[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 847 Enrolled Bill (ENR)]

        H.R.847

                      One Hundred Eleventh Congress

                                 of the

                        United States of America


                          AT THE SECOND SESSION

          Begun and held at the City of Washington on Tuesday,
             the fifth day of January, two thousand and ten


                                 An Act


 
To amend the Public Health Service Act to extend and improve protections 
and services to individuals directly impacted by the terrorist attack in 
      New York City on September 11, 2001, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
    (a) Short Title.--This Act may be cited as the ``James Zadroga 9/11 
Health and Compensation Act of 2010''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

Sec. 101. World Trade Center Health Program.

            ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM

       ``Subtitle A--Establishment of Program; Advisory Committee

    ``Sec. 3301. Establishment of World Trade Center Health Program.
    ``Sec. 3302. WTC Health Program Scientific/Technical Advisory 
              Committee; WTC Health Program Steering Committees.
    ``Sec. 3303. Education and outreach.
    ``Sec. 3304. Uniform data collection and analysis.
    ``Sec. 3305. Clinical Centers of Excellence and Data Centers.
    ``Sec. 3306. Definitions.

  ``Subtitle B--Program of Monitoring, Initial Health Evaluations, and 
                                Treatment

                        ``PART 1--WTC Responders

    ``Sec. 3311. Identification of WTC responders and provision of WTC-
              related monitoring services.
    ``Sec. 3312. Treatment of enrolled WTC responders for WTC-related 
              health conditions.
    ``Sec. 3313. National arrangement for benefits for eligible 
              individuals outside New York.

                         ``PART 2--WTC Survivors

    ``Sec. 3321. Identification and initial health evaluation of 
              screening-eligible and certified-eligible WTC survivors.
    ``Sec. 3322. Followup monitoring and treatment of certified-eligible 
              WTC survivors for WTC-related health conditions.
    ``Sec. 3323. Followup monitoring and treatment of other individuals 
              with WTC-related health conditions.

                       ``PART 3--Payor Provisions

    ``Sec. 3331. Payment of claims.
    ``Sec. 3332. Administrative arrangement authority.

                 ``Subtitle C--Research Into Conditions

    ``Sec. 3341. Research regarding certain health conditions related to 
              September 11 terrorist attacks.
    ``Sec. 3342. World Trade Center Health Registry.

                          ``Subtitle D--Funding

    ``Sec. 3351. World Trade Center Health Program Fund.

        TITLE II--SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001

Sec. 201. Definitions.
Sec. 202. Extended and expanded eligibility for compensation.
Sec. 203. Requirement to update regulations.
Sec. 204. Limited liability for certain claims.
Sec. 205. Funding; attorney fees.

                  TITLE III--REVENUE RELATED PROVISIONS

Sec. 301. Excise tax on foreign procurement.
Sec. 302. Renewal of fees for visa-dependent employers.

                       TITLE IV--BUDGETARY EFFECTS

Sec. 401. Compliance with Statutory Pay-As-You-Go Act of 2010.

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

    SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM.
    The Public Health Service Act is amended by adding at the end the 
following new title:

           ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM
       ``Subtitle A--Establishment of Program; Advisory Committee

``SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM.
    ``(a) In General.--There is hereby established within the 
Department of Health and Human Services a program to be known as the 
World Trade Center Health Program, which shall be administered by the 
WTC Program Administrator, to provide beginning on July 1, 2011--
        ``(1) medical monitoring and treatment benefits to eligible 
    emergency responders and recovery and cleanup workers (including 
    those who are Federal employees) who responded to the September 11, 
    2001, terrorist attacks; and
        ``(2) initial health evaluation, monitoring, and treatment 
    benefits to residents and other building occupants and area workers 
    in New York City who were directly impacted and adversely affected 
    by such attacks.
    ``(b) Components of Program.--The WTC Program includes the 
following components:
        ``(1) Medical monitoring for responders.--Medical monitoring 
    under section 3311, including clinical examinations and long-term 
    health monitoring and analysis for enrolled WTC responders who were 
    likely to have been exposed to airborne toxins that were released, 
    or to other hazards, as a result of the September 11, 2001, 
    terrorist attacks.
        ``(2) Initial health evaluation for survivors.--An initial 
    health evaluation under section 3321, including an evaluation to 
    determine eligibility for followup monitoring and treatment.
        ``(3) Followup monitoring and treatment for wtc-related health 
    conditions for responders and survivors.--Provision under sections 
    3312, 3322, and 3323 of followup monitoring and treatment and 
    payment, subject to the provisions of subsection (d), for all 
    medically necessary health and mental health care expenses of an 
    individual with respect to a WTC-related health condition 
    (including necessary prescription drugs).
        ``(4) Outreach.--Establishment under section 3303 of an 
    education and outreach program to potentially eligible individuals 
    concerning the benefits under this title.
        ``(5) Clinical data collection and analysis.--Collection and 
    analysis under section 3304 of health and mental health data 
    relating to individuals receiving monitoring or treatment benefits 
    in a uniform manner in collaboration with the collection of 
    epidemiological data under section 3342.
        ``(6) Research on health conditions.--Establishment under 
    subtitle C of a research program on health conditions resulting 
    from the September 11, 2001, terrorist attacks.
    ``(c) No Cost Sharing.--Monitoring and treatment benefits and 
initial health evaluation benefits are provided under subtitle B 
without any deductibles, copayments, or other cost sharing to an 
enrolled WTC responder or certified-eligible WTC survivor. Initial 
health evaluation benefits are provided under subtitle B without any 
deductibles, copayments, or other cost sharing to a screening-eligible 
WTC survivor.
    ``(d) Preventing Fraud and Unreasonable Administrative Costs.--
        ``(1) Fraud.--The Inspector General of the Department of Health 
    and Human Services shall develop and implement a program to review 
    the WTC Program's health care expenditures to detect fraudulent or 
    duplicate billing and payment for inappropriate services. This 
    title is a Federal health care program (as defined in section 
    1128B(f) of the Social Security Act) and is a health plan (as 
    defined in section 1128C(c) of such Act) for purposes of applying 
    sections 1128 through 1128E of such Act.
        ``(2) Unreasonable administrative costs.--The Inspector General 
    of the Department of Health and Human Services shall develop and 
    implement a program to review the WTC Program for unreasonable 
    administrative costs, including with respect to infrastructure, 
    administration, and claims processing.
    ``(e) Quality Assurance.--The WTC Program Administrator working 
with the Clinical Centers of Excellence shall develop and implement a 
quality assurance program for the monitoring and treatment delivered by 
such Centers of Excellence and any other participating health care 
providers. Such program shall include--
        ``(1) adherence to monitoring and treatment protocols;
        ``(2) appropriate diagnostic and treatment referrals for 
    participants;
        ``(3) prompt communication of test results to participants; and
        ``(4) such other elements as the Administrator specifies in 
    consultation with the Clinical Centers of Excellence.
    ``(f) Annual Program Report.--
        ``(1) In general.--Not later than 6 months after the end of 
    each fiscal year in which the WTC Program is in operation, the WTC 
    Program Administrator shall submit an annual report to the Congress 
    on the operations of this title for such fiscal year and for the 
    entire period of operation of the program.
        ``(2) Contents included in report.--Each annual report under 
    paragraph (1) shall include at least the following:
            ``(A) Eligible individuals.--Information for each clinical 
        program described in paragraph (3)--
                ``(i) on the number of individuals who applied for 
            certification under subtitle B and the number of such 
            individuals who were so certified;
                ``(ii) of the individuals who were certified, on the 
            number who received monitoring under the program and the 
            number of such individuals who received medical treatment 
            under the program;
                ``(iii) with respect to individuals so certified who 
            received such treatment, on the WTC-related health 
            conditions for which they were treated; and
                ``(iv) on the projected number of individuals who will 
            be certified under subtitle B in the succeeding fiscal year 
            and the succeeding 10-year period.
            ``(B) Monitoring, initial health evaluation, and treatment 
        costs.--For each clinical program so described--
                ``(i) information on the costs of monitoring and 
            initial health evaluation and the costs of treatment and on 
            the estimated costs of such monitoring, evaluation, and 
            treatment in the succeeding fiscal year; and
                ``(ii) an estimate of the cost of medical treatment for 
            WTC-related health conditions that have been paid for or 
            reimbursed by workers' compensation, by public or private 
            health plans, or by New York City under section 3331.
            ``(C) Administrative costs.--Information on the cost of 
        administering the program, including costs of program support, 
        data collection and analysis, and research conducted under the 
        program.
            ``(D) Administrative experience.--Information on the 
        administrative performance of the program, including--
                ``(i) the performance of the program in providing 
            timely evaluation of and treatment to eligible individuals; 
            and
                ``(ii) a list of the Clinical Centers of Excellence and 
            other providers that are participating in the program.
            ``(E) Scientific reports.--A summary of the findings of any 
        new scientific reports or studies on the health effects 
        associated with exposure described in section 3306(1), 
        including the findings of research conducted under section 
        3341(a).
            ``(F) Advisory committee recommendations.--A list of 
        recommendations by the WTC Scientific/Technical Advisory 
        Committee on additional WTC Program eligibility criteria and on 
        additional WTC-related health conditions and the action of the 
        WTC Program Administrator concerning each such recommendation.
        ``(3) Separate clinical programs described.--In paragraph (2), 
    each of the following shall be treated as a separate clinical 
    program of the WTC Program:
            ``(A) Firefighters and related personnel.--The benefits 
        provided for enrolled WTC responders described in section 
        3311(a)(2)(A).
            ``(B) Other wtc responders.--The benefits provided for 
        enrolled WTC responders not described in subparagraph (A).
            ``(C) WTC survivors.--The benefits provided for screening-
        eligible WTC survivors and certified-eligible WTC survivors in 
        section 3321(a).
    ``(g) Notification to Congress Upon Reaching 80 Percent of 
Eligibility Numerical Limits.--The Secretary shall promptly notify the 
Congress of each of the following:
        ``(1) When the number of enrollments of WTC responders subject 
    to the limit established under section 3311(a)(4) has reached 80 
    percent of such limit.
        ``(2) When the number of certifications for certified-eligible 
    WTC survivors subject to the limit established under section 
    3321(a)(3) has reached 80 percent of such limit.
    ``(h) Consultation.--The WTC Program Administrator shall engage in 
ongoing outreach and consultation with relevant stakeholders, including 
the WTC Health Program Steering Committees and the Advisory Committee 
under section 3302, regarding the implementation and improvement of 
programs under this title.
``SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY 
COMMITTEE; WTC HEALTH PROGRAM STEERING COMMITTEES.
    ``(a) Advisory Committee.--
        ``(1) Establishment.--The WTC Program Administrator shall 
    establish an advisory committee to be known as the WTC Health 
    Program Scientific/Technical Advisory Committee (in this subsection 
    referred to as the `Advisory Committee') to review scientific and 
    medical evidence and to make recommendations to the Administrator 
    on additional WTC Program eligibility criteria and on additional 
    WTC-related health conditions.
        ``(2) Composition.--The WTC Program Administrator shall appoint 
    the members of the Advisory Committee and shall include at least--
            ``(A) 4 occupational physicians, at least 2 of whom have 
        experience treating WTC rescue and recovery workers;
            ``(B) 1 physician with expertise in pulmonary medicine;
            ``(C) 2 environmental medicine or environmental health 
        specialists;
            ``(D) 2 representatives of WTC responders;
            ``(E) 2 representatives of certified-eligible WTC 
        survivors;
            ``(F) an industrial hygienist;
            ``(G) a toxicologist;
            ``(H) an epidemiologist; and
            ``(I) a mental health professional.
        ``(3) Meetings.--The Advisory Committee shall meet at such 
    frequency as may be required to carry out its duties.
        ``(4) Reports.--The WTC Program Administrator shall provide for 
    publication of recommendations of the Advisory Committee on the 
    public Web site established for the WTC Program.
        ``(5) Duration.--Notwithstanding any other provision of law, 
    the Advisory Committee shall continue in operation during the 
    period in which the WTC Program is in operation.
        ``(6) Application of faca.--Except as otherwise specifically 
    provided, the Advisory Committee shall be subject to the Federal 
    Advisory Committee Act.
    ``(b) WTC Health Program Steering Committees.--
        ``(1) Consultation.--The WTC Program Administrator shall 
    consult with 2 steering committees (each in this section referred 
    to as a `Steering Committee') that are established as follows:
            ``(A) WTC responders steering committee.--One Steering 
        Committee, to be known as the WTC Responders Steering 
        Committee, for the purpose of receiving input from affected 
        stakeholders and facilitating the coordination of monitoring 
        and treatment programs for the enrolled WTC responders under 
        part 1 of subtitle B.
            ``(B) WTC survivors steering committee.--One Steering 
        Committee, to be known as the WTC Survivors Steering Committee, 
        for the purpose of receiving input from affected stakeholders 
        and facilitating the coordination of initial health 
        evaluations, monitoring, and treatment programs for screening-
        eligible and certified-eligible WTC survivors under part 2 of 
        subtitle B.
        ``(2) Membership.--
            ``(A) WTC responders steering committee.--
                ``(i) Representation.--The WTC Responders Steering 
            Committee shall include--

                    ``(I) representatives of the Centers of Excellence 
                providing services to WTC responders;
                    ``(II) representatives of labor organizations 
                representing firefighters, police, other New York City 
                employees, and recovery and cleanup workers who 
                responded to the September 11, 2001, terrorist attacks; 
                and
                    ``(III) 3 representatives of New York City, 1 of 
                whom will be selected by the police commissioner of New 
                York City, 1 by the health commissioner of New York 
                City, and 1 by the mayor of New York City.

