    [House Report 111-560]
    [From the U.S. Government Publishing Office]

    111th Congress                                            Rept. 111-560
                            HOUSE OF REPRESENTATIVES
     2d Session                                                      Part 1

    ======================================================================

             JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010

                                    _______

     July 22, 2010.--Committed to the Committee of the Whole House on the
                  State of the Union and ordered to be printed

                                    _______

     Mr. Waxman, from the Committee on Energy and Commerce, submitted the
                                   following

                                  R E P O R T

                                 together with

                                DISSENTING VIEWS

                            [To accompany H.R. 847]

          [Including cost estimate of the Congressional Budget Office]

      The Committee on Energy and Commerce, to whom was referred
    the bill (H.R. 847) 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, having considered
    the same, report favorably thereon with an amendment and
    recommend that the bill as amended do pass.

                                    CONTENTS

                                                                       Page
    Amendment........................................................     2
    Purpose and Summary..............................................    28
    Background and Need for Legislation..............................    28
    Legislative History..............................................    32
    Committee Consideration..........................................    32
    Committee Votes..................................................    33
    Committee Oversight Findings and Recommendations.................    46
    New Budget Authority, Entitlement Authority, and Tax Expenditures    46
    Statement of General Performance Goals and Objectives............    46
    Constitutional Authority Statement...............................    46
    Earmarks and Tax and Tariff Benefits.............................    46
    Advisory Committee Statement.....................................    46
    Applicability of Law to the Legislative Branch...................    46
    Federal Mandates Statement.......................................    46
    Committee Cost Estimate..........................................    47
    Congressional Budget Office Estimate.............................    47
    Section-by-Section Analysis of the Legislation...................    61
    Changes in Existing Law Made by the Bill, as Reported............    67
    Dissenting Views.................................................   103

                                   Amendment

      The amendment is as follows:
      Strike all after the enacting clause and insert the
    following:

    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.''.

                              Purpose and Summary

        Title I of H.R. 847, the James Zadroga 9/11 Health and
    Compensation Act of 2010, amends the Public Health Service Act
    to provide monitoring and treatment services to individuals
    with health conditions resulting from the September 11, 2001,
    terrorist attacks at the World Trade Center (WTC), the
    Pentagon, and Shanksville, Pennsylvania, including rescue
    personnel, workers who participated in clean-up, and residents
    and others present in the area near the World Trade Center.
    Title II of H.R. 847 amends the Air Transportation Safety and
    System Stabilization Act to reopen the September 11 Victim
    Compensation Fund of 2001 to provide monetary compensation to
    eligible individuals for physical harm resulting from the
    terrorist attacks.

                      Background and Need for Legislation

                  THE TERRORIST ATTACKS OF SEPTEMBER 11, 2001

        On September 11, 2001, terrorists flying four airplanes
    attacked the United States. One plane flew into the Pentagon,
    one crashed in a field in Shanksville, Pennsylvania, en route
    to Washington, D.C., and two planes were crashed into the World
    Trade Center Twin Towers in New York City.
        The resulting collapse of the Twin Towers (and a third
    building) killed more than 2,751 people, including 343
    firefighters and rescue workers. It also produced ``a complex
    and unprecedented mix of toxic chemicals.''\1\ Burning jet fuel
    resulted in a plume of black smoke containing benzene, metals,
    and polycyclic aromatic hydrocarbons. From the wreckage of the
    Twin Towers arose an enormous dust cloud consisting of
    pulverized cement, microscopic glass fibers and shards,
    asbestos, lead, hydrochloric acid, polychlorinated biphenyls
    (PCBs), organochlorine pesticides, furans, and dioxins. The
    pulverized cement accounted for 60% to 65% of the total dust
    mass, making it extremely caustic, with a pH between 9 and 11
    similar to lye.\2\
    ---------------------------------------------------------------------------
        \1\Testimony of Jacqueline Moline, M.D. M. Sc., Director, World
    Trade Center Medical Monitoring and Treatment Program at Mount Sinai
    School of Medicine, before the House Committee on Energy and Commerce
    Subcommittee on Health, Hearing on H.R. 847 (Apr. 22, 2009).
        \2\Landrigan et al., Health and Environmental Consequences of the
    World Trade Center Disaster, Environ Health Perspect, pp. 731-739
    (2004).
    ---------------------------------------------------------------------------
        An estimated 60,000 to 70,000 first responders and
    volunteers from all 50 states converged on the World Trade
    Center site to help in the rescue and recovery and debris
    removal and clean-up efforts. Some of these responders worked
    at the site for days, weeks, and even months. Fires burned
    above and below ground until December 2001. The debris removal
    and cleanup continued until May 2002. During much of this time,
    the air around the site remained toxic.
        Exposure to the dust and toxic chemicals, and to the death
    and devastation at the site, had long-term health effects on
    the responders and on those who returned to the area around the
    site to live and to work. The Subcommittee on Health heard
    testimony from the Director of the World Trade Center Medical
    Monitoring and Treatment Program at the Mount Sinai School of
    Medicine that the following conditions were common among the
    responders being treated there: sinus disorders, asthma,
    gastro-esophageal reflux disorder, post-traumatic stress
    disorder (PTSD), and major depression. A study recently
    published in the New England Journal of Medicine reported that
    firefighters and EMS workers who were at the World Trade Center
    site during the first two weeks after the attacks lost about
    10% of their lung function in the first year, and that this
    loss persisted during the subsequent 6 years.\3\ This decrease
    in ventilatory function is equivalent to 12 years of age-
    related decline.\4\
    ---------------------------------------------------------------------------
        \3\Aldrich et al., Lung Function in Rescue Workers at the World
    Trade Center after 7 Years, New England Journal of Medicine (April 8,
    2010), pp. 1263-1272.
        \4\Banauch et al., Pulmonary Function after Exposure to the World
    Trade Center in the New York City Fire Department, Am J Respir Crit
    Care Med, pp. 312-319 (2006).
    ---------------------------------------------------------------------------

                     THE WORLD TRADE CENTER HEALTH PROGRAMS

        The World Trade Center Health Programs provide medical
    screening, monitoring, and treatment services for responders as
    well as for non-responders who resided, worked, or went to
    school in the community directly affected by the September 11,
    2001, attacks. The programs are administered by the National
    Institute for Occupational Safety and Health (NIOSH), an agency
    of the Centers for Disease Control and Prevention (CDC) within
    the Department of Health and Human Services (HHS). NIOSH
    supports six clinical centers and two data coordination centers
    as well as the WTC Health Registry. A total of $71 million is
    appropriated in FY2010 to support these activities. The
    President's budget requests $150 million in FY2011. Since
    FY2003, a total of $326 million has been obligated for these
    purposes.
        There are three WTC Responder programs: a program operated
    by the Fire Department of New York (FDNY); a consortium
    coordinated by Mt. Sinai School of Medicine; and a national
    program for responders outside of the New York City/New Jersey
    metropolitan area managed by Logistics Health, Inc., under
    contract to NIOSH. As of March 31, 2010, a total of 52,700
    individuals were enrolled in the WTC Responders programs (about
    4,500 of these were enrolled in the national program). During
    the previous year, 24,100 of these enrolled responders received
    monitoring exams, and 13,300 received treatment through five
    clinical centers of excellence: Bellevue Hospital/New York
    University School of Medicine; City University of New York/
    Queens College; Mount Sinai School of Medicine; State
    University of New York at Stony Brook; and the University of
    Medicine and Dentistry of New Jersey/Robert Wood Johnson
    Medical School. These clinical centers are supported by two
    data and coordination centers: one located at the FDNY, the
    other at Mt. Sinai. The Responder programs have been funded by
    the federal government since FY2003; in FY2009, $104 million
    was obligated for this purpose.
        Federal funding for the WTC Community Program began in
    September 2008. The program is operated by the New York City
    Health and Hospitals Corporation through three locations:
    Bellevue Hospital Center on the East Side of Manhattan;
    Gouverneur Healthcare Services in Lower Manhattan; and Elmhurst
    Hospital in Queens. About 4,600 individuals were enrolled in
    the WTC Community Program as of March 31, 2010. Of these, 1,200
    received monitoring exams and 2,600 received treatment during
    the previous year. In FY2009, $10 million was obligated for the
    Community Program.
        In addition to providing initial screening, monitoring, and
    treatment services, the WTC Health Programs have supported
    research on the health effects of exposure to the toxic dust
    cloud by rescue workers and others at the World Trade Center
    site. This developing science is used to inform the treatment
    of enrollees in the Responder and Community programs and is
    posted on the NIOSH website.\5\ In addition, the New York City
    Department of Health and Mental Hygiene established the WTC
    Health Registry, which includes individuals at risk for
    possible near and long term physical and mental health effects
    from the attacks. Before it closed to new registrants in 2004,
    the WTC Health Registry had enrolled more than 70,000
    residents, workers, students, and responders. NIOSH funding
    helps to support the Registry.
    ---------------------------------------------------------------------------
        \5\http://www.cdc.gov/niosh/topics/wtc/SciSumAllByYear.html.
    ---------------------------------------------------------------------------

