[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 847 Reported in House (RH)]
Union Calendar No. 321
111th CONGRESS
2d Session
H. R. 847
[Report No. 111-560, Parts I and II]
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.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 4, 2009
Mrs. Maloney (for herself, Mr. Nadler of New York, Mr. King of New
York, Mr. McMahon, Mr. Rangel, Mr. Ackerman, Mr. Arcuri, Mr. Bishop of
New York, Mr. Burgess, Mr. Crowley, Mr. Engel, Mr. Hall of New York,
Mr. Higgins, Mr. Himes, Mr. Hinchey, Mr. Israel, Mr. Lee of New York,
Mrs. Lowey, Mr. Maffei, Mr. Massa, Mrs. McCarthy of New York, Mr.
McGovern, Mr. McHugh, Mr. Meeks of New York, Mr. Pascrell, Mr. Serrano,
Ms. Sutton, Mr. Tonko, Mr. Towns, Mr. Weiner, Ms. Woolsey, and Ms.
Clarke) introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
the Judiciary, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
July 22, 2010
Reported from the Committee on Energy and Commerce with an amendment
[Strike out all after the enacting clause and insert the part printed
in italic]
July 22, 2010
Additional sponsors: Ms. Berkley, Mr. Gene Green of Texas, Ms.
Schakowsky, Mr. Smith of New Jersey, Mr. Connolly of Virginia, Mr.
Lance, Mr. Klein of Florida, Mr. Kucinich, Ms. DeLauro, Ms. Lee of
California, Mr. Lewis of Georgia, Mr. Grijalva, Mr. Bishop of Georgia,
Mr. Doyle, Mr. Dent, Mr. Murphy of Connecticut, Mr. Holt, Mr. Larson of
Connecticut, Mr. Sestak, Mr. Pierluisi, Ms. Slaughter, Ms. Velazquez,
Mrs. Dahlkemper, Mr. Etheridge, Mr. Conyers, Mr. Wexler, Mrs.
Christensen, Mr. Cohen, Mr. Andrews, Mr. Brady of Pennsylvania, Mr.
Schauer, Mr. Garrett of New Jersey, Mr. McCaul, Mr. Hodes, Ms.
Schwartz, Mr. Murphy of New York, Mr. Fattah, Mr. Gonzalez, Mr.
Courtney, Mr. Jones, Mr. Stupak, Mrs. Capps, Ms. Castor of Florida, Mr.
Sarbanes, Mr. Tim Murphy of Pennsylvania, Mr. Sires, Mr. Lipinski, Mr.
Thompson of Mississippi, Mr. Rush, Ms. Baldwin, Mr. Ellsworth, Mr.
Carney, Ms. Jackson Lee of Texas, Mr. Neal of Massachusetts, Mr.
Patrick J. Murphy of Pennsylvania, Mr. Upton, Mr. Filner, Ms. Harman,
Ms. Norton, Mr. Holden, Mr. Cummings, Ms. Shea-Porter, Mr. Rothman of
New Jersey, Mrs. Napolitano, Mr. Lynch, Mr. Cao, Mr. Markey of
Massachusetts, Mr. Nye, Mr. Walz, Ms. McCollum, Mr. Braley of Iowa, Mr.
Reichert, Mr. Owens, Mr. Welch, Mr. Davis of Illinois, Ms. Eshoo, Mr.
Butterfield, Mr. Garamendi, Mr. Baca, Mr. Miller of North Carolina, Mr.
Oberstar, Mr. LoBiondo, Ms. Eddie Bernice Johnson of Texas, and Mr.
Payne
July 22, 2010
Reported from the Committee on the Judiciary with an amendment,
committed to the Committee of the Whole House on the State of the
Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed
in boldface roman]
[For text of introduced bill, see copy of bill as introduced on
February 4, 2009]
_______________________________________________________________________
A BILL
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
in New York City.
``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.
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 (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 in
accordance with section 3304.
``(2) Contracts with data centers.--
``(A) In general.--The WTC Program Administrator
shall enter into contracts with 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.
``(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 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 reimbursable by the WTC
Program Administrator under section 3312(c).
``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) The term `WTC Program Administrator' means--
``(A) 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
``(B) 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.
``(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
in 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.--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. For treatment not covered under the
previous sentence or subparagraph (B), the WTC Program
Administrator shall establish by regulation a
reimbursement rate for such treatment.
``(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.
``(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).
``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 2020 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.
``(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 2020 (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) $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,
$431,000,000 for fiscal year 2015, $481,000,000
for fiscal year 2016, $537,000,000 for fiscal
year 2017, $601,000,000 for fiscal year 2018,
$672,000,000 for fiscal year 2019, and
$743,000,000 for fiscal year 2020; 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.
``(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,'' 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 August 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 December 22, 2031.''.
(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) Authority to reinstitute certain lawsuits.--Such
section, as so redesignated, is further amended by adding at
the end the following new clause:
``(iii) Authority to reinstitute certain
lawsuits.--In the case of a claimant who was a
party to a civil action described in clause
(i), who withdrew from such action pursuant to
clause (ii), and who is subsequently determined
to not be an eligible individual for purposes
of this subsection, such claimant may
reinstitute such action without prejudice
during the 90-day period beginning after the
date of such ineligibility determination.''.
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 90 days after the date
of the enactment of the James Zadroga 9/11 Health and Compensation Act
of 2008, 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.--
``(A) In general.--Notwithstanding any other
provision of law, subject to subparagraph (B),
liability for all claims and actions (including claims
or actions that have been previously resolved, that are
currently pending, and that may be filed through
December 22, 2031) for compensatory damages,
contribution or indemnity, or any other form or type of
relief, arising from or related to debris removal,
against New York City, 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 thereof, shall not be in an amount that
exceeds the sum of the following:
``(i) The amount of funds of the WTC
Captive Insurance Company, including the
cumulative interest.
``(ii) The amount of all available
insurance identified in schedule 2 of the WTC
Captive Insurance Company insurance policy.
``(iii) The amount that is the greater of
New York City'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
clauses (i) and (ii) shall not be included.
``(iv) The amount of all available
liability insurance coverage maintained by 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.
``(v) The amount of all available liability
insurance coverage maintained by contractors
and subcontractors.
``(B) Exception.--Subparagraph (A) shall not apply
to claims or actions based upon conduct held to be
intentionally tortious in nature or to acts of gross
negligence or other such acts to the extent to which
punitive damages are awarded as a result of such
conduct or acts.
``(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)(A) applies, shall be paid solely
from the following funds in the following order:
``(A) The funds described in clause (i) or (ii) of
paragraph (4)(A).
``(B) If there are no funds available as described
in clause (i) or (ii) of paragraph (4)(A), the funds
described in clause (iii) of such paragraph.
``(C) If there are no funds available as described
in clause (i), (ii), or (iii) of paragraph (4)(A), the
funds described in clause (iv) of such paragraph.
``(D) If there are no funds available as described
in clause (i), (ii), (iii), or (iv) of paragraph
(4)(A), the funds described in clause (v) of such
paragraph.
``(6) Declaratory judgment actions and direct action.--Any
party to a claim or action to which paragraph (4)(A) 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.''.
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.
Sec. 2. Findings.
TITLE I--WORLD TRADE CENTER HEALTH PROGRAM
Sec. 101. World Trade Center Health Program.
``TITLE XXX--WORLD TRADE CENTER HEALTH PROGRAM
``Subtitle A--Establishment of Program; Advisory and Steering
Committees
``Sec. 3001. Establishment of World Trade Center Health Program
within NIOSH.
``Sec. 3002. WTC Health Program Scientific/Technical Advisory
Committee.
``Sec. 3003. WTC Health Program Steering Committees.
``Sec. 3004. Community education and outreach.
``Sec. 3005. Uniform data collection.
``Sec. 3006. Centers of excellence.
``Sec. 3007. Entitlement authorities.
``Sec. 3008. Definitions.
``Subtitle B--Program of Monitoring, Initial Health Evaluations, and
Treatment
``Part 1--For WTC Responders
``Sec. 3011. Identification of eligible WTC responders and
provision of WTC-related monitoring
services.
``Sec. 3012. Treatment of certified eligible WTC responders for
WTC-related health conditions.
``Part 2--Community Program
``Sec. 3021. Identification and initial health evaluation of
eligible WTC community members.
``Sec. 3022. Followup monitoring and treatment of certified
eligible WTC community members for WTC-
related health conditions.
``Sec. 3023. Followup monitoring and treatment of other
individuals with WTC-related health
conditions.
``Part 3--National Arrangement for Benefits for Eligible Individuals
Outside New York
``Sec. 3031. National arrangement for benefits for eligible
individuals outside New York.
``Subtitle C--Research Into Conditions
``Sec. 3041. Research regarding certain health conditions
related to September 11 terrorist attacks
in New York City.
``Subtitle D--Programs of the New York City Department of Health and
Mental Hygiene
``Sec. 3051. World Trade Center Health Registry.
``Sec. 3052. Mental health services.
