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

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

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

             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. Conyers, from the Committee on the Judiciary, 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 the Judiciary, 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,
    reports favorably thereon with an amendment and recommends that
    the bill as amended do pass.

                                    CONTENTS

                                                                       Page
    The Amendment....................................................     3
    Purpose and Summary..............................................    30
    Background and Need for the Legislation..........................    30
    Hearings.........................................................    34
    Committee Consideration..........................................    35
    Committee Votes..................................................    35
    Committee Oversight Findings.....................................    36
    New Budget Authority and Tax Expenditures........................    37
    Congressional Budget Office Cost Estimate........................    37
    Performance Goals and Objectives.................................    50
    Constitutional Authority Statement...............................    50
    Advisory on Earmarks.............................................    50
    Section-by-Section Analysis......................................    50
    Changes in Existing Law Made by the Bill, as Reported............    53
    Dissenting Views.................................................    59

                                 The 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.
    Sec. 2. Findings.

                   TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

    Sec. 101. World Trade Center Health Program.

                 ``TITLE XXX--WORLD TRADE CENTER HEALTH PROGRAM

         ``Subtitle A--Establishment of Program; Advisory and Steering
                                   Committees

            ``Sec. 3001. Establishment of World Trade Center Health Program
                            within NIOSH.
            ``Sec. 3002. WTC Health Program Scientific/Technical Advisory
                            Committee.
            ``Sec. 3003. WTC Health Program Steering Committees.
            ``Sec. 3004. Community education and outreach.
            ``Sec. 3005. Uniform data collection.
            ``Sec. 3006. Centers of excellence.
            ``Sec. 3007. Entitlement authorities.
            ``Sec. 3008. Definitions.

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

                          ``Part 1--For WTC Responders

            ``Sec. 3011. Identification of eligible WTC responders and
                            provision of WTC-related monitoring services.
            ``Sec. 3012. Treatment of certified eligible WTC responders for
                            WTC-related health conditions.

                          ``Part 2--Community Program

            ``Sec. 3021. Identification and initial health evaluation of
                            eligible WTC community members.
            ``Sec. 3022. Followup monitoring and treatment of certified
                            eligible WTC community members for WTC-related
                            health conditions.
            ``Sec. 3023. Followup monitoring and treatment of other
                            individuals with WTC-related health conditions.

     ``Part 3--National Arrangement for Benefits for Eligible Individuals
                                Outside New York

            ``Sec. 3031. National arrangement for benefits for eligible
                            individuals outside New York.

                     ``Subtitle C--Research Into Conditions

            ``Sec. 3041. Research regarding certain health conditions
                            related to September 11 terrorist attacks in
                            New York City.

     ``Subtitle D--Programs of the New York City Department of Health and
                                 Mental Hygiene

            ``Sec. 3051. World Trade Center Health Registry.
            ``Sec. 3052. Mental health services.

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

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

    SEC. 2. FINDINGS.

      Congress finds the following:
              (1) Thousands of rescue workers who responded to the areas
            devastated by the terrorist attacks of September 11, local
            residents, office and area workers, and school children
            continue to suffer significant medical problems as a result of
            compromised air quality and the release of other toxins from
            the attack sites.
              (2) In a September 2006 peer-reviewed study conducted by the
            World Trade Center Medical Monitoring Program, of 9,500 World
            Trade Center responders, almost 70 percent of World Trade
            Center responders had a new or worsened respiratory symptom
            that developed during or after their time working at the World
            Trade Center; among the responders who were asymptomatic before
            9/11, 61 percent developed respiratory symptoms while working
            at the World Trade Center; close to 60 percent still had a new
            or worsened respiratory symptom at the time of their
            examination; one-third had abnormal pulmonary function tests;
            and severe respiratory conditions including pneumonia were
            significantly more common in the 6 months after 9/11 than in
            the prior 6 months.
              (3) An April 2006 study documented that, on average, a New
            York City firefighter who responded to the World Trade Center
            has experienced a loss of 12 years of lung capacity.
              (4) A peer-reviewed study of residents who lived near the
            World Trade Center titled ``The World Trade Center Residents'
            Respiratory Health Study: New Onset Respiratory Symptoms and
            Pulmonary Function'', found that data demonstrated a three-fold
            increase in new-onset, persistent lower respiratory symptoms in
            residents near the former World Trade Center as compared to a
            control population.
              (5) Previous research on the health impacts of the
            devastation caused by the September 11 terrorist attacks has
            shown relationships between the air quality from Ground Zero
            and a host of health impacts, including lower pregnancy rates,
            higher rates of respiratory and lung disorders, and a variety
            of post-disaster mental health conditions (including
            posttraumatic stress disorder) in workers and residents near
            Ground Zero.
              (6) A variety of tests conducted by independent scientists
            have concluded that significant WTC contamination settled in
            indoor environments surrounding the disaster site. The
            Environmental Protection Agency's (EPA) cleanup programs for
            indoor residential spaces, in 2003 and 2005, though limited,
            are an acknowledgment that indoor contamination continued after
            the WTC attacks.
              (7) At the request of the Department of Energy, the Davis
            DELTA Group at the University of California conducted outdoor
            dust sampling in October 2001 at Varick and Houston Streets
            (approximately 1.2 miles north of Ground Zero) and found that
            the contamination from the World Trade Center ``outdid even the
            worst pollution from the Kuwait oil fields fires''. Further,
            the United States Geological Survey (USGS) reported on November
            27, 2001, that dust samples collected from indoor surfaces
            registered at levels that were ``as caustic as liquid drain
            cleaners''.
              (8) According to both the EPA's own Inspector General's (EPA
            IG) report of August 21, 2003 and General Accountability
            Offices's (GAO) report of September 2007, no comprehensive
            program has ever been conducted in order to characterize the
            full extent of WTC contamination, and therefore the full impact
            of that contamination--geographic or otherwise--remains
            unknown.
              (9) Such reports found that there has never been a
            comprehensive program to remediate WTC toxins from indoor
            spaces. Thus, area residents, workers and students may continue
            to be exposed to WTC contamination in their homes, workplaces
            and schools.
              (10) Because of the failure to release federally appropriated
            funds for community care, a lack of sufficient outreach, the
            fact that many community members are receiving care from
            physicians outside the current City-funded World Trade Center
            Environmental Health Center program and thus fall outside data
            collection efforts, and other factors, the number of community
            members being treated at the World Trade Center Environmental
            Health Center underrepresents the total number in the community
            that have been affected by exposure to Ground Zero toxins.
              (11) Research by Columbia University's Center for Children's
            Environmental Health has shown negative health effects on
            babies born to women living within 2 miles of the World Trade
            Center in the month following 9/11.
              (12) Federal funding allocated for the monitoring of rescue
            workers' health is not sufficient to ensure the long-term study
            of health impacts of September 11.
              (13) A significant portion of those who have developed health
            problems as result of exposures to airborne toxins or other
            hazards resulting from the September 11, 2001, attacks on the
            World Trade Center have no health insurance, have lost their
            health insurance as a result of the attacks, or have inadequate
            health insurance.
              (14) The Federal program to provide medical treatments to
            those who responded to the September 11 aftermath, and who
            continue to experience health problems as a result, was finally
            established more than five years after the attacks, but has no
            certain long-term funding.
              (15) Rescue workers and volunteers seeking workers'
            compensation have reported that their applications have been
            denied, delayed for months, or redirected, instead of receiving
            assistance in a timely and supportive manner.
              (16) A February 2007 report released by the City of New York
            estimated that approximately 410,000 people were the most
            heavily exposed to the environmental hazards and trauma of the
            September 11 terrorist attacks. More than 30 percent of the
            Fire Department of the City of New York first responders were
            still experiencing some respiratory symptoms more than five
            years after the attacks and according to the report, 59 percent
            of those seen by the WTC Environmental Health Center at
            Bellevue Hospital (which serves community members) are without
            insurance and 65 percent have incomes less than $15,000 per
            year. The report also found a need to continue and expand
            mental health services.
              (17) Since the 5th anniversary of the attack (September 11,
            2006), hundreds of workers a month have been signing up with
            the monitoring and treatment programs.
              (18) In April 2008, the Department of Health and Human
            Services reported to Congress that in fiscal year 2007 11,359
            patients received medical treatment in the existing WTC
            Responder Medical and Treatment program for WTC-related health
            problems, and that number of responders who need treatment and
            the severity of health problems is expected to increase.
              (19) The September 11 Victim Compensation Fund of 2001 was
            established to provide compensation to individuals who were
            physically injured or killed as a result of the terrorist-
            related aircraft crashes of September 11, 2001.
              (20) The deadline for filing claims for compensation under
            the Victim Compensation Fund was December 22, 2003.
              (21) Some individuals did not know they were eligible to file
            claims for compensation for injuries or did not know they had
            suffered physical harm as a result of the terrorist-related
            aircraft crashes until after the December 22, 2003, deadline.
              (22) Further research is needed to evaluate more
            comprehensively the extent of the health impacts of September
            11, including research for emerging health problems such as
            cancer, which have been predicted.
              (23) Research is needed regarding possible treatment for the
            illnesses and injuries of September 11.
              (24) The Federal response to medical and financial issues
            arising from the September 11 response efforts needs a
            comprehensive, coordinated long-term response in order to meet
            the needs of all the individuals who were exposed to the toxins
            of Ground Zero and are suffering health problems from the
            disaster.
              (25) The failure to extend the appointment of Dr. John Howard
            as Director of the National Institute for Occupational Safety
            and Health in July 2008 is not in the interests of the
            administration of such Institute nor the continued operation of
            the World Trade Center Medical Monitoring and Treatment Program
            which he has headed, and the Secretary of Health and Human
            Services should reconsider extending such appointment.

                   TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

    SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM.

      The Public Health Service Act is amended by adding at the end the
    following new title:

                 ``TITLE XXX--WORLD TRADE CENTER HEALTH PROGRAM

         ``Subtitle A--Establishment of Program; Advisory and Steering
                                   Committees

    ``SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM WITHIN
                        NIOSH.