                              NEED FOR LEGISLATION

        The WTC Health Programs currently funded by the federal
    government are not authorized in statute. That is, there is no
    legislation authorizing the appropriation of funds to NIOSH to
    support these programs. The absence of such legislation has not
    precluded--and should not preclude--the funding of these
    programs. It is far preferable, however, for Congress to set
    forth in an authorizing statute the purpose and scope of the
    programs needed, the individuals intended to be assisted, and
    the resources necessary. An authorizing statute can improve
    accountability of the agency responsible for administering the
    programs, transparency in operation, and stability of funding
    over time.
        In the case of the September 11, 2001, terrorist attacks,
    the need for monitoring and treatment will not end this fiscal
    year or anytime in the near future. The evidence from the
    current WTC Health Program is overwhelming: many responders and
    non-responders in the affected communities have developed
    complex health conditions resulting from exposures at the sites
    of the attacks that require specialized treatment, and more
    health conditions requiring such treatment are likely to emerge
    among these populations in the future.
        The September 11, 2001, terrorist attacks at the Pentagon,
    the World Trade Center, and Shanksville were an attack on this
    nation. The Committee believes the federal government has a
    moral obligation to ensure that those who participated in the
    rescue and recovery and debris removal and clean-up operations
    at these sites receive the services necessary to treat the
    health conditions resulting from their participation. In the
    case of the World Trade Center site, this obligation extends to
    those who returned to the affected neighborhoods shortly after
    the attack to live, work, and go to school and, as a result,
    were exposed to the toxic dust.
        To fulfill this moral obligation, the federal government
    must make a long-term commitment to the monitoring and
    treatment of health and mental health conditions resulting from
    the terrorist attacks. The Committee bill represents that
    commitment.
        The bill would amend the Public Health Service Act to
    establish a new World Trade Center Health Program to monitor
    and treat the health conditions developed by responders and
    community residents as the result of the September 11, 2001,
    attacks. The new WTC Program, to be administered primarily by
    NIOSH, would build upon and improve the existing WTC health
    programs. The federal government would provide funding on a
    mandatory basis over the next 10 years for 90% of the costs of
    operating the new program. The remaining 10% of the costs of
    the program would be the responsibility of New York City.
        The federal government's contribution to the new program
    would not be open-ended. Federal funds would be capped at the
    lower of 90% of the costs or a specified amount each fiscal
    year beginning in FY2011 and ending in FY2020. Over this 10-
    year period, federal outlays for all aspects of the new
    program--education and outreach, initial evaluation,
    monitoring, treatment, data collection, and research--could not
    exceed $4.59 billion. No federal funds would be available for
    the program after FY2020. The bill prohibits the disbursement
    of any federal funds for the program unless New York City has
    entered into an enforceable contract with the WTC Program
    Administrator in which it agrees to pay its share of program
    costs on a timely basis.
        The bill contains a number of provisions designed to ensure
    that federal funds committed to the WTC Program are spent
    efficiently and effectively. Payment may not be made for
    treatment services unless they are medically necessary as
    determined under regulations issued by the WTC Program
    Administrator. In addition, treatment services must be
    consistent with protocols developed by the Data Centers and
    approved by the Administrator. Monitoring services must also be
    consistent with protocols approved by the Administrator in
    order to qualify for payment. The bill also authorizes the WTC
    Program Administrator, based on utilization and quality data
    furnished by the Clinical Centers of Excellence, to modify
    amounts and methodologies for payments to providers in order to
    improve quality and efficient delivery of services. To ensure
    accountability, the bill directs the Inspector General of HHS
    to review the program's expenditures to detect fraudulent or
    duplicate billing, payment for inappropriate services, or
    unreasonable administrative costs.
        Finally, the bill strengthens the federal government's
    commitment to uniform data collection through Data Centers
    designated by the Program Administrator, epidemiological
    surveillance through the WTC Registry, and ongoing research
    into health conditions that may be related to exposures to the
    toxic dust at the World Trade Center site. The bill sets aside
    mandatory funding, up to specified amounts, for these
    activities for each fiscal year through FY2020. This clinical
    and epidemiological data, and the research on WTC-related
    health conditions, will provide information about medical
    trends, patterns of disease, outcomes, and efficacy of
    treatments essential to improving the treatment of responders
    and survivors and their health outcomes.
        The September 11, 2001, attacks at the Pentagon and
    Shanksville, Pennsylvania sites have been less well documented
    than the World Trade Center site. The Office of the Secretary
    of Defense estimates that there were less than 1,000 responders
    in the first few days following the attack at the Pentagon site
    and approximately 3,500 individuals who participated in the
    cleanup of that site in the year after it occurred.

                              Legislative History

        On February 4, 2009, Reps. Carolyn B. Maloney (D-NY) and
    Jerrold Nadler (D-NY) and other members of the New York
    delegation introduced H.R. 847, the ``James Zadroga 9/11 Health
    and Compensation Act of 2009''. The bill 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. H.R. 847 is a revision of H.R. 7174,
    the bill from the 110th Congress that was introduced on
    September 27, 2008.
        H.R. 847 was referred to the Subcommittee on Health on
    February 9, 2010, and a legislative hearing on the bill was
    held April 22, 2009. Testimony was heard from sponsors of the
    legislation; a construction worker who volunteered to help with
    debris removal in the immediate aftermath of the attack on the
    World Trade Center; the Directors of the WTC Environmental
    Health Center at Bellevue Hospital and the WTC Medical
    Monitoring and Treatment Center at Mt. Sinai Medical School;
    and a representative from the City of New York.

                            Committee Consideration

        On March 16, 2010, the Subcommittee on Health met in open
    markup session to consider H.R. 847. Subcommittee Chairman
    Pallone offered a manager's amendment in the form of an
    amendment in the nature of a substitute, which was approved by
    a voice vote. Subsequently, the Subcommittee approved a motion
    to forward H.R. 847, amended, favorably to the full Committee
    by a roll call vote: 25-8.
        On May 25, 2010, the Committee on Energy and Commerce met
    in open markup session to consider H.R. 847 as approved by the
    Subcommittee on Health. Chairman Waxman offered a manager's
    amendment in the form of an amendment in the nature of a
    substitute. The Committee agreed to four amendments offered to
    the substitute amendment. The Committee adopted the Waxman
    manager's amendment, as amended, by a voice vote. Subsequently,
    the Committee ordered H.R. 847 favorably reported to the House,
    amended, by a roll call vote: 33-12.

                                Committee Votes

        Clause 3(b) of rule XIII of the Rules of the House of
    Representatives requires the Committee to list each record vote
    on the motion to report legislation and amendments thereto. A
    motion by Mr. Waxman to order H.R. 847 favorably reported to
    the House, amended, was approved by a record vote of 33 yeas
    and 12 nays. The following is the record vote taken during
    Committee consideration, including the names of those members
    voting for and against:

                Committee Oversight Findings and Recommendations

        In compliance with clause 3(c)(1) of rule XIII of the Rules
    of the House of Representatives, the findings and
    recommendations of the Committee are reflected in the
    descriptive portions of this report.

       New Budget Authority, Entitlement Authority, and Tax Expenditures

        Regarding compliance with clause 3(c)(2) of rule XIII of
    the Rules of the House of Representatives, the Committee adopts
    as its own the estimate prepared by the Director of the
    Congressional Budget Office pursuant to section 402 of the
    Congressional Budget Act of 1974.

             Statement of General Performance Goals and Objectives

        In accordance with clause 3(c)(4) of rule XIII of the Rules
    of the House of Representatives, the performance goals and
    objectives of H.R. 847 are reflected in the descriptive
    portions of this report.

                       Constitutional Authority Statement

        Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
    House of Representatives, the Committee finds that the
    constitutional authority for H.R. 847 is provided in Article I,
    section 8, clauses 1, 3, and 18 of the Constitution of the
    United States.

                      Earmarks and Tax and Tariff Benefits

        H.R. 847 does not contain any congressional earmarks,
    limited tax benefits, or limited tariff benefits as defined in
    clause 9 of rule XXI of the Rules of the House of
    Representatives.

                          Advisory Committee Statement

        The Committee finds that the legislation establishes or
    authorizes the establishment of an advisory committee within
    the meaning of section 5 U.S.C. App., 5(b) of the Federal
    Advisory Committee Act. Title I of H.R. 847 provides for the
    creation of the WTC Health Program Scientific Technical
    Advisory Committee to review scientific and medical evidence
    and make recommendations to the Administrator of the WTC Health
    Program. The Committee finds that this Advisory Committee is
    needed to assist the Administrator in evaluating WTC Program
    eligibility criteria and whether there are additional WTC-
    related health conditions.

                 Applicability of Law to the Legislative Branch

        The Committee finds that Title I of H.R. 847 does not
    relate to the terms and conditions of employment or access to
    public services or accommodations within the meaning of section
    102(b)(3) of the Congressional Accountability Act of 1985.

                           Federal Mandates Statement

        The Committee adopts as its own the estimates of federal
    mandates relating to Title I of H.R. 847 prepared by the
    Director of the Congressional Budget Office pursuant to section
    423 of the Unfunded Mandate Reform Act.

                            Committee Cost Estimate

        Pursuant to clause 3(d) of rule XIII of the Rules of the
    House of Representatives, the Committee adopts as its own the
    cost estimate of Title I of H.R. 847 prepared by the Director
    of the Congressional Budget Office pursuant to section 402 of
    the Congressional Budget Act.

                      Congressional Budget Office Estimate

        Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
    House of Representatives, the following is the cost estimate on
    H.R. 847 provided by the Congressional Budget Office pursuant
    to section 402 of the Congressional Budget Act of 1974:

                                         U.S. Congress,
                                   Congressional Budget Office,
                                         Washington, DC, June 25, 2010.
    Hon. Henry A. Waxman,
    Chairman, Committee on Energy and Commerce,
    House of Representatives, Washington, DC.
        Dear Mr. Chairman: The Congressional Budget Office has
    prepared the enclosed cost estimate for H.R. 847, the James
    Zadroga 9/11 Health and Compensation Act of 2010. As you
    requested, CBO has completed an estimate that reflects Title I
    of the bill as ordered reported by the Committee on Energy and
    Commerce and Title II as ordered reported by the Committee on
    the Judiciary.
        If you wish further details on this estimate, we will be
    pleased to provide them. The CBO staff contacts are Stephanie
    Cameron (Title I), and Leigh Angres (Title II).
                Sincerely,
                                             Robert A. Sunshine
                                  (For Douglas W. Elmendorf, Director).
        Enclosure.