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.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Thousands of rescue workers who responded to the areas
devastated by the terrorist attacks of September 11, local
residents, office and area workers, and school children
continue to suffer significant medical problems as a result of
compromised air quality and the release of other toxins from
the attack sites.
(2) In a September 2006 peer-reviewed study conducted by
the World Trade Center Medical Monitoring Program, of 9,500
World Trade Center responders, almost 70 percent of World Trade
Center responders had a new or worsened respiratory symptom
that developed during or after their time working at the World
Trade Center; among the responders who were asymptomatic before
9/11, 61 percent developed respiratory symptoms while working
at the World Trade Center; close to 60 percent still had a new
or worsened respiratory symptom at the time of their
examination; one-third had abnormal pulmonary function tests;
and severe respiratory conditions including pneumonia were
significantly more common in the 6 months after 9/11 than in
the prior 6 months.
(3) An April 2006 study documented that, on average, a New
York City firefighter who responded to the World Trade Center
has experienced a loss of 12 years of lung capacity.
(4) A peer-reviewed study of residents who lived near the
World Trade Center titled ``The World Trade Center Residents'
Respiratory Health Study: New Onset Respiratory Symptoms and
Pulmonary Function'', found that data demonstrated a three-fold
increase in new-onset, persistent lower respiratory symptoms in
residents near the former World Trade Center as compared to a
control population.
(5) Previous research on the health impacts of the
devastation caused by the September 11 terrorist attacks has
shown relationships between the air quality from Ground Zero
and a host of health impacts, including lower pregnancy rates,
higher rates of respiratory and lung disorders, and a variety
of post-disaster mental health conditions (including
posttraumatic stress disorder) in workers and residents near
Ground Zero.
(6) A variety of tests conducted by independent scientists
have concluded that significant WTC contamination settled in
indoor environments surrounding the disaster site. The
Environmental Protection Agency's (EPA) cleanup programs for
indoor residential spaces, in 2003 and 2005, though limited,
are an acknowledgment that indoor contamination continued after
the WTC attacks.
(7) At the request of the Department of Energy, the Davis
DELTA Group at the University of California conducted outdoor
dust sampling in October 2001 at Varick and Houston Streets
(approximately 1.2 miles north of Ground Zero) and found that
the contamination from the World Trade Center ``outdid even the
worst pollution from the Kuwait oil fields fires''. Further,
the United States Geological Survey (USGS) reported on November
27, 2001, that dust samples collected from indoor surfaces
registered at levels that were ``as caustic as liquid drain
cleaners''.
(8) According to both the EPA's own Inspector General's
(EPA IG) report of August 21, 2003 and General Accountability
Offices's (GAO) report of September 2007, no comprehensive
program has ever been conducted in order to characterize the
full extent of WTC contamination, and therefore the full impact
of that contamination--geographic or otherwise--remains
unknown.
(9) Such reports found that there has never been a
comprehensive program to remediate WTC toxins from indoor
spaces. Thus, area residents, workers and students may continue
to be exposed to WTC contamination in their homes, workplaces
and schools.
(10) Because of the failure to release federally
appropriated funds for community care, a lack of sufficient
outreach, the fact that many community members are receiving
care from physicians outside the current City-funded World
Trade Center Environmental Health Center program and thus fall
outside data collection efforts, and other factors, the number
of community members being treated at the World Trade Center
Environmental Health Center underrepresents the total number in
the community that have been affected by exposure to Ground
Zero toxins.
(11) Research by Columbia University's Center for
Children's Environmental Health has shown negative health
effects on babies born to women living within 2 miles of the
World Trade Center in the month following 9/11.
(12) Federal funding allocated for the monitoring of rescue
workers' health is not sufficient to ensure the long-term study
of health impacts of September 11.
(13) A significant portion of those who have developed
health problems as result of exposures to airborne toxins or
other hazards resulting from the September 11, 2001, attacks on
the World Trade Center have no health insurance, have lost
their health insurance as a result of the attacks, or have
inadequate health insurance.
(14) The Federal program to provide medical treatments to
those who responded to the September 11 aftermath, and who
continue to experience health problems as a result, was finally
established more than five years after the attacks, but has no
certain long-term funding.
(15) Rescue workers and volunteers seeking workers'
compensation have reported that their applications have been
denied, delayed for months, or redirected, instead of receiving
assistance in a timely and supportive manner.
(16) A February 2007 report released by the City of New
York estimated that approximately 410,000 people were the most
heavily exposed to the environmental hazards and trauma of the
September 11 terrorist attacks. More than 30 percent of the
Fire Department of the City of New York first responders were
still experiencing some respiratory symptoms more than five
years after the attacks and according to the report, 59 percent
of those seen by the WTC Environmental Health Center at
Bellevue Hospital (which serves community members) are without
insurance and 65 percent have incomes less than $15,000 per
year. The report also found a need to continue and expand
mental health services.
(17) Since the 5th anniversary of the attack (September 11,
2006), hundreds of workers a month have been signing up with
the monitoring and treatment programs.
(18) In April 2008, the Department of Health and Human
Services reported to Congress that in fiscal year 2007 11,359
patients received medical treatment in the existing WTC
Responder Medical and Treatment program for WTC-related health
problems, and that number of responders who need treatment and
the severity of health problems is expected to increase.
(19) The September 11 Victim Compensation Fund of 2001 was
established to provide compensation to individuals who were
physically injured or killed as a result of the terrorist-
related aircraft crashes of September 11, 2001.
(20) The deadline for filing claims for compensation under
the Victim Compensation Fund was December 22, 2003.
(21) Some individuals did not know they were eligible to
file claims for compensation for injuries or did not know they
had suffered physical harm as a result of the terrorist-related
aircraft crashes until after the December 22, 2003, deadline.
(22) Further research is needed to evaluate more
comprehensively the extent of the health impacts of September
11, including research for emerging health problems such as
cancer, which have been predicted.
(23) Research is needed regarding possible treatment for
the illnesses and injuries of September 11.
(24) The Federal response to medical and financial issues
arising from the September 11 response efforts needs a
comprehensive, coordinated long-term response in order to meet
the needs of all the individuals who were exposed to the toxins
of Ground Zero and are suffering health problems from the
disaster.
(25) The failure to extend the appointment of Dr. John
Howard as Director of the National Institute for Occupational
Safety and Health in July 2008 is not in the interests of the
administration of such Institute nor the continued operation of
the World Trade Center Medical Monitoring and Treatment Program
which he has headed, and the Secretary of Health and Human
Services should reconsider extending such appointment.
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 XXX--WORLD TRADE CENTER HEALTH PROGRAM
``Subtitle A--Establishment of Program; Advisory and Steering
Committees
``SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM WITHIN
NIOSH.
``(a) In General.--There is hereby established within the National
Institute for Occupational Safety and Health a program to be known as
the `World Trade Center Health Program' (in this title referred to as
the `WTC program') to provide--
``(1) medical monitoring and treatment benefits to eligible
emergency responders and recovery and clean-up workers
(including those who are Federal employees) who responded to
the September 11, 2001, terrorist attacks on the World Trade
Center; 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 3011, including clinical examinations
and long-term health monitoring and analysis for individuals
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 on the World Trade
Center.
``(2) Initial health evaluation for community members.--An
initial health evaluation under section 3021, including an
evaluation to determine eligibility for followup monitoring and
treatment.
``(3) Follow-up monitoring and treatment for wtc-related
conditions for responders and community members.--Provision
under sections 3012, 3022, and 3023 of follow-up monitoring and
treatment and payment, subject to the provisions of subsection
(d), for all medically necessary health and mental health care
expenses (including necessary prescription drugs) of
individuals with a WTC-related health condition.
``(4) Outreach.--Establishment under section 3004 of an
outreach program to potentially eligible individuals concerning
the benefits under this title.
``(5) Uniform data collection.--Collection under section
3005 of health and mental health data on individuals receiving
monitoring or treatment benefits, using a uniform system of
data collection.
``(6) Research on wtc conditions.--Establishment under
subtitle C of a research program on health conditions resulting
from the September 11, 2001, terrorist attacks on the World
Trade Center.
``(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
eligible WTC responder or any eligible WTC community member.
``(d) Payor.--
``(1) In general.--Except as provided in paragraphs (2) and
(3), the cost of monitoring and treatment benefits and initial
health evaluation benefits provided under subtitle B shall be
paid for by the WTC program.
``(2) Workers' compensation payment.--
``(A) In general.--Except as provided in
subparagraph (B), payment for treatment under subtitle
B of a WTC-related condition in an individual that is
work-related shall be reduced or recouped to the extent
that the Secretary 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
or a State, 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 (42 U.S.C. 1395y(b)(2)) and
paragraph (3) of such section shall apply to the
recoupment under this paragraph 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.
``(B) Exception.--If the WTC Program Administrator
certifies that the City of New York has contributed the
matching contribution required under section 3006(a)(3)
for a 12-month period (specified by the WTC Program
Administrator), subparagraph (A) shall not apply for
that 12-month period with respect to a workers'
compensation law or plan, including line of duty
compensation, to which the City is obligated to make
payments.