                ``(ii) Initial membership.--The WTC Responders Steering 
            Committee shall initially be composed of members of the WTC 
            Monitoring and Treatment Program Steering Committee (as in 
            existence on the day before the date of the enactment of 
            this title).
            ``(B) WTC survivors steering committee.--
                ``(i) Representation.--The WTC Survivors Steering 
            Committee shall include representatives of--

                    ``(I) the Centers of Excellence providing services 
                to screening-eligible and certified-eligible WTC 
                survivors;
                    ``(II) the population of residents, students, and 
                area and other workers affected by the September 11, 
                2001, terrorist attacks;
                    ``(III) screening-eligible and certified-eligible 
                survivors receiving initial health evaluations, 
                monitoring, or treatment under part 2 of subtitle B and 
                organizations advocating on their behalf; and
                    ``(IV) New York City.

                ``(ii) Initial membership.--The WTC Survivors Steering 
            Committee shall initially be composed of members of the WTC 
            Environmental Health Center Survivor Advisory Committee (as 
            in existence on the day before the date of the enactment of 
            this title).
            ``(C) Additional appointments.--Each Steering Committee may 
        recommend, if approved by a majority of voting members of the 
        Committee, additional members to the Committee.
            ``(D) Vacancies.--A vacancy in a Steering Committee shall 
        be filled by an individual recommended by the Steering 
        Committee.
``SEC. 3303. EDUCATION AND OUTREACH.
    ``The WTC Program Administrator shall institute a program that 
provides education and outreach on the existence and availability of 
services under the WTC Program. The outreach and education program--
        ``(1) shall include--
            ``(A) the establishment of a public Web site with 
        information about the WTC Program;
            ``(B) meetings with potentially eligible populations;
            ``(C) development and dissemination of outreach materials 
        informing people about the program; and
            ``(D) the establishment of phone information services; and
        ``(2) shall be conducted in a manner intended--
            ``(A) to reach all affected populations; and
            ``(B) to include materials for culturally and 
        linguistically diverse populations.
``SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS.
    ``(a) In General.--The WTC Program Administrator shall provide for 
the uniform collection of data, including claims data (and analysis of 
data and regular reports to the Administrator) on the prevalence of 
WTC-related health conditions and the identification of new WTC-related 
health conditions. Such data shall be collected for all individuals 
provided monitoring or treatment benefits under subtitle B and 
regardless of their place of residence or Clinical Center of Excellence 
through which the benefits are provided. The WTC Program Administrator 
shall provide, through the Data Centers or otherwise, for the 
integration of such data into the monitoring and treatment program 
activities under this title.
    ``(b) Coordinating Through Centers of Excellence.--Each Clinical 
Center of Excellence shall collect data described in subsection (a) and 
report such data to the corresponding Data Center for analysis by such 
Data Center.
    ``(c) Collaboration With WTC Health Registry.--The WTC Program 
Administrator shall provide for collaboration between the Data Centers 
and the World Trade Center Health Registry described in section 3342.
    ``(d) Privacy.--The data collection and analysis under this section 
shall be conducted and maintained in a manner that protects the 
confidentiality of individually identifiable health information 
consistent with applicable statutes and regulations, including, as 
applicable, HIPAA privacy and security law (as defined in section 
3009(a)(2)) and section 552a of title 5, United States Code.
``SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA CENTERS.
    ``(a) In General.--
        ``(1) Contracts with clinical centers of excellence.--The WTC 
    Program Administrator shall, subject to subsection (b)(1)(B), enter 
    into contracts with Clinical Centers of Excellence (as defined in 
    subsection (b)(1)(A))--
            ``(A) for the provision of monitoring and treatment 
        benefits and initial health evaluation benefits under subtitle 
        B;
            ``(B) for the provision of outreach activities to 
        individuals eligible for such monitoring and treatment 
        benefits, for initial health evaluation benefits, and for 
        followup to individuals who are enrolled in the monitoring 
        program;
            ``(C) for the provision of counseling for benefits under 
        subtitle B, with respect to WTC-related health conditions, for 
        individuals eligible for such benefits;
            ``(D) for the provision of counseling for benefits for WTC-
        related health conditions that may be available under workers' 
        compensation or other benefit programs for work-related 
        injuries or illnesses, health insurance, disability insurance, 
        or other insurance plans or through public or private social 
        service agencies and assisting eligible individuals in applying 
        for such benefits;
            ``(E) for the provision of translational and interpretive 
        services for program participants who are not English language 
        proficient; and
            ``(F) for the collection and reporting of data, including 
        claims data, in accordance with section 3304.
        ``(2) Contracts with data centers.--
            ``(A) In general.--The WTC Program Administrator shall 
        enter into contracts with one or more Data Centers (as defined 
        in subsection (b)(2))--
                ``(i) for receiving, analyzing, and reporting to the 
            WTC Program Administrator on data, in accordance with 
            section 3304, that have been collected and reported to such 
            Data Centers by the corresponding Clinical Centers of 
            Excellence under subsection (b)(1)(B)(iii);
                ``(ii) for the development of monitoring, initial 
            health evaluation, and treatment protocols, with respect to 
            WTC-related health conditions;
                ``(iii) for coordinating the outreach activities 
            conducted under paragraph (1)(B) by each corresponding 
            Clinical Center of Excellence;
                ``(iv) for establishing criteria for the credentialing 
            of medical providers participating in the nationwide 
            network under section 3313;
                ``(v) for coordinating and administering the activities 
            of the WTC Health Program Steering Committees established 
            under section 3002(b); and
                ``(vi) for meeting periodically with the corresponding 
            Clinical Centers of Excellence to obtain input on the 
            analysis and reporting of data collected under clause (i) 
            and on the development of monitoring, initial health 
            evaluation, and treatment protocols under clause (ii).
            ``(B) Medical provider selection.--The medical providers 
        under subparagraph (A)(iv) shall be selected by the WTC Program 
        Administrator on the basis of their experience treating or 
        diagnosing the health conditions included in the list of WTC-
        related health conditions.
            ``(C) Clinical discussions.--In carrying out subparagraph 
        (A)(ii), a Data Center shall engage in clinical discussions 
        across the WTC Program to guide treatment approaches for 
        individuals with a WTC-related health condition.
            ``(D) Transparency of data.--A contract entered into under 
        this subsection with a Data Center shall require the Data 
        Center to make any data collected and reported to such Center 
        under subsection (b)(1)(B)(iii) available to health researchers 
        and others as provided in the CDC/ATSDR Policy on Releasing and 
        Sharing Data.
        ``(3) Authority for contracts to be class specific.--A contract 
    entered into under this subsection with a Clinical Center of 
    Excellence or a Data Center may be with respect to one or more 
    class of enrolled WTC responders, screening-eligible WTC survivors, 
    or certified-eligible WTC survivors.
        ``(4) Use of cooperative agreements.--Any contract under this 
    title between the WTC Program Administrator and a Data Center or a 
    Clinical Center of Excellence may be in the form of a cooperative 
    agreement.
        ``(5) Review on feasibility of consolidating data centers.--Not 
    later than July 1, 2011, the Comptroller General of the United 
    States shall submit to the Committee on Energy and Commerce of the 
    House of Representatives and the Committee on Health, Education, 
    Labor, and Pensions of the Senate a report on the feasibility of 
    consolidating Data Centers into a single Data Center.
    ``(b) Centers of Excellence.--
        ``(1) Clinical centers of excellence.--
            ``(A) Definition.--For purposes of this title, the term 
        `Clinical Center of Excellence' means a Center that 
        demonstrates to the satisfaction of the Administrator that the 
        Center--
                ``(i) uses an integrated, centralized health care 
            provider approach to create a comprehensive suite of health 
            services under this title that are accessible to enrolled 
            WTC responders, screening-eligible WTC survivors, or 
            certified-eligible WTC survivors;
                ``(ii) has experience in caring for WTC responders and 
            screening-eligible WTC survivors or includes health care 
            providers who have been trained pursuant to section 
            3313(c);
                ``(iii) employs health care provider staff with 
            expertise that includes, at a minimum, occupational 
            medicine, environmental medicine, trauma-related psychiatry 
            and psychology, and social services counseling; and
                ``(iv) meets such other requirements as specified by 
            the Administrator.
            ``(B) Contract requirements.--The WTC Program Administrator 
        shall not enter into a contract with a Clinical Center of 
        Excellence under subsection (a)(1) unless the Center agrees to 
        do each of the following:
                ``(i) Establish a formal mechanism for consulting with 
            and receiving input from representatives of eligible 
            populations receiving monitoring and treatment benefits 
            under subtitle B from such Center.
                ``(ii) Coordinate monitoring and treatment benefits 
            under subtitle B with routine medical care provided for the 
            treatment of conditions other than WTC-related health 
            conditions.
                ``(iii) Collect and report to the corresponding Data 
            Center data, including claims data, in accordance with 
            section 3304(b).
                ``(iv) Have in place safeguards against fraud that are 
            satisfactory to the Administrator, in consultation with the 
            Inspector General of the Department of Health and Human 
            Services.
                ``(v) Treat or refer for treatment all individuals who 
            are enrolled WTC responders or certified-eligible WTC 
            survivors with respect to such Center who present 
            themselves for treatment of a WTC-related health condition.
                ``(vi) Have in place safeguards, consistent with 
            section 3304(c), to ensure the confidentiality of an 
            individual's individually identifiable health information, 
            including requiring that such information not be disclosed 
            to the individual's employer without the authorization of 
            the individual.
                ``(vii) Use amounts paid under subsection (c)(1) only 
            for costs incurred in carrying out the activities described 
            in subsection (a), other than those described in subsection 
            (a)(1)(A).
                ``(viii) Utilize health care providers with 
            occupational and environmental medicine expertise to 
            conduct physical and mental health assessments, in 
            accordance with protocols developed under subsection 
            (a)(2)(A)(ii).
                ``(ix) Communicate with WTC responders and screening-
            eligible and certified-eligible WTC survivors in 
            appropriate languages and conduct outreach activities with 
            relevant stakeholder worker or community associations.
                ``(x) Meet all the other applicable requirements of 
            this title, including regulations implementing such 
            requirements.
            ``(C) Transition rule to ensure continuity of care.--The 
        WTC Program Administrator shall to the maximum extent feasible 
        ensure continuity of care in any period of transition from 
        monitoring and treatment of an enrolled WTC responder or 
        certified-eligible WTC survivor by a provider to a Clinical 
        Center of Excellence or a health care provider participating in 
        the nationwide network under section 3313.
        ``(2) Data centers.--For purposes of this title, the term `Data 
    Center' means a Center that the WTC Program Administrator 
    determines has the capacity to carry out the responsibilities for a 
    Data Center under subsection (a)(2).
        ``(3) Corresponding centers.--For purposes of this title, a 
    Clinical Center of Excellence and a Data Center shall be treated as 
    `corresponding' to the extent that such Clinical Center and Data 
    Center serve the same population group.
    ``(c) Payment for Infrastructure Costs.--
        ``(1) In general.--The WTC Program Administrator shall 
    reimburse a Clinical Center of Excellence for the fixed 
    infrastructure costs of such Center in carrying out the activities 
    described in subtitle B at a rate negotiated by the Administrator 
    and such Centers. Such negotiated rate shall be fair and 
    appropriate and take into account the number of enrolled WTC 
    responders receiving services from such Center under this title.
        ``(2) Fixed infrastructure costs.--For purposes of paragraph 
    (1), the term `fixed infrastructure costs' means, with respect to a 
    Clinical Center of Excellence, the costs incurred by such Center 
    that are not otherwise reimbursable by the WTC Program 
    Administrator under section 3312(c) for patient evaluation, 
    monitoring, or treatment but which are needed to operate the WTC 
    program such as the costs involved in outreach to participants or 
    recruiting participants, data collection and analysis, social 
    services for counseling patients on other available assistance 
    outside the WTC program, and the development of treatment 
    protocols. Such term does not include costs for new construction or 
    other capital costs.
    ``(d) GAO Analysis.--Not later than July 1, 2011, the Comptroller 
General shall submit to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Health, Education, Labor, 
and Pensions of the Senate an analysis on whether Clinical Centers of 
Excellence with which the WTC Program Administrator enters into a 
contract under this section have financial systems that will allow for 
the timely submission of claims data for purposes of section 3304 and 
subsections (a)(1)(F) and (b)(1)(B)(iii).
``SEC. 3306. DEFINITIONS.
    ``In this title:
        ``(1) The term `aggravating' means, with respect to a health 
    condition, a health condition that existed on September 11, 2001, 
    and that, as a result of exposure to airborne toxins, any other 
    hazard, or any other adverse condition resulting from the September 
    11, 2001, terrorist attacks, requires medical treatment that is (or 
    will be) in addition to, more frequent than, or of longer duration 
    than the medical treatment that would have been required for such 
    condition in the absence of such exposure.
        ``(2) The term `certified-eligible WTC survivor' has the 
    meaning given such term in section 3321(a)(2).
        ``(3) The terms `Clinical Center of Excellence' and `Data 
    Center' have the meanings given such terms in section 3305.
        ``(4) The term `enrolled WTC responder' means a WTC responder 
    enrolled under section 3311(a)(3).
        ``(5) The term `initial health evaluation' includes, with 
    respect to an individual, a medical and exposure history, a 
    physical examination, and additional medical testing as needed to 
    evaluate whether the individual has a WTC-related health condition 
    and is eligible for treatment under the WTC Program.
        ``(6) The term `list of WTC-related health conditions' means--
            ``(A) for WTC responders, the health conditions listed in 
        section 3312(a)(3); and
            ``(B) for screening-eligible and certified-eligible WTC 
        survivors, the health conditions listed in section 3322(b).
        ``(7) The term `New York City disaster area' means the area 
    within New York City that is--
            ``(A) the area of Manhattan that is south of Houston 
        Street; and
            ``(B) any block in Brooklyn that is wholly or partially 
        contained within a 1.5-mile radius of the former World Trade 
        Center site.
        ``(8) The term `New York metropolitan area' means an area, 
    specified by the WTC Program Administrator, within which WTC 
    responders and eligible WTC screening-eligible survivors who reside 
    in such area are reasonably able to access monitoring and treatment 
    benefits and initial health evaluation benefits under this title 
    through a Clinical Center of Excellence described in subparagraphs 
    (A), (B), or (C) of section 3305(b)(1).
        ``(9) The term `screening-eligible WTC survivor' has the 
    meaning given such term in section 3321(a)(1).
        ``(10) Any reference to `September 11, 2001' shall be deemed a 
    reference to the period on such date subsequent to the terrorist 
    attacks at the World Trade Center, Shanksville, Pennsylvania, or 
    the Pentagon, as applicable, on such date.
        ``(11) The term `September 11, 2001, terrorist attacks' means 
    the terrorist attacks that occurred on September 11, 2001, in New 
    York City, in Shanksville, Pennsylvania, and at the Pentagon, and 
    includes the aftermath of such attacks.
        ``(12) The term `WTC Health Program Steering Committee' means 
    such a Steering Committee established under section 3302(b).
        ``(13) The term `WTC Program' means the Word Trade Center 
    Health Program established under section 3301(a).
        ``(14)(A) The term `WTC Program Administrator' means--
            ``(i) subject to subparagraph (B), with respect to 
        paragraphs (3) and (4) of section 3311(a) (relating to 
        enrollment of WTC responders), section 3312(c) and the 
        corresponding provisions of section 3322 (relating to payment 
        for initial health evaluation, monitoring, and treatment, 
        paragraphs (1)(C), (2)(B), and (3) of section 3321(a) (relating 
        to determination or certification of screening-eligible or 
        certified-eligible WTC responders), and part 3 of subtitle B 
        (relating to payor provisions), an official in the Department 
        of Health and Human Services, to be designated by the 
        Secretary; and
            ``(ii) with respect to any other provision of this title, 
        the Director of the National Institute for Occupational Safety 
        and Health, or a designee of such Director.
        ``(B) In no case may the Secretary designate under subparagraph 
    (A)(i) the Director of the National Institute for Occupational 
    Safety and Health or a designee of such Director with respect to 
    section 3322 (relating to payment for initial health evaluation, 
    monitoring, and treatment).
        ``(15) The term `WTC-related health condition' is defined in 
    section 3312(a).
        ``(16) The term `WTC responder' is defined in section 3311(a).
        ``(17) The term `WTC Scientific/Technical Advisory Committee' 
    means such Committee established under section 3302(a).