    H.R. 847--James Zadroga 9/11 Health and Compensation Act of 2010

        Summary: H.R. 847 would establish the World Trade Center
    (WTC) Health Program and extend and expand eligibility for
    compensation under the September 11th Victim Compensation Fund
    (VCF) of 2001. Specifically, H.R. 847 would provide:
               Health care benefits for eligible emergency
            personnel who responded to the September 11, 2001,
            terrorist attacks (the terrorist attacks) in New York
            City, the Pentagon, and Shanksville, Pennsylvania, and
            for workers who participated in recovery and cleanup
            following the attacks (collectively referred to as
            responders in this estimate);
               Health care benefits for eligible residents
            and others present in the area of New York City near
            the World Trade Center (defined as survivors under the
            bill); and
               Monetary compensation to individuals
            eligible under the bill to submit claims for death and
            physical injury claims resulting from the attacks.
        CBO estimates that enacting H.R. 847 would increase direct
    spending by $7.2 billion over the 2011-2015 period and $10.5
    billion over the 2011-2020 period. Pay-as-you-go procedures
    apply because enacting the legislation would affect direct
    spending.
        In addition, we estimate that, subject to appropriation of
    the necessary amounts, administering the VCF awards process
    would cost $514 million over the next 10 years. However,
    assuming appropriation actions consistent with title I of the
    bill, CBO estimates a $688 million reduction in discretionary
    outlays over the 2011-2020 period because some spending that is
    currently funded by annual appropriations would become direct
    spending under the bill. On balance, CBO estimates that
    discretionary spending would decrease by $174 million over 10
    years.
        H.R. 847 contains no intergovernmental mandates as defined
    in the Unfunded Mandates Reform Act (UMRA).
        H.R. 847 would impose a private-sector mandate as defined
    in UMRA. The bill would impose a mandate on individuals seeking
    compensatory damages or other relief arising from or related to
    debris removal from sites of the terrorist attacks by limiting
    the liability of entities from which individuals might win
    compensation. CBO cannot determine whether the aggregate cost
    of complying with that mandate would exceed the threshold
    established by UMRA for private-sector mandates in 2011 ($141
    million in 2010, adjusted annually for inflation).
        Estimated cost to the Federal Government: The estimated
    budgetary impact of H.R. 847 is shown in the following table.
    The costs of this legislation fall within budget functions 550
    (health), 570 (Medicare), and 750 (administration of justice).
        Basis of estimate: For this estimate, CBO assumes that H.R.
    847 will be enacted by the end of fiscal year 2010. H.R. 847
    would provide health benefits and compensation to those who
    qualify based on a combination of factors, including where they
    were exposed to hazardous conditions following the terrorist
    attacks, and their current and expected future health
    conditions. CBO's estimate is based on an analysis of the size
    of the potentially affected populations, the prevalence of
    certain health conditions in those populations, the propensity
    to seek health services or compensation from the program, and
    the monetary damages previously awarded by the VCF through
    2004.
        Under H.R. 847, spending for the WTC Health Program and VCF
    awards would increase direct spending, while the administrative
    costs associated with the VCF would be subject to future
    appropriations. Expenditures related to the WTC Health Program
    would be subject to annual spending caps totaling about $4.6
    billion through 2020, when the program would sunset. Award
    payments under the VCF would be subject to a lifetime spending
    cap of $8.4 billion through 2032, when the program would cease
    operation.

                               ESTIMATED BUDGETARY EFFECTS OF H.R. 847, THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                      By fiscal year, in millions of dollars--
                                                       -----------------------------------------------------------------------------------------------------
                                                         2011    2012    2013    2014    2015    2016    2017    2018    2019    2020   2011-2015  2011-2020
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                   CHANGES IN DIRECT SPENDING

    Title I: World Trade Center Health Program
    WTC Health Program:

        Estimated Budget Authority....................      70     318     349     380     424     469     521     578     639     706      1,541      4,454
        Estimated Outlays.............................      63     306     345     376     418     464     515     571     632     698      1,508      4,388
    Medicare and Medicaid:
        Estimated Budget Authority....................       0      -5     -10     -10     -10     -20     -20     -30     -40     -40        -35       -185
        Estimated Outlays.............................       0      -5     -10     -10     -10     -20     -20     -30     -40     -40        -35       -185
    Subtotal, Title I:
        Estimated Budget Authority....................      70     313     339     370     414     449     501     548     599     666      1,506      4,269
        Estimated Outlays.............................      63     301     335     366     408     444     495     541     592     658      1,473      4,203

    Title II: September 11th Victim Compensation Fund

        Estimated Budget Authority....................     500   1,000   3,500     500     200     150     150     100     100     100      5,700      6,300
        Estimated Outlays.............................     450     950   3,250     800     230     155     150     105     100     100      5,680      6,290

    Total Changes in Direct Spending: Titles I and II

        Estimated Budget Authority....................     570   1,313   3,839     870     614     599     651     648     699     766      7,206     10,569
        Estimated Outlays.............................     513   1,251   3,585   1,166     638     599     645     646     692     763      7,153     10,498

                                                          CHANGES IN SPENDING SUBJECT TO APPROPRIATION

    Administration of the September 11th Victim
     Compensation Fund:
        Estimated Authorization Level.................      75     100     200     100      10      10       5       5       5       5        485        515
        Estimated Outlays.............................      56      94     175     125      33      10       6       5       5       5        483        514
    Appropriation for NIOSH World Trade Center Health
     Program:
        Estimated Authorization Level.................     -71     -72     -73     -74     -75     -77     -78     -80     -81     -83       -365       -764
        Estimated Outlays.............................     -26     -60     -69     -71     -73     -75     -76     -78     -79     -81       -299       -688

    Total Changes in Discretionary Spending

        Estimated Authorization Level.................       4      28     127      26     -65     -67     -73     -75     -76     -78        120       -249
        Estimated Outlays.............................      30      34     106      54     -40     -65      70     -73     -74     -76        184      -174
    --------------------------------------------------------------------------------------------------------------------------------------------------------
    Note: NIOSH = National Institute of Occupational Safety and Health.

        On June 10, 2010, a federal district court judge approved a
    settlement between firefighters, police, contractors, and
    others who worked at the World Trade Center site, and New York
    City and its contractors for claims of injuries associated with
    their rescue and cleanup work. To become final, the settlement
    requires the participation of 95 percent of the plaintiffs, who
    have yet to agree to the terms. Should that settlement become
    final, CBO expects that the number and value of compensation
    awards provided through the VCF would be lower than presented
    in this cost estimate for H.R. 847.

    Eligible Population

        CBO's analysis focused on two populations--responders and
    survivors. The responder population includes those who were
    involved in the rescue, recovery, and cleanup efforts following
    the terrorist attacks in 2001. Survivors include commuters,
    residents, ``passers-by,'' and students who were in the New
    York City (NYC) disaster area around the time of the attacks
    and in the months following. Under H.R. 847, CBO estimates that
    roughly 650,000 individuals from the NYC disaster area--
    approximately 75,000 responders and 575,000 survivors--would
    meet the exposure requirements specified in the legislation,
    along with potentially another 10,000 responders from the
    Pentagon and Shanksville, Pennsylvania, sites. Although many of
    those individuals may have or develop health conditions related
    to the terrorist attacks, CBO estimates that only a portion
    would participate in the WTC Health Program and apply for an
    award under the VCF. Overall, CBO expects that of the total
    population that meets the exposure requirements, slightly less
    than 15 percent would enroll in the WTC Health Program by 2020
    and slightly more than 5 percent would receive awards from the
    VCF. Those estimated participation rates reflect people's
    willingness to enroll in government programs as well as
    additional requirements that would have to be met to receive a
    VCF award.
        Geographic and Time-Period Requirements. Title I specifies
    that individuals must have been present in the following
    locations following the terrorist attacks to be eligible for
    the new health program: NYC disaster area, the Pentagon site,
    and the Shanksville, Pennsylvania, site. Title II would give
    discretion to the VCF Special Master (appointed by the U.S.
    Attorney General to administer the fund) to define the
    geographic area for awards from that fund; for this estimate,
    CBO assumes that the geographic areas of exposure specified in
    title I would also be used as the criteria for compensation
    payments under title II. Title I defines the NYC disaster area
    as the part of Manhattan that is south of Houston Street and
    any block in Brooklyn that is wholly or partially contained
    within a 1.5-mile radius of the former World Trade Center site.
    H.R. 847 would also base eligibility on the amount of time an
    individual spent in the specified region. Based on those
    requirements, CBO estimates that about 75,000 responders and
    575,000 survivors from the NYC disaster area would meet the
    geographic-eligibility and time-period requirements specified
    in H.R. 847, as well as potentially another 10,000 responders
    from the Pentagon and Shanksville, Pensylvania, sites.
        Those estimates are based on information collected by
    certain hospitals (known as the Centers of Excellence) in the
    NYC area that are treating responders, New York City's
    Department of Health and Mental Hygiene, the U.S. Department of
    Health and Human Services, Research Triangle International, and
    New York State Laborers' Tri-Fund. In particular, CBO's
    analysis relies heavily on the WTC Health Registry which was
    developed by New York City's Department of Health and Mental
    Hygiene and the U.S. Department of Health and Human Services
    (HHS) to document and evaluate the short- and long-term
    physical and mental health issues associated with the terrorist
    attacks and recovery efforts. The Registry established
    eligibility criteria that considered an individual's residence,
    location at the time of attacks, and intensity and duration of
    exposure to hazardous conditions. About 71,000 individuals
    enrolled voluntarily in this Registry before it closed in
    November 2004.
        Diseases. The bill would require a determination that the
    terrorist attacks were substantially likely to be a significant
    factor in aggravating, contributing to, or causing the
    condition or illness prior to receiving treatment through the
    WTC Health Program. Title I would specify certain physical and
    mental health conditions deemed WTC-related for both responders
    and survivors. Title II would give discretion to the Special
    Master to determine what physical conditions would be eligible
    for an award; for this estimate, CBO assumes that the diseases
    specified in title I would also be used as criteria for
    compensation payments.
        In general, individuals whose health conditions developed
    or were aggravated as a result of the terrorist attacks cannot
    easily be distinguished from individuals whose conditions would
    have developed or worsened in the absence of those attacks.
    Therefore, CBO considered the entire population that may
    develop and seek treatment for eligible physical and mental
    health conditions that might be associated with the aftermath
    of the terrorist attacks. The existence of a causal
    relationship between the attacks and specific diseases
    generally would be difficult to establish or disprove.
        CBO analyzed more than a dozen studies on the incidence and
    prevalence of the WTC-related health conditions in both
    responders and survivors. We also analyzed data collected in
    the Morbidity and Mortality Weekly Report (MMWR) and population
    level data collected by the Medical Expenditure Panel Survey
    (MEPS). The MEPS collects annual data pertaining to the use of
    health care services, sources of payment for those services,
    and health insurance coverage. Based on those analyses, CBO
    estimates that about 280,000 of the individuals (about 40
    percent) who meet the exposure criteria defined in the
    legislation have or will develop a health condition that meets
    the criteria set in the bill.
        Responders who meet the geographic-eligibility criteria and
    survivors who both meet the geographic-eligibility criteria and
    develop a qualifying physical or mental health condition, as
    defined in the bill, would be eligible to enroll in the WTC
    Health Program.
        CBO estimates that about 50,000 responders and 230,000
    survivors would develop at least one qualifying physical or
    mental health condition. That estimate reflects the prevalence
    of the eligible conditions among the general population as well
    as the increase in prevalence attributable to the attacks
    themselves.
        Eligibility for an award under the VCF would differ from
    that for the WTC Health Program. The VCF would only compensate
    individuals with physical health conditions who have received
    treatment. CBO estimates that about 100,000 responders and
    survivors would meet those criteria.

