message Content with other Participants by conducting activities including, but not limited to, the following: a. Determining whether to admit a New Participant; b. Maintaining a definitive list of all Transaction Patterns supported by each of the Participants; c. Developing and amending Operating Policies and Procedures in accordance with Section 11 of this Agreement; d. Receiving reports of Breaches and acting upon such reports in accordance with Section 14.03 of this Agreement (Breach Notification); e. Suspending or terminating Participants in accordance with Section 19 of this Agreement (Suspension and Termination); f. Resolving Disputes between Participants in accordance with Section 21 of this Agreement (Dispute Resolution); Restatement I of the Data Use and Reciprocal Support Agreement Page 8 of 41 FINAL – September 30, 2014 g. Managing the amendment of this Agreement in accordance with Section 23.02 of this Agreement; h. Evaluating, prioritizing and adopting new Performance and Service Specifications, changes to existing Performance and Service Specifications and the artifacts required by the Validation Plan in accordance with Section 10 of this Agreement; i. Maintaining a process for managing versions of the Performance and Service Specifications, including migration planning; j. Evaluating requests for the introduction of Emergent Specifications into the production environment used by the Participants to Transact Message Content; k. Coordinating with ONC to help ensure the interoperability of the Performance and Service Specifications with other health information exchange initiatives including, but not limited to, providing input into the broader ONC specifications activities and ONC Standards and Interoperability Framework initiatives; and l. Fulfilling all other responsibilities delegated by the Participants to the Coordinating Committee as set forth in this Agreement. To the extent permitted under Applicable Law, this grant of authority to the Coordinating Committee is unconditional and does not require any further consideration or action by any Participant. The Coordinating Committee shall have the authority to unilaterally delegate to the Chairperson of the Coordinating Committee or a subcommittee of the Coordinating Committee any of the authorities, duties or responsibilities granted to the Coordinating Committee by the Participants. Any delegation of the Coordinating Committee’s authorities, duties or responsibilities to a designee other than the Chairperson of the Coordinating Committee or a subcommittee of the Coordinating Committee shall be accomplished through the adoption of Operating Policies and Procedures pursuant to Section 11.03. 4.04. In no case shall a Participant be required to disclose PHI to the Coordinating Committee in violation of Applicable Law. The Coordinating Committee shall not retaliate against a Participant that decides not to disclose PHI upon the request of the Coordinating Committee. 5. Use of Message Content. 5.01. Permitted Purpose. Participants shall only Transact Message Content for a Permitted Purpose as defined in this Agreement. Each Participant shall require that its Participant Users comply with t