``(3) Health insurance coverage.--
``(A) In general.--In the case of an individual who
has a WTC-related condition that is not work-related
and has health coverage for such condition through any
public or private health plan, the provisions of
section 1862(b) of the Social Security Act (42 U.S.C.
1395y(b)) shall apply to such a health plan and such
individual in the same manner as they apply to a group
health plan and an individual entitled to benefits
under title XVIII of such Act pursuant to section
226(a). 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.
``(B) Recovery by individual providers.--Nothing in
subparagraph (A) 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.
``(4) Work-related described.--For the purposes of this
subsection, a WTC-related condition shall be treated as a
condition that is work-related if--
``(A) the condition is diagnosed in an eligible WTC
responder, or in an individual who qualifies as an
eligible WTC community member on the basis of being a
rescue, recovery, or clean-up worker; or
``(B) 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.
``(e) Quality Assurance and Monitoring of Clinical Expenditures.--
``(1) Quality assurance.--The WTC Program Administrator
working with the Clinical Centers of Excellence shall develop
and implement a quality assurance program for the medical
monitoring and treatment delivered by such Centers of
Excellence and any other participating health care providers.
Such program shall include--
``(A) adherence to medical monitoring and treatment
protocols;
``(B) appropriate diagnostic and treatment
referrals for participants;
``(C) prompt communication of test results to
participants; and
``(D) such other elements as the Administrator
specifies in consultation with the Clinical Centers of
Excellence.
``(2) Fraud prevention.--The WTC Program Administrator
shall develop and implement a program to review the program's
health care expenditures to detect fraudulent or duplicate
billing and payment for inappropriate services. Such program
shall be similar to current methods used in connection with the
Medicare program under title XVIII of the Social Security Act.
This title is a Federal health care program (as defined in
section 1128B(f) of such 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.
``(f) WTC Program Administration.--The WTC program shall be
administered by the Director of the National Institute for Occupational
Safety and Health, or a designee of such Director.
``(g) 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 of report.--Each annual report under
paragraph (1) shall include 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 medical
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.
``(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 conditions that have
been paid for or reimbursed by workers'
compensation, by public or private health
plans, or by the City of New York under section
3012(c)(4).
``(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 WTC center
exposures, including the findings of research conducted
under section 3041(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) FDNY responders.--The benefits provided for
eligible WTC responders described in section
3006(b)(1)(A).
``(B) Other eligible wtc responders.--The benefits
provided for eligible WTC responders not described in
subparagraph (A).
``(C) Eligible wtc community members.--The benefits
provided for eligible WTC community members in section
3006(b)(1)(C).
``(h) Notification to Congress When Reach 80 Percent of Eligibility
Numerical Limits.--The WTC Program Administrator shall promptly notify
the Congress--
``(1) when the number of certifications for eligible WTC
responders subject to the limit established under section
3011(a)(5) has reached 80 percent of such limit; and
``(2) when the number of certifications for eligible WTC
community members subject to the limit established under
section 3021(a)(5) has reached 80 percent of such limit.
``(i) GAO Report.--Not later than 3 years after the date of the
enactment of this Act, the Comptroller General of the United States
shall submit to the Congress a report on the costs of the monitoring
and treatment programs provided under this title.
``(j) NYC Recommendations.--The City of New York may make
recommendations to the WTC Program Administrator on ways to improve the
monitoring and treatment programs under this title for both eligible
WTC responders and eligible WTC community members.
``SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY
COMMITTEE.
``(a) Establishment.--The WTC Program Administrator shall establish
an advisory committee to be known as the WTC Health Program Scientific/
Technical Advisory Committee (in this section 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.
``(b) Composition.--The WTC Program Administrator shall appoint the
members of the Advisory Committee and shall include at least--
``(1) 4 occupational physicians, at least two of whom have
experience treating WTC rescue and recovery workers;
``(2) 1 physician with expertise in pulmonary medicine;
``(3) 2 environmental medicine or environmental health
specialists;
``(4) 2 representatives of eligible WTC responders;
``(5) 2 representatives of WTC community members;
``(6) an industrial hygienist;
``(7) a toxicologist;
``(8) an epidemiologist; and
``(9) a mental health professional.
``(c) Meetings.--The Advisory Committee shall meet at such
frequency as may be required to carry out its duties.
``(d) Reports.--The WTC Program Administrator shall provide for
publication of recommendations of the Advisory Committee on the public
website established for the WTC program.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated such sums as
may be necessary, not to exceed $100,000, for each fiscal year
beginning with fiscal year 2009.
``(f) 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.
``(g) Application of FACA.--Except as otherwise specifically
provided, the Advisory Committee shall be subject to the Federal
Advisory Committee Act.
``SEC. 3003. WTC HEALTH PROGRAM STEERING COMMITTEES.
``(a) Establishment.--The WTC Program Administrator shall establish
two steering committees (each in this section referred to as a
`Steering Committee') as follows:
``(1) WTC responders steering committee.--One steering
committee, to be known as the WTC Responders Steering
Committee, for the purpose of facilitating the coordination of
medical monitoring and treatment programs for the eligible WTC
responders under part 1 of subtitle B.
``(2) WTC community program steering committee.--One
steering committee, to be known as the WTC Community Program
Steering Committee, for the purpose of facilitating the
coordination of initial health evaluations, monitoring, and
treatment programs for eligible WTC community members under
part 2 of subtitle B.
``(b) Membership.--
``(1) Initial membership of wtc responders steering
committee.--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). In
addition, the committee membership shall include--
``(A) a representative of the Police Commissioner
of the City of New York;
``(B) a representative of the Department of Health
of the City of New York;
``(C) a representative of another agency of the
City of New York, selected by the Mayor of New York
City, which had a large number of non-uniformed City
workers who responded to the WTC disaster; and
``(D) three representatives of eligible WTC
responders;
in order that eligible WTC responders constitute half the
members of the Steering Committee.
``(2) Initial membership of wtc community program steering
committee.--
``(A) In general.--The WTC Community Program
Steering Committee shall initially be composed of
members of the WTC Environmental Health Center
Community Advisory Committee (as in existence on the
day before the date of the enactment of this title) and
shall initially have, as voting members, the following:
``(i) 11 representatives of the affected
populations of residents, students, area
workers, and other community members.
``(ii) The Medical Director of the WTC
Environmental Health Center.
``(iii) The Executive Director of the WTC
Environmental Health Center.
``(iv) Three physicians, one each
representing the three WTC Environmental Health
Center treatment sites of Bellevue Hospital
Center, Gouverneur Healthcare Services, and
Elmhurst Hospital Center.
``(v) Five specialists with WTC related
expertise or experience in treating non-
responder WTC diseases, such as a pediatrician,
an epidemiologist, a psychiatrist or
psychologist, an environmental/occupational
specialists or a social worker from a WTC
Environmental Health Center treatment site, or
other relevant specialists.
``(vi) A representative of the Department
of Health and Mental Hygiene of the City of New
York.
``(B) Appointments.--
``(i) WTC ehc community advisory
committee.--The WTC Environmental Health Center
Community Advisory Committee as in existence on
the date of the enactment of this title shall
nominate members for positions described in
subparagraph (A)(i).
``(ii) NYC health and hospitals
corporation.--The New York City Health and
Hospitals Corporation shall nominate members
for positions described in clauses (iv) and (v)
of subparagraph (A).
``(iii) Timing.--Nominations under clauses
(i) and (ii) shall be recommended to the WTC
Program Administrator not later than 60 days
after the date of the enactment of this title.
``(iv) Appointment.--The WTC Program
Administrator shall appoint members of the WTC
Community Program Steering Committee not later
than 90 days after the date of the enactment of
this title.
``(v) General representatives.--Of the
members appointed under subparagraph (A)(i)--
``(I) the representation shall
reflect the broad and diverse WTC-
affected populations and constituencies
and the diversity of impacted
neighborhoods, including residents,
hard-to-reach populations, students,
area workers, school parents,
community-based organizations,
Community Boards, WTC Environmental
Health Center patients, labor unions,
and labor advocacy organizations; and
``(II) no one individual
organization can have more than one
representative.
``(3) Additional appointments.--Each Steering Committee may
appoint, if approved by a majority of voting members of the
Committee, additional members to the Committee.
``(4) Vacancies.--A vacancy in a Steering Committee shall
be filled by the Steering Committee, subject to the approval of
the WTC Program Administrator, so long as--
``(A) in the case of the WTC Responders Steering
Committee, the composition of the Committee includes
representatives of eligible WTC responders and
representatives of each Clinical Center of Excellence
and each Coordinating Center of Excellence that serves
eligible WTC responders and such composition has
eligible WTC responders constituting half of the
membership of the Steering Committee; or
``(B) in the case of the WTC Community Program
Steering Committee, the composition of the Committee
includes representatives of eligible WTC community
members and representatives of each Clinical Center of
Excellence and each Coordinating Center of Excellence
that serves eligible WTC community members and the
nominating process is consistent with paragraph (2)(B).