    Direct Spending

        CBO estimates that enacting H.R. 847 would increase direct
    spending by $10.5 billion over the 2011-2020 period. About $4.2
    billion of that amount would result from spending for health
    care benefits provided under title I. The remaining $6.3
    billion would be spent on compensation payments provided under
    title II.
        Title I: Health Care Benefits. Under current law, the
    National Institute of Occupational Safety and Health (NIOSH)
    provides funding to several programs that offer medical
    monitoring and treatment to responders and survivors with
    conditions associated with the September 11, 2001, terrorist
    attacks under the umbrella of the WTC Medical Monitoring and
    Treatment Program. Those programs treat or have enrolled
    approximately 60,000 individuals: about 40,000 in the Mt. Sinai
    Coordinated Consortium Responder Health Program and the
    National Responder Program; about 16,000 in the Fire Department
    City of New York Responder Health Program; and about 4,600
    survivors in the WTC Environmental Health Center Program.
    Funding for those programs is subject to annual appropriation.
    For 2010, $70 million was appropriated to NIOSH through the
    Centers for Disease Control and Prevention (CDC) to support
    those programs.
        H.R. 847 would establish the WTC Health Program within HHS
    to replace and expand the NIOSH programs. The WTC Health
    Program would provide monitoring and treatment benefits for
    qualifying health conditions to individuals who were engaged in
    emergency response, recovery, and cleanup operations related to
    the terrorist attacks. It also would provide monitoring and
    treatment benefits to certain residents and others with a
    qualifying health condition who were working, visiting, or
    residing near the WTC during the year following the attacks.
    H.R. 847 would replace annual appropriations for the NIOSH
    programs with mandatory funding for the WTC Health Program. (An
    estimated reduction in authorized discretionary spending is
    discussed below under ``Spending Subject to Appropriation.'')
        CBO estimates that, if unconstrained, the WTC Health
    Program would cost between $5 billion and $6 billion over the
    2011-2020 period. In contrast, the cap on federal spending
    specified in H.R. 847 is about $4.6 billion over that same
    period. Taking that spending cap into consideration, CBO
    estimates that gross spending would total $4.4 billion over the
    2011-2020 period. The WTC Health Program also would result in
    some savings for Medicare and Medicaid, yielding a net increase
    in direct spending of $4.2 billion over the 2011-2020 period,
    as shown in the table on page 3. CBO also estimates that New
    York City would contribute $0.5 billion to the WTC Health
    Program over the 2011-2020 period.
        Program Participation. The WTC Health Program would cover
    individuals enrolled in the existing programs as of the date of
    enactment and would allow up to an additional 25,000 responders
    and 25,000 survivors to enroll in the program. H.R. 847 defines
    exposure and health criteria for an eligible WTC responder and
    an eligible WTC survivor. The program's administrator would be
    allowed to expand those eligibility criteria until 80 percent
    of the numerical limitation is reached.
        CBO estimates that about 65,000 of the approximately 85,000
    responders at the various sites who would meet the exposure
    criteria would enroll in the WTC Health Program and that about
    20 percent of those enrollees would receive treatment through
    the program in a given year. We estimate that about 250,000
    individuals, or roughly 40 percent of the approximately 575,000
    survivors who would meet those criteria, would also meet the
    health condition criteria specified in title I of H.R. 847. CBO
    expects that less than 10 percent of those individuals would
    enroll in the WTC Health Program by 2020. In part, this
    estimate reflects the expectation that most individuals will
    continue to receive care from providers who are not affiliated
    with a Center of Excellence or the WTC Health Program. CBO
    further expects that, in a given year, slightly less than half
    of the enrolled survivors would receive treatment through the
    WTC Health Program.
        Survivor and Responder Health Benefits. H.R. 847 would
    provide for health benefits, including monitoring and medically
    necessary follow-up treatment for enrolled responders.
    Survivors would receive an initial health evaluation to
    determine program eligibility. Once eligibility is determined,
    H.R. 847 would provide for monitoring and medically necessary
    follow-up treatment for survivors. Monitoring, initial health
    evaluations, and medically necessary follow-up would only be
    covered when provided by Centers of Excellence or by providers
    who participate in the nationwide network established by the
    WTC program administrator. The WTC Health Program would also
    provide funding for coordination and administrative expenses
    for the Centers of Excellence. CBO estimates that the cost of
    the health benefits program (including initial health
    evaluations, monitoring, treatment, and administration) would
    total up to $4.5 billion over the 2011-2020 period. That amount
    comprises about $4.2 billion for monitoring and medically
    necessary treatment and $0.3 billion for administrative costs.
        The WTC Health Program would pay for the monitoring and
    medically necessary treatment costs associated with a
    qualifying health condition that are not covered by a patient's
    primary insurer, including deductibles, copayments,
    coinsurance, and other cost-sharing requirements. (As a
    practical matter, the WTC Health Program would be the primary
    insurer for individuals covered by Medicare.) H.R. 847
    specifies a series of WTC-related health conditions; however,
    H.R. 847 would authorize the administrator to approve
    conditions and illnesses not specified in the legislation but
    deemed to be a WTC-related health condition for treatment. The
    administrator could also add illnesses and conditions to the
    list of WTC-related health conditions through the rulemaking
    process, which might include requesting a recommendation of the
    Advisory Panel. In addition, for an individual, a condition not
    on the list would be deemed to be WTC-related if a physician
    determines that it was likely to have been caused or aggravated
    by exposure to the terrorist attacks.
        CBO estimated the cost of treatment for WTC-related health
    conditions using data from MEPS, Medicare, and the Federal
    Employees Compensation Act (FECA) program. CBO analyzed MEPS
    data to estimate the national average cost of treating
    qualifying conditions. Those costs were then adjusted to
    reflect the relative costs in New York City--spending per
    Medicare enrollee is about 20 percent higher in New York City
    than the national average--and to account for differences
    between payment rates in the FECA program and those underlying
    our estimate of national average cost. Those costs were then
    projected based on CBO's estimates of growth in per capita
    health spending. The administrator would be required to
    establish a program for necessary outpatient prescription
    pharmaceuticals prescribed under this title through contracts
    with one or more vendors. Separately, CBO estimated the cost of
    outpatient prescription drugs and assumed that those payment
    amounts would be comparable to prices paid in the private
    market.
        The WTC Health Program would be the secondary payer for
    survivors with private insurance or Medicaid coverage and for
    responders receiving benefits from a non-NYC worker's
    compensation or other work-related injury or illness benefit
    plan. For those individuals, the program would pay the
    difference between FECA payment rates and the amounts paid by
    the primary insurer; the individual would have no out-of-pocket
    obligation.\1\ CBO estimates that primary insurers would cover
    about 60 percent of the cost of treating WTC-related health
    conditions for those individuals, with the WTC Health Program
    paying the rest.
    ---------------------------------------------------------------------------
        \1\For responders employed by New York City, all WTC-related
    conditions would be considered work-related. The legislation would
    relieve the city's worker's compensation program or other work-related
    injury or illness benefit plan of the obligation to pay for those
    conditions in return for the city's participation in the financing of
    the WTC Health Program.
    ---------------------------------------------------------------------------
        CBO estimates that federal spending for Medicaid would be
    reduced by about $30 million over the 2011-2020 period. Those
    savings would occur largely because, in some cases, providers
    would bill the WTC Health Program instead of Medicaid to avoid
    the administrative cost of dealing with two payers.
        The WTC Health Program would reduce Medicare spending
    because it would replace Medicare as the primary payer for
    individuals enrolled in Medicare. CBO estimates that Medicare
    savings would total about $155 million over the 2011-2020
    period.
        CBO estimates that costs incurred to administer health
    evaluations, monitor, and provide treatment would total up to
    $0.3 billion over the 2011-2020 period. H.R. 847 would direct
    the administrator to enter into contracts with Clinical Centers
    of Excellence to provide monitoring and treatment benefits and
    initial health evaluations, counseling, outreach, translational
    and interpretive services, and to collect and report on
    utilization, incidence, and prevalence data.
        Other Health Benefits and Program Funding. H.R. 847 would
    provide funding for:
               Mental health benefits for surviving family
            members of responders who died at the WTC site on
            September 11, 2001;
               Creation of a scientific committee and
            technical advisory committee;
               Education and outreach;
               Uniform data collection;
               Research pertaining to conditions related to
            the September 11, 2001, terrorist attacks; and
               Maintaining ongoing data collection through
            the WTC health registry.
        The bill specifies a maximum amount for each of those
    activities. CBO estimates that the costs of those activities
    would total up to $0.5 billion over the 2011-2020 period. In
    addition, H.R. 847 would provide funding for training and
    technical assistance, transportation expenses, and claims
    processing. CBO estimates that the costs of those activities
    would total an additional $0.2 billion over the 2011-2020
    period. Thus, the total cost of other activities would total up
    to $0.7 billion over the 2011-2020 period.
        World Trade Center Health Program Fund. H.R. 847 would
    establish the WTC Health Program Fund to pay for the benefits
    included under title I. New York City and the federal
    government would contribute to the fund based on percentages
    and amounts provided in the legislation.
        The legislation would authorize implementation of the WTC
    Health Program only if New York City enters into a contract
    with the WTC program administrator in which the city agrees to
    pay 10 percent of program costs. This estimate assumes that the
    city would enter into that contract and that the city would
    reimburse the WTC Health Program within six to nine months.
    (Alternatively, if the city would not enter into a contract
    with the administrator, CBO expects that no payments would be
    made from the WTC Health Program Fund, resulting in no increase
    in direct spending over the 2011-2020 period.)
        The federal government would be required to contribute the
    lesser of 90 percent of the program expenditures or an annual
    amount specified in the legislation. That cap on federal
    spending would rise from $71 million in 2011 to $743 million in
    2020 and would total about $4.6 billion over the 2011-2020
    period.
        In the absence of a cap, CBO estimates that the federal
    share of annual expenditures for the WTC Health Program would
    probably be about 1 percent to 5 percent higher than the annual
    caps. However, CBO's cost estimate targets the midpoint of a
    distribution of likely spending outcomes. Establishing a cap on
    annual spending truncates that distribution of likely outcomes
    by eliminating the potential for spending above the cap.
    Therefore, the middle of the truncated range of likely spending
    outcomes would be slightly below the cap. As a result, CBO
    estimates that federal spending would total about $4.4 billion
    over the 2011-2020 period.
        H.R. 847 would require New York City to cover 10 percent of
    the expenditures for carrying out title I. If the city pays its
    share, the WTC Health Program would assume responsibility for
    treatment costs for responders that would under current law be
    the responsibility of the city's worker's compensation or other
    work-related injury or illness benefit plan. Late payments from
    the city would accrue interest on the unpaid amount. For the
    purpose of our estimate, we assume that New York City would
    make payments on time. If the city fails to pay pursuant to its
    contract with the administrator and interest accrues on the
    unpaid amount, the federal expenditures would reach the cap
    more quickly.
        CBO estimates that the city of New York would contribute
    about $0.5 billion over the 2011-2020 period.
        Title II: Compensation Payments. Title II would reopen the
    September 11, 2001, Victim Compensation Fund, which provided
    compensation to any individual (or relatives of a deceased
    individual) who was physically injured or killed as a result of
    the terrorist attacks. The VCF, which terminated operations in
    2004, was established by the Air Transportation Safety and
    System Stabilization Act (Public Law 107-42) as an
    administrative alternative to litigation. That act created a
    Special Master, who determined the compensation levels based on
    specified eligibility criteria and subsequent regulations.
    Through 2004, the VCF made 2,880 death and 2,680 injury awards,
    totaling more than $7 billion (about $6 billion was for death
    awards). Public Law 107-42 did not cap the number or amount of
    awards that could be issued by the Special Master.
        H.R. 847 would establish broader eligibility rules for
    compensation than those established for the VCF under Public
    Law 107-42. Under the bill, total payments would be capped at
    $8.4 billion through 2032. CBO estimates that compensation
    payments would total $6.3 billion over the 2011-2020 period,
    with about 90 percent ($5.7 billion) of those payments made in
    the first five years following enactment. Most of the awards
    would be for physical injuries associated with the attacks or
    with debris removal and response activities following the
    attacks. CBO estimates that the VCF would make additional
    payments totalling about $300 million after 2020.
        CBO's estimate of those payments is based on a number of
    assumptions and projections regarding eligibility, average
    award amounts, and attorneys' fees.
        Changes in Eligibility. Title II would make many more
    individuals who were involved in the rescue, recovery, and
    cleanup efforts potentially eligible for compensation. Based on
    information provided by the previous Special Master of the VCF,
    CBO assumes that the VCF would be administered in the same
    manner as it was previously but would reflect new regulations
    written after the bill's enactment. Those regulations would
    reflect the following changes made by the bill:
         Time Present at Site: Eligibility would be
    determined in part based on the time an individual was present
    or near the sites of the terrorist attacks. Specifically, the
    bill would require that an eligible individual must have been
    at those sites some time during the period beginning on
    September 11, 2001, and ending on August 30, 2002. Prior to the
    sunset of the original VCF, the implementing regulations
    required that an individual had to have been present at those
    sites during the 12 hours immediately following the attacks, or
    for responders, 96 hours after the attacks.
         Geographical Expansion: Based on regulations
    promulgated under Public Law 107-42, the Special Master
    originally defined the crash site as a zone bounded by specific
    streets very close to the WTC area. H.R. 847 would expand the
    definition of the crash site to include routes related to
    debris removal (such as barges and landfills). Although the
    bill does not specify other changes to the site definition, the
    Special Master would have discretion to expand the site if it
    is determined that there was demonstrable risk of physical harm
    in adjacent areas. For this estimate, CBO assumes that the new
    regulations would extend the boundaries to be the same as those
    defined for eligibility for the health care benefits authorized
    in title I of the bill.
         Extended Claims Filing Deadlines: Generally, the
    filing deadline under the bill would depend primarily on when
    the Special Master determines that a claimant realizes that he
    or she suffered some form of physical harm resulting from the
    terrorist attacks or associated debris removal. If the Special
    Master determines that a claimant was aware (or should have
    been aware) of such an injury by the time the regulations are
    promulgated, the claimant would have two years to file from
    that time (roughly by the end of December 2012). For all
    others, if a claimant realizes such an injury after the new
    regulations are finalized, the claimant would have two years
    from when the Special Master determines that the claimant
    should have been aware of such injury. All claims would have to
    be filed by December 22, 2031.
        Awards and Average Award Amount. CBO expects that the
    bill's expanded eligibility criteria would significantly
    increase the number of individuals who could seek compensation
    from the VCF. CBO expects that most of the awards would be for
    injuries associated with the attacks, and therefore our
    analysis focused on those claims. Further, the bill would not
    provide compensation for mental health conditions although it
    would provide treatment for mental illnesses under title I.
    Over the next 10 years, CBO estimates that about 35,000 awards
    would be made, with an average award amount of about $180,000.
         Number of Awards: CBO expects that the number of
    awards would depend largely on the estimated number of
    responders and survivors who have or will have health
    conditions or symptoms associated with the terrorist attacks
    and recovery efforts, and are being treated for such
    conditions. Under H.R. 847, the VCF would require that all
    claimants prove they were treated by medical professionals and
    provide contemporaneous medical records to verify that
    treatment. CBO estimates that about 100,000 individuals--nearly
    25,000 responders and more than 75,000 survivors--would meet
    that additional eligibility requirement.
        CBO estimated the proportion of those individuals who would
    file a claim by reviewing studies on the propensity of
    individuals to seek legal remedy for injuries. Although CBO
    estimates that the overall claim rate would be a bit under 50
    percent, we expect that responders would have a much higher
    filing rate than survivors because of their involvement in the
    existing treatment programs at the Centers of Excellence and
    because of the efforts by certain union organizations to
    publicize the possible health issues associated with the
    cleanup efforts.
        Taking into account the VCF's previous approval rate and
    the approval rates of other compensation programs, CBO
    estimates that about 35,000 awards would be made, including
    payments to nearly 20,000 responders and 15,000 survivors. CBO
    expects that the number of death claims would be very small
    because there is little evidence that many individuals have
    died from injuries caused by the 2001 terrorist attacks after
    compensation benefits were first awarded.
         Average Award Amount: Under the bill, award
    amounts would be determined in the same way as they were before
    the sunset of the original VCF. Awards would comprise two
    parts--economic and noneconomic loss--adjusted for collateral
    offsets such as pensions. For injury victims, economic loss
    would reflect the actual lost income or expenses incurred as a
    direct result of the injury and future lost income and costs
    due to those injuries. Noneconomic loss would reflect
    compensation for pain and suffering due to injuries associated
    with the attacks. Awards, which would be provided in one
    payment, would be determined within 120 days of filing the
    claim and paid within 20 days of such determination.
        Based on information provided by administrators of the
    previous VCF program, CBO estimates that the average injury
    award would be about $180,000. (For death claims, the average
    award would be about $2 million, the same amount provided under
    the original VCF.) CBO estimated the average injury award by
    considering the characteristics of the current population
    enrolled in WTC Medical Monitoring and Treatment Programs,
    including average age, extent of disability, estimated income,
    and employer-provided benefits such as pensions and health
    insurance. CBO estimates that the average award would be higher
    for responders--about $240,000 per claim--because we expect
    that a greater proportion of responders have more serious
    injuries. In contrast, we estimate that awards for survivors
    would average about $100,000. The award estimates also were
    adjusted to account for certain health care benefits provided
    under title I.
        Attorneys' Fees. This estimate does not include any
    significant additional costs for attorneys' compensation that
    the Special Master could award under the bill. The bill would
    give the Special Master discretion to provide compensation to
    attorneys for services rendered on cases filed in district
    court for injuries associated with the terrorist attacks, but
    CBO expects that this authority would be used sparingly, based
    on the historical experience of the VCF. Previously, attorneys
    provided free legal assistance to claimants.

