IN THE SENATE OF THE UNITED STATES
July 29, 2010
Mr. Harkin (for himself, Mr. Bayh, and Mr. Bond) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions
To require the Secretary of Health and Human Services to establish a demonstration program to award grants to, and enter into contracts with, medical-legal partnerships to assist patients and their families to navigate health-related programs and activities.
This Act may be cited as the
Medical-Legal Partnership for Health
Congress finds the following:
Numerous studies and reports, including the annual National Healthcare Disparities Report and Unequal Treatment, the 2002 Institute of Medicine Report, document the extensiveness to which vulnerable populations suffer from health disparities across the country.
These studies have found that, on average, racial and ethnic minorities and low-income populations are disproportionately afflicted with chronic and acute conditions such as asthma, cancer, diabetes, and hypertension and suffer worse health outcomes, worse health status, and higher mortality rates.
Several recent studies also show that health and healthcare quality are a function of not only access to healthcare, but also the social determinants of health, including the environment, the physical structure of communities, socio-economic status, nutrition, educational attainment, employment, race, ethnicity, geography, and language preference, that directly and indirectly affect the health, healthcare, and wellness of individuals and communities.
Formally integrating medical and legal professionals in the health setting can more effectively address the health needs of vulnerable populations and ultimately reduce health disparities.
All over the United States, healthcare providers who take care of low-income individuals and families are partnering with legal professionals to assist them in providing better quality of healthcare.
Medical-legal partnerships integrate lawyers in a health setting to help patients navigate the complex government, legal, and service systems in addressing social determinants of health, such as income supports for food insecure families and mold removal from the home of asthmatics.
The purposes of this Act are to—
support and advance opportunity for medical-legal partnerships to be more fully integrated in healthcare settings nationwide;
to improve the quality of care for vulnerable populations by reducing health disparities among health disparities populations and addressing the social determinants of health; and
identify and develop cost-effective strategies that will improve patient outcomes and realize savings for healthcare systems.
The Secretary of Health and Human Services shall establish a nationwide demonstration project consisting of—
awarding grants to, and entering into contracts with, medical-legal partnerships to assist patients and their families to navigate programs and activities; and
evaluating the effectiveness of such partnerships.
The Secretary may, directly or through grants or contracts, provide technical assistance to grantees under subsection (a)(1) to support the establishment and sustainability of medical-legal partnerships. Not to exceed 5 percent of the amount appropriated to carry out this section in a fiscal year may be used for purposes of this subsection.
Use of funds
Amounts received as a grant or pursuant to a contract under this section shall be used to assist patients and their families to navigate health-related programs and activities for purposes of achieving one or more of the following goals:
Enhancing access to healthcare services.
Improving health outcomes for low-income individuals, as defined in subsection (g).
Reducing health disparities among health disparities populations.
Enhancing wellness and prevention of chronic conditions and other health problems.
Reducing cost of care to the healthcare system.
Addressing the social determinants of health.
Addressing situational contributing factors.
Authorization of appropriations
There are authorized to be appropriated to carry out this section such sums as may be necessary, but not to exceed $10,000,000, for each of the fiscal years 2011 through 2015.
For each fiscal year, the Secretary may not award a grant or contract under this section to a entity unless the entity agrees to make available non-Federal contributions (which may include in-kind contributions) toward the costs of a grant or contract awarded under this section in an amount that is not less than $1 for each $10 of Federal funds provided under the grant or contract.
Of the amounts appropriated pursuant to paragraph (2) for a fiscal year, the Secretary may obligate not more than 5 percent for the administrative expenses of the Secretary in carrying out this section.
To be eligible to receive a grant or contract under this section, an entity shall—
be an organization experienced in bridging the medical and legal professions on behalf of vulnerable populations nationally; and
submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including information demonstrating that the applicant has experience in bridging the medical and legal professions or a strategy or plan for cultivating and building medical-legal partnerships.
No funds under this section may be used—
for any medical malpractice action or proceeding;
to provide any support to an alien who is not—
a qualified alien (as defined in section 431 of the Immigration and Nationality Act);
a nonimmigrant under the Immigration and Nationality Act; or
an alien who is paroled into the United States under section 212(d)(5) of such Act for less than one year;
to provide legal assistance with respect to any proceeding or litigation which seeks to procure an abortion or to compel any individual or institution to perform an abortion, or assist in the performance of an abortion; or
to initiate or participate in a class action lawsuit.
Final report by secretary
Not later than 6 months after the date of the completion of the demonstration program under this section, the Secretary shall conduct a study of the results of the program and submit to the Congress a report on such results that includes the following:
An evaluation of the program outcomes, including—
a description of the extent to which medical-legal partnerships funded through this section achieved the goals described in subsection (b);
quantitative and qualitative analysis of baseline and benchmark measures; and
aggregate information about the individuals served and program activities.
Recommendations on whether the programs funded under this section could be used to improve patient outcomes in other public health areas.
Interim reports by secretary
The Secretary may provide interim reports to the Congress on the demonstration program under this section at such intervals as the Secretary determines to be appropriate.
Reports by grantees
The Secretary may require each recipient of a grant under this section to submit interim and final reports on the programs carried out by such recipient with such grant.
In this section:
The term health disparities populations has the meaning given such term in section 485E(d) of the Public Health Service Act.
The term low-income individuals refers to the population of individuals and families who earn up to 200 percent of the Federal poverty level.
The term medical-legal partnership means an entity—
that is a partnership between—
a community health center, public hospital, children’s hospital, or other provider of healthcare services to a significant number of low-income beneficiaries; and
one or more legal professionals; and
whose primary mission is to assist patients and their families navigate health-related programs, activities, and services through the provision of relevant civil legal assistance on-site in the healthcare setting involved, in conjunction with regular training for healthcare staff and providers regarding the connections between legal interventions, social determinants, and health of low-income individuals.
The term Secretary means the Secretary of Health and Human Services.