``(5) Co-chairs of wtc community program steering
committee.--The WTC Community Program Steering Committee shall
have two Co-Chairs as follows:
``(A) Community/Labor co-chair.--A Community/Labor
Co-Chair who shall be chosen by the community and
labor-based members of the Steering Committee.
``(B) Environmental health clinic co-chair.--A WTC
Environmental Health Clinic Co-Chair who shall be
chosen by the WTC Environmental Health Center members
on the Steering Committee.
``(c) Relation to FACA.--Each Steering Committee shall not be
subject to the Federal Advisory Committee Act.
``(d) Meetings.--Each Steering Committee shall meet at such
frequency necessary to carry out its duties, but not less than 4 times
each calendar year and at least two such meetings each year shall be a
joint meeting with the voting membership of the other Steering
Committee for the purpose of exchanging information regarding the WTC
program.
``(e) Duration.--Notwithstanding any other provision of law, each
Steering Committee shall continue in operation during the period in
which the WTC program is in operation.
``SEC. 3004. COMMUNITY EDUCATION AND OUTREACH.
``(a) In General.--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 website 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.
``(b) Partnerships.--To the greatest extent possible, in carrying
out this section, the WTC Program Administrator shall enter into
partnerships with local governments and organizations with experience
performing outreach to the affected populations, including community
and labor-based organizations.
``SEC. 3005. UNIFORM DATA COLLECTION.
``(a) In General.--The WTC Program Administrator shall provide for
the uniform collection of data (and analysis of data and regular
reports to the Administrator) on the utilization of monitoring and
treatment benefits provided to eligible WTC responders and eligible WTC
community members, the prevalence of WTC-related health conditions, and
the identification of new WTC-related medical 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.
``(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 Coordinating Center of Excellence
for analysis by such Coordinating Center of Excellence.
``(c) Privacy.--The data collection and analysis under this section
shall be conducted in a manner that protects the confidentiality of
individually identifiable health information consistent with applicable
legal requirements.
``SEC. 3006. CENTERS OF EXCELLENCE.
``(a) In General.--
``(1) Contracts with clinical centers of excellence.--The
WTC Program Administrator shall enter into contracts with
Clinical Centers of Excellence specified in subsection (b)(1)--
``(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 follow-up 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 as for program participants who
are not English language proficient; and
``(F) for the collection and reporting of data in
accordance with section 3005.
``(2) Contracts with coordinating centers of excellence.--
The WTC Program Administrator shall enter into contracts with
Coordinating Centers of Excellence specified in subsection
(b)(2)--
``(A) for receiving, analyzing, and reporting to
the WTC Program Administrator on data, in accordance
with section 3005, that has been collected and reported
to such Coordinating Centers by the corresponding
Clinical Centers of Excellence under subsection (d)(3);
``(B) for the development of medical monitoring,
initial health evaluation, and treatment protocols,
with respect to WTC-related health conditions;
``(C) for coordinating the outreach activities
conducted under paragraph (1)(B) by each corresponding
Clinical Center of Excellence;
``(D) for establishing criteria for the
credentialing of medical providers participating in the
nationwide network under section 3031;
``(E) for coordinating and administrating the
activities of the WTC Health Program Steering
Committees established under section 3003(a); and
``(F) for meeting periodically with the
corresponding Clinical Centers of Excellence to obtain
input on the analysis and reporting of data collected
under subparagraph (A) and on the development of
medical monitoring, initial health evaluation, and
treatment protocols under subparagraph (B).
The medical providers under subparagraph (D) shall be selected
by the WTC Program Administrator on the basis of their
experience treating or diagnosing the medical conditions
included in the list of identified WTC-related conditions for
responders and of identified WTC-related conditions for
community members.
``(3) Required participation by new york city in monitoring
and treatment program and costs.--
``(A) In general.--In order for New York City, any
agency or Department thereof, or the New York City
Health and Hospitals Corporation to qualify for a
contract for the provision of monitoring and treatment
benefits and other services under section 3006, New
York City is required to contribute a matching amount
of 10 percent of the amount of the covered monitoring
and treatment payment (as defined in subparagraph (B)).
``(B) Covered monitoring and treatment payment
defined.--For the purposes of this paragraph, the term
`covered monitoring and treatment payment' means
payment under paragraphs (1) and (2), including under
such paragraph as applied under section 3021(b),
3022(a), and 3023, and reimbursement under 3006(c) for
items and services furnished by a Clinical Center of
Excellence or Coordinating Center of Excellence, and
providers designated by the WTC Program under section
3031, after the application of paragraphs (2) and (3)
of section 3001 (d).
``(C) Payment of new york city share of monitoring
and treatment costs.--The WTC Program Administrator
shall--
``(i) bill the amount specified in
subparagraph (A) directly to New York City; and
``(ii) certify periodically, for purposes
of section 3001(d)(2), whether or not New York
City has paid the amount so billed.
``(D) Limitation on required amount.--In no case is
New York City required under this paragraph to
contribute more than a total of $500,000,000 over any
10-year period.
``(b) Centers of Excellence Defined.--
``(1) Clinical center of excellence.--In this title, the
term `Clinical Center of Excellence' means the following:
``(A) For fdny responders.--With respect to an
eligible WTC responder who responded to the 9/11
attacks as an employee of the Fire Department of the
City of New York and who--
``(i) is an active employee of such
Department--
``(I) with respect to monitoring,
such Fire Department; and
``(II) with respect to treatment,
such Fire Department (or such entity as
has entered into a contract with the
Fire Department for treatment of such
responders) or any other Clinical
Center of Excellence described in
subparagraph (B), (C), or (D); or
``(ii) is not an active employee of such
Department, such Fire Department (or such
entity as has entered into a contract with the
Fire Department for monitoring or treatment of
such responders) or any other or any other
Clinical Center of Excellence described in
subparagraph (B), (C), or (D).
``(B) Other eligible wtc responders.--With respect
to other eligible WTC responders, whether or not they
reside in the New York Metropolitan area, the Mt. Sinai
coordinated consortium, Queens College, State
University of New York at Stony Brook, University of
Medicine and Dentistry of New Jersey, and Bellevue
Hospital.
``(C) WTC community members.--With respect to
eligible WTC community members, whether or not they
reside in the New York Metropolitan area, the World
Trade Center Environmental Health Center at Bellevue
Hospital and such hospitals or other facilities,
including but not limited to those within the New York
City Health and Hospitals Corporation, as are
identified by the WTC Program Administrator.
``(D) All eligible wtc responders and eligible wtc
community members.--With respect to all eligible WTC
responders and eligible WTC community members, such
other hospitals or other facilities as are identified
by the WTC Program Administrator.
The WTC Program Administrator shall limit the number of
additional Centers of Excellence identified under subparagraph
(D) to ensure that the participating centers have adequate
experience in the treatment and diagnosis of identified WTC-
related medical conditions.
``(2) Coordinating center of excellence.--In this title,
the term `Coordinating Center of Excellence' means the
following:
``(A) For fdny responders.--With respect to an
eligible WTC responder who responded to the 9/11
attacks as an employee of the Fire Department of the
City of New York, such Fire Department.
``(B) Other wtc responders.--With respect to other
eligible WTC responders, the Mt. Sinai coordinated
consortium.
``(C) Wtc community members.--With respect to
eligible WTC community members, the World Trade Center
Environmental Health Center at Bellevue Hospital.
``(3) Corresponding centers.--In this title, a Clinical
Center of Excellence and a Coordinating Center of Excellence
shall be treated as `corresponding' to the extent that such
Clinical Center and Coordinating Center serve the same
population group.
``(c) Reimbursement for Non-treatment, Non-monitoring Program
Costs.--A Clinical or Coordinating Center of Excellence with a contract
under this section shall be reimbursed for the costs of such Center in
carrying out the activities described in subsection (a), other than
those described in subsection (a)(1)(A), subject to the provisions of
section 3001(d), as follows:
``(1) Clinical centers of excellence.--For carrying out
subparagraphs (B) through (F) of subsection (a)(1)--
``(A) Clinical center for fdny responders in new
york.--The Clinical Center of Excellence for FDNY
Responders in New York specified in subsection
(b)(1)(A) shall be reimbursed--
``(i) in the first year of the contract
under this section, $600 per certified eligible
WTC responder in the medical treatment program,
and $300 per certified eligible WTC responder
in the monitoring program; and
``(ii) in each subsequent contract year,
subject to paragraph (3), at the rates
specified in this subparagraph for the previous
contract year adjusted by the WTC Program
Administrator to reflect the rate of medical
care inflation during the previous contract
year.
``(B) Clinical centers serving other eligible wtc
responders in new york.--A Clinical Center of
Excellence for other WTC responders in New York
specified in subsection (b)(1)(B) shall be reimbursed
the amounts specified in subparagraph (A).