    Spending subject to appropriation

        CBO estimates that implementing H.R. 847 would decrease
    discretionary spending by $174 million over the 2011-2020
    period.
        Administering VCF Awards. Under H.R. 847, additional
    funding would be required to administer the VCF. The original
    compensation program was administered by the Department of
    Justice's (DOJ's) Civil Division. About $87 million was spent
    to process about 7,400 claims, and the average administrative
    cost per claim was about $11,500. Under the bill, CBO assumes
    that DOJ would again administer and oversee the program.
        Based on information provided by DOJ, CBO estimates that
    the average cost to process a claim under H.R. 847 would be
    about $10,000. CBO expects that the average cost would be lower
    than under the original program because the administrative
    infrastructure already exists and because we assume that
    certain efficiencies would be achieved with a larger number of
    claims. In total, CBO estimates that, assuming appropriation of
    the necessary amounts, administrative costs for the program
    would total $483 million over 2011-2015 period and $514 million
    over the 2011-2020 period to process an estimated 50,000
    claims, including many from individuals who would not qualify
    for an award. Most of that amount would be for salaries of
    hundreds of individuals to process millions of documents,
    operate a claims management system, and manage 20 to 30 claims-
    assistance sites around the country. Compensation also would be
    provided for DOJ attorneys, administrative law judges, and
    support staff.
        NIOSH World Trade Center Health Program. As discussed
    above, the enactment of H.R. 847 would replace annual
    appropriations with mandatory funding for NIOSH through CDC.
    Under the current-law baseline, CBO projects that discretionary
    appropriations will continue at the current level of funding
    adjusted annually for anticipated inflation. Assuming
    appropriation actions consistent with the bill, CBO estimates
    that appropriations for NIOSH would be reduced by $71 million
    in 2011 and increasing amounts in subsequent years because that
    baseline spending would be replaced by new direct spending
    under H.R. 847. We estimate that the reduction in
    appropriations would total $764 million over the 2011-2020
    period, resulting in a corresponding reduction in outlays of
    $688 million over the same period.
        Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
    Act of 2010 establishes budget reporting and enforcement
    procedures for legislation affecting direct spending or
    revenues. The net changes in outlays that are subject to those
    pay-as-you-go procedures are shown in the following table.

      CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR TITLE I OF H.R. 847 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON MAY 25, 2010, AND
                                TITLE II OF H.R. 847 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON THE JUDICIARY ON JULY 29, 2009
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  By fiscal year, in millions of dollars--
                                               -------------------------------------------------------------------------------------------------------------
                                                 2010    2011    2012    2013    2014    2015    2016    2017    2018    2019    2020   2010-2015  2010-2020
    --------------------------------------------------------------------------------------------------------------------------------------------------------
                                                           NET INCREASE OR DECREASE (-) IN THE DEFICIT

    Statutory Pay-As-You-Go Impact............       0     513   1,251   3,585   1,166     638     599     645     646     692     763     7,153     10,498
    --------------------------------------------------------------------------------------------------------------------------------------------------------

        Estimated impact on state, local, and tribal governments:
    H.R. 847 contains no intergovernmental mandates as defined in
    UMRA. The bill would place conditions on the city of New York
    for participating in the health program authorized by the bill,
    but those conditions would not be intergovernmental mandates as
    defined in UMRA.
        Estimated impact on the private sector: H.R. 847 would
    impose a private-sector mandate as defined in UMRA by limiting
    the liability of New York City, any entity with a property
    interest in the World Trade Center on September 11, 2001, and
    any contractors and subcontractors thereof. Liability would be
    limited to the total amount of available insurance coverage of
    those entities for compensatory damages or other relief arising
    from or related to debris removal from sites of the terrorist
    attacks. By limiting the liability of those entities, the bill
    would impose a mandate on individuals seeking compensatory
    damages or other relief. Because of uncertainty about the
    potential amount of the awards and the ability of the city of
    New York and other entities whose liability would be limited to
    pay for any awards in excess of the liability limit, CBO cannot
    determine the costs the mandate would impose on the affected
    individuals.
        Estimate prepared by: Federal Costs: Stephanie Cameron,
    Leigh Angres, and Chapin White; Impact on State, Local, and
    Tribal Governments: Lisa Ramirez-Branum; Impact on the Private
    Sector: Sarah Axeen.
        Estimate approved by: Holly Harvey, Deputy Assistant
    Director for Budget Analysis.

                 Section-by-Section Analysis of the Legislation

        The following section-by-section analysis describes the
    provisions in Title I of the legislation (World Trade Center
    Health Program). For the section-by-section analysis of Title
    II of the legislation (September 11th Victim Compensation Fund
    of 2001), see Part II of this Report.

    Section 1. Short title; table of contents

        Section 1(a) designates the short title as the ``James
    Zadroga
    9/11 Health and Compensation Act of 2010''.
        Section 1(b) sets forth the table of contents.

                   Title I--World Trade Center Health Program

    Section 101. World Trade Center Health Program

        Section 101 amends the Public Health Service Act by adding
    a new Title XXXIII that contains the following sections:

       Title XXXIII of the Public Health Service Act--World Trade Center
                                 Health Program

            SUBTITLE A--ESTABLISHMENT OF PROGRAM ADVISORY COMMITTEE

        Section 3301. Establishment of World Trade Center Health
    Program. Establishes, effective July 1, 2011, a World Trade
    Center Health Program (the WTC Program) within the Department
    of Health and Human Services (HHS) to be administered by the
    WTC Program Administrator. The WTC Program includes the
    following components: (1) medical monitoring for responders to
    the September 11, 2001, terrorist attacks on the WTC in New
    York City, at the Pentagon and in Shanksville, Pennsylvania;
    (2) initial health evaluation for survivors (i.e., residents
    and other building occupants and area workers in the area
    affected by the terrorist attack on the World Trade Center);
    (3) followup monitoring and treatment for WTC-related health
    conditions for eligible responders and survivors; (4) outreach
    and education to potentially eligible individuals; (5) clinical
    data collection and analysis; and (6) research on WTC-related
    health conditions. Prohibits the imposition of cost-sharing
    with respect to initial health evaluations, monitoring, or
    treatment benefits. Directs the Inspector General of HHS to
    develop and implement a program to review expenditures by the
    WTC Program to detect fraudulent billing and unreasonable
    administrative costs. Directs the WTC Program Administrator to
    establish a quality assurance program for services delivered by
    Centers of Excellence and other participating providers.
    Requires the WTC Program Administrator to submit an annual
    report to Congress on the operation of the program.
        Section 3302. WTC Health Program Scientific/Technical
    Advisory Committee; WTC Health Program Steering Committees.
    Requires the WTC Program Administrator to establish the WTC
    Health Program Scientific/Technical Advisory Committee to
    review scientific and medical evidence and make recommendations
    on additional WTC Program eligibility criteria and additional
    WTC-related health conditions. Requires the Administrator to
    consult with the WTC Responders Steering Committee and the WTC
    Survivors Steering Committee.
        Section 3303. Education and Outreach. Requires the WTC
    Program Administrator to institute a program to provide
    education and outreach to potentially eligible individuals
    regarding the existence of and services available under the WTC
    Health Program.
        Section 3304. Uniform Data Collection and Analysis.
    Requires the WTC Program Administrator to provide for the
    collection, analysis, and reporting of data, consistent with
    applicable privacy requirements, on the prevalence of WTC-
    related health conditions, and the identification of new WTC-
    related health conditions. Directs Clinical Centers of
    Excellence to collect and report data to a Data Center for
    analysis. Requires the Administrator to ensure collaboration
    between Data Centers and World Trade Center Health Registry.
        Section 3305. Clinical Centers of Excellence and Data
    Centers. Requires the WTC Program Administrator to enter into
    contracts or cooperative agreements with the Clinical Centers
    of Excellence and Data Centers. Requires Clinical Centers of
    Excellence to provide monitoring, initial health evaluation,
    and treatment benefits; conduct outreach activities; provide
    counseling for benefits for eligible individuals; provide
    translational and interpretive services for eligible
    individuals who are not English language proficient; and
    collect and report data to the Data Centers for analysis.
    Requires Data Centers to receive and analyze data for the
    purposes of developing protocols for monitoring, initial health
    evaluation, and treatment of WTC-related health conditions;
    conducting outreach activities; and establishing criteria for
    credentialing providers in the nationwide network. Sets forth
    contract requirements for Clinical Centers of Excellence.
    Requires the Administrator to reimburse Clinical Centers of
    Excellence for fixed infrastructure costs using a fair and
    appropriate negotiated rate.
        Section 3306. Definitions. Sets forth definitions for
    certain terms used in Title I. In the case of the term ``WTC
    Program Administrator,'' authorizes the Secretary of HHS to
    designate one or more officials in the Department to carry the
    following responsibilities: enrollment of WTC responders;
    processing claims for reimbursement for initial health
    evaluations, monitoring and treatment; determination of
    eligibility of WTC responders; and administering secondary
    payor provisions. Specifies that the Director of the National
    Institute for Occupational Safety and Health (NIOSH), or a
    designee, is responsible for all other activities of the WTC
    Health Program.

      SUBTITLE B--PROGRAM OF MONITORING, INITIAL HEALTH EVALUATIONS, AND
                                   TREATMENT

                             PART 1--WTC RESPONDERS

        Section 3311. Identification of WTC Responders and
    Provision of WTC-Related Monitoring Services. Defines the term
    ``WTC responder'' as any of the following: (1) a responder who
    is identified as eligible for monitoring on the date of
    enactment; (2) a responder who meets current eligibility
    criteria; and (3) a responder who meets eligibility criteria
    modified by the WTC Program Administrator after consultation
    with the WTC Scientific/Technical Advisory Committee. Specifies
    that current eligibility criteria include firefighters and
    emergency personnel; law enforcement officers; rescue,
    recovery, and cleanup workers; and the surviving immediate
    family members of firefighters or emergency personnel who were
    killed as a result of the September 11, 2001, terrorist attacks
    on the World Trade Center. Further specifies that current
    eligibility criteria include members of fire or police
    departments, recovery or cleanup workers, or volunteers who
    performed rescue, recovery, debris cleanup, or related services
    at the Pentagon and in Shanksville, Pennsylvania, in the
    aftermath of the September 11, 2001, terrorist attacks. Directs
    the WTC Program Administrator to establish an enrollment
    process for WTC responders. Limits enrollment in the WTC
    responder program at any time to 25,000 responders in addition
    to those identified as eligible for monitoring on the day of
    enactment and the surviving immediate family members of
    firefighters or emergency personnel killed at the World Trade
    Center site. (Of these 25,000, no more than 2,500 may qualify
    based on eligibility criteria modified by the Administrator).
    Disqualifies individuals on the Department of Homeland
    Security's terrorist watch list from receiving benefits as WTC
    responders. Requires the WTC Program to provide monitoring
    consistent with protocols approved by the Administrator to
    enrolled WTC responders (other than surviving immediate family
    members of firefighters or emergency personnel).
        Section 3312. Treatment of Enrolled WTC Responders for WTC-
    Related Health Conditions. Sets forth a list of WTC-related
    health conditions, including aerodigestive disorders and mental
    health conditions, for which treatment is to be furnished to
    WTC responders through Centers of Excellence and the national
    program. Establishes a process for the addition of conditions
    to the list that includes an option for interested parties to
    submit written petitions, recommendations from the WTC Health
    Program Scientific/Technical Advisory Committee, and formal
    notice and comment rulemaking by the WTC Program Administrator.
    Requires the Administrator to periodically review all available
    scientific and medical evidence related to cancer to determine
    if particular types of cancers should be added to the list of
    WTC-related health conditions. Establishes a process for a
    physician at a Clinical Center of Excellence to be paid for
    treating an enrolled WTC responder for a condition that is not
    on the list of WTC-related health conditions but that the
    treating physician determines is medically associated with a
    WTC-related health condition. Requires physicians and other
    providers treating enrolled WTC responders to provide treatment
    that is medically necessary and in accordance with medical
    treatment protocols approved by the WTC Program Administrator;
    requires the Administrator to issue regulations specifying a
    standard for determining medical necessity; and prohibits the
    Administrator from paying for treatment that the Administrator
    determines is not medically necessary or not in accordance with
    such medical treatment protocols. Requires the Administrator to
    reimburse costs for medically necessary treatment for WTC-
    related health conditions at rates applicable under the Federal
    Employees Compensation Act (FECA). Authorizes the Administrator
    to modify the payment amounts and methodologies if, based on
    utilization and quality data furnished by the Clinical Centers
    of Excellence, the Administrator determines that another
    payment methodology would better ensure high quality and
    efficient delivery. In the case of outpatient prescription
    drugs, directs the Administrator to establish a program to use
    outside vendors selected through a competitive bidding process.
        Section 3313. National Arrangement for Benefits for
    Eligible Individuals Outside New York. Requires the WTC Program
    Administrator to establish a nationwide network of health care
    providers to furnish monitoring and treatment benefits and
    initial health evaluations to enrolled WTC responders and
    eligible WTC survivors who reside outside of the New York City
    metropolitan area. Requires that health care providers
    participating in this network meet credentialing criteria
    specified by the Data Centers, follow the approved protocols,
    collect and report data, and comply with program integrity,
    quality assurance, and other requirements established by the
    Administrator.