      ``(a) In General.--There is hereby established within the National
    Institute for Occupational Safety and Health a program to be known as
    the `World Trade Center Health Program' (in this title referred to as
    the `WTC program') to provide--
              ``(1) medical monitoring and treatment benefits to eligible
            emergency responders and recovery and clean-up workers
            (including those who are Federal employees) who responded to
            the September 11, 2001, terrorist attacks on the World Trade
            Center; and
              ``(2) initial health evaluation, monitoring, and treatment
            benefits to residents and other building occupants and area
            workers in New York City who were directly impacted and
            adversely affected by such attacks.
      ``(b) Components of Program.--The WTC program includes the following
    components:
              ``(1) Medical monitoring for responders.--Medical monitoring
            under section 3011, including clinical examinations and long-
            term health monitoring and analysis for individuals who were
            likely to have been exposed to airborne toxins that were
            released, or to other hazards, as a result of the September 11,
            2001, terrorist attacks on the World Trade Center.
              ``(2) Initial health evaluation for community members.--An
            initial health evaluation under section 3021, including an
            evaluation to determine eligibility for followup monitoring and
            treatment.
              ``(3) Follow-up monitoring and treatment for wtc-related
            conditions for responders and community members.--Provision
            under sections 3012, 3022, and 3023 of follow-up monitoring and
            treatment and payment, subject to the provisions of subsection
            (d), for all medically necessary health and mental health care
            expenses (including necessary prescription drugs) of
            individuals with a WTC-related health condition.
              ``(4) Outreach.--Establishment under section 3004 of an
            outreach program to potentially eligible individuals concerning
            the benefits under this title.
              ``(5) Uniform data collection.--Collection under section 3005
            of health and mental health data on individuals receiving
            monitoring or treatment benefits, using a uniform system of
            data collection.
              ``(6) Research on wtc conditions.--Establishment under
            subtitle C of a research program on health conditions resulting
            from the September 11, 2001, terrorist attacks on the World
            Trade Center.
      ``(c) No Cost-sharing.--Monitoring and treatment benefits and initial
    health evaluation benefits are provided under subtitle B without any
    deductibles, copayments, or other cost-sharing to an eligible WTC
    responder or any eligible WTC community member.
      ``(d) Payor.--
              ``(1) In general.--Except as provided in paragraphs (2) and
            (3), the cost of monitoring and treatment benefits and initial
            health evaluation benefits provided under subtitle B shall be
            paid for by the WTC program.
              ``(2) Workers' compensation payment.--
                      ``(A) In general.--Except as provided in subparagraph
                    (B), payment for treatment under subtitle B of a WTC-
                    related condition in an individual that is work-related
                    shall be reduced or recouped to the extent that the
                    Secretary determines that payment has been made, or can
                    reasonably be expected to be made, under a workers'
                    compensation law or plan of the United States or a
                    State, or other work-related injury or illness benefit
                    plan of the employer of such individual, for such
                    treatment. The provisions of clauses (iii), (iv), (v),
                    and (vi) of paragraph (2)(B) of section 1862(b) of the
                    Social Security Act (42 U.S.C. 1395y(b)(2)) and
                    paragraph (3) of such section shall apply to the
                    recoupment under this paragraph of a payment to the WTC
                    program with respect to a workers' compensation law or
                    plan, or other work-related injury or illness plan of
                    the employer involved, and such individual in the same
                    manner as such provisions apply to the reimbursement of
                    a payment under section 1862(b)(2) of such Act to the
                    Secretary, with respect to such a law or plan and an
                    individual entitled to benefits under title XVIII of
                    such Act.
                      ``(B) Exception.--If the WTC Program Administrator
                    certifies that the City of New York has contributed the
                    matching contribution required under section 3006(a)(3)
                    for a 12-month period (specified by the WTC Program
                    Administrator), subparagraph (A) shall not apply for
                    that 12-month period with respect to a workers'
                    compensation law or plan, including line of duty
                    compensation, to which the City is obligated to make
                    payments.
              ``(3) Health insurance coverage.--
                      ``(A) In general.--In the case of an individual who
                    has a WTC-related condition that is not work-related
                    and has health coverage for such condition through any
                    public or private health plan, the provisions of
                    section 1862(b) of the Social Security Act (42 U.S.C.
                    1395y(b)) shall apply to such a health plan and such
                    individual in the same manner as they apply to a group
                    health plan and an individual entitled to benefits
                    under title XVIII of such Act pursuant to section
                    226(a). Any costs for items and services covered under
                    such plan that are not reimbursed by such health plan,
                    due to the application of deductibles, copayments,
                    coinsurance, other cost-sharing, or otherwise, are
                    reimbursable under this title to the extent that they
                    are covered under the WTC program.
                      ``(B) Recovery by individual providers.--Nothing in
                    subparagraph (A) shall be construed as requiring an
                    entity providing monitoring and treatment under this
                    title to seek reimbursement under a health plan with
                    which the entity has no contract for reimbursement.
              ``(4) Work-related described.--For the purposes of this
            subsection, a WTC-related condition shall be treated as a
            condition that is work-related if--
                      ``(A) the condition is diagnosed in an eligible WTC
                    responder, or in an individual who qualifies as an
                    eligible WTC community member on the basis of being a
                    rescue, recovery, or clean-up worker; or
                      ``(B) with respect to the condition the individual
                    has filed and had established a claim under a workers'
                    compensation law or plan of the United States or a
                    State, or other work-related injury or illness benefit
                    plan of the employer of such individual.
      ``(e) Quality Assurance and Monitoring of Clinical Expenditures.--
              ``(1) Quality assurance.--The WTC Program Administrator
            working with the Clinical Centers of Excellence shall develop
            and implement a quality assurance program for the medical
            monitoring and treatment delivered by such Centers of
            Excellence and any other participating health care providers.
            Such program shall include--
                      ``(A) adherence to medical monitoring and treatment
                    protocols;
                      ``(B) appropriate diagnostic and treatment referrals
                    for participants;
                      ``(C) prompt communication of test results to
                    participants; and
                      ``(D) such other elements as the Administrator
                    specifies in consultation with the Clinical Centers of
                    Excellence.
              ``(2) Fraud prevention.--The WTC Program Administrator shall
            develop and implement a program to review the program's health
            care expenditures to detect fraudulent or duplicate billing and
            payment for inappropriate services. Such program shall be
            similar to current methods used in connection with the Medicare
            program under title XVIII of the Social Security Act. This
            title is a Federal health care program (as defined in section
            1128B(f) of such Act) and is a health plan (as defined in
            section 1128C(c) of such Act) for purposes of applying sections
            1128 through 1128E of such Act.
      ``(f) WTC Program Administration.--The WTC program shall be
    administered by the Director of the National Institute for Occupational
    Safety and Health, or a designee of such Director.
      ``(g) Annual Program Report.--
              ``(1) In general.--Not later than 6 months after the end of
            each fiscal year in which the WTC program is in operation, the
            WTC Program Administrator shall submit an annual report to the
            Congress on the operations of this title for such fiscal year
            and for the entire period of operation of the program.
              ``(2) Contents of report.--Each annual report under paragraph
            (1) shall include the following:
                      ``(A) Eligible individuals.--Information for each
                    clinical program described in paragraph (3)--
                              ``(i) on the number of individuals who
                            applied for certification under subtitle B and
                            the number of such individuals who were so
                            certified;
                              ``(ii) of the individuals who were certified,
                            on the number who received medical monitoring
                            under the program and the number of such
                            individuals who received medical treatment
                            under the program;
                              ``(iii) with respect to individuals so
                            certified who received such treatment, on the
                            WTC-related health conditions for which they
                            were treated; and
                              ``(iv) on the projected number of individuals
                            who will be certified under subtitle B in the
                            succeeding fiscal year.
                      ``(B) Monitoring, initial health evaluation, and
                    treatment costs.--For each clinical program so
                    described--
                              ``(i) information on the costs of monitoring
                            and initial health evaluation and the costs of
                            treatment and on the estimated costs of such
                            monitoring, evaluation, and treatment in the
                            succeeding fiscal year; and
                              ``(ii) an estimate of the cost of medical
                            treatment for WTC-related conditions that have
                            been paid for or reimbursed by workers'
                            compensation, by public or private health
                            plans, or by the City of New York under section
                            3012(c)(4).
                      ``(C) Administrative costs.--Information on the cost
                    of administering the program, including costs of
                    program support, data collection and analysis, and
                    research conducted under the program.
                      ``(D) Administrative experience.--Information on the
                    administrative performance of the program, including--
                              ``(i) the performance of the program in
                            providing timely evaluation of and treatment to
                            eligible individuals; and
                              ``(ii) a list of the Clinical Centers of
                            Excellence and other providers that are
                            participating in the program.
                      ``(E) Scientific reports.--A summary of the findings
                    of any new scientific reports or studies on the health
                    effects associated with WTC center exposures, including
                    the findings of research conducted under section
                    3041(a).
                      ``(F) Advisory committee recommendations.--A list of
                    recommendations by the WTC Scientific/Technical
                    Advisory Committee on additional WTC program
                    eligibility criteria and on additional WTC-related
                    health conditions and the action of the WTC Program
                    Administrator concerning each such recommendation.
              ``(3) Separate clinical programs described.--In paragraph
            (2), each of the following shall be treated as a separate
            clinical program of the WTC program:
                      ``(A) FDNY responders.--The benefits provided for
                    eligible WTC responders described in section
                    3006(b)(1)(A).
                      ``(B) Other eligible wtc responders.--The benefits
                    provided for eligible WTC responders not described in
                    subparagraph (A).
                      ``(C) Eligible wtc community members.--The benefits
                    provided for eligible WTC community members in section
                    3006(b)(1)(C).
      ``(h) Notification to Congress When Reach 80 Percent of Eligibility
    Numerical Limits.--The WTC Program Administrator shall promptly notify
    the Congress--
              ``(1) when the number of certifications for eligible WTC
            responders subject to the limit established under section
            3011(a)(5) has reached 80 percent of such limit; and
              ``(2) when the number of certifications for eligible WTC
            community members subject to the limit established under
            section 3021(a)(5) has reached 80 percent of such limit.
      ``(i) GAO Report.--Not later than 3 years after the date of the
    enactment of this Act, the Comptroller General of the United States
    shall submit to the Congress a report on the costs of the monitoring
    and treatment programs provided under this title.
      ``(j) NYC Recommendations.--The City of New York may make
    recommendations to the WTC Program Administrator on ways to improve the
    monitoring and treatment programs under this title for both eligible
    WTC responders and eligible WTC community members.

    ``SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY
                        COMMITTEE.

      ``(a) Establishment.--The WTC Program Administrator shall establish
    an advisory committee to be known as the WTC Health Program Scientific/
    Technical Advisory Committee (in this section referred to as the
    `Advisory Committee') to review scientific and medical evidence and to
    make recommendations to the Administrator on additional WTC program
    eligibility criteria and on additional WTC-related health conditions.
      ``(b) Composition.--The WTC Program Administrator shall appoint the
    members of the Advisory Committee and shall include at least--
              ``(1) 4 occupational physicians, at least two of whom have
            experience treating WTC rescue and recovery workers;
              ``(2) 1 physician with expertise in pulmonary medicine;
              ``(3) 2 environmental medicine or environmental health
            specialists;
              ``(4) 2 representatives of eligible WTC responders;
              ``(5) 2 representatives of WTC community members;
              ``(6) an industrial hygienist;
              ``(7) a toxicologist;
              ``(8) an epidemiologist; and
              ``(9) a mental health professional.
      ``(c) Meetings.--The Advisory Committee shall meet at such frequency
    as may be required to carry out its duties.
      ``(d) Reports.--The WTC Program Administrator shall provide for
    publication of recommendations of the Advisory Committee on the public
    website established for the WTC program.
      ``(e) Authorization of Appropriations.--For the purpose of carrying
    out this section, there are authorized to be appropriated such sums as
    may be necessary, not to exceed $100,000, for each fiscal year
    beginning with fiscal year 2009.
      ``(f) Duration.--Notwithstanding any other provision of law, the
    Advisory Committee shall continue in operation during the period in
    which the WTC program is in operation.
      ``(g) Application of FACA.--Except as otherwise specifically
    provided, the Advisory Committee shall be subject to the Federal
    Advisory Committee Act.

    ``SEC. 3003. WTC HEALTH PROGRAM STEERING COMMITTEES.