 ``Subtitle B--Program of Monitoring, Initial Health Evaluations, and 
                               Treatment

                        ``PART 1--WTC RESPONDERS

``SEC. 3311. IDENTIFICATION OF WTC RESPONDERS AND PROVISION OF WTC-
RELATED MONITORING SERVICES.
    ``(a) WTC Responder Defined.--
        ``(1) In general.--For purposes of this title, the term `WTC 
    responder' means any of the following individuals, subject to 
    paragraph (4):
            ``(A) Currently identified responder.--An individual who 
        has been identified as eligible for monitoring under the 
        arrangements as in effect on the date of the enactment of this 
        title between the National Institute for Occupational Safety 
        and Health and--
                ``(i) the consortium coordinated by Mt. Sinai Hospital 
            in New York City that coordinates the monitoring and 
            treatment for enrolled WTC responders other than with 
            respect to those covered under the arrangement with the 
            Fire Department of New York City; or
                ``(ii) the Fire Department of New York City.
            ``(B) Responder who meets current eligibility criteria.--An 
        individual who meets the current eligibility criteria described 
        in paragraph (2).
            ``(C) Responder who meets modified eligibility criteria.--
        An individual who--
                ``(i) performed rescue, recovery, demolition, debris 
            cleanup, or other related services in the New York City 
            disaster area in response to the September 11, 2001, 
            terrorist attacks, regardless of whether such services were 
            performed by a State or Federal employee or member of the 
            National Guard or otherwise; and
                ``(ii) meets such eligibility criteria relating to 
            exposure to airborne toxins, other hazards, or adverse 
            conditions resulting from the September 11, 2001, terrorist 
            attacks as the WTC Program Administrator, after 
            consultation with the WTC Scientific/Technical Advisory 
            Committee, determines appropriate.
        The WTC Program Administrator shall not modify such eligibility 
        criteria on or after the date that the number of enrollments of 
        WTC responders has reached 80 percent of the limit described in 
        paragraph (4) or on or after the date that the number of 
        certifications for certified-eligible WTC survivors under 
        section 3321(a)(2)(B) has reached 80 percent of the limit 
        described in section 3321(a)(3).
        ``(2) Current eligibility criteria.--The eligibility criteria 
    described in this paragraph for an individual is that the 
    individual is described in any of the following categories:
            ``(A) Firefighters and related personnel.--The individual--
                ``(i) was a member of the Fire Department of New York 
            City (whether fire or emergency personnel, active or 
            retired) who participated at least one day in the rescue 
            and recovery effort at any of the former World Trade Center 
            sites (including Ground Zero, Staten Island Landfill, and 
            the New York City Chief Medical Examiner's Office) for any 
            time during the period beginning on September 11, 2001, and 
            ending on July 31, 2002; or
                ``(ii)(I) is a surviving immediate family member of an 
            individual who was a member of the Fire Department of New 
            York City (whether fire or emergency personnel, active or 
            retired) and was killed at the World Trade site on 
            September 11, 2001; and
                ``(II) received any treatment for a WTC-related health 
            condition described in section 3312(a)(1)(A)(ii) (relating 
            to mental health conditions) on or before September 1, 
            2008.
            ``(B) Law enforcement officers and wtc rescue, recovery, 
        and cleanup workers.--The individual--
                ``(i) worked or volunteered onsite in rescue, recovery, 
            debris cleanup, or related support services in lower 
            Manhattan (south of Canal St.), the Staten Island Landfill, 
            or the barge loading piers, for at least 4 hours during the 
            period beginning on September 11, 2001, and ending on 
            September 14, 2001, for at least 24 hours during the period 
            beginning on September 11, 2001, and ending on September 
            30, 2001, or for at least 80 hours during the period 
            beginning on September 11, 2001, and ending on July 31, 
            2002;
                ``(ii)(I) was a member of the Police Department of New 
            York City (whether active or retired) or a member of the 
            Port Authority Police of the Port Authority of New York and 
            New Jersey (whether active or retired) who participated 
            onsite in rescue, recovery, debris cleanup, or related 
            services in lower Manhattan (south of Canal St.), including 
            Ground Zero, the Staten Island Landfill, or the barge 
            loading piers, for at least 4 hours during the period 
            beginning September 11, 2001, and ending on September 14, 
            2001;
                ``(II) participated onsite in rescue, recovery, debris 
            cleanup, or related services at Ground Zero, the Staten 
            Island Landfill, or the barge loading piers, for at least 
            one day during the period beginning on September 11, 2001, 
            and ending on July 31, 2002;
                ``(III) participated onsite in rescue, recovery, debris 
            cleanup, or related services in lower Manhattan (south of 
            Canal St.) for at least 24 hours during the period 
            beginning on September 11, 2001, and ending on September 
            30, 2001; or
                ``(IV) participated onsite in rescue, recovery, debris 
            cleanup, or related services in lower Manhattan (south of 
            Canal St.) for at least 80 hours during the period 
            beginning on September 11, 2001, and ending on July 31, 
            2002;
                ``(iii) was an employee of the Office of the Chief 
            Medical Examiner of New York City involved in the 
            examination and handling of human remains from the World 
            Trade Center attacks, or other morgue worker who performed 
            similar post-September 11 functions for such Office staff, 
            during the period beginning on September 11, 2001, and 
            ending on July 31, 2002;
                ``(iv) was a worker in the Port Authority Trans-Hudson 
            Corporation Tunnel for at least 24 hours during the period 
            beginning on February 1, 2002, and ending on July 1, 2002; 
            or
                ``(v) was a vehicle-maintenance worker who was exposed 
            to debris from the former World Trade Center while 
            retrieving, driving, cleaning, repairing, and maintaining 
            vehicles contaminated by airborne toxins from the September 
            11, 2001, terrorist attacks during a duration and period 
            described in subparagraph (A).
            ``(C) Responders to the september 11 attacks at the 
        pentagon and shanksville, pennsylvania.--The individual--
                ``(i)(I) was a member of a fire or police department 
            (whether fire or emergency personnel, active or retired), 
            worked for a recovery or cleanup contractor, or was a 
            volunteer; and performed rescue, recovery, demolition, 
            debris cleanup, or other related services at the Pentagon 
            site of the terrorist-related aircraft crash of September 
            11, 2001, during the period beginning on September 11, 
            2001, and ending on the date on which the cleanup of the 
            site was concluded, as determined by the WTC Program 
            Administrator; or
                ``(II) was a member of a fire or police department 
            (whether fire or emergency personnel, active or retired), 
            worked for a recovery or cleanup contractor, or was a 
            volunteer; and performed rescue, recovery, demolition, 
            debris cleanup, or other related services at the 
            Shanksville, Pennsylvania, site of the terrorist-related 
            aircraft crash of September 11, 2001, during the period 
            beginning on September 11, 2001, and ending on the date on 
            which the cleanup of the site was concluded, as determined 
            by the WTC Program Administrator; and
                ``(ii) is determined by the WTC Program Administrator 
            to be at an increased risk of developing a WTC-related 
            health condition as a result of exposure to airborne 
            toxins, other hazards, or adverse conditions resulting from 
            the September 11, 2001, terrorist attacks, and meets such 
            eligibility criteria related to such exposures, as the WTC 
            Program Administrator determines are appropriate, after 
            consultation with the WTC Scientific/Technical Advisory 
            Committee.
        ``(3) Enrollment process.--
            ``(A) In general.--The WTC Program Administrator shall 
        establish a process for enrolling WTC responders in the WTC 
        Program. Under such process--
                ``(i) WTC responders described in paragraph (1)(A) 
            shall be deemed to be enrolled in such Program;
                ``(ii) subject to clause (iii), the Administrator shall 
            enroll in such program individuals who are determined to be 
            WTC responders;
                ``(iii) the Administrator shall deny such enrollment to 
            an individual if the Administrator determines that the 
            numerical limitation in paragraph (4) on enrollment of WTC 
            responders has been met;
                ``(iv) there shall be no fee charged to the applicant 
            for making an application for such enrollment;
                ``(v) the Administrator shall make a determination on 
            such an application not later than 60 days after the date 
            of filing the application; and
                ``(vi) an individual who is denied enrollment in such 
            Program shall have an opportunity to appeal such 
            determination in a manner established under such process.
            ``(B) Timing.--
                ``(i) Currently identified responders.--In accordance 
            with subparagraph (A)(i), the WTC Program Administrator 
            shall enroll an individual described in paragraph (1)(A) in 
            the WTC Program not later than July 1, 2011.
                ``(ii) Other responders.--In accordance with 
            subparagraph (A)(ii) and consistent with paragraph (4), the 
            WTC Program Administrator shall enroll any other individual 
            who is determined to be a WTC responder in the WTC Program 
            at the time of such determination.
        ``(4) Numerical limitation on eligible wtc responders.--
            ``(A) In general.--The total number of individuals not 
        described in paragraph (1)(A) or (2)(A)(ii) who may be enrolled 
        under paragraph (3)(A)(ii) shall not exceed 25,000 at any time, 
        of which no more than 2,500 may be individuals enrolled based 
        on modified eligibility criteria established under paragraph 
        (1)(C).
            ``(B) Process.--In implementing subparagraph (A), the WTC 
        Program Administrator shall--
                ``(i) limit the number of enrollments made under 
            paragraph (3)--

                    ``(I) in accordance with such subparagraph; and
                    ``(II) to such number, as determined by the 
                Administrator based on the best available information 
                and subject to amounts available under section 3351, 
                that will ensure sufficient funds will be available to 
                provide treatment and monitoring benefits under this 
                title, with respect to all individuals who are enrolled 
                through the end of fiscal year 2020; and