                             PART 2--WTC SURVIVORS

        Section 3321. Identification and Initial Health Evaluation
    of Screening-Eligible and Certified-Eligible WTC Survivors.
    Defines a ``screening-eligible WTC survivor'' as an individual
    who (1) has been identified as eligible for medical monitoring
    and treatment by the WTC Environmental Health Center as of the
    date of enactment, (2) claims symptoms of a WTC-related health
    condition and meets current eligibility criteria, or (3) claims
    symptoms of a WTC-related health condition and meets
    eligibility criteria modified by the WTC Program Administrator
    after consultation with the WTC Scientific/Technical Advisory
    Committee. Specifies that current eligibility criteria include
    individuals present in the New York City disaster area in the
    dust or dust cloud on September 11, 2001, and individuals who
    worked, resided, or attended school or childcare during the 4-
    month period beginning on September 11, 2001. Directs the
    Administrator to establish a process for individuals to be
    determined to be screening-eligible WTC survivors. Requires the
    WTC Program to provide for a single initial health evaluation
    for each screening-eligible WTC survivor to determine if the
    survivor has a WTC-related health condition and is eligible for
    follow-up monitoring and treatment benefits. The initial health
    evaluation must be conducted through a Clinical Center of
    Excellence consistent with protocols approved by the
    Administrator. Defines ``certified-eligible WTC survivor'' as a
    screening-eligible WTC survivor who, based on an initial health
    evaluation, has been determined to be eligible for follow-up
    monitoring and treatment. Directs the Administration to
    establish a process for certification of this determination.
    Limits to 25,000 at any time the number of certified-
    eligible WTC survivors in addition to those who were identified
    as eligible for medical monitoring and treatment as of
    enactment. Disqualifies individuals on the Department of
    Homeland Security's terrorist watch list from receiving
    benefits as WTC survivors.
        Section 3322. Followup Monitoring and Treatment of
    Certified-Eligible WTC Survivors for WTC-Related Health
    Conditions. Sets forth a list of WTC-related health conditions,
    including aerodigestive disorders and mental health conditions,
    for which the WTC Program provides followup monitoring and
    treatment to certified-eligible WTC survivors. Provides that
    any cancers or other conditions added to the list of WTC-
    related health conditions for enrolled WTC responders under
    section 3312(a) are included in the list of WTC-related health
    conditions applicable to certified-eligible WTC survivors.
    Specifies that the provisions applicable to the monitoring and
    treatment of WTC-related health conditions for enrolled WTC
    responders, including those relating to the use of protocols
    and a standard of medical necessity approved by the WTC Program
    Administrator, also apply with respect to followup monitoring
    and treatment of WTC-related health conditions for certified-
    eligible WTC survivors.
        Section 3323. Followup Monitoring and Treatment of
    Certified-
    Eligible WTC Survivors for WTC-Related Health Conditions.
    Authorizes the provision of monitoring and treatment services
    to individuals who are not enrolled WTC responders or
    certified-eligible WTC survivors in certain circumstances but
    who are diagnosed at a Clinical Center of Excellence with a
    WTC-related health condition for certified-eligible WTC
    survivors. Limits the funds available for this purpose to $5
    million in FY2011 and $20 million in FY2012, adjusted by the
    consumer price index every year thereafter through FY2020.

                            PART 3--PAYOR PROVISIONS

        Section 3331. Payment of Claims. Establishes the general
    rule that the WTC Health Program pays the costs of furnishing
    monitoring and treatment benefits and initial health
    evaluations from the WTC Health Program Fund, subject to
    certain exceptions. In the case of treatment for a WTC-related
    health condition that is work-related, the bill requires the
    WTC Program Administrator to reduce or recoup payment for the
    treatment using the Medicare secondary payor procedures if the
    Administrator determines that payment for the treatment has
    been made or can reasonably be expected to be made under a
    worker's compensation law or plan. In the case of treatment for
    a WTC-related health condition that is not work-related, the
    bill requires the Administrator to apply the Medicare secondary
    payor rules. For this purpose, treats Medicaid as primary to
    the WTC Program. Effective July 2014, it allows the WTC Program
    to make payment for monitoring or treatment only on behalf of
    individuals who have minimum essential coverage, unless the
    individual is exempt from the requirement to obtain such
    coverage. Provides that no funds may be disbursed from the WTC
    Health Program Fund until New York City enters into a contract
    with the WTC Program Administrator under which it agrees to
    contribute 10% of WTC Health Program expenditures in each
    calendar quarter. Specifies limits totaling $510 million on the
    amount of this 10% contribution owed in each fiscal year
    through FY 2020. Specifies interest penalties for late payments
    and provides that amounts owed to the WTC Administrator under
    the contract are recoverable by the United States. Specifies
    that New York City may not satisfy this 10% contribution using
    federal funds, payments made prior to enactment, or payments to
    satisfy a judgment or as part of a settlement related to
    injuries or illnesses related to the September 11, 2001,
    terrorist attacks. Provides that, in any quarter in which New
    York City makes the full payment it is obligated to make under
    the contract, the City is not required to make worker's
    compensation or line-of-duty payments toward the treatment of
    WTC-related health conditions that are work-related.
        Section 3332. Administrative Arrangement Authority.
    Authorizes the WTC Program Administrator to enter into
    arrangements with government agencies, insurance companies, or
    other third-party administrators for processing of provider
    claims for payment for monitoring and treatment services
    furnished under the WTC Health Program to eligible WTC
    responders or survivors.

                      SUBTITLE C--RESEARCH INTO CONDITIONS

        Section 3341. Research Regarding Certain Health Conditions
    Related to September 11 Terrorist Attacks in New York City.
    Directs the WTC Program Administrator, in consultation with the
    WTC Scientific/Technical Advisory Committee, to conduct or
    support research on physical and mental health conditions that
    may be related to the September 11, 2001, terrorist attacks,
    including research on diagnosing and treating WTC-related
    health conditions on which there has been treatment
    uncertainty.
        Section 3342. World Trade Center Health Registry. Directs
    the WTC Program Administrator to ensure the maintenance of a
    registry of victims of the September 11 terrorist attacks at
    least as comprehensive as the WTC Health Registry in effect as
    of April 20, 2009, under arrangements with the New York City
    Department of Health and Mental Hygiene.

                              SUBTITLE D--FUNDING

        Section 3351. World Trade Center Health Program Fund.
    Establishes the World Trade Center Health Program Fund for
    payment of costs of carrying out the WTC Health Program
    beginning in the last calendar quarter of FY2011 and continuing
    through FY2020. Provides mandatory funding for the federal
    contribution to the Fund in amount equal to the lesser of (1)
    90% of the expenditures in carrying out the WTC Program in each
    fiscal year or (2) a specified annual cap amount for each
    fiscal year ($71 million in FY2011, $318 million in FY2012,
    $354 million in FY2013, $382 million in FY2014, $431 million in
    FY2015, $481 million in FY2016, $537 million in FY2017, $601
    million in FY2018, $672 million in FY2019, and $743 million in
    FY2020). Provides that no federal dollars be disbursed from the
    Fund unless New York City has entered into the contract with
    the WTC Program Administrator required under section 3331.
    Directs that the City's 10% contribution be deposited into the
    Fund, and specifies that any failure of the City to make its
    full contribution shall not increase the federal deposit into
    the Fund. Makes amounts deposited into the Fund available for
    carrying out the WTC Health Program, including payment of the
    costs of identification, initial health evaluations,
    monitoring, and treatment of WTC-related health conditions of
    WTC responders and WTC survivors. Also makes amounts deposited
    into the Fund available, subject to specified limits, to
    support the WTC Health Program Scientific/Technical Advisory
    Committee, education and outreach activities, data collection
    and analysis, Data Centers, infrastructure costs of Clinical
    Centers of Excellence, research on WTC-related health
    conditions, and the WTC Health Registry.

             Changes in Existing Law Made by the Bill, as Reported

      The bill was referred to this committee for consideration of
    such provisions of the bill as fall within the jurisdiction of
    this committee pursuant to clause 2 of rule XII of the Rules of
    the House of Representatives. In compliance with clause 3(e) of
    rule XIII of the Rules of the House of Representatives, changes
    in existing law made by such provisions of the bill, as
    reported, are shown as follows (new matter is printed in italic
    and existing law in which no change is proposed is shown in
    roman):

    PUBLIC HEALTH SERVICE ACT

               *       *       *       *       *       *       *

                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.