      ``(a) Establishment.--The WTC Program Administrator shall establish
    two steering committees (each in this section referred to as a
    `Steering Committee') as follows:
              ``(1) WTC responders steering committee.--One steering
            committee, to be known as the WTC Responders Steering
            Committee, for the purpose of facilitating the coordination of
            medical monitoring and treatment programs for the eligible WTC
            responders under part 1 of subtitle B.
              ``(2) WTC community program steering committee.--One steering
            committee, to be known as the WTC Community Program Steering
            Committee, for the purpose of facilitating the coordination of
            initial health evaluations, monitoring, and treatment programs
            for eligible WTC community members under part 2 of subtitle B.
      ``(b) Membership.--
              ``(1) Initial membership of wtc responders steering
            committee.--The WTC Responders Steering Committee shall
            initially be composed of members of the WTC Monitoring and
            Treatment Program Steering Committee (as in existence on the
            day before the date of the enactment of this title). In
            addition, the committee membership shall include--
                      ``(A) a representative of the Police Commissioner of
                    the City of New York;
                      ``(B) a representative of the Department of Health of
                    the City of New York;
                      ``(C) a representative of another agency of the City
                    of New York, selected by the Mayor of New York City,
                    which had a large number of non-uniformed City workers
                    who responded to the WTC disaster; and
                      ``(D) three representatives of eligible WTC
                    responders;
            in order that eligible WTC responders constitute half the
            members of the Steering Committee.
              ``(2) Initial membership of wtc community program steering
            committee.--
                      ``(A) In general.--The WTC Community Program Steering
                    Committee shall initially be composed of members of the
                    WTC Environmental Health Center Community Advisory
                    Committee (as in existence on the day before the date
                    of the enactment of this title) and shall initially
                    have, as voting members, the following:
                              ``(i) 11 representatives of the affected
                            populations of residents, students, area
                            workers, and other community members.
                              ``(ii) The Medical Director of the WTC
                            Environmental Health Center.
                              ``(iii) The Executive Director of the WTC
                            Environmental Health Center.
                              ``(iv) Three physicians, one each
                            representing the three WTC Environmental Health
                            Center treatment sites of Bellevue Hospital
                            Center, Gouverneur Healthcare Services, and
                            Elmhurst Hospital Center.
                              ``(v) Five specialists with WTC related
                            expertise or experience in treating non-
                            responder WTC diseases, such as a pediatrician,
                            an epidemiologist, a psychiatrist or
                            psychologist, an environmental/occupational
                            specialists or a social worker from a WTC
                            Environmental Health Center treatment site, or
                            other relevant specialists.
                              ``(vi) A representative of the Department of
                            Health and Mental Hygiene of the City of New
                            York.
                      ``(B) Appointments.--
                              ``(i) WTC ehc community advisory committee.--
                            The WTC Environmental Health Center Community
                            Advisory Committee as in existence on the date
                            of the enactment of this title shall nominate
                            members for positions described in subparagraph
                            (A)(i).
                              ``(ii) NYC health and hospitals
                            corporation.--The New York City Health and
                            Hospitals Corporation shall nominate members
                            for positions described in clauses (iv) and (v)
                            of subparagraph (A).
                              ``(iii) Timing.--Nominations under clauses
                            (i) and (ii) shall be recommended to the WTC
                            Program Administrator not later than 60 days
                            after the date of the enactment of this title.
                              ``(iv) Appointment.--The WTC Program
                            Administrator shall appoint members of the WTC
                            Community Program Steering Committee not later
                            than 90 days after the date of the enactment of
                            this title.
                              ``(v) General representatives.--Of the
                            members appointed under subparagraph (A)(i)--
                                      ``(I) the representation shall
                                    reflect the broad and diverse WTC-
                                    affected populations and constituencies
                                    and the diversity of impacted
                                    neighborhoods, including residents,
                                    hard-to-reach populations, students,
                                    area workers, school parents,
                                    community-based organizations,
                                    Community Boards, WTC Environmental
                                    Health Center patients, labor unions,
                                    and labor advocacy organizations; and
                                      ``(II) no one individual organization
                                    can have more than one representative.
              ``(3) Additional appointments.--Each Steering Committee may
            appoint, if approved by a majority of voting members of the
            Committee, additional members to the Committee.
              ``(4) Vacancies.--A vacancy in a Steering Committee shall be
            filled by the Steering Committee, subject to the approval of
            the WTC Program Administrator, so long as--
                      ``(A) in the case of the WTC Responders Steering
                    Committee, the composition of the Committee includes
                    representatives of eligible WTC responders and
                    representatives of each Clinical Center of Excellence
                    and each Coordinating Center of Excellence that serves
                    eligible WTC responders and such composition has
                    eligible WTC responders constituting half of the
                    membership of the Steering Committee; or
                      ``(B) in the case of the WTC Community Program
                    Steering Committee, the composition of the Committee
                    includes representatives of eligible WTC community
                    members and representatives of each Clinical Center of
                    Excellence and each Coordinating Center of Excellence
                    that serves eligible WTC community members and the
                    nominating process is consistent with paragraph (2)(B).
              ``(5) Co-chairs of wtc community program steering
            committee.--The WTC Community Program Steering Committee shall
            have two Co-Chairs as follows:
                      ``(A) Community/Labor co-chair.--A Community/Labor
                    Co-Chair who shall be chosen by the community and
                    labor-based members of the Steering Committee.
                      ``(B) Environmental health clinic co-chair.--A WTC
                    Environmental Health Clinic Co-Chair who shall be
                    chosen by the WTC Environmental Health Center members
                    on the Steering Committee.
      ``(c) Relation to FACA.--Each Steering Committee shall not be subject
    to the Federal Advisory Committee Act.
      ``(d) Meetings.--Each Steering Committee shall meet at such frequency
    necessary to carry out its duties, but not less than 4 times each
    calendar year and at least two such meetings each year shall be a joint
    meeting with the voting membership of the other Steering Committee for
    the purpose of exchanging information regarding the WTC program.
      ``(e) Duration.--Notwithstanding any other provision of law, each
    Steering Committee shall continue in operation during the period in
    which the WTC program is in operation.

    ``SEC. 3004. COMMUNITY EDUCATION AND OUTREACH.

      ``(a) In General.--The WTC Program Administrator shall institute a
    program that provides education and outreach on the existence and
    availability of services under the WTC program. The outreach and
    education program--
              ``(1) shall include--
                      ``(A) the establishment of a public website with
                    information about the WTC program;
                      ``(B) meetings with potentially eligible populations;
                      ``(C) development and dissemination of outreach
                    materials informing people about the program; and
                      ``(D) the establishment of phone information
                    services; and
              ``(2) shall be conducted in a manner intended--
                      ``(A) to reach all affected populations; and
                      ``(B) to include materials for culturally and
                    linguistically diverse populations.
      ``(b) Partnerships.--To the greatest extent possible, in carrying out
    this section, the WTC Program Administrator shall enter into
    partnerships with local governments and organizations with experience
    performing outreach to the affected populations, including community
    and labor-based organizations.

    ``SEC. 3005. UNIFORM DATA COLLECTION.

      ``(a) In General.--The WTC Program Administrator shall provide for
    the uniform collection of data (and analysis of data and regular
    reports to the Administrator) on the utilization of monitoring and
    treatment benefits provided to eligible WTC responders and eligible WTC
    community members, the prevalence of WTC-related health conditions, and
    the identification of new WTC-related medical conditions. Such data
    shall be collected for all individuals provided monitoring or treatment
    benefits under subtitle B and regardless of their place of residence or
    Clinical Center of Excellence through which the benefits are provided.
      ``(b) Coordinating Through Centers of Excellence.--Each Clinical
    Center of Excellence shall collect data described in subsection (a) and
    report such data to the corresponding Coordinating Center of Excellence
    for analysis by such Coordinating Center of Excellence.
      ``(c) Privacy.--The data collection and analysis under this section
    shall be conducted in a manner that protects the confidentiality of
    individually identifiable health information consistent with applicable
    legal requirements.

    ``SEC. 3006. CENTERS OF EXCELLENCE.