``(C) Clinical centers serving wtc community
members.--A Clinical Center of Excellence for eligible
WTC community members in New York specified in
subsection (b)(1)(C) shall be reimbursed--
``(i) in the first year of the contract
under this section, for each certified eligible
WTC community member in a medical treatment
program enrolled at a non-hospital-based
facility, $600, and for each certified eligible
WTC community member in a medical treatment
program enrolled at a hospital-based facility,
$300; and
``(ii) in each subsequent contract year,
subject to paragraph (3), at the rates
specified in this subparagraph for the previous
contract year adjusted by the WTC Program
Administrator to reflect the rate of medical
care inflation during the previous contract
year.
``(D) Other clinical centers.--A Clinical Center of
Excellence or other providers not described in a
previous subparagraph shall be reimbursed at a rate set
by the WTC Program Administrator.
``(E) Reimbursement rules.--The reimbursement
provided under subparagraphs (A), (B) and (C) shall be
made for each certified eligible WTC responder and for
each WTC community member in the WTC program per year
that the member receives such services, regardless of
the volume or cost of services required.
``(2) Coordinating centers of excellence.--A Coordinating
Centers of Excellence specified in section (a)(2) shall be
reimbursed for the provision of services set forth in this
section at such levels as are established by the WTC Program
Administrator.
``(3) Review of rates.--
``(A) Initial review.--Before the end of the third
contract year of the WTC program, the WTC Program
Administrator shall conduct a review to determine
whether the reimbursement rates set forth in this
subsection provide fair and appropriate reimbursement
for such program services. Based on such review, the
Administrator may, by rule beginning with the fourth
contract year, may modify such rates, taking into
account a reasonable and fair rate for the services
being provided.
``(B) Subsequent reviews.--After the fourth
contract year, the WTC Program Administrator shall
conduct periodic reviews to determine whether the
reimbursement rates in effect under this subsection
provide fair and appropriate reimbursement for such
program services. Based upon such a review, the
Administrator may by rule modify such rates, taking
into account a reasonable and fair rate for the
services being provided.
``(C) GAO review.--The Comptroller General of the
United States shall review the WTC Program
Administrator's determinations regarding fair and
appropriate reimbursement for program services under
this paragraph.
``(d) Requirements.--The WTC Program Administrator shall not enter
into a contract with a Clinical Center of Excellence under subsection
(a)(1) unless--
``(1) the Center establishes 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;
``(2) the Center provides for the coordination of
monitoring and treatment benefits under subtitle B with routine
medical care provided for the treatment of conditions other
than WTC-related health conditions;
``(3) the Center collects and reports to the corresponding
Coordinating Center of Excellence data in accordance with
section 3005;
``(4) the Center has in place safeguards against fraud that
are satisfactory to the Administrator;
``(5) the Center agrees to treat or refer for treatment all
individuals who are eligible WTC responders or eligible WTC
community members with respect to such Center who present
themselves for treatment of a WTC-related health condition;
``(6) the Center has in place safeguards 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;
``(7) the Center provides assurances that the amounts paid
under subsection (c)(1) are used only for costs incurred in
carrying out the activities described in subsection (a), other
than those described in subsection (a)(1)(A); and
``(8) the Center agrees to meet all the other applicable
requirements of this title, including regulations implementing
such requirements.
``SEC. 3007. ENTITLEMENT AUTHORITIES.
``Subject to subsections (b)(4)(C) and (c)(5) of section 3012,
subtitle B constitutes budget authority in advance of appropriations
Acts and represents the obligation of the Federal Government to provide
for the payment for monitoring, initial health evaluations, and
treatment in accordance with such subtitle and section 3006(c)
constitutes such budget authority and represents the obligation of the
Federal Government to provide for the payment described in such
section.
``SEC. 3008. 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 on the World Trade
Center 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 terms `certified eligible WTC responder' and
`certified eligible WTC community member' mean an individual
who has been certified as an eligible WTC responder under
section 3011(a)(4) or an eligible WTC community member under
section 3021(a)(4), respectively.
``(3) The terms `Clinical Center of Excellence' and
`Coordinating Center of Excellence' have the meanings given
such terms in section 3006(b).
``(4) The term `current consortium arrangements' means the
arrangements as in effect on the date of the enactment of this
title between the National Institute for Occupational Safety
and Health and the Mt. Sinai-coordinated consortium and the
Fire Department of the City of New York.
``(5) The terms `eligible WTC responder' and `eligible WTC
community member' are defined in sections 3011(a) and 3021(a),
respectively.
``(6) 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.
``(7) The term `list of identified WTC-related health
conditions' means--
``(A) for eligible WTC responders, the identified
WTC-related health condition for eligible WTC
responders under section 3012(a)(3) or 3012(a)(4); or
``(B) for eligible WTC community members, the
identified WTC-related health condition for WTC
community members under section 3022(b)(1) or
3022(b)(2).
``(8) The term `Mt.-Sinai-coordinated consortium' means the
consortium coordinated by Mt. Sinai hospital in New York City
that coordinates the monitoring and treatment under the current
consortium arrangements for eligible WTC responders other than
with respect to those covered under the arrangement with the
Fire Department of the City of New York.
``(9) 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.
``(10) The term `New York metropolitan area' means an area,
specified by the WTC Program Administrator, within which
eligible WTC responders and eligible WTC community members 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 Centers of Excellence
described in subparagraphs (A), (B), or (C) of section
3006(b)(1).
``(11) Any reference to `September 11, 2001' shall be
deemed a reference to the period on such date subsequent to the
terrorist attacks on the World Trade Center on such date.
``(12) The term `September 11, 2001, terrorist attacks on
the World Trade Center' means the terrorist attacks that
occurred on September 11, 2001, in New York City and includes
the aftermath of such attacks.
``(13) The term `WTC Health Program Steering Committee'
means such a Steering Committee established under section 3003.
``(14) The term `WTC Program Administrator' means the
individual responsible under section 3001(f) for the
administration of the WTC program.
``(15) The term `WTC-related health condition' is defined
in section 3012(a).
``(16) The term `WTC Scientific/Technical Advisory
Committee' means such Committee established under section 3002.
``Subtitle B--Program of Monitoring, Initial Health Evaluations, and
Treatment
``PART 1--FOR WTC RESPONDERS
``SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPONDERS AND PROVISION OF
WTC-RELATED MONITORING SERVICES.
``(a) Eligible WTC Responder Defined.--
``(1) In general.--For purposes of this title, the term
`eligible WTC responder' means any of the following
individuals, subject to paragraph (5):
``(A) Currently identified responder.--An
individual who has been identified as eligible for
medical monitoring under the current consortium
arrangements (as defined in section 3008(4)).
``(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 on the World Trade Center, 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 on
the World Trade Center as the WTC Program
Administrator, after consultation with the WTC
Responders Steering Committee and 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 certifications for eligible responders has
reached 80 percent of the limit described in paragraph
(5) or on or after the date that the number of
certifications for eligible community members has
reached 80 percent of the limit described in section
3021(a)(5).
``(2) Current eligibility criteria.--The eligibility
criteria described in this paragraph for an individual is that
the individual is described in either of the following
categories:
``(A) Fire fighters and related personnel.--The
individual--
``(i) was a member of the Fire Department
of the City of New York (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 sites (including Ground Zero, Staten
Island land fill, and the NYC 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 the City of New York
(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 mental health condition described in
section 3012(a)(1)(B) on or before September 1,
2008.
``(B) Law enforcement officers and wtc rescue,
recovery, and clean-up workers.--The individual--
``(i) worked or volunteered on-site 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 the City of New York (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 on-site in rescue, recovery,
debris clean-up, 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 on-site in rescue,
recovery, debris clean-up, or related services
in 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 on-site in rescue,
recovery, debris clean-up, 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 on-site in rescue,
recovery, debris clean-up, 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 the City of New
York 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 on the
World Trade Center during a duration and period
described in subparagraph (A).
``(3) Application process.--The WTC Program Administrator
in consultation with the Coordinating Centers of Excellence
shall establish a process for individuals, other than eligible
WTC responders described in paragraph (1)(A), to apply to be
determined to be eligible WTC responders. Under such process--
``(A) there shall be no fee charged to the
applicant for making an application for such
determination;
``(B) the Administrator shall make a determination
on such an application not later than 60 days after the
date of filing the application; and
``(C) an individual who is determined not to be an
eligible WTC responder shall have an opportunity to
appeal such determination before an administrative law
judge in a manner established under such process.
``(4) Certification.--
``(A) In general.--In the case of an individual who
is described in paragraph (1)(A) or who is determined
under paragraph (3) (consistent with paragraph (5)) to
be an eligible WTC responder, the WTC Program
Administrator shall provide an appropriate
certification of such fact and of eligibility for
monitoring and treatment benefits under this part. The
Administrator shall make determinations of eligibility
relating to an applicant's compliance with this title,
including the verification of information submitted in
support of the application, and shall not deny such a
certification to an individual unless the Administrator
determines that--
``(i) based on the application submitted,
the individual does not meet the eligibility
criteria; or
``(ii) the numerical limitation on eligible
WTC responders set forth in paragraph (5) has
been met.
``(B) Timing.--
``(i) Currently identified responders.--In
the case of an individual who is described in
paragraph (1)(A), the WTC Program Administrator
shall provide the certification under
subparagraph (A) not later than 60 days after
the date of the enactment of this title.
