[Congressional Record Volume 156, Number 113 (Thursday, July 29, 2010)]
[Senate]
[Pages S6524-S6526]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. HARKIN (for himself, Mr. Bayh, and Mr. Bond):
  S. 3668. A bill 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; to the 
Committee on Health, Education, Labor, and Pensions.
  Mr. HARKIN. Mr. President, today I join Senator Bayh and Senator Bond 
to introduce the Medical-Legal Partnership for Health Act. This 
legislation builds upon the great work that medical-legal partnerships 
are doing every day, all across the United States.
  Medical-legal partnerships bring legal aid services into medical 
settings, such as hospitals and community health centers, to provide 
patients with legal help to address conditions that lead to poor 
health, lengthy hospital stays, and repeated emergency room visits. 
Imagine, for example, that your child develops chronic ear infections. 
You repeatedly bring your sick child to the local emergency room, 
struggling each time to pay the high costs of medical care and 
prescription antibiotics. Imagine further that you are the head of a 
low-income family, you don't have health insurance or the money to pay 
for the ER visits, and the hospital or community bears the brunt of the 
costs.
  Medical-legal partnerships can help break this expensive and 
avoidable cycle. If the emergency room doctor is trained in screening 
for families who could benefit from legal intervention, the doctor may 
learn, for example, that the family's landlord refuses to turn on the 
heat in their apartment building. The frigid temperatures in their home 
have made their child more susceptible to illness, which explains the 
chronic ear infections. By referring the patient to the hospital's 
medical-legal partnership program, the family receives legal aid to go 
after the slumlord and require the heat to be turned on, and the 
children's ear infections stop. As a consequence, the family is 
healthier, their home is warm, and both they and the hospital save on 
health costs. All of this is possible because of a low-cost, common-
sense intervention.
  The first medical-legal partnership was started in Boston in 1993, 
and since

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then, 85 more have sprung up in 38 States. These centers can serve 
multiple hospitals and clinics within a community. Currently, medical-
legal partnerships support more than 200 hospitals, clinics, and health 
centers. They help vulnerable patients resolve social conditions that 
lead to poor health outcomes, such as getting a landlord to change air 
filters to help minimize asthma and allergies, assisting victims of 
domestic violence with preventing future abuse, and helping terminally 
ill patients make custodial arrangements for their dependent children.
  In many cases, patients aren't even aware that their health 
challenges are caused by their living environment, or that their 
problem can be addressed through the legal system.
  After graduating from law school, I served as a Legal Services 
attorney in Iowa. I learned first-hand how crucial this assistance is 
to struggling families and individuals who have no place else to turn 
when they are taken advantage of or abused. I know the invaluable legal 
help provided to battered women trying to leave abusive relationships 
while fearing for their safety and the safety of their children. I know 
that, without access to the legal system, the poor are often powerless 
against the injustices they suffer.
  I am very proud to say that my home State of Iowa has a particularly 
successful partnership. The Iowa Legal Aid Health and Law Project 
harnesses the talents of Iowa physicians and attorneys to improve the 
lives of vulnerable Iowans. Many times these situations involve 
substandard housing, discrimination, elder abuse, or problems accessing 
disability, Social Security, health, or veteran's benefits. By 
partnering with 17 hospitals and health centers across my State, the 
Iowa Legal Aid Health and Law Project is able to extend services from 
Sioux City to Dubuque, and from Council Bluffs to Fort Dodge. Last 
year, the program served 880 Iowans, and 94 percent of their cases had 
a positive outcome. The Iowa Legal Aid Health and Law Project does a 
remarkable job. They are just one example of the great work going on 
across the country.
  You may be surprised to learn that when it comes to medical-legal 
partnerships, a little money can go a long way. Iowa's program was 
started with a Federal investment of less than $300,000. The program 
prevents hospital admissions and emergency room visits that cost 
hospitals and patients many thousands of dollars in health care costs 
and insurance premiums. A modest investment in these community programs 
can help people achieve healthier, safer lives and prevent future 
hospitalizations and health care costs. That sounds like common sense 
to me. And that's why, today, I am proud to introduce the Medical-Legal 
Partnership for Health Act along with Senators Bayh and Bond: to give 
health care providers and lawyers across the country the opportunity to 
start such programs.
  The Act creates a Federal demonstration program to help create, 
strengthen, and evaluate medical-legal partnerships. Overall, this 
legislation will support 60 MLP sites in community health centers, the 
Veterans Administration, hospitals, and other health care settings.
  In the spirit of compromise and bipartisanship, we have taken 
contentious issues off the table. For example, the bill excludes 
Federal money from being used toward class action law suits, medical 
malpractice cases, representation of undocumented individuals, and 
abortion or abortion-counseling services.
  In addition to having bipartisan support, medical-legal partnerships 
have been praised by prominent organizations representing physicians 
and attorneys. They have received endorsement from the American Medical 
Association, the American Bar Association, the American Academy of 
Pediatrics, the American Hospital Association, and the Accreditation 
Council of Graduate Medical Education, to name just a few.
  Through this community-based, common-sense investment in addressing 
the social effects of poverty, we will be able to help so many of our 
most at-risk citizens to avoid illness and hospitalization.
  I extend my sincere thanks to Senator Bayh and Senator Bond for their 
hard work and commitment to this bill. And I urge our colleagues to 
join us in supporting this investment in medical-legal partnerships.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 3668