      ``(a) In General.--
              ``(1) Contracts with clinical centers of excellence.--The WTC
            Program Administrator shall enter into contracts with Clinical
            Centers of Excellence specified in subsection (b)(1)--
                      ``(A) for the provision of monitoring and treatment
                    benefits and initial health evaluation benefits under
                    subtitle B;
                      ``(B) for the provision of outreach activities to
                    individuals eligible for such monitoring and treatment
                    benefits, for initial health evaluation benefits, and
                    for follow-up to individuals who are enrolled in the
                    monitoring program;
                      ``(C) for the provision of counseling for benefits
                    under subtitle B, with respect to WTC-related health
                    conditions, for individuals eligible for such benefits;
                      ``(D) for the provision of counseling for benefits
                    for WTC-related health conditions that may be available
                    under Workers' Compensation or other benefit programs
                    for work-related injuries or illnesses, health
                    insurance, disability insurance, or other insurance
                    plans or through public or private social service
                    agencies and assisting eligible individuals in applying
                    for such benefits;
                      ``(E) for the provision of translational and
                    interpretive services as for program participants who
                    are not English language proficient; and
                      ``(F) for the collection and reporting of data in
                    accordance with section 3005.
              ``(2) Contracts with coordinating centers of excellence.--The
            WTC Program Administrator shall enter into contracts with
            Coordinating Centers of Excellence specified in subsection
            (b)(2)--
                      ``(A) for receiving, analyzing, and reporting to the
                    WTC Program Administrator on data, in accordance with
                    section 3005, that has been collected and reported to
                    such Coordinating Centers by the corresponding Clinical
                    Centers of Excellence under subsection (d)(3);
                      ``(B) for the development of medical monitoring,
                    initial health evaluation, and treatment protocols,
                    with respect to WTC-related health conditions;
                      ``(C) for coordinating the outreach activities
                    conducted under paragraph (1)(B) by each corresponding
                    Clinical Center of Excellence;
                      ``(D) for establishing criteria for the credentialing
                    of medical providers participating in the nationwide
                    network under section 3031;
                      ``(E) for coordinating and administrating the
                    activities of the WTC Health Program Steering
                    Committees established under section 3003(a); and
                      ``(F) for meeting periodically with the corresponding
                    Clinical Centers of Excellence to obtain input on the
                    analysis and reporting of data collected under
                    subparagraph (A) and on the development of medical
                    monitoring, initial health evaluation, and treatment
                    protocols under subparagraph (B).
            The medical providers under subparagraph (D) shall be selected
            by the WTC Program Administrator on the basis of their
            experience treating or diagnosing the medical conditions
            included in the list of identified WTC-related conditions for
            responders and of identified WTC-related conditions for
            community members.
              ``(3) Required participation by new york city in monitoring
            and treatment program and costs.--
                      ``(A) In general.--In order for New York City, any
                    agency or Department thereof, or the New York City
                    Health and Hospitals Corporation to qualify for a
                    contract for the provision of monitoring and treatment
                    benefits and other services under section 3006, New
                    York City is required to contribute a matching amount
                    of 10 percent of the amount of the covered monitoring
                    and treatment payment (as defined in subparagraph (B)).
                      ``(B) Covered monitoring and treatment payment
                    defined.--For the purposes of this paragraph, the term
                    `covered monitoring and treatment payment' means
                    payment under paragraphs (1) and (2), including under
                    such paragraph as applied under section 3021(b),
                    3022(a), and 3023, and reimbursement under 3006(c) for
                    items and services furnished by a Clinical Center of
                    Excellence or Coordinating Center of Excellence, and
                    providers designated by the WTC Program under section
                    3031, after the application of paragraphs (2) and (3)
                    of section 3001 (d).
                      ``(C) Payment of new york city share of monitoring
                    and treatment costs.--The WTC Program Administrator
                    shall--
                              ``(i) bill the amount specified in
                            subparagraph (A) directly to New York City; and
                              ``(ii) certify periodically, for purposes of
                            section 3001(d)(2), whether or not New York
                            City has paid the amount so billed.
                      ``(D) Limitation on required amount.--In no case is
                    New York City required under this paragraph to
                    contribute more than a total of $500,000,000 over any
                    10-year period.
      ``(b) Centers of Excellence Defined.--
              ``(1) Clinical center of excellence.--In this title, the term
            `Clinical Center of Excellence' means the following:
                      ``(A) For fdny responders.--With respect to an
                    eligible WTC responder who responded to the 9/11
                    attacks as an employee of the Fire Department of the
                    City of New York and who--
                              ``(i) is an active employee of such
                            Department--
                                      ``(I) with respect to monitoring,
                                    such Fire Department; and
                                      ``(II) with respect to treatment,
                                    such Fire Department (or such entity as
                                    has entered into a contract with the
                                    Fire Department for treatment of such
                                    responders) or any other Clinical
                                    Center of Excellence described in
                                    subparagraph (B), (C), or (D); or
                              ``(ii) is not an active employee of such
                            Department, such Fire Department (or such
                            entity as has entered into a contract with the
                            Fire Department for monitoring or treatment of
                            such responders) or any other or any other
                            Clinical Center of Excellence described in
                            subparagraph (B), (C), or (D).
                      ``(B) Other eligible wtc responders.--With respect to
                    other eligible WTC responders, whether or not they
                    reside in the New York Metropolitan area, the Mt. Sinai
                    coordinated consortium, Queens College, State
                    University of New York at Stony Brook, University of
                    Medicine and Dentistry of New Jersey, and Bellevue
                    Hospital.
                      ``(C) WTC community members.--With respect to
                    eligible WTC community members, whether or not they
                    reside in the New York Metropolitan area, the World
                    Trade Center Environmental Health Center at Bellevue
                    Hospital and such hospitals or other facilities,
                    including but not limited to those within the New York
                    City Health and Hospitals Corporation, as are
                    identified by the WTC Program Administrator.
                      ``(D) All eligible wtc responders and eligible wtc
                    community members.--With respect to all eligible WTC
                    responders and eligible WTC community members, such
                    other hospitals or other facilities as are identified
                    by the WTC Program Administrator.
            The WTC Program Administrator shall limit the number of
            additional Centers of Excellence identified under subparagraph
            (D) to ensure that the participating centers have adequate
            experience in the treatment and diagnosis of identified WTC-
            related medical conditions.
              ``(2) Coordinating center of excellence.--In this title, the
            term `Coordinating Center of Excellence' means the following:
                      ``(A) For fdny responders.--With respect to an
                    eligible WTC responder who responded to the 9/11
                    attacks as an employee of the Fire Department of the
                    City of New York, such Fire Department.
                      ``(B) Other wtc responders.--With respect to other
                    eligible WTC responders, the Mt. Sinai coordinated
                    consortium.
                      ``(C) Wtc community members.--With respect to
                    eligible WTC community members, the World Trade Center
                    Environmental Health Center at Bellevue Hospital.
              ``(3) Corresponding centers.--In this title, a Clinical
            Center of Excellence and a Coordinating Center of Excellence
            shall be treated as `corresponding' to the extent that such
            Clinical Center and Coordinating Center serve the same
            population group.
      ``(c) Reimbursement for Non-treatment, Non-monitoring Program
    Costs.--A Clinical or Coordinating Center of Excellence with a contract
    under this section shall be reimbursed for the costs of such Center in
    carrying out the activities described in subsection (a), other than
    those described in subsection (a)(1)(A), subject to the provisions of
    section 3001(d), as follows:
              ``(1) Clinical centers of excellence.--For carrying out
            subparagraphs (B) through (F) of subsection (a)(1)--
                      ``(A) Clinical center for fdny responders in new
                    york.--The Clinical Center of Excellence for FDNY
                    Responders in New York specified in subsection
                    (b)(1)(A) shall be reimbursed--
                              ``(i) in the first year of the contract under
                            this section, $600 per certified eligible WTC
                            responder in the medical treatment program, and
                            $300 per certified eligible WTC responder in
                            the monitoring program; and
                              ``(ii) in each subsequent contract year,
                            subject to paragraph (3), at the rates
                            specified in this subparagraph for the previous
                            contract year adjusted by the WTC Program
                            Administrator to reflect the rate of medical
                            care inflation during the previous contract
                            year.
                      ``(B) Clinical centers serving other eligible wtc
                    responders in new york.--A Clinical Center of
                    Excellence for other WTC responders in New York
                    specified in subsection (b)(1)(B) shall be reimbursed
                    the amounts specified in subparagraph (A).
                      ``(C) Clinical centers serving wtc community
                    members.--A Clinical Center of Excellence for eligible
                    WTC community members in New York specified in
                    subsection (b)(1)(C) shall be reimbursed--
                              ``(i) in the first year of the contract under
                            this section, for each certified eligible WTC
                            community member in a medical treatment program
                            enrolled at a non-hospital-based facility,
                            $600, and for each certified eligible WTC
                            community member in a medical treatment program
                            enrolled at a hospital-based facility, $300;
                            and
                              ``(ii) in each subsequent contract year,
                            subject to paragraph (3), at the rates
                            specified in this subparagraph for the previous
                            contract year adjusted by the WTC Program
                            Administrator to reflect the rate of medical
                            care inflation during the previous contract
                            year.
                      ``(D) Other clinical centers.--A Clinical Center of
                    Excellence or other providers not described in a
                    previous subparagraph shall be reimbursed at a rate set
                    by the WTC Program Administrator.
                      ``(E) Reimbursement rules.--The reimbursement
                    provided under subparagraphs (A), (B) and (C) shall be
                    made for each certified eligible WTC responder and for
                    each WTC community member in the WTC program per year
                    that the member receives such services, regardless of
                    the volume or cost of services required.
              ``(2) Coordinating centers of excellence.--A Coordinating
            Centers of Excellence specified in section (a)(2) shall be
            reimbursed for the provision of services set forth in this
            section at such levels as are established by the WTC Program
            Administrator.
              ``(3) Review of rates.--
                      ``(A) Initial review.--Before the end of the third
                    contract year of the WTC program, the WTC Program
                    Administrator shall conduct a review to determine
                    whether the reimbursement rates set forth in this
                    subsection provide fair and appropriate reimbursement
                    for such program services. Based on such review, the
                    Administrator may, by rule beginning with the fourth
                    contract year, may modify such rates, taking into
                    account a reasonable and fair rate for the services
                    being provided.
                      ``(B) Subsequent reviews.--After the fourth contract
                    year, the WTC Program Administrator shall conduct
                    periodic reviews to determine whether the reimbursement
                    rates in effect under this subsection provide fair and
                    appropriate reimbursement for such program services.
                    Based upon such a review, the Administrator may by rule
                    modify such rates, taking into account a reasonable and
                    fair rate for the services being provided.
                      ``(C) GAO review.--The Comptroller General of the
                    United States shall review the WTC Program
                    Administrator's determinations regarding fair and
                    appropriate reimbursement for program services under
                    this paragraph.
      ``(d) Requirements.--The WTC Program Administrator shall not enter
    into a contract with a Clinical Center of Excellence under subsection
    (a)(1) unless--
              ``(1) the Center establishes a formal mechanism for
            consulting with and receiving input from representatives of
            eligible populations receiving monitoring and treatment
            benefits under subtitle B from such Center;
              ``(2) the Center provides for the coordination of monitoring
            and treatment benefits under subtitle B with routine medical
            care provided for the treatment of conditions other than WTC-
            related health conditions;
              ``(3) the Center collects and reports to the corresponding
            Coordinating Center of Excellence data in accordance with
            section 3005;
              ``(4) the Center has in place safeguards against fraud that
            are satisfactory to the Administrator;
              ``(5) the Center agrees to treat or refer for treatment all
            individuals who are eligible WTC responders or eligible WTC
            community members with respect to such Center who present
            themselves for treatment of a WTC-related health condition;
              ``(6) the Center has in place safeguards to ensure the
            confidentiality of an individual's individually identifiable
            health information, including requiring that such information
            not be disclosed to the individual's employer without the
            authorization of the individual;
              ``(7) the Center provides assurances that the amounts paid
            under subsection (c)(1) are used only for costs incurred in
            carrying out the activities described in subsection (a), other
            than those described in subsection (a)(1)(A); and
              ``(8) the Center agrees to meet all the other applicable
            requirements of this title, including regulations implementing
            such requirements.

    ``SEC. 3007. ENTITLEMENT AUTHORITIES.

      ``Subject to subsections (b)(4)(C) and (c)(5) of section 3012,
    subtitle B constitutes budget authority in advance of appropriations
    Acts and represents the obligation of the Federal Government to provide
    for the payment for monitoring, initial health evaluations, and
    treatment in accordance with such subtitle and section 3006(c)
    constitutes such budget authority and represents the obligation of the
    Federal Government to provide for the payment described in such
    section.

    ``SEC. 3008. DEFINITIONS.

