Senate Bill S8751B

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   8751
 
                             I N  S E N A T E
 
                              January 8, 2026
                                ___________
 
 Introduced by Sen. SEPULVEDA -- read twice and ordered printed, and when
   printed to be committed to the Committee on Health
 
 AN  ACT  in relation to establishing the New York-Dominican health part-
   nership act, creating a commission to study and  develop  a  framework
   for  authorizing  New  York  state-funded health services for eligible
   seniors and individuals with disabilities residing part-time or  full-
   time  in  the  Dominican  Republic,  and  to  explore bilateral health
   collaboration between the state of New York and the  Dominican  Repub-
   lic;  and  provides  for the repeal of such provisions upon expiration
   thereof
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "New York-Dominican health partnership act".
   § 2. Legislative findings and intent. 1. The legislature finds that  a
 significant number of New York residents, particularly seniors and indi-
 viduals  with disabilities, maintain close cultural, familial, and resi-
 dential ties with the Dominican Republic, often  residing  part  of  the
 year abroad while remaining eligible for health care and social services
 in New York state.
   2.  The legislature further finds that medical services in the Domini-
 can Republic can often be delivered at a substantially lower  cost  than
 comparable  services  in  New York, while maintaining acceptable quality
 standards, particularly when coordinated through accredited facilities.
   3. It is the intent of this legislation to explore innovative ways to:
   (a) improve health care accessibility and affordability  for  eligible
 New York residents abroad;
   (b) strengthen bilateral cooperation between the state of New York and
 the  Dominican  Republic  in public health, medical education, and elder
 care; and
   (c) identify potential state-only pilot  programs  or  federal  waiver
 mechanisms  that  could  permit  Medicaid  or  state  health benefits to
 support care provided in certified Dominican medical institutions.
   4. 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.
 
              

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD13909-01-5
 S. 8751                             2
 
   §  3.  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 nine members, appointed as follows:
   (a) The commissioner of health, or their designee;
   (b) The commissioner of the office for the aging, or their designee;
   (c)  The commissioner of temporary and disability assistance, or their
 designee;
   (d) One member appointed by the speaker of the assembly;
   (e) One member appointed by the temporary president of the senate;
   (f) One member appointed by the governor;
   (g) One member representing the Consulate  General  of  the  Dominican
 Republic in New York;
   (h)  One  expert  in international health policy from a New York-based
 university; and
   (i) One representative from a recognized Dominican community organiza-
 tion in New York state.
   3. The commission shall select from among its  members  a  chairperson
 and vice-chairperson. Members shall serve without compensation but shall
 be  entitled  to  reimbursement  for  necessary expenses incurred in the
 performance of their duties.
   § 4. Duties of the commission. The commission shall:
   1. Conduct a comprehensive study on the  feasibility,  cost-effective-
 ness, and legal requirements of establishing a bilateral health partner-
 ship between the state of New York and the Dominican Republic.
   2. Explore potential models for:
   (a)  state-funded pilot programs allowing qualified New York residents
 to access approved medical services abroad;
   (b) accreditation systems for Dominican health facilities meeting  New
 York public health standards;
   (c) reciprocal telehealth and information exchange programs;
   (d) long-term care partnerships and geriatrics exchange programs; and
   (e)  opportunities  for federal collaboration or waivers under section
 1115 of the Social Security Act.
   3. Assess potential fiscal savings to New York's Medicaid program  and
 economic benefits for both jurisdictions.
   4. Develop recommendations for:
   (a) statutory or regulatory changes required at the state level;
   (b)  potential  memoranda  of understanding (MOUs) or bilateral agree-
 ments between New York and the Dominican Ministry of Public Health; and
   (c) next steps toward implementation of a demonstration project.
   § 5. Reporting. The commission shall submit  a  final  report  of  its
 findings  and recommendations to the governor, the speaker of the assem-
 bly, the temporary president of the senate, and the chairs of the health
 and aging committees no later than eighteen months after  the  effective
 date  of this act. The report shall include proposed statutory language,
 fiscal impact estimates, and an implementation plan for potential  pilot
 initiatives.
   §  6.  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.
   § 7. This act shall take effect immediately and shall  expire  and  be
 deemed repealed two years after such date.

                             
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                  8751--A
 
                             I N  S E N A T E
 
                              January 8, 2026
                                ___________
 
 Introduced by Sen. SEPULVEDA -- read twice and ordered printed, and when
   printed  to  be  committed  to  the  Committee  on Health -- committee
   discharged, bill amended, ordered reprinted as amended and recommitted
   to said committee
 
 AN ACT in relation to establishing the New York-Dominican  health  part-
   nership  act,  creating  a commission to study and develop a framework
   for authorizing New York state-funded  health  services  for  eligible
   seniors  and individuals with disabilities residing part-time or full-
   time in the Dominican Republic through a pilot  partnership  with  the
   Seguro  Nacional  de Salud (SeNaSa), the primary public health insurer
   of the Dominican Republic, and to  explore  bilateral  health  collab-
   oration  between the state of New York and the Dominican Republic; and
   providing for the repeal of such provisions upon expiration thereof
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:
 
   Section  1.  Short  title. This act shall be known and may be cited as
 the "New York-Dominican health partnership act".
   § 2. Legislative findings and intent. 1. The legislature finds that:
   (a) A significant number of New  York  state  residents,  particularly
 seniors  aged  65  years and older and individuals with disabilities who
 are enrolled in the New York  state  Medicaid  program,  maintain  close
 cultural,  familial,  and  residential ties with the Dominican Republic,
 often residing six months or more of each year in the Dominican Republic
 while remaining eligible for health care and social services in New York
 state;
   (b) Such dual-residence patterns create  significant  gaps  in  health
 care  continuity,  as  the  federal  Medicaid program does not authorize
 payment for medical services rendered outside the United States, result-
 ing in eligible beneficiaries delaying or forgoing necessary primary and
 preventive care while residing abroad;
   (c) The absence of accessible, affordable primary and preventive  care
 for  these  populations  while  residing in the Dominican Republic often
 leads to the progression of manageable health conditions into  acute  or
 emergency  situations  requiring costly interventions upon the benefici-
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD13909-04-6
 S. 8751--A                          2
 
 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;
   (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;
 S. 8751--A                          3
 
   (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
 common illnesses and injuries, management of chronic conditions,  health
 education, and preventive care.
 S. 8751--A                          4
 
   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.
   5. Members shall serve without compensation but shall be  entitled  to
 reimbursement  for  necessary  expenses  incurred  in the performance of
 their duties.
 S. 8751--A                          5
 
   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.
   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
 S. 8751--A                          6
 
 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;
   (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;
 S. 8751--A                          7
 
   (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.