A. 9169--A 2
leads to the progression of manageable health conditions into acute or
emergency situations requiring costly interventions upon the benefici-
ary's return to New York state, thereby increasing overall Medicaid
expenditures;
(d) Medical services in the Dominican Republic can often be delivered
at substantially lower costs than comparable services in New York state,
while maintaining acceptable quality standards, particularly when coor-
dinated through accredited facilities and the Dominican Republic's
established public health insurance infrastructure;
(e) The Dominican Republic operates a comprehensive three-tiered
public health insurance system managed by the Seguro Nacional de Salud
(SeNaSa), which serves over seven million beneficiaries and maintains an
extensive network of certified public and private health care providers
throughout the country;
(f) SeNaSa operates under the regulatory oversight of the Superinten-
dencia de Salud y Riesgos Laborales (SISALRIL) and provides coverage
through multiple regimes, including the Contributory Subsidized Regime
(Regimen Contributivo Subsidiado), which provides coverage for self-em-
ployed workers and individuals with limited income who have not contrib-
uted to the social security system through payroll taxes;
(g) A bilateral health partnership between New York state and the
Dominican Republic, utilizing SeNaSa's established infrastructure and
provider network, represents an innovative approach to addressing health
care access gaps while potentially generating long-term savings for the
New York state Medicaid program;
(h) There are approximately eight hundred thousand dual-eligible medi-
care-Medicaid enrollees in New York state, many of whom are seniors of
Dominican heritage who maintain connections to the Dominican Republic;
and
(i) An initial pilot program funded entirely with state-only dollars
could demonstrate proof of concept for such partnerships, including the
viability of cross-border payment systems, care coordination mechanisms,
quality assurance protocols, and cost-effectiveness, thereby providing
the evidentiary basis for a potential federal section 1115 demonstration
waiver application to the Centers for Medicare and Medicaid Services.
2. It is the intent of this legislation to:
(a) Establish a commission to evaluate the feasibility and develop a
framework for a state-only funded pilot program that would provide
primary and preventive health care services to eligible New York state
Medicaid beneficiaries aged 65 years and older who reside part-time or
full-time in the Dominican Republic;
(b) Explore the establishment of a formal partnership between the New
York state Medicaid program and the Seguro Nacional de Salud (SeNaSa) of
the Dominican Republic to deliver covered health care services through
SeNaSa's Contributory Subsidized Regime tier and its network of certi-
fied providers;
(c) Improve health care accessibility and affordability for eligible
New York state residents residing abroad by ensuring continuity of care
and access to primary and preventive services that would otherwise be
unavailable or unaffordable;
(d) Reduce overall Medicaid expenditures by preventing the escalation
of manageable health conditions into acute or emergency situations
requiring costly interventions upon beneficiaries' return to New York
state;
A. 9169--A 3
(e) Strengthen bilateral cooperation between the state of New York and
the Dominican Republic in public health, health care delivery, medical
education, and elder care;
(f) Develop the operational infrastructure, including payment mech-
anisms, provider credentialing, care coordination protocols, and quality
measurement systems, necessary to support a cross-border health care
partnership; and
(g) Generate sufficient evidence of cost-effectiveness and program
viability to support a future application to the Centers for Medicare
and Medicaid Services for a section 1115 demonstration waiver and poten-
tial designation as a designated state health program (DSHP), which
could provide federal matching funds of up to 50 percent of program
costs.
3. Nothing in this act shall be construed to expand eligibility for
federal Medicaid expenditures outside the United States, unless express-
ly authorized by federal law or waiver. The pilot program contemplated
by this act shall be funded exclusively with state-only appropriations
until such time as federal approval and matching funds are obtained.
§ 3. Definitions. As used in this act, the following terms shall have
the following meanings:
1. "Commission" means the New York-Dominican health partnership
commission established pursuant to section four of this act.