                ``(ii) provide priority (subject to paragraph 
            (3)(A)(i)) in such enrollments in the order in which 
            individuals apply for enrollment under paragraph (3).
        ``(5) Disqualification of individuals on terrorist watch 
    list.--No individual who is on the terrorist watch list maintained 
    by the Department of Homeland Security shall qualify as an eligible 
    WTC responder. Before enrolling any individual as a WTC responder 
    in the WTC Program under paragraph (3), the Administrator, in 
    consultation with the Secretary of Homeland Security, shall 
    determine whether the individual is on such list.
    ``(b) Monitoring Benefits.--
        ``(1) In general.--In the case of an enrolled WTC responder 
    (other than one described in subsection (a)(2)(A)(ii)), the WTC 
    Program shall provide for monitoring benefits that include 
    monitoring consistent with protocols approved by the WTC Program 
    Administrator and including clinical examinations and long-term 
    health monitoring and analysis. In the case of an enrolled WTC 
    responder who is an active member of the Fire Department of New 
    York City, the responder shall receive such benefits as part of the 
    individual's periodic company medical exams.
        ``(2) Provision of monitoring benefits.--The monitoring 
    benefits under paragraph (1) shall be provided through the Clinical 
    Center of Excellence for the type of individual involved or, in the 
    case of an individual residing outside the New York metropolitan 
    area, under an arrangement under section 3313.
``SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS FOR WTC-RELATED 
HEALTH CONDITIONS.
    ``(a) WTC-Related Health Condition Defined.--
        ``(1) In general.--For purposes of this title, the term `WTC-
    related health condition' means a condition that--
            ``(A)(i) is an illness or health condition for which 
        exposure to airborne toxins, any other hazard, or any other 
        adverse condition resulting from the September 11, 2001, 
        terrorist attacks, based on an examination by a medical 
        professional with experience in treating or diagnosing the 
        health conditions included in the applicable list of WTC-
        related health conditions, is substantially likely to be a 
        significant factor in aggravating, contributing to, or causing 
        the illness or health condition, as determined under paragraph 
        (2); or
            ``(ii) is a mental health condition for which such attacks, 
        based on an examination by a medical professional with 
        experience in treating or diagnosing the health conditions 
        included in the applicable list of WTC-related health 
        conditions, is substantially likely to be a significant factor 
        in aggravating, contributing to, or causing the condition, as 
        determined under paragraph (2); and
            ``(B) is included in the applicable list of WTC-related 
        health conditions or--
                ``(i) with respect to a WTC responder, is provided 
            certification of coverage under subsection (b)(2)(B)(iii); 
            or
                ``(ii) with respect to a screening-eligible WTC 
            survivor or certified-eligible WTC survivor, is provided 
            certification of coverage under subsection (b)(2)(B)(iii), 
            as applied under section 3322(a).
    In the case of a WTC responder described in section 
    3311(a)(2)(A)(ii) (relating to a surviving immediate family member 
    of a firefighter), such term does not include an illness or health 
    condition described in subparagraph (A)(i).
        ``(2) Determination.--The determination under paragraph (1) or 
    subsection (b) of whether the September 11, 2001, terrorist attacks 
    were substantially likely to be a significant factor in 
    aggravating, contributing to, or causing an individual's illness or 
    health condition shall be made based on an assessment of the 
    following:
            ``(A) The individual's exposure to airborne toxins, any 
        other hazard, or any other adverse condition resulting from the 
        terrorist attacks. Such exposure shall be--
                ``(i) evaluated and characterized through the use of a 
            standardized, population-appropriate questionnaire approved 
            by the Director of the National Institute for Occupational 
            Safety and Health; and
                ``(ii) assessed and documented by a medical 
            professional with experience in treating or diagnosing 
            health conditions included on the list of WTC-related 
            health conditions.
            ``(B) The type of symptoms and temporal sequence of 
        symptoms. Such symptoms shall be--
                ``(i) assessed through the use of a standardized, 
            population-appropriate medical questionnaire approved by 
            the Director of the National Institute for Occupational 
            Safety and Health and a medical examination; and
                ``(ii) diagnosed and documented by a medical 
            professional described in subparagraph (A)(ii).
        ``(3) List of health conditions for wtc responders.--The list 
    of health conditions for WTC responders consists of the following:
            ``(A) Aerodigestive disorders.--
                ``(i) Interstitial lung diseases.
                ``(ii) Chronic respiratory disorder--fumes/vapors.
                ``(iii) Asthma.
                ``(iv) Reactive airways dysfunction syndrome (RADS).
                ``(v) WTC-exacerbated chronic obstructive pulmonary 
            disease (COPD).
                ``(vi) Chronic cough syndrome.
                ``(vii) Upper airway hyperreactivity.
                ``(viii) Chronic rhinosinusitis.
                ``(ix) Chronic nasopharyngitis.
                ``(x) Chronic laryngitis.
                ``(xi) Gastroesophageal reflux disorder (GERD).
                ``(xii) Sleep apnea exacerbated by or related to a 
            condition described in a previous clause.
            ``(B) Mental health conditions.--
                ``(i) Posttraumatic stress disorder (PTSD).
                ``(ii) Major depressive disorder.
                ``(iii) Panic disorder.
                ``(iv) Generalized anxiety disorder.
                ``(v) Anxiety disorder (not otherwise specified).
                ``(vi) Depression (not otherwise specified).
                ``(vii) Acute stress disorder.
                ``(viii) Dysthymic disorder.
                ``(ix) Adjustment disorder.
                ``(x) Substance abuse.
            ``(C) Musculoskeletal disorders for certain wtc 
        responders.--In the case of a WTC responder described in 
        paragraph (4), a condition described in such paragraph.
            ``(D) Additional conditions.--Any cancer (or type of 
        cancer) or other condition added, pursuant to paragraph (5) or 
        (6), to the list under this paragraph.
        ``(4) Musculoskeletal disorders.--
            ``(A) In general.--For purposes of this title, in the case 
        of a WTC responder who received any treatment for a WTC-related 
        musculoskeletal disorder on or before September 11, 2003, the 
        list of health conditions in paragraph (3) shall include:
                ``(i) Low back pain.
                ``(ii) Carpal tunnel syndrome (CTS).
                ``(iii) Other musculoskeletal disorders.
            ``(B) Definition.--The term `WTC-related musculoskeletal 
        disorder' means a chronic or recurrent disorder of the 
        musculoskeletal system caused by heavy lifting or repetitive 
        strain on the joints or musculoskeletal system occurring during 
        rescue or recovery efforts in the New York City disaster area 
        in the aftermath of the September 11, 2001, terrorist attacks.
        ``(5) Cancer.--
            ``(A) In general.--The WTC Program Administrator shall 
        periodically conduct a review of all available scientific and 
        medical evidence, including findings and recommendations of 
        Clinical Centers of Excellence, published in peer-reviewed 
        journals to determine if, based on such evidence, cancer or a 
        certain type of cancer should be added to the applicable list 
        of WTC-related health conditions. The WTC Program Administrator 
        shall conduct the first review under this subparagraph not 
        later than 180 days after the date of the enactment of this 
        title.
            ``(B) Proposed regulations and rulemaking.--Based on the 
        periodic reviews under subparagraph (A), if the WTC Program 
        Administrator determines that cancer or a certain type of 
        cancer should be added to such list of WTC-related health 
        conditions, the WTC Program Administrator shall propose 
        regulations, through rulemaking, to add cancer or the certain 
        type of cancer to such list.
            ``(C) Final regulations.--Based on all the available 
        evidence in the rulemaking record, the WTC Program 
        Administrator shall make a final determination of whether 
        cancer or a certain type of cancer should be added to such list 
        of WTC-related health conditions. If such a determination is 
        made to make such an addition, the WTC Program Administrator 
        shall by regulation add cancer or the certain type of cancer to 
        such list.
            ``(D) Determinations not to add cancer or certain types of 
        cancer.--In the case that the WTC Program Administrator 
        determines under subparagraph (B) or (C) that cancer or a 
        certain type of cancer should not be added to such list of WTC-
        related health conditions, the WTC Program Administrator shall 
        publish an explanation for such determination in the Federal 
        Register. Any such determination to not make such an addition 
        shall not preclude the addition of cancer or the certain type 
        of cancer to such list at a later date.
        ``(6) Addition of health conditions to list for wtc 
    responders.--
            ``(A) In general.--Whenever the WTC Program Administrator 
        determines that a proposed rule should be promulgated to add a 
        health condition to the list of health conditions in paragraph 
        (3), the Administrator may request a recommendation of the 
        Advisory Committee or may publish such a proposed rule in the 
        Federal Register in accordance with subparagraph (D).
            ``(B) Administrator's options after receipt of petition.--
        In the case that the WTC Program Administrator receives a 
        written petition by an interested party to add a health 
        condition to the list of health conditions in paragraph (3), 
        not later than 60 days after the date of receipt of such 
        petition the Administrator shall--
                ``(i) request a recommendation of the Advisory 
            Committee;
                ``(ii) publish a proposed rule in the Federal Register 
            to add such health condition, in accordance with 
            subparagraph (D);
                ``(iii) publish in the Federal Register the 
            Administrator's determination not to publish such a 
            proposed rule and the basis for such determination; or
                ``(iv) publish in the Federal Register a determination 
            that insufficient evidence exists to take action under 
            clauses (i) through (iii).
            ``(C) Action by advisory committee.--In the case that the 
        Administrator requests a recommendation of the Advisory 
        Committee under this paragraph, with respect to adding a health 
        condition to the list in paragraph (3), the Advisory Committee 
        shall submit to the Administrator such recommendation not later 
        than 60 days after the date of such request or by such date 
        (not to exceed 180 days after such date of request) as 
        specified by the Administrator. Not later than 60 days after 
        the date of receipt of such recommendation, the Administrator 
        shall, in accordance with subparagraph (D), publish in the 
        Federal Register a proposed rule with respect to such 
        recommendation or a determination not to propose such a 
        proposed rule and the basis for such determination.
            ``(D) Publication.--The WTC Program Administrator shall, 
        with respect to any proposed rule under this paragraph--
                ``(i) publish such proposed rule in accordance with 
            section 553 of title 5, United States Code; and
                ``(ii) provide interested parties a period of 30 days 
            after such publication to submit written comments on the 
            proposed rule.
        The WTC Program Administrator may extend the period described 
        in clause (ii) upon a finding of good cause. In the case of 
        such an extension, the Administrator shall publish such 
        extension in the Federal Register.
            ``(E) Interested party defined.--For purposes of this 
        paragraph, the term `interested party' includes a 
        representative of any organization representing WTC responders, 
        a nationally recognized medical association, a Clinical or Data 
        Center, a State or political subdivision, or any other 
        interested person.
    ``(b) Coverage of Treatment for WTC-Related Health Conditions.--
        ``(1) Determination for enrolled wtc responders based on a wtc-
    related health condition.--
            ``(A) In general.--If a physician at a Clinical Center of 
        Excellence that is providing monitoring benefits under section 
        3311 for an enrolled WTC responder makes a determination that 
        the responder has a WTC-related health condition that is in the 
        list in subsection (a)(3) and that exposure to airborne toxins, 
        other hazards, or adverse conditions resulting from the 
        September 1, 2001, terrorist attacks is substantially likely to 
        be a significant factor in aggravating, contributing to, or 
        causing the condition--
                ``(i) the physician shall promptly transmit such 
            determination to the WTC Program Administrator and provide 
            the Administrator with the medical facts supporting such 
            determination; and
                ``(ii) on and after the date of such transmittal and 
            subject to subparagraph (B), the WTC Program shall provide 
            for payment under subsection (c) for medically necessary 
            treatment for such condition.
            ``(B) Review; certification; appeals.--
                ``(i) Review.--A Federal employee designated by the WTC 
            Program Administrator shall review determinations made 
            under subparagraph (A).
                ``(ii) Certification.--The Administrator shall provide 
            a certification of such condition based upon reviews 
            conducted under clause (i). Such a certification shall be 
            provided unless the Administrator determines that the 
            responder's condition is not a WTC-related health condition 
            in the list in subsection (a)(3) or that exposure to 
            airborne toxins, other hazards, or adverse conditions 
            resulting from the September 1, 2001, terrorist attacks is 
            not substantially likely to be a significant factor in 
            aggravating, contributing to, or causing the condition.
                ``(iii) Appeal process.--The Administrator shall 
            establish, by rule, a process for the appeal of 
            determinations under clause (ii).
        ``(2) Determination based on medically associated wtc-related 
    health conditions.--
            ``(A) In general.--If a physician at a Clinical Center of 
        Excellence determines pursuant to subsection (a) that the 
        enrolled WTC responder has a health condition described in 
        subsection (a)(1)(A) that is not in the list in subsection 
        (a)(3) but which is medically associated with a WTC-related 
        health condition--
                ``(i) the physician shall promptly transmit such 
            determination to the WTC Program Administrator and provide 
            the Administrator with the facts supporting such 
            determination; and
                ``(ii) the Administrator shall make a determination 
            under subparagraph (B) with respect to such physician's 
            determination.
            ``(B) Procedures for review, certification, and appeal.--
        The WTC Program Administrator shall, by rule, establish 
        procedures for the review and certification of physician 
        determinations under subparagraph (A). Such rule shall provide 
        for--
                ``(i) the timely review of such a determination by a 
            physician panel with appropriate expertise for the 
            condition and recommendations to the WTC Program 
            Administrator;
                ``(ii) not later than 60 days after the date of the 
            transmittal under subparagraph (A)(i), a determination by 
            the WTC Program Administrator on whether or not the 
            condition involved is described in subsection (a)(1)(A) and 
            is medically associated with a WTC-related health 
            condition;
                ``(iii) certification in accordance with paragraph 
            (1)(B)(ii) of coverage of such condition if determined to 
            be described in subsection (a)(1)(A) and medically 
            associated with a WTC-related health condition; and
                ``(iv) a process for appeals of determinations relating 
            to such conditions.
            ``(C) Inclusion in list of health conditions.--If the WTC 
        Program Administrator provides certification under subparagraph 
        (B)(iii) for coverage of a condition, the Administrator may, 
        pursuant to subsection (a)(6), add the condition to the list in 
        subsection (a)(3).
            ``(D) Conditions already declined for inclusion in list.--
        If the WTC Program Administrator publishes a determination 
        under subsection (a)(6)(B) not to include a condition in the 
        list in subsection (a)(3), the WTC Program Administrator shall 
        not provide certification under subparagraph (B)(iii) for 
        coverage of the condition. In the case of an individual who is 
        certified under subparagraph (B)(iii) with respect to such 
        condition before the date of the publication of such 
        determination the previous sentence shall not apply.
        ``(3) Requirement of medical necessity.--
            ``(A) In general.--In providing treatment for a WTC-related 
        health condition, a physician or other provider shall provide 
        treatment that is medically necessary and in accordance with 
        medical treatment protocols established under subsection (d).
            ``(B) Regulations relating to medical necessity.--For the 
        purpose of this title, the WTC Program Administrator shall 
        issue regulations specifying a standard for determining medical 
        necessity with respect to health care services and prescription 
        pharmaceuticals, a process for determining whether treatment 
        furnished and pharmaceuticals prescribed under this title meet 
        such standard (including any prior authorization requirement), 
        and a process for appeal of a determination under subsection 
        (c)(3).
        ``(4) Scope of treatment covered.--
            ``(A) In general.--The scope of treatment covered under 
        this subsection includes services of physicians and other 
        health care providers, diagnostic and laboratory tests, 
        prescription drugs, inpatient and outpatient hospital services, 
        and other medically necessary treatment.
            ``(B) Pharmaceutical coverage.--With respect to ensuring 
        coverage of medically necessary outpatient prescription drugs, 
        such drugs shall be provided, under arrangements made by the 
        WTC Program Administrator, directly through participating 
        Clinical Centers of Excellence or through one or more outside 
        vendors.
            ``(C) Transportation expenses for nationwide network.--The 
        WTC Program Administrator may provide for necessary and 
        reasonable transportation and expenses incident to the securing 
        of medically necessary treatment through the nationwide network 
        under section 3313 involving travel of more than 250 miles and 
        for which payment is made under this section in the same manner 
        in which individuals may be furnished necessary and reasonable 
        transportation and expenses incident to services involving 
        travel of more than 250 miles under regulations implementing 
        section 3629(c) of the Energy Employees Occupational Illness 
        Compensation Program Act of 2000 (title XXXVI of Public Law 
        106-398; 42 U.S.C. 7384t(c)).
        ``(5) Provision of treatment pending certification.--With 
    respect to an enrolled WTC responder for whom a determination is 
    made by an examining physician under paragraph (1) or (2), but for 
    whom the WTC Program Administrator has not yet determined whether 
    to certify the determination, the WTC Program Administrator may 
    establish by rule a process through which the Administrator may 
    approve the provision of medical treatment under this subsection 
    (and payment under subsection (c)) with respect to such responder 
    and such responder's WTC-related health condition (under such terms 
    and conditions as the Administrator may provide) until the 
    Administrator makes a decision on whether to certify the 
    determination.
    ``(c) Payment for Initial Health Evaluation, Monitoring, and 
Treatment of WTC-Related Health Conditions.--
        ``(1) Medical treatment.--
            ``(A) Use of feca payment rates.--
                ``(i) In general.--Subject to clause (ii):