      ``In this title:
              ``(1) The term `aggravating' means, with respect to a health
            condition, a health condition that existed on September 11,
            2001, and that, as a result of exposure to airborne toxins, any
            other hazard, or any other adverse condition resulting from the
            September 11, 2001, terrorist attacks on the World Trade Center
            requires medical treatment that is (or will be) in addition to,
            more frequent than, or of longer duration than the medical
            treatment that would have been required for such condition in
            the absence of such exposure.
              ``(2) The terms `certified eligible WTC responder' and
            `certified eligible WTC community member' mean an individual
            who has been certified as an eligible WTC responder under
            section 3011(a)(4) or an eligible WTC community member under
            section 3021(a)(4), respectively.
              ``(3) The terms `Clinical Center of Excellence' and
            `Coordinating Center of Excellence' have the meanings given
            such terms in section 3006(b).
              ``(4) The term `current consortium arrangements' means the
            arrangements as in effect on the date of the enactment of this
            title between the National Institute for Occupational Safety
            and Health and the Mt. Sinai-coordinated consortium and the
            Fire Department of the City of New York.
              ``(5) The terms `eligible WTC responder' and `eligible WTC
            community member' are defined in sections 3011(a) and 3021(a),
            respectively.
              ``(6) The term `initial health evaluation' includes, with
            respect to an individual, a medical and exposure history, a
            physical examination, and additional medical testing as needed
            to evaluate whether the individual has a WTC-related health
            condition and is eligible for treatment under the WTC program.
              ``(7) The term `list of identified WTC-related health
            conditions' means--
                      ``(A) for eligible WTC responders, the identified
                    WTC-related health condition for eligible WTC
                    responders under section 3012(a)(3) or 3012(a)(4); or
                      ``(B) for eligible WTC community members, the
                    identified WTC-related health condition for WTC
                    community members under section 3022(b)(1) or
                    3022(b)(2).
              ``(8) The term `Mt.-Sinai-coordinated consortium' means the
            consortium coordinated by Mt. Sinai hospital in New York City
            that coordinates the monitoring and treatment under the current
            consortium arrangements for eligible WTC responders other than
            with respect to those covered under the arrangement with the
            Fire Department of the City of New York.
              ``(9) The term `New York City disaster area' means the area
            within New York City that is--
                      ``(A) the area of Manhattan that is south of Houston
                    Street; and
                      ``(B) any block in Brooklyn that is wholly or
                    partially contained within a 1.5-mile radius of the
                    former World Trade Center site.
              ``(10) The term `New York metropolitan area' means an area,
            specified by the WTC Program Administrator, within which
            eligible WTC responders and eligible WTC community members who
            reside in such area are reasonably able to access monitoring
            and treatment benefits and initial health evaluation benefits
            under this title through a Clinical Centers of Excellence
            described in subparagraphs (A), (B), or (C) of section
            3006(b)(1).
              ``(11) Any reference to `September 11, 2001' shall be deemed
            a reference to the period on such date subsequent to the
            terrorist attacks on the World Trade Center on such date.
              ``(12) The term `September 11, 2001, terrorist attacks on the
            World Trade Center' means the terrorist attacks that occurred
            on September 11, 2001, in New York City and includes the
            aftermath of such attacks.
              ``(13) The term `WTC Health Program Steering Committee' means
            such a Steering Committee established under section 3003.
              ``(14) The term `WTC Program Administrator' means the
            individual responsible under section 3001(f) for the
            administration of the WTC program.
              ``(15) The term `WTC-related health condition' is defined in
            section 3012(a).
              ``(16) The term `WTC Scientific/Technical Advisory Committee'
            means such Committee established under section 3002.

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

                          ``PART 1--FOR WTC RESPONDERS

    ``SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPONDERS AND PROVISION OF
                        WTC-RELATED MONITORING SERVICES.

      ``(a) Eligible WTC Responder Defined.--
              ``(1) In general.--For purposes of this title, the term
            `eligible WTC responder' means any of the following
            individuals, subject to paragraph (5):
                      ``(A) Currently identified responder.--An individual
                    who has been identified as eligible for medical
                    monitoring under the current consortium arrangements
                    (as defined in section 3008(4)).
                      ``(B) Responder who meets current eligibility
                    criteria.--An individual who meets the current
                    eligibility criteria described in paragraph (2).
                      ``(C) Responder who meets modified eligibility
                    criteria.--An individual who--
                              ``(i) performed rescue, recovery, demolition,
                            debris cleanup, or other related services in
                            the New York City disaster area in response to
                            the September 11, 2001, terrorist attacks on
                            the World Trade Center, regardless of whether
                            such services were performed by a State or
                            Federal employee or member of the National
                            Guard or otherwise; and
                              ``(ii) meets such eligibility criteria
                            relating to exposure to airborne toxins, other
                            hazards, or adverse conditions resulting from
                            the September 11, 2001, terrorist attacks on
                            the World Trade Center as the WTC Program
                            Administrator, after consultation with the WTC
                            Responders Steering Committee and the WTC
                            Scientific/Technical Advisory Committee,
                            determines appropriate.
                    The WTC Program Administrator shall not modify such
                    eligibility criteria on or after the date that the
                    number of certifications for eligible responders has
                    reached 80 percent of the limit described in paragraph
                    (5) or on or after the date that the number of
                    certifications for eligible community members has
                    reached 80 percent of the limit described in section
                    3021(a)(5).
              ``(2) Current eligibility criteria.--The eligibility criteria
            described in this paragraph for an individual is that the
            individual is described in either of the following categories:
                      ``(A) Fire fighters and related personnel.--The
                    individual--
                              ``(i) was a member of the Fire Department of
                            the City of New York (whether fire or emergency
                            personnel, active or retired) who participated
                            at least one day in the rescue and recovery
                            effort at any of the former World Trade sites
                            (including Ground Zero, Staten Island land
                            fill, and the NYC Chief Medical Examiner's
                            office) for any time during the period
                            beginning on September 11, 2001, and ending on
                            July 31, 2002; or
                              ``(ii)(I) is a surviving immediate family
                            member of an individual who was a member of the
                            Fire Department of the City of New York
                            (whether fire or emergency personnel, active or
                            retired) and was killed at the World Trade site
                            on September 11, 2001; and
                              ``(II) received any treatment for a WTC-
                            related mental health condition described in
                            section 3012(a)(1)(B) on or before September 1,
                            2008.
                      ``(B) Law enforcement officers and wtc rescue,
                    recovery, and clean-up workers.--The individual--
                              ``(i) worked or volunteered on-site in
                            rescue, recovery, debris-cleanup or related
                            support services in lower Manhattan (south of
                            Canal St.), the Staten Island Landfill, or the
                            barge loading piers, for at least 4 hours
                            during the period beginning on September 11,
                            2001, and ending on September 14, 2001, for at
                            least 24 hours during the period beginning on
                            September 11, 2001, and ending on September 30,
                            2001, or for at least 80 hours during the
                            period beginning on September 11, 2001, and
                            ending on July 31, 2002;
                              ``(ii)(I) was a member of the Police
                            Department of the City of New York (whether
                            active or retired) or a member of the Port
                            Authority Police of the Port Authority of New
                            York and New Jersey (whether active or retired)
                            who participated on-site in rescue, recovery,
                            debris clean-up, or related services in lower
                            Manhattan (south of Canal St.), including
                            Ground Zero, the Staten Island Landfill or the
                            barge loading piers, for at least 4 hours
                            during the period beginning September 11, 2001,
                            and ending on September 14, 2001;
                              ``(II) participated on-site in rescue,
                            recovery, debris clean-up, or related services
                            in at Ground Zero, the Staten Island Landfill
                            or the barge loading piers, for at least one
                            day during the period beginning on September
                            11, 2001, and ending on July 31, 2002;
                              ``(III) participated on-site in rescue,
                            recovery, debris clean-up, or related services
                            in lower Manhattan (south of Canal St.) for at
                            least 24 hours during the period beginning on
                            September 11, 2001, and ending on September 30,
                            2001; or
                              ``(IV) participated on-site in rescue,
                            recovery, debris clean-up, or related services
                            in lower Manhattan (south of Canal St.) for at
                            least 80 hours during the period beginning on
                            September 11, 2001, and ending on July 31,
                            2002;
                              ``(iii) was an employee of the Office of the
                            Chief Medical Examiner of the City of New York
                            involved in the examination and handling of
                            human remains from the World Trade Center
                            attacks, or other morgue worker who performed
                            similar post-September 11 functions for such
                            Office staff, during the period beginning on
                            September 11, 2001 and ending on July 31, 2002;
                              ``(iv) was a worker in the Port Authority
                            Trans-Hudson Corporation tunnel for at least 24
                            hours during the period beginning on February
                            1, 2002, and ending on July 1, 2002; or
                              ``(v) was a vehicle-maintenance worker who
                            was exposed to debris from the former World
                            Trade Center while retrieving, driving,
                            cleaning, repairing, and maintaining vehicles
                            contaminated by airborne toxins from the
                            September 11, 2001, terrorist attacks on the
                            World Trade Center during a duration and period
                            described in subparagraph (A).
              ``(3) Application process.--The WTC Program Administrator in
            consultation with the Coordinating Centers of Excellence shall
            establish a process for individuals, other than eligible WTC
            responders described in paragraph (1)(A), to apply to be
            determined to be eligible WTC responders. Under such process--
                      ``(A) there shall be no fee charged to the applicant
                    for making an application for such determination;
                      ``(B) the Administrator shall make a determination on
                    such an application not later than 60 days after the
                    date of filing the application; and
                      ``(C) an individual who is determined not to be an
                    eligible WTC responder shall have an opportunity to
                    appeal such determination before an administrative law
                    judge in a manner established under such process.
              ``(4) Certification.--
                      ``(A) In general.--In the case of an individual who
                    is described in paragraph (1)(A) or who is determined
                    under paragraph (3) (consistent with paragraph (5)) to
                    be an eligible WTC responder, the WTC Program
                    Administrator shall provide an appropriate
                    certification of such fact and of eligibility for
                    monitoring and treatment benefits under this part. The
                    Administrator shall make determinations of eligibility
                    relating to an applicant's compliance with this title,
                    including the verification of information submitted in
                    support of the application, and shall not deny such a
                    certification to an individual unless the Administrator
                    determines that--
                              ``(i) based on the application submitted, the
                            individual does not meet the eligibility
                            criteria; or
                              ``(ii) the numerical limitation on eligible
                            WTC responders set forth in paragraph (5) has
                            been met.
                      ``(B) Timing.--
                              ``(i) Currently identified responders.--In
                            the case of an individual who is described in
                            paragraph (1)(A), the WTC Program Administrator
                            shall provide the certification under
                            subparagraph (A) not later than 60 days after
                            the date of the enactment of this title.
                              ``(ii) Other responders.--In the case of
                            another individual who is determined under
                            paragraph (3) and consistent with paragraph (5)
                            to be an eligible WTC responder, the WTC
                            Program Administrator shall provide the
                            certification under subparagraph (A) at the
                            time of the determination.
              ``(5) Numerical limitation on eligible wtc responders.--
                      ``(A) In general.--The total number of individuals
                    not described in subparagraph (C) who may qualify as
                    eligible WTC responders for purposes of this title, and
                    be certified as eligible WTC responders under paragraph
                    (4), shall not exceed 15,000, subject to adjustment
                    under paragraph (6), of which no more than 2,500 may be
                    individuals certified based on modified eligibility
                    criteria established under paragraph (1)(C). In
                    applying the previous sentence, any individual who at
                    any time so qualifies as an eligible WTC responder
                    shall be counted against such numerical limitation.
                      ``(B) Process.--In implementing subparagraph (A), the
                    WTC Program Administrator shall--
                              ``(i) limit the number of certifications
                            provided under paragraph (4) in accordance with
                            such subparagraph; and
                              ``(ii) provide priority in such
                            certifications in the order in which
                            individuals apply for a determination under
                            paragraph (3).
                      ``(C) Currently identified responders not counted.--
                    Individuals described in this subparagraph are
                    individuals who are described in paragraph (1)(A).
              ``(6) Potential adjustment in numerical limitations dependent
            upon actual spending relative to estimated spending.--
                      ``(A) Initial calculation for fiscal years 2009
                    through 2011.--If the WTC Program Administrator
                    determines as of December 1, 2011, that the WTC
                    expenditure-to-CBO-estimate percentage (as defined in
                    subparagraph (D)(iii)) for fiscal years 2009 through
                    2011 does not exceed 90 percent, then, effective
                    January 1, 2012, the WTC Program Administrator may
                    increase the numerical limitation under paragraph
                    (5)(A), the numerical limitation under section
                    3021(a)(5), or both, by a number of percentage points
                    not to exceed the number of percentage points specified
                    in subparagraph (C) for such period of fiscal years.
                      ``(B) Subsequent calculation for fiscal years 2009
                    through 2015.--If the Secretary determines as of
                    December 1, 2015, that the WTC expenditure-to-CBO-
                    estimate percentages for fiscal years 2009 through 2015
                    and for fiscal years 2012 through 2015 do not exceed 90
                    percent, then, effective January 1, 2015, the WTC
                    Program Administrator may increase the numerical
                    limitation under paragraph (5)(A), the numerical
                    limitation under section 3021(a)(5), or both, as in
                    effect after the application of subparagraph (A), by a
                    number of percentage points not to exceed twice the
                    lesser of--
                              ``(i) the number of percentage points
                            specified in subparagraph (C) for fiscal years
                            2009 through 2012, or
                              ``(ii) the number of percentage points
                            specified in subparagraph (C) for fiscal years
                            2012 through 2015.
                      ``(C) Maximum percentage increase in numerical
                    limitations for period of fiscal years.--The number of
                    percentage points specified in this clause for a period
                    of fiscal years is--
                              ``(i) 100 percentage points, multiplied by
                              ``(ii) one minus a fraction the numerator of
                            which is the net Federal WTC spending for such
                            period, and the denominator of which is the CBO
                            WTC spending estimate under this title for such
                            period.
                      ``(D) Definitions.--For purposes of this paragraph:
                              ``(i) Net federal spending.--The term `net
                            Federal WTC spending' means, with respect to a
                            period of fiscal years, the net Federal
                            spending under this title for such fiscal
                            years.
                              ``(ii) CBO wtc spending estimate under this
                            title.--The term `CBO WTC medical spending
                            estimate under this title' means, with respect
                            to--
                                      ``(I) fiscal years 2009 through 2011,
                                    $900,000,000;
                                      ``(II) fiscal years 2012 through
                                    2015, $1,890,000,000; and
                                      ``(III) fiscal years 2009 through
                                    2015, the sum of the amounts specified
                                    in subclauses (I) and (II).
                              ``(iii) WTC expenditure-to-cbo-estimate
                            percentage.--The term `WTC expenditure-to-
                            estimate percentage' means, with respect to a
                            period of fiscal years, the ratio (expressed as
                            a percentage) of--
                                      ``(I) the net Federal WTC spending
                                    for such period, to
                                      ``(II) the CBO WTC spending estimate
                                    under this title for such period.
      ``(b) Monitoring Benefits.--
              ``(1) In general.--In the case of an eligible WTC responder
            under section 3011(a)(4) (other than one described in
            subsection (a)(2)(A)(ii)), the WTC program shall provide for
            monitoring benefits that include medical monitoring consistent
            with protocols approved by the WTC Program Administrator and
            including clinical examinations and long-term health monitoring
            and analysis. In the case of an eligible WTC responder who is
            an active member of the Fire Department of the City of New
            York, the responder shall receive such benefits as part of the
            individual's periodic company medical exams.
              ``(2) Provision of monitoring benefits.--The monitoring
            benefits under paragraph (1) shall be provided through the
            Clinical Center of Excellence for the type of individual
            involved or, in the case of an individual residing outside the
            New York metropolitan area, under an arrangement under section
            3031.