``(ii) Other responders.--In the case of
another individual who is determined under
paragraph (3) and consistent with paragraph (5)
to be an eligible WTC responder, the WTC
Program Administrator shall provide the
certification under subparagraph (A) at the
time of the determination.
``(5) Numerical limitation on eligible wtc responders.--
``(A) In general.--The total number of individuals
not described in subparagraph (C) who may qualify as
eligible WTC responders for purposes of this title, and
be certified as eligible WTC responders under paragraph
(4), shall not exceed 15,000, subject to adjustment
under paragraph (6), of which no more than 2,500 may be
individuals certified based on modified eligibility
criteria established under paragraph (1)(C). In
applying the previous sentence, any individual who at
any time so qualifies as an eligible WTC responder
shall be counted against such numerical limitation.
``(B) Process.--In implementing subparagraph (A),
the WTC Program Administrator shall--
``(i) limit the number of certifications
provided under paragraph (4) in accordance with
such subparagraph; and
``(ii) provide priority in such
certifications in the order in which
individuals apply for a determination under
paragraph (3).
``(C) Currently identified responders not
counted.--Individuals described in this subparagraph
are individuals who are described in paragraph (1)(A).
``(6) Potential adjustment in numerical limitations
dependent upon actual spending relative to estimated
spending.--
``(A) Initial calculation for fiscal years 2009
through 2011.--If the WTC Program Administrator
determines as of December 1, 2011, that the WTC
expenditure-to-CBO-estimate percentage (as defined in
subparagraph (D)(iii)) for fiscal years 2009 through
2011 does not exceed 90 percent, then, effective
January 1, 2012, the WTC Program Administrator may
increase the numerical limitation under paragraph
(5)(A), the numerical limitation under section
3021(a)(5), or both, by a number of percentage points
not to exceed the number of percentage points specified
in subparagraph (C) for such period of fiscal years.
``(B) Subsequent calculation for fiscal years 2009
through 2015.--If the Secretary determines as of
December 1, 2015, that the WTC expenditure-to-CBO-
estimate percentages for fiscal years 2009 through 2015
and for fiscal years 2012 through 2015 do not exceed 90
percent, then, effective January 1, 2015, the WTC
Program Administrator may increase the numerical
limitation under paragraph (5)(A), the numerical
limitation under section 3021(a)(5), or both, as in
effect after the application of subparagraph (A), by a
number of percentage points not to exceed twice the
lesser of--
``(i) the number of percentage points
specified in subparagraph (C) for fiscal years
2009 through 2012, or
``(ii) the number of percentage points
specified in subparagraph (C) for fiscal years
2012 through 2015.
``(C) Maximum percentage increase in numerical
limitations for period of fiscal years.--The number of
percentage points specified in this clause for a period
of fiscal years is--
``(i) 100 percentage points, multiplied by
``(ii) one minus a fraction the numerator
of which is the net Federal WTC spending for
such period, and the denominator of which is
the CBO WTC spending estimate under this title
for such period.
``(D) Definitions.--For purposes of this paragraph:
``(i) Net federal spending.--The term `net
Federal WTC spending' means, with respect to a
period of fiscal years, the net Federal
spending under this title for such fiscal
years.
``(ii) CBO wtc spending estimate under this
title.--The term `CBO WTC medical spending
estimate under this title' means, with respect
to--
``(I) fiscal years 2009 through
2011, $900,000,000;
``(II) fiscal years 2012 through
2015, $1,890,000,000; and
``(III) fiscal years 2009 through
2015, the sum of the amounts specified
in subclauses (I) and (II).
``(iii) WTC expenditure-to-cbo-estimate
percentage.--The term `WTC expenditure-to-
estimate percentage' means, with respect to a
period of fiscal years, the ratio (expressed as
a percentage) of--
``(I) the net Federal WTC spending
for such period, to
``(II) the CBO WTC spending
estimate under this title for such
period.
``(b) Monitoring Benefits.--
``(1) In general.--In the case of an eligible WTC responder
under section 3011(a)(4) (other than one described in
subsection (a)(2)(A)(ii)), the WTC program shall provide for
monitoring benefits that include medical 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 eligible WTC responder who is
an active member of the Fire Department of the City of New
York, 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
3031.
``SEC. 3012. TREATMENT OF CERTIFIED ELIGIBLE 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) 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 on the World Trade Center,
based on an examination by a medical professional with
experience in treating or diagnosing the medical
conditions included in the applicable list of
identified WTC-related 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
``(B) a mental health condition for which such
attacks, based on an examination by a medical
professional with experience in treating or diagnosing
the medical conditions included in the applicable list
of identified WTC-related conditions, is substantially
likely be a significant factor in aggravating,
contributing to, or causing the condition, as
determined under paragraph (2).
In the case of an eligible WTC responder described in section
3011(a)(2)(A)(ii), such term only includes the mental health
condition described in subparagraph (B).
``(2) Determination.--The determination of whether the
September 11, 2001, terrorist attacks on the World Trade Center
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 medical conditions included on the
list of identified WTC-related 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 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 identified wtc-related health conditions for
certified eligible wtc responders.--For purposes of this title,
the term `identified WTC-related health condition for eligible
WTC responders' means any of the following health conditions:
``(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) Gastro-esophageal reflux disorder
(GERD).
``(xii) Sleep apnea exacerbated by or
related to a condition described in a previous
clause.
``(B) Mental health conditions.--
``(i) Post traumatic 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.
``(xi) V codes (treatments not specifically
related to psychiatric disorders, such as
marital problems, parenting problems etc.),
secondary to another identified WTC-related
health condition for WTC eligible responders.
``(C) Musculoskeletal disorders.--
``(i) Low back pain.
``(ii) Carpal tunnel syndrome (CTS).
``(iii) Other musculoskeletal disorders.
``(4) Addition of identified wtc-related health conditions
for eligible wtc responders.--
``(A) In general.--The WTC Program Administrator
may promulgate regulations to add an illness or health
condition not described in paragraph (3) to be added to
the list of identified WTC-related conditions for
eligible WTC responders. In promulgating such
regulations, the Secretary shall provide for notice and
opportunity for a public hearing and at least 90 days
of public comment. In promulgating such regulations,
the WTC Program Administrator shall take into account
the findings and recommendations of Clinical Centers of
Excellence published in peer reviewed journals in the
determination of whether an additional illness or
health condition, such as cancer, should be added to
the list of identified WTC-related health conditions
for eligible WTC responders.
``(B) Petitions.--Any person (including the WTC
Health Program Scientific/Technical Advisory Committee)
may petition the WTC Program Administrator to propose
regulations described in subparagraph (A). Unless
clearly frivolous, or initiated by such Committee, any
such petition shall be referred to such Committee for
its recommendations. Following--
``(i) receipt of any recommendation of the
Committee; or
``(ii) 180 days after the date of the
referral to the Committee,
whichever occurs first, the WTC Program Administrator
shall conduct a rulemaking proceeding on the matters
proposed in the petition or publish in the Federal
Register a statement of reasons for not conducting such
proceeding.
``(C) Effectiveness.--Any addition under
subparagraph (A) of an illness or health condition
shall apply only with respect to applications for
benefits under this title which are filed after the
effective date of such regulation.
``(D) Role of advisory committee.--Except with
respect to a regulation recommended by the WTC Health
Program Scientific/Technical Advisory Committee), the
WTC Program Administrator may not propose a regulation
under this paragraph, unless the Administrator has
first provided to the Committee a copy of the proposed
regulation, requested recommendations and comments by
the Committee, and afforded the Committee at least 90
days to make such recommendations.
``(b) Coverage of Treatment for WTC-Related Health Conditions.--
``(1) Determination based on an identified wtc-related
health condition for certified eligible wtc responders.--
``(A) In general.--If a physician at a Clinical
Center of Excellence that is providing monitoring
benefits under section 3011 for a certified eligible
WTC responder determines that the responder has an
identified WTC-related health condition, and the
physician makes a clinical determination that exposure
to airborne toxins, other hazards, or adverse
conditions resulting from the 9/11 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) of a WTC-related health
condition.
``(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 an identified WTC-
related health condition or that exposure to
airborne toxins, other hazards, or adverse
conditions resulting from the 9/11 terrorist
attacks is not substantially likely to be a
significant factor in significantly
aggravating, contributing to, or causing the
condition.
``(iii) Appeal process.--The Administrator
shall provide a process for the appeal of
determinations under clause (ii) before an
administrative law judge.
``(2) Determination based on other wtc-related health
condition.--
``(A) In general.--If a physician at a Clinical
Center of Excellence determines pursuant to subsection
(a) that the certified eligible WTC responder has a
WTC-related health condition that is not an identified
WTC-related health condition for eligible WTC
responders--
``(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) Review; certification.--
``(i) Use of physician panel.--With respect
to each determination relating to a WTC-related
health condition transmitted under subparagraph
(A)(i), the WTC Program Administrator shall
provide for the review of the condition to be
made by a physician panel with appropriate
expertise appointed by the WTC Program
Administrator. Such a panel shall make
recommendations to the Administrator on the
evidence supporting such determination.