                                DISSENTING VIEWS

        We, the undersigned Members of the Committee on Energy and
    Commerce, offer the following comments on H.R. 847, the ``James
    Zadroga 9/11 Health and Compensation Act of 2009.'' Republicans
    have supported and continue to support providing monitoring and
    treatment of benefits for first responders to the 2001 World
    Trade Center (WTC) tragedy. Although this bill has been
    represented as merely authorizing in statute the existing WTC-
    related program, H.R. 847 in fact changes the program
    significantly without providing needed protections to ensure
    taxpayer funds are spent properly and effectively. H.R. 847
    increases federal spending by creating a new entitlement
    program without requiring Congress to find wasteful spending
    programs that could be cut or eliminated. The bill provides
    incentives to providers to over-utilize services while at the
    same time providing inflated reimbursement rates. The
    legislation also does not protect taxpayer funds for paying for
    benefits for illegal aliens. Republicans offered amendments to
    authorize and improve the existing program, but they were
    defeated.
        The debate over H.R. 847 has been intentionally
    mischaracterized by some proponents of the legislation. During
    the markup of H.R. 847, some implied that supporters of the
    legislation were the only ones who support providing health
    care benefits to those who responded to the attack and charged
    that those that questioned the structure of the bill opposed
    providing help to these heroes. This mischaracterization does a
    disservice to the legislative process.
        The Majority Committee Report rightfully noted that ``The
    WTC Health Programs currently funded by the federal government
    are not authorized in statute. That is, there is no legislation
    authorizing the appropriation of funds to the National
    Institute for Occupational Health and Safety (NIOSH) to support
    these programs. The absence of such legislation has not
    precluded--and should not preclude--the funding of these
    programs. It is far preferable, however, for the Congress to
    set forth in an authorizing statute the purpose and scope of
    the programs needed, the individuals intended to be assisted,
    and the resources necessary to such programs. An authorizing
    statute can improve accountability of the agency responsible
    for administering the programs, transparency, and stability of
    funding over time.''
        Although some claim this bill simply authorizes the
    existing program at NIOSH, H.R. 847 operates in a significantly
    different manner than the current program. The NIOSH does not
    have expertise in administering a health care payment program.
    The current program functions as a block grant program and
    individual grantees must conduct research, monitor conditions,
    and provide treatment for those afflicted with World Trade
    Center-related conditions. Under the bill, NIOSH could have
    vastly expanded functions, many of which it has no expertise in
    doing, such as negotiating provider payment rates, approving
    treatment protocols, establishing a competitive bidding program
    for prescription drugs, and evaluating the health of potential
    enrollees in the program. Since the Administration was not
    invited to testify on the legislation, we were unable to hear
    its position on the proper agency to perform the activities set
    forth in the legislation. Republicans advocated that the
    Secretary of Health and Human Services have the discretion to
    determine which agency had the necessary expertise to
    administer the WTC health care program.
        Mr. Rogers offered an amendment that would authorize in
    statute the current WTC health program at NIOSH while also
    providing needed accountability improvements to ensure the
    funds were being spent appropriately. In addition to codifying
    the existing monitoring and treatment program for first
    responders, the Republican amendment would provide for outreach
    to educate eligible individuals about the benefits of the
    program and allow for continued data collection about 9-11
    conditions. The amendment also contained needed accountability
    reforms like requiring the Secretary to verify citizenship/
    legal residency so that only those lawfully present in the
    United States receive services and mandating an annual
    accounting of the use of funds by the program. The amendment
    set funding for the program in Fiscal Year 2011 at President
    Obama's requested level of $150 million. The amendment was not
    agreed to by a roll call vote of 19 Yeas to 30 Nays.
        Some proponents of the legislation also mischaracterized
    the debate over whether the program should be funded on an
    annual basis or if the government should set mandatory
    obligations for the program for the next ten years. The
    Committee on Energy and Commerce is an authorizing committee
    with a mission to set policy and specify spending priorities.
    It is the function of the Committee on Appropriations to
    allocate funds to the program this Committee authorizes.
    Republicans find suspect the suggestion that if a program is
    funded through the normal appropriations process then the
    recipients of those funds must hold out a tin cup each year to
    beg for money. Many federal health care programs, including
    those that provide health care services to our current military
    and veterans, and those that conduct research, are funded
    through the regular, yearly appropriations process. This does
    not mean these programs are at risk of being eliminated. When
    there is agreement that a program is a priority, it gets
    funded. Republicans believe that in a time of a $13 trillion
    national debt and the expectation that the current budget will
    add an additional $10 trillion of debt by the end of the
    decade, a new multi-billion program can and should be
    accompanied by a reduction in wasteful or unneeded programs.
        The only reason to pass a mandatory spending program is to
    grow the size of government and excuse Congress of its
    obligation to cut or eliminate wasteful spending. The Taxpayers
    for Common Sense have calculated that last year almost $16
    billion was spent on Congressional earmarks. $772 million was
    spent on earmarks in the Labor-Health and Human Services
    appropriations bill alone. This demonstrates there are funds in
    the annual appropriations bill that can be used to offset the
    spending of the new program this bill would create. Proponents
    of the legislation have argued that the Committee on
    Appropriations will not fund the World Trade Center health care
    program even though there would be more than sufficient funds
    to cover the expense of the program just by simply eliminating
    earmarks. Instead of prioritizing our federal spending, like
    eliminating earmarks, the proponents of the legislation offered
    a promise to pay for the bill in the future with tax increases.
        With scarce federal resources, we must ensure that we spend
    the people's money efficiently. Therefore, those funds should
    not be used on those who are in the country illegally. The
    underlying bill does not require the Secretary to verify
    applicants' citizenship. H.R. 847 establishes a cap for the
    number of people who may enroll in the program. Due to the lack
    of a citizenship verification requirement, American citizens
    may be blocked from accessing the program. Such a scenario is
    unacceptable. Mr. Buyer offered an amendment that would ensure
    only Americans and those in the country legally would be
    provided benefits under this program. That amendment was
    defeated by a vote of 16 Yeas to 27 Nays.
        Dr. Burgess also offered a common sense amendment to ensure
    benefits go to those that truly need them. The amendment would
    have precluded millionaires from accessing this new health
    entitlement program. That amendment was first defeated by a
    vote of 16 Yeas to 29 Nays. After a motion to reconsider the
    vote, the amendment was defeated again by a vote of 21 Yeas to
    22 Nays.
        Additionally, the World Trade Center health program should
    be about providing benefits to first responders, not about
    providing additional revenue for New York area hospitals. But
    H.R. 847 increases reimbursement rates only for New York
    hospitals and provides incentives for those hospitals to engage
    in wasteful behavior. With respect to reimbursement, the bill
    actually reimburses New York area hospitals at a rate that is
    140% of the Medicare reimbursement rate and provides a perverse
    incentive for hospitals to use unnecessary services because it
    will result in higher payments from the federal government.
        The Patient Protection and Affordable Care Act will slash
    over $150 billion in payments to hospitals for care provided to
    seniors. The Chief Actuary for the Centers for Medicare and
    Medicaid Services concluded in an April 22, 2010, letter that
    these Medicare cuts to hospitals and other Part A providers
    could lead to 15% of those providers going out of business. The
    Actuary stated these cuts could ``possibly jeopardize access to
    care for beneficiaries.'' It is difficult to reconcile the
    justification to cut hospital payments to every hospital in the
    country while at the same time creating a new program that
    provides reimbursement rates so far above the Medicare payment
    level in the New York City area. Mr. Shimkus offered an
    amendment that would have reimbursed these New York area
    hospitals at the Medicare reimbursement rate, but that
    amendment was defeated by a vote of 17 Yeas to 26 Nays.
        H.R. 847 also fails to encourage quality care by those New
    York hospitals. During the health care reform debate, there was
    universal recognition that our federal health care programs
    must start reimbursing providers based on the quality of
    services they provide rather than the volume of services they
    provide. The health care reform bill failed to make this
    transition because existing government programs are slow to
    adapt and change. In the creation of the new program under H.R.
    847, there were no existing policies to prevent Congress from
    demanding this program pay for quality rather than volume.
        However, under H.R. 847, hospitals participating in the
    program would receive financial windfalls for ordering more
    tests regardless of the quality of care. Participants in the
    program would have no incentive to question the cost of their
    care because imposing any form of cost sharing is prohibited.
    We are disappointed the Majority created only a superficial fix
    for this issue by giving the Secretary discretion to modify
    reimbursement methods after the program is already up and
    running. The benefits of the bill are delayed until July 2011,
    which is ample time for the Secretary to develop a
    reimbursement method that is fair to all taxpayers, does not
    reward over-utilization of services, and promotes quality of
    care.
        Republicans and Democrats share a common goal, which is to
    ensure that first responders of the World Trade Center attack
    have their conditions monitored and receive treatment for
    conditions associated with the attacks. Republicans offered an
    amendment to authorize the program and fund it at the
    President's requested level. We offered amendments to increase
    the accountability of how taxpayer dollars are spent and
    offered an amendment that would ensure that Americans and those
    in this country legally get care rather than those in the
    country illegally. Unfortunately, these amendments were
    defeated.
        We continue to believe those who responded to the World
    Trade Center attack should get the treatment they need because
    they dutifully answered a call for help. The opposition to H.R.
    847 is not opposition to providing health benefits. Rather, it
    is an opposition to the structure and administration of the
    program. We believe it is important to pay for our priorities
    and eliminate unnecessary spending in other areas. We believe
    that federal benefits should not go to those in the country
    illegally. We also believe that programs should not provide
    incentives to hospitals in the New York City area to order
    unnecessary tests while paying those providers rates far beyond
    what other federal programs reimburse, particularly when
    hospitals in other parts of the country may be forced to close
    due to the recently enacted Medicare cuts called for in the
    health care reform law. Unfortunately, H.R. 847 fails to meet
    these principles shared by most Americans. For these reasons we
    encourage a ``no'' vote on H.R. 847.

                                       Joe Barton.
                                       John Shimkus.
                                       Joseph R. Pitts.
                                       Phil Gingrey.
                                       Robert E. Latta.
                                       Cliff Stearns.
                                       Roy Blunt.
                                       John B. Shadegg.
                                       Mike Rogers (MI).
                                       Steve Buyer.