    ``SEC. 3012. TREATMENT OF CERTIFIED ELIGIBLE WTC RESPONDERS FOR WTC-
                        RELATED HEALTH CONDITIONS.

      ``(a) WTC-Related Health Condition Defined.--
              ``(1) In general.--For purposes of this title, the term `WTC-
            related health condition' means--
                      ``(A) an illness or health condition for which
                    exposure to airborne toxins, any other hazard, or any
                    other adverse condition resulting from the September
                    11, 2001, terrorist attacks on the World Trade Center,
                    based on an examination by a medical professional with
                    experience in treating or diagnosing the medical
                    conditions included in the applicable list of
                    identified WTC-related conditions, is substantially
                    likely to be a significant factor in aggravating,
                    contributing to, or causing the illness or health
                    condition, as determined under paragraph (2); or
                      ``(B) a mental health condition for which such
                    attacks, based on an examination by a medical
                    professional with experience in treating or diagnosing
                    the medical conditions included in the applicable list
                    of identified WTC-related conditions, is substantially
                    likely be a significant factor in aggravating,
                    contributing to, or causing the condition, as
                    determined under paragraph (2).
            In the case of an eligible WTC responder described in section
            3011(a)(2)(A)(ii), such term only includes the mental health
            condition described in subparagraph (B).
              ``(2) Determination.--The determination of whether the
            September 11, 2001, terrorist attacks on the World Trade Center
            were substantially likely to be a significant factor in
            aggravating, contributing to, or causing an individual's
            illness or health condition shall be made based on an
            assessment of the following:
                      ``(A) The individual's exposure to airborne toxins,
                    any other hazard, or any other adverse condition
                    resulting from the terrorist attacks. Such exposure
                    shall be--
                              ``(i) evaluated and characterized through the
                            use of a standardized, population appropriate
                            questionnaire approved by the Director of the
                            National Institute for Occupational Safety and
                            Health; and
                              ``(ii) assessed and documented by a medical
                            professional with experience in treating or
                            diagnosing medical conditions included on the
                            list of identified WTC-related conditions.
                      ``(B) The type of symptoms and temporal sequence of
                    symptoms. Such symptoms shall be--
                              ``(i) assessed through the use of a
                            standardized, population appropriate medical
                            questionnaire approved by Director of the
                            National Institute for Occupational Safety and
                            Health and a medical examination; and
                              ``(ii) diagnosed and documented by a medical
                            professional described in subparagraph (A)(ii).
              ``(3) List of identified wtc-related health conditions for
            certified eligible wtc responders.--For purposes of this title,
            the term `identified WTC-related health condition for eligible
            WTC responders' means any of the following health conditions:
                      ``(A) Aerodigestive disorders.--
                              ``(i) Interstitial lung diseases.
                              ``(ii) Chronic respiratory disorder-fumes/
                            vapors.
                              ``(iii) Asthma.
                              ``(iv) Reactive airways dysfunction syndrome
                            (RADS).
                              ``(v) WTC-exacerbated chronic obstructive
                            pulmonary disease (COPD).
                              ``(vi) Chronic cough syndrome.
                              ``(vii) Upper airway hyperreactivity.
                              ``(viii) Chronic rhinosinusitis.
                              ``(ix) Chronic nasopharyngitis.
                              ``(x) Chronic laryngitis.
                              ``(xi) Gastro-esophageal reflux disorder
                            (GERD).
                              ``(xii) Sleep apnea exacerbated by or related
                            to a condition described in a previous clause.
                      ``(B) Mental health conditions.--
                              ``(i) Post traumatic stress disorder (PTSD).
                              ``(ii) Major depressive disorder.
                              ``(iii) Panic disorder.
                              ``(iv) Generalized anxiety disorder.
                              ``(v) Anxiety disorder (not otherwise
                            specified).
                              ``(vi) Depression (not otherwise specified).
                              ``(vii) Acute stress disorder.
                              ``(viii) Dysthymic disorder.
                              ``(ix) Adjustment disorder.
                              ``(x) Substance abuse.
                              ``(xi) V codes (treatments not specifically
                            related to psychiatric disorders, such as
                            marital problems, parenting problems etc.),
                            secondary to another identified WTC-related
                            health condition for WTC eligible responders.
                      ``(C) Musculoskeletal disorders.--
                              ``(i) Low back pain.
                              ``(ii) Carpal tunnel syndrome (CTS).
                              ``(iii) Other musculoskeletal disorders.
              ``(4) Addition of identified wtc-related health conditions
            for eligible wtc responders.--
                      ``(A) In general.--The WTC Program Administrator may
                    promulgate regulations to add an illness or health
                    condition not described in paragraph (3) to be added to
                    the list of identified WTC-related conditions for
                    eligible WTC responders. In promulgating such
                    regulations, the Secretary shall provide for notice and
                    opportunity for a public hearing and at least 90 days
                    of public comment. In promulgating such regulations,
                    the WTC Program Administrator shall take into account
                    the findings and recommendations of Clinical Centers of
                    Excellence published in peer reviewed journals in the
                    determination of whether an additional illness or
                    health condition, such as cancer, should be added to
                    the list of identified WTC-related health conditions
                    for eligible WTC responders.
                      ``(B) Petitions.--Any person (including the WTC
                    Health Program Scientific/Technical Advisory Committee)
                    may petition the WTC Program Administrator to propose
                    regulations described in subparagraph (A). Unless
                    clearly frivolous, or initiated by such Committee, any
                    such petition shall be referred to such Committee for
                    its recommendations. Following--
                              ``(i) receipt of any recommendation of the
                            Committee; or
                              ``(ii) 180 days after the date of the
                            referral to the Committee,
                    whichever occurs first, the WTC Program Administrator
                    shall conduct a rulemaking proceeding on the matters
                    proposed in the petition or publish in the Federal
                    Register a statement of reasons for not conducting such
                    proceeding.
                      ``(C) Effectiveness.--Any addition under subparagraph
                    (A) of an illness or health condition shall apply only
                    with respect to applications for benefits under this
                    title which are filed after the effective date of such
                    regulation.
                      ``(D) Role of advisory committee.--Except with
                    respect to a regulation recommended by the WTC Health
                    Program Scientific/Technical Advisory Committee), the
                    WTC Program Administrator may not propose a regulation
                    under this paragraph, unless the Administrator has
                    first provided to the Committee a copy of the proposed
                    regulation, requested recommendations and comments by
                    the Committee, and afforded the Committee at least 90
                    days to make such recommendations.
      ``(b) Coverage of Treatment for WTC-Related Health Conditions.--
              ``(1) Determination based on an identified wtc-related health
            condition for certified eligible wtc responders.--
                      ``(A) In general.--If a physician at a Clinical
                    Center of Excellence that is providing monitoring
                    benefits under section 3011 for a certified eligible
                    WTC responder determines that the responder has an
                    identified WTC-related health condition, and the
                    physician makes a clinical determination that exposure
                    to airborne toxins, other hazards, or adverse
                    conditions resulting from the 9/11 terrorist attacks is
                    substantially likely to be a significant factor in
                    aggravating, contributing to, or causing the
                    condition--
                              ``(i) the physician shall promptly transmit
                            such determination to the WTC Program
                            Administrator and provide the Administrator
                            with the medical facts supporting such
                            determination; and
                              ``(ii) on and after the date of such
                            transmittal and subject to subparagraph (B),
                            the WTC program shall provide for payment under
                            subsection (c) for medically necessary
                            treatment for such condition.
                      ``(B) Review; certification; appeals.--
                              ``(i) Review.--A Federal employee designated
                            by the WTC Program Administrator shall review
                            determinations made under subparagraph (A) of a
                            WTC-related health condition.
                              ``(ii) Certification.--The Administrator
                            shall provide a certification of such condition
                            based upon reviews conducted under clause (i).
                            Such a certification shall be provided unless
                            the Administrator determines that the
                            responder's condition is not an identified WTC-
                            related health condition or that exposure to
                            airborne toxins, other hazards, or adverse
                            conditions resulting from the 9/11 terrorist
                            attacks is not substantially likely to be a
                            significant factor in significantly
                            aggravating, contributing to, or causing the
                            condition.
                              ``(iii) Appeal process.--The Administrator
                            shall provide a process for the appeal of
                            determinations under clause (ii) before an
                            administrative law judge.
              ``(2) Determination based on other wtc-related health
            condition.--
                      ``(A) In general.--If a physician at a Clinical
                    Center of Excellence determines pursuant to subsection
                    (a) that the certified eligible WTC responder has a
                    WTC-related health condition that is not an identified
