Standards for Health-Related Legal Services Programs that Serve Income Eligible Individuals and Families Pursuant to PHL Section 22
Background: Chapter 509 of the Laws of New York, 2011, amended the New York State Public Health Law (PHL) to add a new section 22 to establish Health-Related Legal Services Programs. The purpose of the programs is to promote collaborations between health care service providers and legal aid, legal services, pro bono and law school clinical programs to resolve practical needs that impact patient/client and community health. The Department of Health (DOH) is required to establish standards for Health-Related Legal Services Programs that serve income eligible individuals and families.
A Health-Related Legal Services Program is a voluntary collaboration between health care providers and legal assistance organizations including, but not limited to, pro bono programs and law school clinics, to address patients/clients' basic needs by providing a variety of on-site legal services without charge to assist only income-eligible patients/clients and their families to resolve legal matters or needs that have an impact on the patients/clients' health or are created or aggravated by the patients/clients' health issues.
For example, individuals living with chronic, severe or terminal illnesses may require legal assistance in navigating benefit and social entitlement systems to ensure access to needed resources and medical insurance. The impact of discrimination and barriers to access may have serious repercussions to the health and welfare of the individuals and families of those with serious illness. Denial of health insurance or benefits may result in lapses in needed treatment or medication and missed appointments. In addition, individuals with serious illness require support and assistance in understanding and obtaining health care proxies, advance directives and wills. Critically important to these individuals and families is the need for permanency planning for dependent children. The Health-Related Legal Services Program draws on the strength of the legal and health care professions to leverage community resources that would benefit income eligible children and adults.
Designation from New York State Department of Health: A Health-Related Legal Services Program is a voluntary relationship between a health care provider and a legal services organization. The New York State Department of Health may designate, for a maximum period of two years, Health-Related Legal Services Programs that demonstrate in writing that they meet the DOH standards. The Health-Related Legal Services Program may apply for DOH designation on forms prescribed by the Department (i.e., DOH-5068). Such designation is not required for the operation of a Health-Related Legal Services Program. The New York State Department of Health will not compel the initiation or continuation of the relationship of any of the parties involved in a Health-Related Legal Services Program, nor will the Department become involved in disputes between the parties or patient or client complaints regarding the legal services provided. The New York State Department of Health retains the right to terminate the designation when, in its discretion, the certification is no longer in the public interest, provided only that the holder is afforded 30 days notice.
Standards for Health-Related Legal Services Programs:
- Not-for-profit entities: The legal services provided in a Health-Related Legal Services Program must be provided by a not-for-profit entity operated by or affiliated with one or more legal services organizations, law schools or community-based organizations with legal capacity. Documentation of such status or affiliation must be submitted to the New York State Department of Health. The legal services must be provided at a health care provider site licensed under Articles 28 or 36 of the PHL or at a hospice provider site licensed under Article 40 of the PHL.
- Experience: The legal assistance component of the program must be in good standing and have demonstrated the ability and experience to provide high quality, health-related legal services meeting the needs of the population to be served. Participating organizations must possess, at no cost to New York State, all qualifications, licenses and permits to engage in the required business as may be required within the jurisdiction where the work specified is to be performed. Staff employed in the performance of the program should possess the qualifications, training, licenses and permits as may be required within the program's jurisdiction. Any law students or legal interns participating in the program must be supervised by qualified staff. Documentation of current New York State registration as a member of the bar is required of all practicing attorneys. Further, two letters of support for the legal assistance entity must be submitted.
- Health care providers: All health care providers participating in the program must possess a valid operating certificate from the New York State Department of Health for the operation of a hospital, residential care facility, diagnostic and treatment center, hospice or other licensed facility providing health-related services.
- Ethics: All participants in a Health-Related Legal Services Program must adhere to their respective code of ethics. In representing the patient or client, legal service providers will abide by the Rules of Professional Conduct, including rules related to declining or terminating representation, conflicts of interest, confidentiality of information and identification of practice and specialty.
- Legal services: The Health-Related Legal Services Program must agree to perform oversight to ensure patients or clients receive the professional expertise required for adequate representation of their particular legal needs. Legal assistance organizations should establish procedures and parameters for representing patients or clients tailored to their existing practice areas and for making patient/client referrals when necessary. Legal assistance organizations may resolve or refer legal matters set forth by Section 22 (1) of the New York State Public Health Law, which may include, but are not limited to, the following:
- Housing (including utilities)
- Income maintenance including Supplemental Security Income (SSI) and Social Security Disability (SSD)
- Public or private health insurance coverage
- Employment and eligibility for employment benefits
- Government benefits
- Family law (including, but not limited to, spousal support, domestic violence, guardianship, custody and child support)
- Advance planning (including, but not limited to, wills, health care proxies, powers of attorney and permanency planning)
- Special education
- Debtor or creditor issues
- Executed Agreements between Parties: All health care providers and legal assistance organizations that seek designation from the New York State Department of Health must operate under a jointly executed agreement that includes the signature of an authorized representative of a health care facility licensed by the New York State Department of Health. The agreement must be effective for at least one year and include a definite termination date. A renewal provision may be provided. The agreement must address the following operational matters:
- Provide a listing of the types of cases to be handled such that the health care providers will know who to refer to the Health-Related Legal Services Program.
- Specify the process for referring patients/clients to the Health-Related Legal Services Program. Note: It may be beneficial for the legal and health care team to develop and implement a standard clinical screening protocol that addresses detection of patient/client needs (e.g., low income, homelessness) and method to be used for the health care provider to refer the patient/client to legal services.
- Specify the income eligibility criteria for the patients/clients served, which shall include, at a minimum, income at 100% of the federal poverty level or SSI eligibility and SSD eligibility.
- Specify the process for defining "income-eligible" to patients/clients.
- Contain an agreement that any legal services provided to eligible patients/clients will be provided at no charge to patients/clients.
- Contain an agreement by health care providers to identify for legal assistance organizations on-site space including sufficient space for confidential meetings with patients/clients. A telephone and a computer with internet access and word processing capabilities may also be provided.
- Contain an agreement by both parties to adhere to patient/client confidentiality and to obtain the patient/client's consent to access confidential medical records as needed, in compliance with New York State and federal law.
- Contain an agreement by both parties to address all patient/client complaints in a prompt and thorough manner.
- Contain provisions delineating how and on what basis either party may terminate the agreement.
- Contain a provision requiring the participating organization to notify the New York State Department of Health, Office of Public Health within 30 days if the program is terminated according to the agreement with participating entities or if significant changes occur to the agreement. If the agreement between the parties is terminated or if significant changes otherwise occur in the agreement, the designation from the New York State Department of Health is automatically revoked, unless otherwise determined by the New York State Department of Health.