``(ii) Review of recommendations of panel;
certification.--The Administrator, based on
such recommendations shall determine, within 60
days after the date of the transmittal under
subparagraph (A)(i), whether or not the
condition is a WTC-related health condition
and, if it is, provide for a certification
under paragraph (1)(B)(ii) of coverage of such
condition. The Administrator shall provide a
process for the appeal of determinations that
the responder's condition is not a WTC-related
health condition before an administrative law
judge.
``(3) Requirement of medical necessity.--
``(A) In general.--In providing treatment for a
WTC-health condition, a physician shall provide
treatment that is medically necessary and in accordance
with medical protocols established under subsection
(d).
``(B) Medically necessary standard.--For the
purpose of this title, health care services shall be
treated as medically necessary for an individual if a
physician, exercising prudent clinical judgment, would
consider the services to be medically necessary for the
individual for the purpose of evaluating, diagnosing,
or treating an illness, injury, disease or its
symptoms, and that are--
``(i) in accordance with the generally
accepted standards of medical practice;
``(ii) clinically appropriate, in terms of
type, frequency, extent, site, and duration,
and considered effective for the individual's
illness, injury, or disease; and
``(iii) not primarily for the convenience
of the patient or physician, or another
physician, and not more costly than an
alternative service or sequence of services at
least as likely to produce equivalent
therapeutic or diagnostic results as to the
diagnosis or treatment of the individual's
illness, injury, or disease.
``(C) Determination of medical necessity.--
``(i) Review of medical necessity.--As part
of the reimbursement payment process under
subsection (c), the WTC Program Administrator
shall review claims for reimbursement for the
provision of medical treatment to determine if
such treatment is medically necessary.
``(ii) Withholding of payment for medically
unnecessary treatment.--The Administrator may
withhold such payment for treatment that the
Administrator determines is not medically
necessary.
``(iii) Review of determinations of medical
necessity.--The Administrator shall provide a
process for providers to appeal a determination
under clause (ii) that medical treatment is not
medically necessary. Such appeals shall be
reviewed through the use of a physician panel
with appropriate expertise.
``(4) Scope of treatment covered.--
``(A) In general.--The scope of treatment covered
under such paragraphs 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.--To the extent
provided in advance in appropriations Acts, the WTC
Program Administrator may provide for necessary and
reasonable transportation and expenses incident to the
securing of medically necessary treatment 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.--In the
case of a certified eligible WTC responder who has been
determined by an examining physician under subsection (b)(1) to
have an identified WTC-related health condition, but for whom a
certification of the determination has not yet been made by the
WTC Program Administrator, medical treatment may be provided
under this subsection, subject to paragraph (6), until the
Administrator makes a decision on such certification. Medical
treatment provided under this paragraph shall be considered to
be medical treatment for which payment may be made under
subsection (c).
``(6) Prior approval process for non-certified non-
emergency inpatient hospital services.--Non-emergency inpatient
hospital services for a WTC-related health condition identified
by an examining physician under paragraph (b)(1) that is not
certified under paragraph (1)(B)(ii) is not covered unless the
services have been determined to be medically necessary and
approved through a process established by the WTC Program
Administrator. Such process shall provide for a decision on a
request for such services within 15 days of the date of receipt
of the request. The WTC Administrator shall provide a process
for the appeal of a decision that the services are not
medically necessary.
``(c) Payment for Initial Health Evaluation, Medical Monitoring,
and Treatment of WTC-Related Health Conditions.--
``(1) Medical treatment.--
``(A) Use of feca payment rates.--Subject to
subparagraph (B), 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.
``(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 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
select a separate vendor to provide
pharmaceutical benefits to certified eligible
WTC responders for whom the Clinical Center of
Excellence is described in section
3006(b)(1)(A) if such an arrangement is deemed
necessary and beneficial to the program by the
WTC Program Administrator.
``(C) Other treatment.--For treatment not covered
under a preceding subparagraph, the WTC Program
Administrator shall designate a reimbursement rate for
each such service.
``(2) Medical monitoring and initial health evaluation.--
The WTC Program Administrator shall reimburse the costs of
medical monitoring and the costs of an initial health
evaluation provided under this title at a rate set by the
Administrator.
``(3) 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 this section.
``(4) Claims processing subject to appropriations.--The
payment by the WTC Program Administrator for the processing of
claims under this title is limited to the amounts provided in
advance in appropriations Acts.
``(d) Medical Treatment Protocols.--
``(1) Development.--The Coordinating Centers of Excellence
shall develop medical treatment protocols for the treatment of
certified eligible WTC responders and certified eligible WTC
community members for identified WTC-related health conditions.
``(2) Approval.--The WTC Program Administrator shall
approve the medical treatment protocols, in consultation with
the WTC Health Program Steering Committees.
``PART 2--COMMUNITY PROGRAM
``SEC. 3021. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF ELIGIBLE
WTC COMMUNITY MEMBERS.
``(a) Eligible WTC Community Member Defined.--
``(1) In general.--In this title, the term `eligible WTC
community member' means, subject to paragraphs (3) and (5), an
individual who claims symptoms of a WTC-related health
condition and is described in any of the following
subparagraphs:
``(A) Currently identified community member.--An
individual, including an eligible WTC responder, who
has been identified as eligible for medical treatment
or monitoring by the WTC Environmental Health Center as
of the date of enactment of this title.
``(B) Community member who meets current
eligibility criteria.--An individual who is not an
eligible WTC responder and meets any of the current
eligibility criteria described in a subparagraph of
paragraph (2).
``(C) Community member who meets modified
eligibility criteria.--An individual who is not an
eligible WTC responder and meets such eligibility
criteria relating to exposure to airborne toxins, other
hazards, or adverse conditions resulting from the
September 11, 2001, terrorist attacks on the World
Trade Center as the WTC Administrator determines
eligible, after consultation with the WTC Community
Program Steering Committee, Coordinating Centers of
Excellence described in section 3006(b)(1)(C), and the
WTC Scientific/Technical Advisory Committee.
The Administrator shall not modify such criteria under
subparagraph (C) on or after the date that the number of
certifications for eligible community members has reached 80
percent of the limit described in paragraph (5) or on or after
the date that the number of certifications for eligible
responders has reached 80 percent of the limit described in
section 3021(a)(5).
``(2) Current eligibility criteria.--The eligibility
criteria described in this paragraph for an individual are that
the individual is described in any of the following
subparagraphs:
``(A) A person who was present in the New York City
disaster area in the dust or dust cloud on September
11, 2001.
``(B) A person who worked, resided or attended
school, child care or adult day care in the New York
City disaster area for--
``(i) at least four 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.
``(C) Any person who worked as a clean-up 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.
``(D) 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.
``(E) 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 on the World Trade
Center.
``(3) Application process.--The WTC Program Administrator
in consultation with the Coordinating Centers of Excellence
shall establish a process for individuals, other than
individuals described in paragraph (1)(A), to be determined
eligible WTC community member. Under such process--
``(A) there shall be no fee charged to the
applicant for making an application for such
determination;
``(B) the Administrator shall make a determination
on such an application not later than 60 days after the
date of filing the application; and
``(C) an individual who is determined not to be an
eligible WTC community member shall have an opportunity
to appeal such determination before an administrative
law judge in a manner established under such process.
``(4) Certification.--
``(A) In general.--In the case of an individual who
is described in paragraph (1)(A) or who is determined
under paragraph (3) (consistent with paragraph (5)) to
be an eligible WTC community member, the WTC Program
Administrator shall provide an appropriate
certification of such fact and of eligibility for
followup monitoring and treatment benefits under this
part. The Administrator shall make determinations of
eligibility relating to an applicant's compliance with
this title, including the verification of information
submitted in support of the application and shall not
deny such a certification to an individual unless the
Administrator determines that--
``(i) based on the application submitted,
the individual does not meet the eligibility
criteria; or
``(ii) the numerical limitation on
certification of eligible WTC community members
set forth in paragraph (5) has been met.
``(B) Timing.--
``(i) Currently identified community
members.--In the case of an individual who is
described in paragraph (1)(A), the WTC Program
Administrator shall provide the certification
under subparagraph (A) not later than 60 days
after the date of the enactment of this title.
``(ii) Other members.--In the case of
another individual who is determined under
paragraph (3) and consistent with paragraph (5)
to be an eligible WTC community member, the WTC
Program Administrator shall provide the
certification under subparagraph (A) at the
time of such determination.
``(5) Numerical limitation on certification of eligible wtc
community members.--
``(A) In general.--The total number of individuals
not described in subparagraph (C) who may be certified
as eligible WTC community members under paragraph (4)
shall not exceed 15,000. In applying the previous
sentence, any individual who at any time so qualifies
as an eligible WTC community member shall be counted
against such numerical limitation.
``(B) Process.--In implementing subparagraph (A),
the WTC Program Administrator shall--
``(i) limit the number of certifications
provided under paragraph (4) in accordance with
such subparagraph; and
``(ii) provide priority in such
certifications in the order in which
individuals apply for a determination under
paragraph (4).