                    WTC-related health condition for eligible WTC
                    responders--
                              ``(i) the physician shall promptly transmit
                            such determination to the WTC Program
                            Administrator and provide the Administrator
                            with the facts supporting such determination;
                            and
                              ``(ii) the Administrator shall make a
                            determination under subparagraph (B) with
                            respect to such physician's determination.
                      ``(B) Review; certification.--
                              ``(i) Use of physician panel.--With respect
                            to each determination relating to a WTC-related
                            health condition transmitted under subparagraph
                            (A)(i), the WTC Program Administrator shall
                            provide for the review of the condition to be
                            made by a physician panel with appropriate
                            expertise appointed by the WTC Program
                            Administrator. Such a panel shall make
                            recommendations to the Administrator on the
                            evidence supporting such determination.
                              ``(ii) Review of recommendations of panel;
                            certification.--The Administrator, based on
                            such recommendations shall determine, within 60
                            days after the date of the transmittal under
                            subparagraph (A)(i), whether or not the
                            condition is a WTC-related health condition
                            and, if it is, provide for a certification
                            under paragraph (1)(B)(ii) of coverage of such
                            condition. The Administrator shall provide a
                            process for the appeal of determinations that
                            the responder's condition is not a WTC-related
                            health condition before an administrative law
                            judge.
              ``(3) Requirement of medical necessity.--
                      ``(A) In general.--In providing treatment for a WTC-
                    health condition, a physician shall provide treatment
                    that is medically necessary and in accordance with
                    medical protocols established under subsection (d).
                      ``(B) Medically necessary standard.--For the purpose
                    of this title, health care services shall be treated as
                    medically necessary for an individual if a physician,
                    exercising prudent clinical judgment, would consider
                    the services to be medically necessary for the
                    individual for the purpose of evaluating, diagnosing,
                    or treating an illness, injury, disease or its
                    symptoms, and that are--
                              ``(i) in accordance with the generally
                            accepted standards of medical practice;
                              ``(ii) clinically appropriate, in terms of
                            type, frequency, extent, site, and duration,
                            and considered effective for the individual's
                            illness, injury, or disease; and
                              ``(iii) not primarily for the convenience of
                            the patient or physician, or another physician,
                            and not more costly than an alternative service
                            or sequence of services at least as likely to
                            produce equivalent therapeutic or diagnostic
                            results as to the diagnosis or treatment of the
                            individual's illness, injury, or disease.
                      ``(C) Determination of medical necessity.--
                              ``(i) Review of medical necessity.--As part
                            of the reimbursement payment process under
                            subsection (c), the WTC Program Administrator
                            shall review claims for reimbursement for the
                            provision of medical treatment to determine if
                            such treatment is medically necessary.
                              ``(ii) Withholding of payment for medically
                            unnecessary treatment.--The Administrator may
                            withhold such payment for treatment that the
                            Administrator determines is not medically
                            necessary.
                              ``(iii) Review of determinations of medical
                            necessity.--The Administrator shall provide a
                            process for providers to appeal a determination
                            under clause (ii) that medical treatment is not
                            medically necessary. Such appeals shall be
                            reviewed through the use of a physician panel
                            with appropriate expertise.
              ``(4) Scope of treatment covered.--
                      ``(A) In general.--The scope of treatment covered
                    under such paragraphs includes services of physicians
                    and other health care providers, diagnostic and
                    laboratory tests, prescription drugs, inpatient and
                    outpatient hospital services, and other medically
                    necessary treatment.
                      ``(B) Pharmaceutical coverage.--With respect to
                    ensuring coverage of medically necessary outpatient
                    prescription drugs, such drugs shall be provided, under
                    arrangements made by the WTC Program Administrator,
                    directly through participating Clinical Centers of
                    Excellence or through one or more outside vendors.
                      ``(C) Transportation expenses.--To the extent
                    provided in advance in appropriations Acts, the WTC
                    Program Administrator may provide for necessary and
                    reasonable transportation and expenses incident to the
                    securing of medically necessary treatment involving
                    travel of more than 250 miles and for which payment is
                    made under this section in the same manner in which
                    individuals may be furnished necessary and reasonable
                    transportation and expenses incident to services
                    involving travel of more than 250 miles under
                    regulations implementing section 3629(c) of the Energy
                    Employees Occupational Illness Compensation Program Act
                    of 2000 (title XXXVI of Public Law 106-398; 42 U.S.C.
                    7384t(c)).
              ``(5) Provision of treatment pending certification.--In the
            case of a certified eligible WTC responder who has been
            determined by an examining physician under subsection (b)(1) to
            have an identified WTC-related health condition, but for whom a
            certification of the determination has not yet been made by the
            WTC Program Administrator, medical treatment may be provided
            under this subsection, subject to paragraph (6), until the
            Administrator makes a decision on such certification. Medical
            treatment provided under this paragraph shall be considered to
            be medical treatment for which payment may be made under
            subsection (c).
              ``(6) Prior approval process for non-certified non-emergency
            inpatient hospital services.--Non-emergency inpatient hospital
            services for a WTC-related health condition identified by an
            examining physician under paragraph (b)(1) that is not
            certified under paragraph (1)(B)(ii) is not covered unless the
            services have been determined to be medically necessary and
            approved through a process established by the WTC Program
            Administrator. Such process shall provide for a decision on a
            request for such services within 15 days of the date of receipt
            of the request. The WTC Administrator shall provide a process
            for the appeal of a decision that the services are not
            medically necessary.
      ``(c) Payment for Initial Health Evaluation, Medical Monitoring, and
    Treatment of WTC-Related Health Conditions.--
              ``(1) Medical treatment.--
                      ``(A) Use of feca payment rates.--Subject to
                    subparagraph (B), the WTC Program Administrator shall
                    reimburse costs for medically necessary treatment under
                    this title for WTC-related health conditions according
                    to the payment rates that would apply to the provision
                    of such treatment and services by the facility under
                    the Federal Employees Compensation Act.
                      ``(B) Pharmaceuticals.--
                              ``(i) In general.--The WTC Program
                            Administrator shall establish a program for
                            paying for the medically necessary outpatient
                            prescription pharmaceuticals prescribed under
                            this title for WTC-related conditions through
                            one or more contracts with outside vendors.
                              ``(ii) Competitive bidding.--Under such
                            program the Administrator shall--
                                      ``(I) select one or more appropriate
                                    vendors through a Federal competitive
                                    bid process; and
                                      ``(II) select the lowest bidder (or
                                    bidders) meeting the requirements for
                                    providing pharmaceutical benefits for
                                    participants in the WTC program.
                              ``(iii) Treatment of fdny participants.--
                            Under such program the Administrator may enter
                            select a separate vendor to provide
                            pharmaceutical benefits to certified eligible
                            WTC responders for whom the Clinical Center of
                            Excellence is described in section
                            3006(b)(1)(A) if such an arrangement is deemed
                            necessary and beneficial to the program by the
                            WTC Program Administrator.
                      ``(C) Other treatment.--For treatment not covered
                    under a preceding subparagraph, the WTC Program
                    Administrator shall designate a reimbursement rate for
                    each such service.
              ``(2) Medical monitoring and initial health evaluation.--The
            WTC Program Administrator shall reimburse the costs of medical
            monitoring and the costs of an initial health evaluation
            provided under this title at a rate set by the Administrator.
              ``(3) Administrative arrangement authority.--The WTC Program
            Administrator may enter into arrangements with other government
            agencies, insurance companies, or other third-party
            administrators to provide for timely and accurate processing of
            claims under this section.
              ``(4) Claims processing subject to appropriations.--The
            payment by the WTC Program Administrator for the processing of
            claims under this title is limited to the amounts provided in
            advance in appropriations Acts.
      ``(d) Medical Treatment Protocols.--
              ``(1) Development.--The Coordinating Centers of Excellence
            shall develop medical treatment protocols for the treatment of
            certified eligible WTC responders and certified eligible WTC
            community members for identified WTC-related health conditions.
              ``(2) Approval.--The WTC Program Administrator shall approve
            the medical treatment protocols, in consultation with the WTC
            Health Program Steering Committees.

                          ``PART 2--COMMUNITY PROGRAM

    ``SEC. 3021. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF ELIGIBLE
                        WTC COMMUNITY MEMBERS.