2. "Contributory subsidized regime" means the tier of coverage within
the Dominican Social Security System (Sistema Dominicano de Seguridad
Social) that provides health coverage for self-employed workers, inde-
pendent professionals, technical workers, and others with average wages
equivalent to or higher than the national minimum wage who have not
contributed to the system through payroll taxes, funded through contrib-
utions from the worker and a state subsidy.
3. "Covered services" means primary care, preventive care, chronic
disease management, and such other health care services as the commis-
sion may recommend for inclusion in the pilot program, excluding acute
care, emergency care, surgical interventions, and other services to be
specified by the commission.
4. "Designated state health program" or "DSHP" means a state-funded
health program that may be approved by the Centers for Medicare and
Medicaid Services under a section 1115 demonstration waiver as eligible
for federal financial participation.
5. "Dominican Ministry of Public Health" or "Ministerio de Salud
Publica" means the cabinet-level ministry of the government of the
Dominican Republic responsible for public health policy and regulation.
6. "Dual-eligible beneficiary" means an individual who is enrolled in
both the Medicare program under Title XVIII of the Social Security Act
and the Medicaid program under Title XIX of the Social Security Act.
7. "Eligible beneficiary" means a New York state resident who: (a) is
65 years of age or older; (b) is enrolled in the New York state Medicaid
program; (c) resides in the Dominican Republic for a minimum of six
months per calendar year; (d) does not qualify for or is not enrolled in
any private, senior, or retiree health insurance program in the Domini-
can Republic; and (e) meets such other eligibility criteria as the
commission may recommend.
8. "Pilot program" means the New York-Dominican health partnership
pilot program to be developed pursuant to the recommendations of the
commission.
9. "Primary care" means basic health care services including general
medical examinations, health screenings, diagnosis and treatment of
A. 9169--A 4
common illnesses and injuries, management of chronic conditions, health
education, and preventive care.
10. "Preventive care" means health care services intended to prevent
illness or detect health conditions at an early stage, including immuni-
zations, health screenings, wellness visits, and chronic disease
prevention programs.
11. "Seguro Nacional de Salud" or "SeNaSa" means the national health
insurance agency of the Dominican Republic, the public autonomous insti-
tution responsible for administering health risks for beneficiaries of
the subsidized, contributory, and contributory subsidized regimes of the
Dominican Social Security System, established pursuant to Law No. 87-01
of the Dominican Republic.
12. "Section 1115 demonstration waiver" means a demonstration project
authorized by section 1115 of the Social Security Act that permits a
state to waive certain federal Medicaid requirements to test exper-
imental, pilot, or demonstration projects likely to promote the objec-
tives of the Medicaid program.
13. "Superintendencia de Salud y Riesgos Laborales" or "SISALRIL"
means the Superintendency of Health and Occupational Risks, the Domini-
can regulatory agency responsible for oversight of health insurance
providers in the Dominican Republic.
§ 4. Establishment of the New York-Dominican health partnership
commission. 1. There is hereby established the New York-Dominican health
partnership commission ("the commission").
2. The commission shall consist of 12 members, appointed as follows:
(a) The commissioner of health, or their designee;
(b) The director of the office for the aging, or their designee;
(c) The commissioner of temporary and disability assistance, or their
designee;
(d) The Medicaid director of the New York state department of health,
or their designee;
(e) The director of the division of the budget, or their designee;
(f) Two members appointed by the speaker of the assembly, one of whom
shall have expertise in health policy or Medicaid administration and one
of whom shall represent the Dominican community in New York state;
(g) Two members appointed by the temporary president of the senate,
one of whom shall have expertise in health policy or Medicaid adminis-
tration and one of whom shall represent the Dominican community in New
York state;
(h) One member appointed by the governor who shall have expertise in
international health policy, health economics, or cross-border health
care programs;
(i) One member representative designated by the Consulate General of
the Dominican Republic in New York, who shall serve in an advisory
capacity and may participate in commission deliberations but shall not
have voting privileges on matters pertaining to New York state appropri-
ations or policy; and
(j) One expert in international health policy or global health from a
New York-based university or academic medical center.