                    ``(I) Subject to subparagraphs (B) and (C), the WTC 
                Program Administrator shall reimburse costs for 
                medically necessary treatment under this title for WTC-
                related health conditions according to the payment 
                rates that would apply to the provision of such 
                treatment and services by the facility under the 
                Federal Employees Compensation Act.
                    ``(II) For treatment not covered under subclause 
                (i) or subparagraph (B), the WTC Program Administrator 
                shall establish by regulation a reimbursement rate for 
                such treatment.

                ``(ii) Exception.--In no case shall payments for 
            products or services under clause (i) be made at a rate 
            higher than the Office of Worker's Compensation Programs in 
            the Department Labor would pay for such products or 
            services rendered at the time such products or services 
            were provided.
            ``(B) Pharmaceuticals.--
                ``(i) In general.--The WTC Program Administrator shall 
            establish a program for paying for the medically necessary 
            outpatient prescription pharmaceuticals prescribed under 
            this title for WTC-related health conditions through one or 
            more contracts with outside vendors.
                ``(ii) Competitive bidding.--Under such program the 
            Administrator shall--

                    ``(I) select one or more appropriate vendors 
                through a Federal competitive bid process; and
                    ``(II) select the lowest bidder (or bidders) 
                meeting the requirements for providing pharmaceutical 
                benefits for participants in the WTC Program.

                ``(iii) Treatment of fdny participants.--Under such 
            program the Administrator may enter into an agreement with 
            a separate vendor to provide pharmaceutical benefits to 
            enrolled WTC responders for whom the Clinical Center of 
            Excellence is described in section 3305 if such an 
            arrangement is deemed necessary and beneficial to the 
            program by the WTC Program Administrator.
                ``(iv) Pharmaceuticals.--Not later than July 1, 2011, 
            the Comptroller General of the United States shall submit 
            to the Committee on Energy and Commerce of the House of 
            Representatives and the Committee on Health, Education, 
            Labor, and Pensions of the Senate a report on whether 
            existing Federal pharmaceutical purchasing programs can 
            provide pharmaceutical benefits more efficiently and 
            effectively than through the WTC program.
            ``(C) Improving quality and efficiency through modification 
        of payment amounts and methodologies.--The WTC Program 
        Administrator may modify the amounts and methodologies for 
        making payments for initial health evaluations, monitoring, or 
        treatment, if, taking into account utilization and quality data 
        furnished by the Clinical Centers of Excellence under section 
        3305(b)(1)(B)(iii), the Administrator determines that a 
        bundling, capitation, pay for performance, or other payment 
        methodology would better ensure high quality and efficient 
        delivery of initial health evaluations, monitoring, or 
        treatment to an enrolled WTC responder, screening-eligible WTC 
        survivor, or certified-eligible WTC survivor.
        ``(2) Monitoring and initial health evaluation.--The WTC 
    Program Administrator shall reimburse the costs of monitoring and 
    the costs of an initial health evaluation provided under this title 
    at a rate set by the Administrator by regulation.
        ``(3) Determination of medical necessity.--
            ``(A) Review of medical necessity and protocols.--As part 
        of the process for reimbursement or payment under this 
        subsection, the WTC Program Administrator shall provide for the 
        review of claims for reimbursement or payment for the provision 
        of medical treatment to determine if such treatment is 
        medically necessary and in accordance with medical treatment 
        protocols established under subsection (d).
            ``(B) Withholding of payment for medically unnecessary 
        treatment.--The Administrator shall withhold such reimbursement 
        or payment for treatment that the Administrator determines is 
        not medically necessary or is not in accordance with such 
        medical treatment protocols.
    ``(d) Medical Treatment Protocols.--
        ``(1) Development.--The Data Centers shall develop medical 
    treatment protocols for the treatment of enrolled WTC responders 
    and certified-eligible WTC survivors for health conditions included 
    in the applicable list of WTC-related health conditions.
        ``(2) Approval.--The medical treatment protocols developed 
    under paragraph (1) shall be subject to approval by the WTC Program 
    Administrator.
``SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS 
OUTSIDE NEW YORK.
    ``(a) In General.--In order to ensure reasonable access to benefits 
under this subtitle for individuals who are enrolled WTC responders, 
screening-eligible WTC survivors, or certified-eligible WTC survivors 
and who reside in any State, as defined in section 2(f), outside the 
New York metropolitan area, the WTC Program Administrator shall 
establish a nationwide network of health care providers to provide 
monitoring and treatment benefits and initial health evaluations near 
such individuals' areas of residence in such States. Nothing in this 
subsection shall be construed as preventing such individuals from being 
provided such monitoring and treatment benefits or initial health 
evaluation through any Clinical Center of Excellence.
    ``(b) Network Requirements.--Any health care provider participating 
in the network under subsection (a) shall--
        ``(1) meet criteria for credentialing established by the Data 
    Centers;
        ``(2) follow the monitoring, initial health evaluation, and 
    treatment protocols developed under section 3305(a)(2)(A)(ii);
        ``(3) collect and report data in accordance with section 3304; 
    and
        ``(4) meet such fraud, quality assurance, and other 
    requirements as the WTC Program Administrator establishes, 
    including sections 1128 through 1128E of the Social Security Act, 
    as applied by section 3301(d).
    ``(c) Training and Technical Assistance.--The WTC Program 
Administer may provide, including through contract, for the provision 
of training and technical assistance to health care providers 
participating in the network under subsection (a).
    ``(d) Provision of Services Through the VA.--
        ``(1) In general.--The WTC Program Administrator may enter into 
    an agreement with the Secretary of Veterans Affairs for the 
    Secretary to provide services under this section through facilities 
    of the Department of Veterans Affairs.
        ``(2) National program.--Not later than July 1, 2011, the 
    Comptroller General of the United States shall submit to the 
    Committee on Energy and Commerce of the House of Representatives 
    and the Committee on Health, Education, Labor, and Pensions of the 
    Senate a report on whether the Department of Veterans Affairs can 
    provide monitoring and treatment services to individuals under this 
    section more efficiently and effectively than through the 
    nationwide network to be established under subsection (a).

                        ``PART 2--WTC SURVIVORS

``SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF SCREENING-
ELIGIBLE AND CERTIFIED-ELIGIBLE WTC SURVIVORS.
    ``(a) Identification of Screening-Eligible WTC Survivors and 
Certified-Eligible WTC Survivors.--
        ``(1) Screening-eligible wtc survivors.--
            ``(A) Definition.--In this title, the term `screening-
        eligible WTC survivor' means, subject to subparagraph (C) and 
        paragraph (3), an individual who is described in any of the 
        following clauses:
                ``(i) Currently identified survivor.--An individual, 
            including a WTC responder, who has been identified as 
            eligible for medical treatment and monitoring by the WTC 
            Environmental Health Center as of the date of enactment of 
            this title.
                ``(ii) Survivor who meets current eligibility 
            criteria.--An individual who is not a WTC responder, for 
            purposes of the initial health evaluation under subsection 
            (b), claims symptoms of a WTC-related health condition and 
            meets any of the current eligibility criteria described in 
            subparagraph (B).
                ``(iii) Survivor who meets modified eligibility 
            criteria.--An individual who is not a WTC responder, for 
            purposes of the initial health evaluation under subsection 
            (b), claims symptoms of a WTC-related health condition and 
            meets such eligibility criteria relating to exposure to 
            airborne toxins, other hazards, or adverse conditions 
            resulting from the September 11, 2001, terrorist attacks as 
            the WTC Administrator determines, after consultation with 
            the Data Centers described in section 3305 and the WTC 
            Scientific/Technical Advisory Committee and WTC Health 
            Program Steering Committees under section 3302.
        The Administrator shall not modify such criteria under clause 
        (iii) on or after the date that the number of certifications 
        for certified-eligible WTC survivors under paragraph (2)(B) has 
        reached 80 percent of the limit described in paragraph (3) or 
        on or after the date that the number of enrollments of WTC 
        responders has reached 80 percent of the limit described in 
        section 3311(a)(4).
            ``(B) Current eligibility criteria.--The eligibility 
        criteria described in this subparagraph for an individual are 
        that the individual is described in any of the following 
        clauses:
                ``(i) A person who was present in the New York City 
            disaster area in the dust or dust cloud on September 11, 
            2001.
                ``(ii) A person who worked, resided, or attended 
            school, childcare, or adult daycare in the New York City 
            disaster area for--

                    ``(I) at least 4 days during the 4-month period 
                beginning on September 11, 2001, and ending on January 
                10, 2002; or
                    ``(II) at least 30 days during the period beginning 
                on September 11, 2001, and ending on July 31, 2002.

                ``(iii) Any person who worked as a cleanup worker or 
            performed maintenance work in the New York City disaster 
            area during the 4-month period described in subparagraph 
            (B)(i) and had extensive exposure to WTC dust as a result 
            of such work.
                ``(iv) A person who was deemed eligible to receive a 
            grant from the Lower Manhattan Development Corporation 
            Residential Grant Program, who possessed a lease for a 
            residence or purchased a residence in the New York City 
            disaster area, and who resided in such residence during the 
            period beginning on September 11, 2001, and ending on May 
            31, 2003.
                ``(v) A person whose place of employment--

                    ``(I) at any time during the period beginning on 
                September 11, 2001, and ending on May 31, 2003, was in 
                the New York City disaster area; and
                    ``(II) was deemed eligible to receive a grant from 
                the Lower Manhattan Development Corporation WTC Small 
                Firms Attraction and Retention Act program or other 
                government incentive program designed to revitalize the 
                lower Manhattan economy after the September 11, 2001, 
                terrorist attacks.

            ``(C) Application and determination process for screening 
        eligibility.--
                ``(i) In general.--The WTC Program Administrator in 
            consultation with the Data Centers shall establish a 
            process for individuals, other than individuals described 
            in subparagraph (A)(i), to be determined to be screening-
            eligible WTC survivors. Under such process--

                    ``(I) there shall be no fee charged to the 
                applicant for making an application for such 
                determination;
                    ``(II) the Administrator shall make a determination 
                on such an application not later than 60 days after the 
                date of filing the application;
                    ``(III) the Administrator shall make such a 
                determination relating to an applicant's compliance 
                with this title and shall not determine that an 
                individual is not so eligible or deny written 
                documentation under clause (ii) to such individual 
                unless the Administrator determines that--

                        ``(aa) based on the application submitted, the 
                    individual does not meet the eligibility criteria; 
                    or
                        ``(bb) the numerical limitation on 
                    certifications of certified-eligible WTC survivors 
                    set forth in paragraph (3) has been met; and

                    ``(IV) an individual who is determined not to be a 
                screening-eligible WTC survivor shall have an 
                opportunity to appeal such determination in a manner 
                established under such process.

                ``(ii) Written documentation of screening-
            eligibility.--

                    ``(I) In general.--In the case of an individual who 
                is described in subparagraph (A)(i) or who is 
                determined under clause (i) (consistent with paragraph 
                (3)) to be a screening-eligible WTC survivor, the WTC 
                Program Administrator shall provide an appropriate 
                written documentation of such fact.
                    ``(II) Timing.--

                        ``(aa) Currently identified survivors.--In the 
                    case of an individual who is described in 
                    subparagraph (A)(i), the WTC Program Administrator 
                    shall provide the written documentation under 
                    subclause (I) not later than July 1, 2011.
                        ``(bb) Other members.--In the case of another 
                    individual who is determined under clause (i) and 
                    consistent with paragraph (3) to be a screening-
                    eligible WTC survivor, the WTC Program 
                    Administrator shall provide the written 
                    documentation under subclause (I) at the time of 
                    such determination.
        ``(2) Certified-eligible wtc survivors.--
            ``(A) Definition.--The term `certified-eligible WTC 
        survivor' means, subject to paragraph (3), a screening-eligible 
        WTC survivor who the WTC Program Administrator certifies under 
        subparagraph (B) to be eligible for followup monitoring and 
        treatment under this part.
            ``(B) Certification of eligibility for monitoring and 
        treatment.--
                ``(i) In general.--The WTC Program Administrator shall 
            establish a certification process under which the 
            Administrator shall provide appropriate certification to 
            screening-eligible WTC survivors who, pursuant to the 
            initial health evaluation under subsection (b), are 
            determined to be eligible for followup monitoring and 
            treatment under this part.
                ``(ii) Timing.--

                    ``(I) Currently identified survivors.--In the case 
                of an individual who is described in paragraph 
                (1)(A)(i), the WTC Program Administrator shall provide 
                the certification under clause (i) not later than July 
                1, 2011.
                    ``(II) Other members.--In the case of another 
                individual who is determined under clause (i) to be 
                eligible for followup monitoring and treatment, the WTC 
                Program Administrator shall provide the certification 
                under such clause at the time of such determination.