``(C) Individuals currently receiving treatment not
counted.--Individuals described in this subparagraph
are individuals who--
``(i) are described in paragraph (1)(A); or
``(ii) before the date of the enactment of
this title, have received monitoring or
treatment at the World Trade Center
Environmental Health Center at Bellevue
Hospital Center, Gouverneur Health Care
Services, or Elmhurst Hospital Center.
The New York City Health and Hospitals Corporation
shall, not later than 6 months after the date of
enactment of this title, enter into arrangements with
the Mt. Sinai Data and Clinical Coordination Center for
the reporting of medical data concerning eligible WTC
responders described in paragraph (1)(A), as determined
by the WTC Program Administrator and consistent with
applicable Federal and State laws and regulations
relating to confidentiality of individually
identifiable health information.
``(D) Report to congress if numerical limitation to
be reached.--If the WTC Program Administrator
determines that the number of individuals subject to
the numerical limitation of subparagraph (A) is likely
to exceed such numerical limitation, the Administrator
shall submit to Congress a report on such
determination. Such report shall include an estimate of
the number of such individuals in excess of such
numerical limitation and of the additional expenditures
that would result under this title if such numerical
limitation were removed.
``(b) Initial Health Evaluation To Determine Eligibility for
Followup Monitoring or Treatment.--
``(1) In general.--In the case of a certified eligible WTC
community member, the WTC program shall provide for an initial
health evaluation to determine if the member has a WTC-related
health condition and is eligible for followup monitoring and
treatment benefits under the WTC program. Initial health
evaluation protocols shall be approved by the WTC Program
Administrator, in consultation with the World Trade Center
Environmental Health Center at Bellevue Hospital and the WTC
Community Program Steering Committee.
``(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 initial health evaluation under this part for an
eligible WTC community member 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. 3022. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED ELIGIBLE
WTC COMMUNITY MEMBERS FOR WTC-RELATED HEALTH CONDITIONS.
``(a) In General.--Subject to subsection (b), the provisions of
sections 3011 and 3012 shall apply to followup monitoring and treatment
of WTC-related health conditions for certified eligible WTC community
members in the same manner as such provisions apply to the monitoring
and treatment of identified WTC-related health conditions for certified
eligible WTC responders, except that such monitoring shall only be
available to those certified as eligible for treatment under this
title. Under section 3006(a)(3), the City of New York is required to
contribute a share of the costs of such treatment.
``(b) List of Identified WTC-related Health Conditions for WTC
Community Members.--
``(1) Identified wtc-related health conditions for wtc
community members.--For purposes of this title, the term
`identified WTC-related health conditions for WTC community
members' means any of the following health conditions:
``(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) Gastro-esophageal reflux disorder
(GERD).
``(xii) Sleep apnea exacerbated by or
related to a condition described in a previous
clause.
``(B) Mental health conditions.--
``(i) Post traumatic 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.
``(xi) V codes (treatments not specifically
related to psychiatric disorders, such as
marital problems, parenting problems etc.),
secondary to another identified WTC-related
health condition for WTC community members.
``(2) Additions to identified wtc-related health conditions
for wtc community members.--The provisions of paragraph (4) of
section 3012(a) shall apply with respect to an addition to the
list of identified WTC-related conditions for eligible WTC
community members under paragraph (1) in the same manner as
such provisions apply to an addition to the list of identified
WTC-related conditions for eligible WTC responders under
section 3012(a)(3).
``SEC. 3023. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS
WITH WTC-RELATED HEALTH CONDITIONS.
``(a) In General.--Subject to subsection (c), the provisions of
section 3022 shall apply to the followup monitoring and treatment of
WTC-related health conditions for eligible WTC community members 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 WTC community members. Under section
3006(a)(3), the City of New York is required to contribute a share of
the costs of such monitoring and treatment.
``(b) Individuals Described.--An individual described in this
subsection is an individual who, regardless of location of residence--
``(1) is not a eligible WTC responder or an eligible WTC
community member; and
``(2) is diagnosed at a Clinical Center of Excellence (with
respect to an eligible WTC community member) with an identified
WTC-related health condition for WTC community members.
``(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) fiscal year 2009 is $20,000,000; or
``(B) 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--NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS
OUTSIDE NEW YORK
``SEC. 3031. 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 eligible WTC responders or
eligible WTC community members 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
Coordinating Centers of Excellence;
``(2) follow the monitoring, initial health evaluation, and
treatment protocols developed under section 3006(a)(2)(B);
``(3) collect and report data in accordance with section
3005; and
``(4) meet such fraud, quality assurance, and other
requirements as the WTC Program Administrator establishes.
``Subtitle C--Research Into Conditions
``SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO
SEPTEMBER 11 TERRORIST ATTACKS IN NEW YORK CITY.
``(a) In General.--With respect to individuals, including eligible
WTC responders and eligible WTC community members, 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 3051), through a Clinical Center of
Excellence, or through a Coordinating Center of Excellence.
``(b) Types of Research.--The research under subsection (a)(1)
shall include epidemiologic and other research studies on WTC-related
conditions or emerging conditions--
``(1) among WTC responders and community members 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 Health Program Steering
Committees and 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 otherwise conducted by the National Institutes of Health.
``(e) Authorization of Appropriations.--For the purpose of carrying
out this section, there are authorized to be appropriated $15,000,000
for each fiscal year, in addition to any other authorizations of
appropriations that are available for such purpose.
``Subtitle D--Programs of the New York City Department of Health and
Mental Hygiene
``SEC. 3051. WORLD TRADE CENTER HEALTH REGISTRY.
``(a) Program Extension.--For the purpose of ensuring on-going data
collection for victims of the September 11, 2001, terrorist attacks on
the World Trade Center, the WTC Program Administrator, shall extend and
expand the arrangements in effect as of January 1, 2008, with the New
York City Department of Health and Mental Hygiene that provide for the
World Trade Center Health Registry.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated $7,000,000 for each fiscal year to carry out this section.
``SEC. 3052. MENTAL HEALTH SERVICES.
``(a) In General.--The WTC Program Administrator may make grants to
the New York City Department of Health and Mental Hygiene to provide
mental health services to address mental health needs relating to the
September 11, 2001, terrorist attacks on the World Trade Center.
``(b) Authorization of Appropriations.--There are authorized to be
appropriated $8,500,000 for each fiscal year to carry out this
section.''.
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'' 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 August 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 December 22, 2031.''.
(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) Authority to reinstitute certain lawsuits.--Such
section, as so redesignated, is further amended by adding at
the end the following new clause:
``(iii) Authority to reinstitute certain
lawsuits.--In the case of a claimant who was a
party to a civil action described in clause
(i), who withdrew from such action pursuant to
clause (ii), and who is subsequently determined
to not be an eligible individual for purposes
of this subsection, such claimant may
reinstitute such action without prejudice
during the 90-day period beginning after the
date of such ineligibility determination.''.
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 90 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
through December 22, 2031) 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 clauses (i) and (ii)
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)(A) applies, shall be paid solely
from the following funds in the following order, as may be
applicable:
``(A) The funds described in clause (i) or (ii) of
paragraph (4)(A).
``(B) If there are no funds available as described
in clause (i) or (ii) of paragraph (4)(A), the funds
described in clause (iii) of such paragraph.
``(C) If there are no funds available as described
in clause (i), (ii), or (iii) of paragraph (4)(A), the
funds described in clause (iv) of such paragraph.
``(D) If there are no funds available as described
in clause (i), (ii), (iii), or (iv) of paragraph
(4)(A), the funds described in clause (v) of such
paragraph.
``(6) Declaratory judgment actions and direct action.--Any
party to a claim or action to which paragraph (4)(A) 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.''.
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 subsection (d), not later than'';
(2) in subsection (b), by striking ``This title'' and
inserting ``Subject to subsection (d), this title''; and
(3) by adding at the end the following new subsections:
``(d) Limitation.--The total payment of amounts 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 $8,400,000,000.
``(e) Attorney Fees.--
``(1) In general.--Notwithstanding any contract, and except
as provided in paragraph (2), 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) Exception.--With respect to a claim made on behalf of
an individual for whom a lawsuit was filed in the Southern
District of New York prior to January 1, 2009, in the event
that the representative believes in good faith that the fee
limit set by paragraph (1) will not provide adequate
compensation for services rendered in connection with such
claim because of the substantial amount of legal work provided
on behalf of the claimant (including work performed before the
enactment of this legislation), application for greater
compensation may be made to the Special Master. Upon such
application, the Special Master may, in his or her discretion,
award as reasonable compensation for services rendered an
amount greater than that allowed for in paragraph (1). Such fee
award will be final, binding, and non-appealable.''.
Union Calendar No. 321
111th CONGRESS
2d Session
H. R. 847
[Report No. 111-560, Parts I and II]
_______________________________________________________________________
A BILL
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.
_______________________________________________________________________
July 22, 2010
Reported with an amendment, committed to the Committee of the Whole
House on the State of the Union, and ordered to be printed