3. The commissioner of health, or their designee, shall serve as chair
of the commission. The commission shall select from among its voting
members a vice-chairperson.
4. Members shall be appointed within 60 days of the effective date of
this act. Vacancies shall be filled in the same manner as original
appointments within 30 days of the occurrence of such vacancy.
A. 9169--A 5
5. Members shall serve without compensation but shall be entitled to
reimbursement for necessary expenses incurred in the performance of
their duties.
6. A majority of the voting members of the commission shall constitute
a quorum for the transaction of business. The commission shall meet at
least quarterly and at such other times as the chair shall determine.
7. The department of health shall provide staff support to the commis-
sion and shall be responsible for administrative coordination of commis-
sion activities.
§ 5. Duties of the commission. The commission shall:
1. Conduct a comprehensive feasibility study examining:
(a) The legal requirements and regulatory framework necessary to
establish a bilateral health partnership between the state of New York
and the Dominican Republic;
(b) The cost-effectiveness of providing primary and preventive care
services to eligible beneficiaries through SeNaSa's Contributory Subsi-
dized Regime compared to the current pattern of delayed care and subse-
quent acute interventions in New York state;
(c) The estimated number of New York state Medicaid beneficiaries aged
65 and older who reside in the Dominican Republic for six months or more
per year and who would be eligible for the pilot program;
(d) The current health care utilization patterns and costs associated
with such beneficiaries, including emergency department visits, hospi-
talizations, and other acute care episodes upon return to New York
state;
(e) The capacity, quality standards, and accreditation status of
SeNaSa's provider network and whether such standards meet or can be
adapted to meet New York state public health and quality requirements;
(f) The comparative cost of primary and preventive care services in
the Dominican Republic versus New York state; and
(g) Potential barriers to implementation, including legal, regulatory,
administrative, technological, and cultural considerations.
2. Develop a detailed pilot program framework including:
(a) Eligibility criteria for beneficiary participation, including
residency requirements, Medicaid enrollment verification, attestation of
time spent in the Dominican Republic, and exclusion criteria related to
alternative insurance coverage;
(b) A defined scope of covered services, including specific primary
care, preventive care, and chronic disease management services to be
provided under the pilot program, with explicit exclusions for acute
care, emergency care, surgical interventions, and other services;
(c) Proposed enrollment procedures, including outreach strategies,
enrollment verification, and beneficiary education;
(d) A recommended pilot program size, including the number of benefi-
ciaries to be enrolled and geographic targeting considerations;
(e) Quality assurance and utilization review mechanisms to ensure that
services meet acceptable standards of care;
(f) Care coordination protocols, including mechanisms for communi-
cation between Dominican providers and New York state providers, medical
records sharing, and continuity of care during beneficiary transitions
between countries;
(g) Payment mechanisms and contracting requirements, including
proposed reimbursement rates, claims processing procedures, and finan-
cial controls; and
(h) Performance metrics and evaluation criteria to assess pilot
program success.
A. 9169--A 6
3. Explore and recommend models for:
(a) A formal partnership agreement or memorandum of understanding
between the New York state department of health and SeNaSa for the
provision of covered services to eligible New York state Medicaid bene-
ficiaries;
(b) Provider credentialing and facility accreditation systems to
ensure that Dominican health facilities and providers participating in
the pilot program meet New York state public health and quality stand-
ards, or acceptable equivalent standards;
(c) Reciprocal telehealth programs to enable remote consultations
between beneficiaries in the Dominican Republic and New York state-based
providers, and to facilitate care coordination;
(d) Health information exchange systems to enable secure sharing of
medical records and care coordination information between participating
providers in both jurisdictions;
(e) Long-term care partnerships and geriatrics exchange programs to
address the specialized needs of the senior population; and
(f) Future opportunities for federal collaboration or waivers under
section 1115 of the Social Security Act, including potential designation
as a designated state health program.