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medical-Legal Partnership 
     for Health Act''.

     SEC. 2. FINDINGS; PURPOSE.

       (a) Findings.--Congress finds the following:
       (1) 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.
       (2) 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.
       (3) 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.
       (4) 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.
       (5) 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.
       (6) 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.
       (b) Purposes.--The purposes of this Act are to--
       (1) support and advance opportunity for medical-legal 
     partnerships to be more fully integrated in healthcare 
     settings nationwide;
       (2) 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
       (3) identify and develop cost-effective strategies that 
     will improve patient outcomes and realize savings for 
     healthcare systems.

     SEC. 3. MEDICAL-LEGAL PARTNERSHIPS.

       (a) In General.--The Secretary of Health and Human Services 
     shall establish a nationwide demonstration project consisting 
     of--
       (1) awarding grants to, and entering into contracts with, 
     medical-legal partnerships to assist patients and their 
     families to navigate programs and activities; and
       (2) evaluating the effectiveness of such partnerships.
       (b) Technical Assistance.--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.
       (c) Funding.--
       (1) 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:
       (A) Enhancing access to healthcare services.
       (B) Improving health outcomes for low-income individuals, 
     as defined in subsection (g).
       (C) Reducing health disparities among health disparities 
     populations.
       (D) Enhancing wellness and prevention of chronic conditions 
     and other health problems.
       (E) Reducing cost of care to the healthcare system.
       (F) Addressing the social determinants of health.
       (G) Addressing situational contributing factors.
       (2) 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.
       (3) Matching requirement.--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

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     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.
       (4) Allocation.--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.
       (d) Eligible Entities.--To be eligible to receive a grant 
     or contract under this section, an entity shall--
       (1) be an organization experienced in bridging the medical 
     and legal professions on behalf of vulnerable populations 
     nationally; and
       (2) 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.
       (e) Prohibitions.--No funds under this section may be 
     used--
       (1) for any medical malpractice action or proceeding;
       (2) to provide any support to an alien who is not--
       (A) a qualified alien (as defined in section 431 of the 
     Immigration and Nationality Act);
       (B) a nonimmigrant under the Immigration and Nationality 
     Act; or
       (C) an alien who is paroled into the United States under 
     section 212(d)(5) of such Act for less than one year;
       (3) 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
       (4) to initiate or participate in a class action lawsuit.
       (f) Reports.--
       (1) 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:
       (A) An evaluation of the program outcomes, including--
       (i) a description of the extent to which medical-legal 
     partnerships funded through this section achieved the goals 
     described in subsection (b);
       (ii) quantitative and qualitative analysis of baseline and 
     benchmark measures; and
       (iii) aggregate information about the individuals served 
     and program activities.
       (B) Recommendations on whether the programs funded under 
     this section could be used to improve patient outcomes in 
     other public health areas.
       (2) 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.
       (3) 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.
       (g) Definitions.--In this section:
       (1) The term ``health disparities populations'' has the 
     meaning given such term in section 485E(d) of the Public 
     Health Service Act.
       (2) The term ``low-income individuals'' refers to the 
     population of individuals and families who earn up to 200 
     percent of the Federal poverty level.
       (3) The term ``medical-legal partnership'' means an 
     entity--
       (A) that is a partnership between--
       (i) a community health center, public hospital, children's 
     hospital, or other provider of health care services to a 
     significant number of low-income beneficiaries; and
       (ii) one or more legal professionals; and
       (B) 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.
       (4) The term ``Secretary'' means the Secretary of Health 
     and Human Services.
                                 ______