        ``(3) Numerical limitation on certified-eligible wtc 
    survivors.--
            ``(A) In general.--The total number of individuals not 
        described in paragraph (1)(A)(i) who may be certified as 
        certified-eligible WTC survivors under paragraph (2)(B) shall 
        not exceed 25,000 at any time.
            ``(B) Process.--In implementing subparagraph (A), the WTC 
        Program Administrator shall--
                ``(i) limit the number of certifications provided under 
            paragraph (2)(B)--

                    ``(I) in accordance with such subparagraph; and
                    ``(II) to such number, as determined by the 
                Administrator based on the best available information 
                and subject to amounts made available under section 
                3351, that will ensure sufficient funds will be 
                available to provide treatment and monitoring benefits 
                under this title, with respect to all individuals 
                receiving such certifications through the end of fiscal 
                year 2020; and

                ``(ii) provide priority in such certifications in the 
            order in which individuals apply for a determination under 
            paragraph (2)(B).
        ``(4) Disqualification of individuals on terrorist watch 
    list.--No individual who is on the terrorist watch list maintained 
    by the Department of Homeland Security shall qualify as a 
    screening-eligible WTC survivor or a certified-eligible WTC 
    survivor. Before determining any individual to be a screening-
    eligible WTC survivor under paragraph (1) or certifying any 
    individual as a certified eligible WTC survivor under paragraph 
    (2), the Administrator, in consultation with the Secretary of 
    Homeland Security, shall determine whether the individual is on 
    such list.
    ``(b) Initial Health Evaluation To Determine Eligibility for 
Followup Monitoring or Treatment.--
        ``(1) In general.--In the case of a screening-eligible WTC 
    survivor, the WTC Program shall provide for an initial health 
    evaluation to determine if the survivor has a WTC-related health 
    condition and is eligible for followup monitoring and treatment 
    benefits under the WTC Program. Initial health evaluation protocols 
    under section 3305(a)(2)(A)(ii) shall be subject to approval by the 
    WTC Program Administrator.
        ``(2) Initial health evaluation providers.--The initial health 
    evaluation described in paragraph (1) shall be provided through a 
    Clinical Center of Excellence with respect to the individual 
    involved.
        ``(3) Limitation on initial health evaluation benefits.--
    Benefits for an initial health evaluation under this part for a 
    screening-eligible WTC survivor shall consist only of a single 
    medical initial health evaluation consistent with initial health 
    evaluation protocols described in paragraph (1). Nothing in this 
    paragraph shall be construed as preventing such an individual from 
    seeking additional medical initial health evaluations at the 
    expense of the individual.
``SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED-ELIGIBLE 
WTC SURVIVORS FOR WTC-RELATED HEALTH CONDITIONS.
    ``(a) In General.--Subject to subsection (b), the provisions of 
sections 3311 and 3312 shall apply to followup monitoring and treatment 
of WTC-related health conditions for certified-eligible WTC survivors 
in the same manner as such provisions apply to the monitoring and 
treatment of WTC-related health conditions for enrolled WTC responders.
    ``(b) List of WTC-Related Health Conditions for Survivors.--The 
list of health conditions for screening-eligible WTC survivors and 
certified-eligible WTC survivors consists of the following:
        ``(1) Aerodigestive disorders.--
            ``(A) Interstitial lung diseases.
            ``(B) Chronic respiratory disorder--fumes/vapors.
            ``(C) Asthma.
            ``(D) Reactive airways dysfunction syndrome (RADS).
            ``(E) WTC-exacerbated chronic obstructive pulmonary disease 
        (COPD).
            ``(F) Chronic cough syndrome.
            ``(G) Upper airway hyperreactivity.
            ``(H) Chronic rhinosinusitis.
            ``(I) Chronic nasopharyngitis.
            ``(J) Chronic laryngitis.
            ``(K) Gastroesophageal reflux disorder (GERD).
            ``(L) Sleep apnea exacerbated by or related to a condition 
        described in a previous clause.
        ``(2) Mental health conditions.--
            ``(A) Posttraumatic stress disorder (PTSD).
            ``(B) Major depressive disorder.
            ``(C) Panic disorder.
            ``(D) Generalized anxiety disorder.
            ``(E) Anxiety disorder (not otherwise specified).
            ``(F) Depression (not otherwise specified).
            ``(G) Acute stress disorder.
            ``(H) Dysthymic disorder.
            ``(I) Adjustment disorder.
            ``(J) Substance abuse.
        ``(3) Additional conditions.--Any cancer (or type of cancer) or 
    other condition added to the list in section 3312(a)(3) pursuant to 
    paragraph (5) or (6) of section 3312(a), as such provisions are 
    applied under subsection (a) with respect to certified-eligible WTC 
    survivors.
``SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS 
WITH WTC-RELATED HEALTH CONDITIONS.
    ``(a) In General.--Subject to subsection (c), the provisions of 
section 3322 shall apply to the followup monitoring and treatment of 
WTC-related health conditions in the case of individuals described in 
subsection (b) in the same manner as such provisions apply to the 
followup monitoring and treatment of WTC-related health conditions for 
certified-eligible WTC survivors.
    ``(b) Individuals Described.--An individual described in this 
subsection is an individual who, regardless of location of residence--
        ``(1) is not an enrolled WTC responder or a certified-eligible 
    WTC survivor; and
        ``(2) is diagnosed at a Clinical Center of Excellence with a 
    WTC-related health condition for certified-eligible WTC survivors.
    ``(c) Limitation.--
        ``(1) In general.--The WTC Program Administrator shall limit 
    benefits for any fiscal year under subsection (a) in a manner so 
    that payments under this section for such fiscal year do not exceed 
    the amount specified in paragraph (2) for such fiscal year.
        ``(2) Limitation.--The amount specified in this paragraph for--
            ``(A) the last calendar quarter of fiscal year 2011 is 
        $5,000,000;
            ``(B) fiscal year 2012 is $20,000,000; or
            ``(C) a succeeding fiscal year is the amount specified in 
        this paragraph for the previous fiscal year increased by the 
        annual percentage increase in the medical care component of the 
        consumer price index for all urban consumers.

                       ``PART 3--PAYOR PROVISIONS

``SEC. 3331. PAYMENT OF CLAIMS.
    ``(a) In General.--Except as provided in subsections (b) and (c), 
the cost of monitoring and treatment benefits and initial health 
evaluation benefits provided under parts 1 and 2 of this subtitle shall 
be paid for by the WTC Program from the World Trade Center Health 
Program Fund.
    ``(b) Workers' Compensation Payment.--
        ``(1) In general.--Subject to paragraph (2), payment for 
    treatment under parts 1 and 2 of this subtitle of a WTC-related 
    health condition of an individual that is work-related shall be 
    reduced or recouped to the extent that the WTC Program 
    Administrator determines that payment has been made, or can 
    reasonably be expected to be made, under a workers' compensation 
    law or plan of the United States, a State, or a locality, or other 
    work-related injury or illness benefit plan of the employer of such 
    individual, for such treatment. The provisions of clauses (iii), 
    (iv), (v), and (vi) of paragraph (2)(B) of section 1862(b) of the 
    Social Security Act and paragraphs (3) and (4) of such section 
    shall apply to the recoupment under this subsection of a payment to 
    the WTC Program (with respect to a workers' compensation law or 
    plan, or other work-related injury or illness plan of the employer 
    involved, and such individual) in the same manner as such 
    provisions apply to the reimbursement of a payment under section 
    1862(b)(2) of such Act to the Secretary (with respect to such a law 
    or plan and an individual entitled to benefits under title XVIII of 
    such Act) except that any reference in such paragraph (4) to 
    payment rates under title XVIII of the Social Security Act shall be 
    deemed a reference to payment rates under this title.
        ``(2) Exception.--Paragraph (1) shall not apply for any 
    quarter, with respect to any workers' compensation law or plan, 
    including line of duty compensation, to which New York City is 
    obligated to make payments, if, in accordance with terms specified 
    under the contract under subsection (d)(1)(A), New York City has 
    made the full payment required under such contract for such 
    quarter.
        ``(3) Rules of construction.--Nothing in this title shall be 
    construed to affect, modify, or relieve any obligations under a 
    worker's compensation law or plan, other work-related injury or 
    illness benefit plan of an employer, or any health insurance plan.
    ``(c) Health Insurance Coverage.--
        ``(1) In general.--In the case of an individual who has a WTC-
    related health condition that is not work-related and has health 
    coverage for such condition through any public or private health 
    plan (including health benefits under title XVIII, XIX, or XXI of 
    the Social Security Act) the provisions of section 1862(b) of the 
    Social Security Act shall apply to such a health plan and such 
    individual in the same manner as they apply to group health plan 
    and an individual entitled to benefits under title XVIII of such 
    Act pursuant to section 226(a) of such Act. Any costs for items and 
    services covered under such plan that are not reimbursed by such 
    health plan, due to the application of deductibles, copayments, 
    coinsurance, other cost sharing, or otherwise, are reimbursable 
    under this title to the extent that they are covered under the WTC 
    Program. The program under this title shall not be treated as a 
    legally liable party for purposes of applying section 1902(a)(25) 
    of the Social Security Act.
        ``(2) Recovery by individual providers.--Nothing in paragraph 
    (1) shall be construed as requiring an entity providing monitoring 
    and treatment under this title to seek reimbursement under a health 
    plan with which the entity has no contract for reimbursement.
        ``(3) Maintenance of required minimum essential coverage.--No 
    payment may be made for monitoring and treatment under this title 
    for an individual for a month (beginning with July 2014) if with 
    respect to such month the individual--
            ``(A) is an applicable individual (as defined in subsection 
        (d) of section 5000A of Internal Revenue Code of 1986) for whom 
        the exemption under subsection (e) of such section does not 
        apply; and
            ``(B) is not covered under minimum essential coverage, as 
        required under subsection (a) of such section.
    ``(d) Required Contribution by New York City in Program Costs.--
        ``(1) Contract requirement.--
            ``(A) In general.--No funds may be disbursed from the World 
        Trade Center Health Program Fund under section 3351 unless New 
        York City has entered into a contract with the WTC Program 
        Administrator under which New York City agrees, in a form and 
        manner specified by the Administrator, to pay the full 
        contribution described in subparagraph (B) in accordance with 
        this subsection on a timely basis, plus any interest owed 
        pursuant to subparagraph (E)(i). Such contract shall specify 
        the terms under which New York City shall be considered to have 
        made the full payment required for a quarter for purposes of 
        subsection (b)(2).
            ``(B) Full contribution amount.--Under such contract, with 
        respect to the last calendar quarter of fiscal year 2011 and 
        each calendar quarter in fiscal years 2012 through 2015 the 
        full contribution amount under this subparagraph shall be equal 
        to 10 percent of the expenditures in carrying out this title 
        for the respective quarter and with respect to calendar 
        quarters in fiscal year 2016, such full contribution amount 
        shall be equal to \1/9\ of the Federal expenditures in carrying 
        out this title for the respective quarter.
            ``(C) Satisfaction of payment obligation.--The payment 
        obligation under such contract may not be satisfied through any 
        of the following:
                ``(i) An amount derived from Federal sources.
                ``(ii) An amount paid before the date of the enactment 
            of this title.
                ``(iii) An amount paid to satisfy a judgment or as part 
            of a settlement related to injuries or illnesses arising 
            out of the September 11, 2001, terrorist attacks.
            ``(D) Timing of contribution.--The payment obligation under 
        such contract for a calendar quarter in a fiscal year shall be 
        paid not later than the last day of the second succeeding 
        calendar quarter.
            ``(E) Compliance.--
                ``(i) Interest for late payment.--If New York City 
            fails to pay to the WTC Program Administrator pursuant to 
            such contract the amount required for any calendar quarter 
            by the day specified in subparagraph (D), interest shall 
            accrue on the amount not so paid at the rate (determined by 
            the Administrator) based on the average yield to maturity, 
            plus 1 percentage point, on outstanding municipal bonds 
            issued by New York City with a remaining maturity of at 
            least 1 year.
                ``(ii) Recovery of amounts owed.--The amounts owed to 
            the WTC Program Administrator under such contract shall be 
            recoverable by the United States in an action in the same 
            manner as payments made under title XVIII of the Social 
            Security Act may be recoverable in an action brought under 
            section 1862(b)(2)(B)(iii) of such Act.
            ``(F) Deposit in fund.--The WTC Program Administer shall 
        deposit amounts paid under such contract into the World Trade 
        Center Health Program Fund under section 3351.
        ``(2) Payment of new york city share of monitoring and 
    treatment costs.--With respect to each calendar quarter for which a 
    contribution is required by New York City under the contract under 
    paragraph (1), the WTC Program Administrator shall--
            ``(A) provide New York City with an estimate of such amount 
        of the required contribution at the beginning of such quarter 
        and with an updated estimate of such amount at the beginning of 
        each of the subsequent 2 quarters;
            ``(B) bill such amount directly to New York City; and
            ``(C) certify periodically, for purposes of this 
        subsection, whether or not New York City has paid the amount so 
        billed.
    Such amount shall initially be estimated by the WTC Program 
    Administrator and shall be subject to adjustment and reconciliation 
    based upon actual expenditures in carrying out this title.
        ``(3) Rule of construction.--Nothing in this subsection shall 
    be construed as authorizing the WTC Administrator, with respect to 
    a fiscal year, to reduce the numerical limitation under section 
    3311(a)(4) or 3321(a)(3) for such fiscal year if New York City 
    fails to comply with paragraph (1) for a calendar quarter in such 
    fiscal year.
    ``(e) Work-Related Described.--For the purposes of this section, a 
WTC-related health condition shall be treated as a condition that is 
work-related if--
        ``(1) the condition is diagnosed in an enrolled WTC responder, 
    or in an individual who qualifies as a certified-eligible WTC 
    survivor on the basis of being a rescue, recovery, or cleanup 
    worker; or
        ``(2) with respect to the condition the individual has filed 
    and had established a claim under a workers' compensation law or 
    plan of the United States or a State, or other work-related injury 
    or illness benefit plan of the employer of such individual.
``SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY.
    ``The WTC Program Administrator may enter into arrangements with 
other government agencies, insurance companies, or other third-party 
administrators to provide for timely and accurate processing of claims 
under sections 3312, 3313, 3322, and 3323.