4. Assess potential fiscal impacts including:
(a) Estimated state-only costs for the pilot program, including admin-
istrative costs, payments to SeNaSa for covered services, care coordi-
nation costs, and evaluation costs;
(b) Projected savings to the New York state Medicaid program resulting
from reduced acute care episodes, emergency department visits, and
hospitalizations among pilot program participants;
(c) Net fiscal impact of the pilot program to New York state, compar-
ing total costs to projected savings;
(d) Economic benefits to both New York state and the Dominican Repub-
lic; and
(e) Potential federal savings that could result from reduced acute
care costs if a portion of pilot program participants are dual-eligible
for medicare, recognizing that any federal savings would accrue to the
medicare program and not directly to New York state.
5. Develop recommendations for:
(a) Any statutory or regulatory changes required at the state level to
authorize and implement the pilot program;
(b) Proposed memoranda of understanding or bilateral agreements
between the New York state department of health and the Dominican Minis-
try of Public Health, SeNaSa, and any other relevant Dominican govern-
mental entities;
(c) A state-only appropriation amount necessary to fund the pilot
program for an initial three-year demonstration period;
(d) A timeline and implementation plan for pilot program launch and
operation;
(e) A strategy for eventual application to the Centers for Medicare
and Medicaid Services for a section 1115 demonstration waiver to obtain
federal financial participation, including potential designation as a
designated state health program; and
(f) Criteria for evaluating pilot program success and determining
whether to continue, expand, or terminate the program.
6. Consult with:
(a) Representatives of SeNaSa and other appropriate Dominican govern-
ment officials regarding the feasibility and structure of a partnership;
A. 9169--A 7
(b) The Centers for Medicare and Medicaid Services regarding potential
pathways for federal approval and financial participation;
(c) New York state Medicaid beneficiaries who reside part-time in the
Dominican Republic regarding their health care needs and experiences;
(d) Dominican community organizations in New York state;
(e) Health care providers in both New York state and the Dominican
Republic; and
(f) Experts in international health policy, Medicaid administration,
and cross-border health care programs.
§ 6. Reporting. 1. The commission shall submit an interim report of
its preliminary findings and recommendations to the governor, the speak-
er of the assembly, the temporary president of the senate, and the
chairs of the health and aging committees of both houses no later than
nine months after the effective date of this act.
2. The commission shall submit a final report of its findings and
recommendations to the governor, the speaker of the assembly, the tempo-
rary president of the senate, and the chairs of the health and aging
committees of both houses no later than 18 months after the effective
date of this act.
3. Such final report shall include:
(a) an executive summary of findings and recommendations;
(b) a detailed feasibility analysis;
(c) a proposed pilot program design, including eligibility criteria,
covered services, enrollment procedures, and operational framework;
(d) draft statutory language for any legislation necessary to author-
ize and implement the pilot program;
(e) draft memorandum of understanding with SeNaSa and other relevant
Dominican entities;
(f) fiscal impact estimates, including projected costs and savings;
(g) an implementation timeline and operational plan;
(h) evaluation framework and performance metrics;
(i) a strategy for federal waiver application; and
(j) any dissenting views of commission members.
§ 7. Cooperation of agencies. All departments, divisions, boards,
bureaus, commissions, and agencies of the state and its political subdi-
visions shall provide the commission with any information and assistance
it may require in carrying out its duties under this act. The depart-
ment of health shall have primary responsibility for coordinating such
cooperation and providing data related to Medicaid enrollment, utiliza-
tion, and expenditures for the populations of interest.
§ 8. Severability. If any provision of this act, or the application of
such provision to any person or circumstance, shall be held invalid,
illegal or unenforceable, the remainder of this act, and the application
of such provision to persons or circumstances other than those as to
which it is held invalid, illegal or unenforceable, shall not be
affected thereby.
§ 9. This act shall take effect immediately and shall expire and be
deemed repealed two years after such date.