                 ``Subtitle C--Research Into Conditions

``SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO 
SEPTEMBER 11 TERRORIST ATTACKS.
    ``(a) In General.--With respect to individuals, including enrolled 
WTC responders and certified-eligible WTC survivors, receiving 
monitoring or treatment under subtitle B, the WTC Program Administrator 
shall conduct or support--
        ``(1) research on physical and mental health conditions that 
    may be related to the September 11, 2001, terrorist attacks;
        ``(2) research on diagnosing WTC-related health conditions of 
    such individuals, in the case of conditions for which there has 
    been diagnostic uncertainty; and
        ``(3) research on treating WTC-related health conditions of 
    such individuals, in the case of conditions for which there has 
    been treatment uncertainty.
The Administrator may provide such support through continuation and 
expansion of research that was initiated before the date of the 
enactment of this title and through the World Trade Center Health 
Registry (referred to in section 3342), through a Clinical Center of 
Excellence, or through a Data Center.
    ``(b) Types of Research.--The research under subsection (a)(1) 
shall include epidemiologic and other research studies on WTC-related 
health conditions or emerging conditions--
        ``(1) among enrolled WTC responders and certified-eligible WTC 
    survivors under treatment; and
        ``(2) in sampled populations outside the New York City disaster 
    area in Manhattan as far north as 14th Street and in Brooklyn, 
    along with control populations, to identify potential for long-term 
    adverse health effects in less exposed populations.
    ``(c) Consultation.--The WTC Program Administrator shall carry out 
this section in consultation with the WTC Scientific/Technical Advisory 
Committee.
    ``(d) Application of Privacy and Human Subject Protections.--The 
privacy and human subject protections applicable to research conducted 
under this section shall not be less than such protections applicable 
to research conducted or funded by the Department of Health and Human 
Services.
``SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY.
    ``For the purpose of ensuring ongoing data collection relating to 
victims of the September 11, 2001, terrorist attacks, the WTC Program 
Administrator shall ensure that a registry of such victims is 
maintained that is at least as comprehensive as the World Trade Center 
Health Registry maintained under the arrangements in effect as of April 
20, 2009, with the New York City Department of Health and Mental 
Hygiene.

                         ``Subtitle D--Funding

``SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM FUND.
    ``(a) Establishment of Fund.--
        ``(1) In general.--There is established a fund to be known as 
    the World Trade Center Health Program Fund (referred to in this 
    section as the `Fund').
        ``(2) Funding.--Out of any money in the Treasury not otherwise 
    appropriated, there shall be deposited into the Fund for each of 
    fiscal years 2012 through 2016 (and the last calendar quarter of 
    fiscal year 2011)--
            ``(A) the Federal share, consisting of an amount equal to 
        the lesser of--
                ``(i) 90 percent of the expenditures in carrying out 
            this title for the respective fiscal year (initially based 
            on estimates, subject to subsequent reconciliation based on 
            actual expenditures); or
                ``(ii)(I) $71,000,000 for the last calendar quarter of 
            fiscal year 2011, $318,000,000 for fiscal year 2012, 
            $354,000,000 for fiscal year 2013, $382,000,000 for fiscal 
            year 2014, and $431,000,000 for fiscal year 2015; and
                ``(II) subject to paragraph (4), an additional amount 
            for fiscal year 2016 from unexpended amounts for previous 
            fiscal years; plus
            ``(B) the New York City share, consisting of the amount 
        contributed under the contract under section 3331(d).
        ``(3) Contract requirement.--
            ``(A) In general.--No funds may be disbursed from the Fund 
        unless New York City has entered into a contract with the WTC 
        Program Administrator under section 3331(d)(1).
            ``(B) Breach of contract.--In the case of a failure to pay 
        the amount so required under the contract--
                ``(i) the amount is recoverable under subparagraph 
            (E)(ii) of such section;
                ``(ii) such failure shall not affect the disbursement 
            of amounts from the Fund; and
                ``(iii) the Federal share described in paragraph (2)(A) 
            shall not be increased by the amount so unpaid.
        ``(4) Aggregate limitation on funding beginning with fiscal 
    year 2016.--Beginning with fiscal year 2016, in no case shall the 
    share of Federal funds deposited into the Fund under paragraph (2) 
    for such fiscal year and previous fiscal years and quarters exceed 
    the sum of the amounts specified in paragraph (2)(A)(ii)(I).
    ``(b) Mandatory Funds for Monitoring, Initial Health Evaluations, 
Treatment, and Claims Processing.--
        ``(1) In general.--The amounts deposited into the Fund under 
    subsection (a)(2) shall be available, without further 
    appropriation, consistent with paragraph (2) and subsection (c), to 
    carry out subtitle B and sections 3302(a), 3303, 3304, 3305(a)(2), 
    3305(c), 3341, and 3342.
        ``(2) Limitation on mandatory funding.--This title does not 
    establish any Federal obligation for payment of amounts in excess 
    of the amounts available from the Fund for such purpose.
        ``(3) Limitation on authorization for further appropriations.--
    This title does not establish any authorization for appropriation 
    of amounts in excess of the amounts available from the Fund under 
    paragraph (1).
    ``(c) Limits on Spending for Certain Purposes.--Of the amounts made 
available under subsection (b)(1), not more than each of the following 
amounts may be available for each of the following purposes:
        ``(1) Surviving immediate family members of firefighters.--For 
    the purposes of carrying out subtitle B with respect to WTC 
    responders described in section 3311(a)(2)(A)(ii)--
            ``(A) for the last calendar quarter of fiscal year 2011, 
        $100,000;
            ``(B) for fiscal year 2012, $400,000; and
            ``(C) for each subsequent fiscal year, the amount specified 
        under this paragraph for the previous fiscal year increased by 
        the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average) as 
        estimated by the Secretary for the 12-month period ending with 
        March of the previous year.
        ``(2) WTC health program scientific/technical advisory 
    committee.--For the purpose of carrying out section 3302(a)--
            ``(A) for the last calendar quarter of fiscal year 2011, 
        $25,000;
            ``(B) for fiscal year 2012, $100,000; and
            ``(C) for each subsequent fiscal year, the amount specified 
        under this paragraph for the previous fiscal year increased by 
        the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average) as 
        estimated by the Secretary for the 12-month period ending with 
        March of the previous year.
        ``(3) Education and outreach.--For the purpose of carrying out 
    section 3303--
            ``(A) for the last calendar quarter of fiscal year 2011, 
        $500,000;
            ``(B) for fiscal year 2012, $2,000,000; and
            ``(C) for each subsequent fiscal year, the amount specified 
        under this paragraph for the previous fiscal year increased by 
        the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average) as 
        estimated by the Secretary for the 12-month period ending with 
        March of the previous year.
        ``(4) Uniform data collection.--For the purpose of carrying out 
    section 3304 and for reimbursing Data Centers (as defined in 
    section 3305(b)(2)) for the costs incurred by such Centers in 
    carrying out activities under contracts entered into under section 
    3305(a)(2)--
            ``(A) for the last calendar quarter of fiscal year 2011, 
        $2,500,000;
            ``(B) for fiscal year 2012, $10,000,000; and
            ``(C) for each subsequent fiscal year, the amount specified 
        under this paragraph for the previous fiscal year increased by 
        the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average) as 
        estimated by the Secretary for the 12-month period ending with 
        March of the previous year.
        ``(5) Research regarding certain health conditions.--For the 
    purpose of carrying out section 3341--
            ``(A) for the last calendar quarter of fiscal year 2011, 
        $3,750,000;
            ``(B) for fiscal year 2012, $15,000,000; and
            ``(C) for each subsequent fiscal year, the amount specified 
        under this paragraph for the previous fiscal year increased by 
        the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average) as 
        estimated by the Secretary for the 12-month period ending with 
        March of the previous year.
        ``(6) World trade center health registry.--For the purpose of 
    carrying out section 3342--
            ``(A) for the last calendar quarter of fiscal year 2011, 
        $1,750,000;
            ``(B) for fiscal year 2012, $7,000,000; and
            ``(C) for each subsequent fiscal year, the amount specified 
        under this paragraph for the previous fiscal year increased by 
        the percentage increase in the consumer price index for all 
        urban consumers (all items; United States city average) as 
        estimated by the Secretary for the 12-month period ending with 
        March of the previous year.''.

       TITLE II--SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001

    SEC. 201. DEFINITIONS.
    Section 402 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
        (1) in paragraph (6) by inserting ``, or debris removal, 
    including under the World Trade Center Health Program established 
    under section 3001 of the Public Health Service Act, and payments 
    made pursuant to the settlement of a civil action described in 
    section 405(c)(3)(C)(iii)'' after ``September 11, 2001'';
        (2) by inserting after paragraph (6) the following new 
    paragraphs and redesignating subsequent paragraphs accordingly:
        ``(7) Contractor and subcontractor.--The term `contractor and 
    subcontractor' means any contractor or subcontractor (at any tier 
    of a subcontracting relationship), including any general 
    contractor, construction manager, prime contractor, consultant, or 
    any parent, subsidiary, associated or allied company, affiliated 
    company, corporation, firm, organization, or joint venture thereof 
    that participated in debris removal at any 9/11 crash site. Such 
    term shall not include any entity, including the Port Authority of 
    New York and New Jersey, with a property interest in the World 
    Trade Center, on September 11, 2001, whether fee simple, leasehold 
    or easement, direct or indirect.
        ``(8) Debris removal.--The term `debris removal' means rescue 
    and recovery efforts, removal of debris, cleanup, remediation, and 
    response during the immediate aftermath of the terrorist-related 
    aircraft crashes of September 11, 2001, with respect to a 9/11 
    crash site.'';
        (3) by inserting after paragraph (10), as so redesignated, the 
    following new paragraph and redesignating the subsequent paragraphs 
    accordingly:
        ``(11) Immediate aftermath.--The term `immediate aftermath' 
    means any period beginning with the terrorist-related aircraft 
    crashes of September 11, 2001, and ending on May 30, 2002.''; and
        (4) by adding at the end the following new paragraph:
        ``(14) 9/11 crash site.--The term `9/11 crash site' means--
            ``(A) the World Trade Center site, Pentagon site, and 
        Shanksville, Pennsylvania site;
            ``(B) the buildings or portions of buildings that were 
        destroyed as a result of the terrorist-related aircraft crashes 
        of September 11, 2001;
            ``(C) any area contiguous to a site of such crashes that 
        the Special Master determines was sufficiently close to the 
        site that there was a demonstrable risk of physical harm 
        resulting from the impact of the aircraft or any subsequent 
        fire, explosions, or building collapses (including the 
        immediate area in which the impact occurred, fire occurred, 
        portions of buildings fell, or debris fell upon and injured 
        individuals); and
            ``(D) any area related to, or along, routes of debris 
        removal, such as barges and Fresh Kills.''.
    SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.
    (a) Information on Losses Resulting From Debris Removal Included in 
Contents of Claim Form.--Section 405(a)(2)(B) of the Air Transportation 
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended--
        (1) in clause (i), by inserting ``, or debris removal during 
    the immediate aftermath'' after ``September 11, 2001'';
        (2) in clause (ii), by inserting ``or debris removal during the 
    immediate aftermath'' after ``crashes''; and
        (3) in clause (iii), by inserting ``or debris removal during 
    the immediate aftermath'' after ``crashes''.
    (b) Extension of Deadline for Claims Under September 11th Victim 
Compensation Fund of 2001.--Section 405(a)(3) of such Act is amended to 
read as follows:
        ``(3) Limitation.--
            ``(A) In general.--Except as provided by subparagraph (B), 
        no claim may be filed under paragraph (1) after the date that 
        is 2 years after the date on which regulations are promulgated 
        under section 407(a).
            ``(B) Exception.--A claim may be filed under paragraph (1), 
        in accordance with subsection (c)(3)(A)(i), by an individual 
        (or by a personal representative on behalf of a deceased 
        individual) during the period beginning on the date on which 
        the regulations are updated under section 407(b) and ending on 
        the date that is 5 years after the date on which such 
        regulations are updated.''.
    (c) Requirements for Filing Claims During Extended Filing Period.--
Section 405(c)(3) of such Act is amended--
        (1) by redesignating subparagraphs (A) and (B) as subparagraphs 
    (B) and (C), respectively; and
        (2) by inserting before subparagraph (B), as so redesignated, 
    the following new subparagraph:
            ``(A) Requirements for filing claims during extended filing 
        period.--
                ``(i) Timing requirements for filing claims.--An 
            individual (or a personal representative on behalf of a 
            deceased individual) may file a claim during the period 
            described in subsection (a)(3)(B) as follows:

                    ``(I) In the case that the Special Master 
                determines the individual knew (or reasonably should 
                have known) before the date specified in clause (iii) 
                that the individual suffered a physical harm at a 9/11 
                crash site as a result of the terrorist-related 
                aircraft crashes of September 11, 2001, or as a result 
                of debris removal, and that the individual knew (or 
                should have known) before such specified date that the 
                individual was eligible to file a claim under this 
                title, the individual may file a claim not later than 
                the date that is 2 years after such specified date.
                    ``(II) In the case that the Special Master 
                determines the individual first knew (or reasonably 
                should have known) on or after the date specified in 
                clause (iii) that the individual suffered such a 
                physical harm or that the individual first knew (or 
                should have known) on or after such specified date that 
                the individual was eligible to file a claim under this 
                title, the individual may file a claim not later than 
                the last day of the 2-year period beginning on the date 
                the Special Master determines the individual first knew 
                (or should have known) that the individual both 
                suffered from such harm and was eligible to file a 
                claim under this title.

                ``(ii) Other eligibility requirements for filing 
            claims.--An individual may file a claim during the period 
            described in subsection (a)(3)(B) only if--

                    ``(I) the individual was treated by a medical 
                professional for suffering from a physical harm 
                described in clause (i)(I) within a reasonable time 
                from the date of discovering such harm; and
                    ``(II) the individual's physical harm is verified 
                by contemporaneous medical records created by or at the 
                direction of the medical professional who provided the 
                medical care.

                ``(iii) Date specified.--The date specified in this 
            clause is the date on which the regulations are updated 
            under section 407(a).''.
    (d) Clarifying Applicability to All 9/11 Crash Sites.--Section 
405(c)(2)(A)(i) of such Act is amended by striking ``or the site of the 
aircraft crash at Shanksville, Pennsylvania'' and inserting ``the site 
of the aircraft crash at Shanksville, Pennsylvania, or any other 9/11 
crash site''.
    (e) Inclusion of Physical Harm Resulting From Debris Removal.--
Section 405(c) of such Act is amended in paragraph (2)(A)(ii), by 
inserting ``or debris removal'' after ``air crash''.
    (f) Limitations on Civil Actions.--
        (1) Application to damages related to debris removal.--Clause 
    (i) of section 405(c)(3)(C) of such Act, as redesignated by 
    subsection (c), is amended by inserting ``, or for damages arising 
    from or related to debris removal'' after ``September 11, 2001''.
        (2) Pending actions.--Clause (ii) of such section, as so 
    redesignated, is amended to read as follows:
                ``(ii) Pending actions.--In the case of an individual 
            who is a party to a civil action described in clause (i), 
            such individual may not submit a claim under this title--

                    ``(I) during the period described in subsection 
                (a)(3)(A) unless such individual withdraws from such 
                action by the date that is 90 days after the date on 
                which regulations are promulgated under section 407(a); 
                and
                    ``(II) during the period described in subsection 
                (a)(3)(B) unless such individual withdraws from such 
                action by the date that is 90 days after the date on 
                which the regulations are updated under section 
                407(b).''.

        (3) Settled actions.--Such section, as so redesignated, is 
    further amended by adding at the end the following new clause:
                ``(iii) Settled actions.--In the case of an individual 
            who settled a civil action described in clause (i), such 
            individual may not submit a claim under this title unless 
            such action was commenced after December 22, 2003, and a 
            release of all claims in such action was tendered prior to 
            the date on which the James Zadroga 9/11 Health and 
            Compensation Act of 2010 was enacted.''.
    SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.
    Section 407 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
        (1) by striking ``Not later than'' and inserting ``(a) In 
    General.--Not later than''; and
        (2) by adding at the end the following new subsection:
    ``(b) Updated Regulations.--Not later than 180 days after the date 
of the enactment of the James Zadroga 9/11 Health and Compensation Act 
of 2010, the Special Master shall update the regulations promulgated 
under subsection (a) to the extent necessary to comply with the 
provisions of title II of such Act.''.
    SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.
    Section 408(a) of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended by adding at the 
end the following new paragraphs:
        ``(4) Liability for certain claims.--Notwithstanding any other 
    provision of law, liability for all claims and actions (including 
    claims or actions that have been previously resolved, that are 
    currently pending, and that may be filed) for compensatory damages, 
    contribution or indemnity, or any other form or type of relief, 
    arising from or related to debris removal, against the City of New 
    York, any entity (including the Port Authority of New York and New 
    Jersey) with a property interest in the World Trade Center on 
    September 11, 2001 (whether fee simple, leasehold or easement, or 
    direct or indirect) and any contractors and subcontractors, shall 
    not be in an amount that exceeds the sum of the following, as may 
    be applicable:
            ``(A) The amount of funds of the WTC Captive Insurance 
        Company, including the cumulative interest.
            ``(B) The amount of all available insurance identified in 
        schedule 2 of the WTC Captive Insurance Company insurance 
        policy.
            ``(C) As it relates to the limitation of liability of the 
        City of New York, the amount that is the greater of the City of 
        New York's insurance coverage or $350,000,000. In determining 
        the amount of the City's insurance coverage for purposes of the 
        previous sentence, any amount described in subparagraphs (A) 
        and (B) shall not be included.
            ``(D) As it relates to the limitation of liability of any 
        entity, including the Port Authority of New York and New 
        Jersey, with a property interest in the World Trade Center on 
        September 11, 2001 (whether fee simple, leasehold or easement, 
        or direct or indirect), the amount of all available liability 
        insurance coverage maintained by any such entity.
            ``(E) As it relates to the limitation of liability of any 
        individual contractor or subcontractor, the amount of all 
        available liability insurance coverage maintained by such 
        contractor or subcontractor on September 11, 2001.
        ``(5) Priority of claims payments.--Payments to plaintiffs who 
    obtain a settlement or judgment with respect to a claim or action 
    to which paragraph (4) applies, shall be paid solely from the 
    following funds in the following order, as may be applicable:
            ``(A) The funds described in subparagraph (A) or (B) of 
        paragraph (4).
            ``(B) If there are no funds available as described in 
        subparagraph (A) or (B) of paragraph (4), the funds described 
        in subparagraph (C) of such paragraph.
            ``(C) If there are no funds available as described in 
        subparagraph (A), (B), or (C) of paragraph (4), the funds 
        described in subparagraph (D) of such paragraph.
            ``(D) If there are no funds available as described in 
        subparagraph (A), (B), (C), or (D) of paragraph (4), the funds 
        described in subparagraph (E) of such paragraph.
        ``(6) Declaratory judgment actions and direct action.--Any 
    claimant to a claim or action to which paragraph (4) applies may, 
    with respect to such claim or action, either file an action for a 
    declaratory judgment for insurance coverage or bring a direct 
    action against the insurance company involved, except that no such 
    action for declaratory judgment or direct action may be commenced 
    until after the funds available in subparagraph (A), (B), (C), and 
    (D) of paragraph (5) have been exhausted consistent with the order 
    described in such paragraph for payment.''.
    SEC. 205. FUNDING; ATTORNEY FEES.
    Section 406 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
        (1) in subsection (a), by striking ``Not later than'' and 
    inserting ``Subject to the limitations under subsection (d), not 
    later than'';
        (2) in subsection (b)--
            (A) by inserting ``in the amounts provided under subsection 
        (d)(1)'' after ``appropriations Acts''; and
            (B) by inserting ``subject to the limitations under 
        subsection (d)'' before the period; and
        (3) by adding at the end the following new subsections:
    ``(d) Limitation.--
        ``(1) In general.--The total amount of Federal funds paid for 
    compensation under this title, with respect to claims filed on or 
    after the date on which the regulations are updated under section 
    407(b), shall not exceed $2,775,000,000. Of such amounts, not to 
    exceed $875,000,000 shall be available to pay such claims during 
    the 5-year period beginning on such date.
        ``(2) Pro-ration and payment of remaining claims.--
            ``(A) In general.--The Special Master shall ratably reduce 
        the amount of compensation due claimants under this title in a 
        manner to ensure, to the extent possible, that--
                ``(i) all claimants who, before application of the 
            limitation under the second sentence of paragraph (1), 
            would have been determined to be entitled to a payment 
            under this title during such 5-year period, receive a 
            payment during such period; and
                ``(ii) the total amount of all such payments made 
            during such 5-year period do not exceed the amount 
            available under the second sentence of paragraph (1) to pay 
            claims during such period.
            ``(B) Payment of remainder of claim amounts.--In any case 
        in which the amount of a claim is ratably reduced pursuant to 
        subparagraph (A), on or after the first day after the 5-year 
        period described in paragraph (1), but in no event later than 1 
        year after such 5-year period, the Special Master shall pay to 
        the claimant the amount that is equal to the difference 
        between--
                ``(i) the amount that the claimant would have been paid 
            under this title during such period without regard to the 
            limitation under the second sentence of paragraph (1) 
            applicable to such period; and
                ``(ii) the amount the claimant was paid under this 
            title during such period.
            ``(C) Termination.--Upon completion of all payments 
        pursuant to this subsection, the Victim's Compensation Fund 
        shall be permanently closed.
    ``(e) Attorney Fees.--
        ``(1) In general.--Notwithstanding any contract, the 
    representative of an individual may not charge, for services 
    rendered in connection with the claim of an individual under this 
    title, more than 10 percent of an award made under this title on 
    such claim.
        ``(2) Limitation.--
            ``(A) In general.--Except as provided in subparagraph (B), 
        in the case of an individual who was charged a legal fee in 
        connection with the settlement of a civil action described in 
        section 405(c)(3)(C)(iii), the representative of the individual 
        may not charge any amount for compensation for services 
        rendered in connection with a claim filed under this title.
            ``(B) Exception.--If the legal fee charged in connection 
        with the settlement of a civil action described in section 
        405(c)(3)(C)(iii) of an individual is less than 10 percent of 
        the aggregate amount of compensation awarded to such individual 
        through such settlement, the representative of such individual 
        may charge an amount for compensation for services rendered to 
        the extent that such amount charged is not more than--
                ``(i) 10 percent of such aggregate amount through the 
            settlement, minus
                ``(ii) the total amount of all legal fees charged for 
            services rendered in connection with such settlement.
        ``(3) Discretion to lower fee.--In the event that the special 
    master finds that the fee limit set by paragraph (1) or (2) 
    provides excessive compensation for services rendered in connection 
    with such claim, the Special Master may, in the discretion of the 
    Special Master, award as reasonable compensation for services 
    rendered an amount lesser than that permitted for in paragraph 
    (1).''.

                 TITLE III--REVENUE RELATED PROVISIONS

    SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCUREMENT.
    (a) Imposition of Tax.--
        (1) In general.--Subtitle D of the Internal Revenue Code of 
    1986 is amended by adding at the end the following new chapter:

                   ``CHAPTER 50--FOREIGN PROCUREMENT

``Sec. 5000C. Imposition of tax on certain foreign procurement.

``SEC. 5000C. IMPOSITION OF TAX ON CERTAIN FOREIGN PROCUREMENT.
    ``(a) Imposition of Tax.--There is hereby imposed on any foreign 
person that receives a specified Federal procurement payment a tax 
equal to 2 percent of the amount of such specified Federal procurement 
payment.
    ``(b) Specified Federal Procurement Payment.--For purposes of this 
section, the term `specified Federal procurement payment' means any 
payment made pursuant to a contract with the Government of the United 
States for--
        ``(1) the provision of goods, if such goods are manufactured or 
    produced in any country which is not a party to an international 
    procurement agreement with the United States, or
        ``(2) the provision of services, if such services are provided 
    in any country which is not a party to an international procurement 
    agreement with the United States.
    ``(c) Foreign Person.--For purposes of this section, the term 
`foreign person' means any person other than a United States person.
    ``(d) Administrative Provisions.--
        ``(1) Withholding.--The amount deducted and withheld under 
    chapter 3 shall be increased by the amount of tax imposed by this 
    section on such payment.
        ``(2) Other administrative provisions.--For purposes of 
    subtitle F, any tax imposed by this section shall be treated as a 
    tax imposed by subtitle A.''.
        (2) Clerical amendment.--The table of chapters for subtitle D 
    of the Internal Revenue Code of 1986 is amended by adding at the 
    end the following new item:

                  ``Chapter 50--Foreign Procurement''.

        (3) Effective date.--The amendments made by this subsection 
    shall apply to payments received pursuant to contracts entered into 
    on and after the date of the enactment of this Act.
    (b) Prohibition on Reimbursement of Fees.--
        (1) In general.--The head of each executive agency shall take 
    any and all measures necessary to ensure that no funds are 
    disbursed to any foreign contractor in order to reimburse the tax 
    imposed under section 5000C of the Internal Revenue Code of 1986.
        (2) Annual review.--The Administrator for Federal Procurement 
    Policy shall annually review the contracting activities of each 
    executive agency to monitor compliance with the requirements of 
    paragraph (1).
        (3) Executive agency.--For purposes of this subsection, the 
    term ``executive agency'' has the meaning given the term in section 
    4 of the Office of Federal Procurement Policy Act (41 U.S.C. 403).
    (c) Application.--This section and the amendments made by this 
section shall be applied in a manner consistent with United States 
obligations under international agreements.
    SEC. 302. RENEWAL OF FEES FOR VISA-DEPENDENT EMPLOYERS.
    Subsections (a), (b), and (c) of section 402 of Public Law 111-230 
are amended by striking ``2014'' each place that such appears and 
inserting ``2015''.

                      TITLE IV--BUDGETARY EFFECTS

    SEC. 401. COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO ACT OF 2010.
    The budgetary effects of this Act, for the purpose of complying 
with the Statutory Pay-As-You-Go Act of 2010, shall be determined by 
reference to the latest statement titled ``Budgetary Effects of PAYGO 
Legislation'' for this Act, submitted for printing in the Congressional 
Record by the Chairman of the Senate Budget Committee, provided that 
such statement has been submitted prior to the vote on passage.

                               Speaker of the House of Representatives.

                            Vice President of the United States and    
                                               President of the Senate.