      ``(a) Eligible WTC Community Member Defined.--
              ``(1) In general.--In this title, the term `eligible WTC
            community member' means, subject to paragraphs (3) and (5), an
            individual who claims symptoms of a WTC-related health
            condition and is described in any of the following
            subparagraphs:
                      ``(A) Currently identified community member.--An
                    individual, including an eligible WTC responder, who
                    has been identified as eligible for medical treatment
                    or monitoring by the WTC Environmental Health Center as
                    of the date of enactment of this title.
                      ``(B) Community member who meets current eligibility
                    criteria.--An individual who is not an eligible WTC
                    responder and meets any of the current eligibility
                    criteria described in a subparagraph of paragraph (2).
                      ``(C) Community member who meets modified eligibility
                    criteria.--An individual who is not an eligible WTC
                    responder and meets such eligibility criteria relating
                    to exposure to airborne toxins, other hazards, or
                    adverse conditions resulting from the September 11,
                    2001, terrorist attacks on the World Trade Center as
                    the WTC Administrator determines eligible, after
                    consultation with the WTC Community Program Steering
                    Committee, Coordinating Centers of Excellence described
                    in section 3006(b)(1)(C), and the WTC Scientific/
                    Technical Advisory Committee.
            The Administrator shall not modify such criteria under
            subparagraph (C) on or after the date that the number of
            certifications for eligible community members has reached 80
            percent of the limit described in paragraph (5) or on or after
            the date that the number of certifications for eligible
            responders has reached 80 percent of the limit described in
            section 3021(a)(5).
              ``(2) Current eligibility criteria.--The eligibility criteria
            described in this paragraph for an individual are that the
            individual is described in any of the following subparagraphs:
                      ``(A) A person who was present in the New York City
                    disaster area in the dust or dust cloud on September
                    11, 2001.
                      ``(B) A person who worked, resided or attended
                    school, child care or adult day care in the New York
                    City disaster area for--
                              ``(i) at least four days during the 4-month
                            period beginning on September 11, 2001, and
                            ending on January 10, 2002; or
                              ``(ii) at least 30 days during the period
                            beginning on September 11, 2001, and ending on
                            July 31, 2002.
                      ``(C) Any person who worked as a clean-up worker or
                    performed maintenance work in the New York City
                    disaster area during the 4-month period described in
                    subparagraph (B)(i) and had extensive exposure to WTC
                    dust as a result of such work.
                      ``(D) A person who was deemed eligible to receive a
                    grant from the Lower Manhattan Development Corporation
                    Residential Grant Program, who possessed a lease for a
                    residence or purchased a residence in the New York City
                    disaster area, and who resided in such residence during
                    the period beginning on September 11, 2001, and ending
                    on May 31, 2003.
                      ``(E) A person whose place of employment--
                              ``(i) at any time during the period beginning
                            on September 11, 2001, and ending on May 31,
                            2003, was in the New York City disaster area;
                            and
                              ``(ii) was deemed eligible to receive a grant
                            from the Lower Manhattan Development
                            Corporation WTC Small Firms Attraction and
                            Retention Act program or other government
                            incentive program designed to revitalize the
                            Lower Manhattan economy after the September 11,
                            2001, terrorist attacks on the World Trade
                            Center.
              ``(3) Application process.--The WTC Program Administrator in
            consultation with the Coordinating Centers of Excellence shall
            establish a process for individuals, other than individuals
            described in paragraph (1)(A), to be determined eligible WTC
            community member. Under such process--
                      ``(A) there shall be no fee charged to the applicant
                    for making an application for such determination;
                      ``(B) the Administrator shall make a determination on
                    such an application not later than 60 days after the
                    date of filing the application; and
                      ``(C) an individual who is determined not to be an
                    eligible WTC community member shall have an opportunity
                    to appeal such determination before an administrative
                    law judge in a manner established under such process.
              ``(4) Certification.--
                      ``(A) In general.--In the case of an individual who
                    is described in paragraph (1)(A) or who is determined
                    under paragraph (3) (consistent with paragraph (5)) to
                    be an eligible WTC community member, the WTC Program
                    Administrator shall provide an appropriate
                    certification of such fact and of eligibility for
                    followup monitoring and treatment benefits under this
                    part. The Administrator shall make determinations of
                    eligibility relating to an applicant's compliance with
                    this title, including the verification of information
                    submitted in support of the application and shall not
                    deny such a certification to an individual unless the
                    Administrator determines that--
                              ``(i) based on the application submitted, the
                            individual does not meet the eligibility
                            criteria; or
                              ``(ii) the numerical limitation on
                            certification of eligible WTC community members
                            set forth in paragraph (5) has been met.
                      ``(B) Timing.--
                              ``(i) Currently identified community
                            members.--In the case of an individual who is
                            described in paragraph (1)(A), the WTC Program
                            Administrator shall provide the certification
                            under subparagraph (A) not later than 60 days
                            after the date of the enactment of this title.
                              ``(ii) Other members.--In the case of another
                            individual who is determined under paragraph
                            (3) and consistent with paragraph (5) to be an
                            eligible WTC community member, the WTC Program
                            Administrator shall provide the certification
                            under subparagraph (A) at the time of such
                            determination.
              ``(5) Numerical limitation on certification of eligible wtc
            community members.--
                      ``(A) In general.--The total number of individuals
                    not described in subparagraph (C) who may be certified
                    as eligible WTC community members under paragraph (4)
                    shall not exceed 15,000. In applying the previous
                    sentence, any individual who at any time so qualifies
                    as an eligible WTC community member shall be counted
                    against such numerical limitation.
                      ``(B) Process.--In implementing subparagraph (A), the
                    WTC Program Administrator shall--
                              ``(i) limit the number of certifications
                            provided under paragraph (4) in accordance with
                            such subparagraph; and
                              ``(ii) provide priority in such
                            certifications in the order in which
                            individuals apply for a determination under
                            paragraph (4).
                      ``(C) Individuals currently receiving treatment not
                    counted.--Individuals described in this subparagraph
                    are individuals who--
                              ``(i) are described in paragraph (1)(A); or
                              ``(ii) before the date of the enactment of
                            this title, have received monitoring or
                            treatment at the World Trade Center
                            Environmental Health Center at Bellevue
                            Hospital Center, Gouverneur Health Care
                            Services, or Elmhurst Hospital Center.
                    The New York City Health and Hospitals Corporation
                    shall, not later than 6 months after the date of
                    enactment of this title, enter into arrangements with
                    the Mt. Sinai Data and Clinical Coordination Center for
                    the reporting of medical data concerning eligible WTC
                    responders described in paragraph (1)(A), as determined
                    by the WTC Program Administrator and consistent with
                    applicable Federal and State laws and regulations
                    relating to confidentiality of individually
                    identifiable health information.
                      ``(D) Report to congress if numerical limitation to
                    be reached.--If the WTC Program Administrator
                    determines that the number of individuals subject to
                    the numerical limitation of subparagraph (A) is likely
                    to exceed such numerical limitation, the Administrator
                    shall submit to Congress a report on such
                    determination. Such report shall include an estimate of
                    the number of such individuals in excess of such
                    numerical limitation and of the additional expenditures
                    that would result under this title if such numerical
                    limitation were removed.
      ``(b) Initial Health Evaluation To Determine Eligibility for Followup
    Monitoring or Treatment.--
              ``(1) In general.--In the case of a certified eligible WTC
            community member, the WTC program shall provide for an initial
            health evaluation to determine if the member has a WTC-related
            health condition and is eligible for followup monitoring and
            treatment benefits under the WTC program. Initial health
            evaluation protocols shall be approved by the WTC Program
            Administrator, in consultation with the World Trade Center
            Environmental Health Center at Bellevue Hospital and the WTC
            Community Program Steering Committee.
              ``(2) Initial health evaluation providers.--The initial
            health evaluation described in paragraph (1) shall be provided
            through a Clinical Center of Excellence with respect to the
            individual involved.
              ``(3) Limitation on initial health evaluation benefits.--
            Benefits for initial health evaluation under this part for an
            eligible WTC community member shall consist only of a single
            medical initial health evaluation consistent with initial
            health evaluation protocols described in paragraph (1). Nothing
            in this paragraph shall be construed as preventing such an
            individual from seeking additional medical initial health
            evaluations at the expense of the individual.

    ``SEC. 3022. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED ELIGIBLE
                        WTC COMMUNITY MEMBERS FOR WTC-RELATED HEALTH
                        CONDITIONS.

      ``(a) In General.--Subject to subsection (b), the provisions of
    sections 3011 and 3012 shall apply to followup monitoring and treatment
    of WTC-related health conditions for certified eligible WTC community
    members in the same manner as such provisions apply to the monitoring
    and treatment of identified WTC-related health conditions for certified
    eligible WTC responders, except that such monitoring shall only be
    available to those certified as eligible for treatment under this
    title. Under section 3006(a)(3), the City of New York is required to
    contribute a share of the costs of such treatment.
      ``(b) List of Identified WTC-related Health Conditions for WTC
    Community Members.--
              ``(1) Identified wtc-related health conditions for wtc
            community members.--For purposes of this title, the term
            `identified WTC-related health conditions for WTC community
            members' means any of the following health conditions:
                      ``(A) Aerodigestive disorders.--
                              ``(i) Interstitial lung diseases.
                              ``(ii) Chronic respiratory disorder--fumes/
                            vapors.
                              ``(iii) Asthma.
                              ``(iv) Reactive airways dysfunction syndrome
                            (RADS).
                              ``(v) WTC-exacerbated chronic obstructive
                            pulmonary disease (COPD).
                              ``(vi) Chronic cough syndrome.
                              ``(vii) Upper airway hyperreactivity.
                              ``(viii) Chronic rhinosinusitis.
                              ``(ix) Chronic nasopharyngitis.
                              ``(x) Chronic laryngitis.
                              ``(xi) Gastro-esophageal reflux disorder
                            (GERD).
                              ``(xii) Sleep apnea exacerbated by or related
                            to a condition described in a previous clause.
                      ``(B) Mental health conditions.--
                              ``(i) Post traumatic stress disorder (PTSD).
                              ``(ii) Major depressive disorder.
                              ``(iii) Panic disorder.
                              ``(iv) Generalized anxiety disorder.
                              ``(v) Anxiety disorder (not otherwise
                            specified).
                              ``(vi) Depression (not otherwise specified).
                              ``(vii) Acute stress disorder.
                              ``(viii) Dysthymic disorder.
                              ``(ix) Adjustment disorder.
                              ``(x) Substance abuse.
                              ``(xi) V codes (treatments not specifically
                            related to psychiatric disorders, such as
                            marital problems, parenting problems etc.),
                            secondary to another identified WTC-related
                            health condition for WTC community members.
              ``(2) Additions to identified wtc-related health conditions
            for wtc community members.--The provisions of paragraph (4) of
            section 3012(a) shall apply with respect to an addition to the
            list of identified WTC-related conditions for eligible WTC
            community members under paragraph (1) in the same manner as
            such provisions apply to an addition to the list of identified
            WTC-related conditions for eligible WTC responders under
            section 3012(a)(3).

    ``SEC. 3023. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS
                        WITH WTC-RELATED HEALTH CONDITIONS.

      ``(a) In General.--Subject to subsection (c), the provisions of
    section 3022 shall apply to the followup monitoring and treatment of
    WTC-related health conditions for eligible WTC community members in the
    case of individuals described in subsection (b) in the same manner as
    such provisions apply to the followup monitoring and treatment of WTC-
    related health conditions for WTC community members. Under section
    3006(a)(3), the City of New York is required to contribute a share of
    the costs of such monitoring and treatment.
      ``(b) Individuals Described.--An individual described in this
    subsection is an individual who, regardless of location of residence--
              ``(1) is not a eligible WTC responder or an eligible WTC
            community member; and
              ``(2) is diagnosed at a Clinical Center of Excellence (with
            respect to an eligible WTC community member) with an identified
            WTC-related health condition for WTC community members.
      ``(c) Limitation.--
              ``(1) In general.--The WTC Program Administrator shall limit
            benefits for any fiscal year under subsection (a) in a manner
            so that payments under this section for such fiscal year do not
            exceed the amount specified in paragraph (2) for such fiscal
            year.
              ``(2) Limitation.--The amount specified in this paragraph
            for--
                      ``(A) fiscal year 2009 is $20,000,000; or
                      ``(B) a succeeding fiscal year is the amount
                    specified in this paragraph for the previous fiscal
                    year increased by the annual percentage increase in the
                    medical care component of the consumer price index for
                    all urban consumers.

     ``PART 3--NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS
                                OUTSIDE NEW YORK

    ``SEC. 3031. NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS
                        OUTSIDE NEW YORK.

      ``(a) In General.--In order to ensure reasonable access to benefits
    under this subtitle for individuals who are eligible WTC responders or
    eligible WTC community members and who reside in any State, as defined
    in section 2(f), outside the New York metropolitan area, the WTC
    Program Administrator shall establish a nationwide network of health
    care providers to provide monitoring and treatment benefits and initial
    health evaluations near such individuals' areas of residence in such
    States. Nothing in this subsection shall be construed as preventing
    such individuals from being provided such monitoring and treatment
    benefits or initial health evaluation through any Clinical Center of
    Excellence.
      ``(b) Network Requirements.--Any health care provider participating
    in the network under subsection (a) shall--
              ``(1) meet criteria for credentialing established by the
            Coordinating Centers of Excellence;
              ``(2) follow the monitoring, initial health evaluation, and
            treatment protocols developed under section 3006(a)(2)(B);
              ``(3) collect and report data in accordance with section
            3005; and
              ``(4) meet such fraud, quality assurance, and other
            requirements as the WTC Program Administrator establishes.

                     ``Subtitle C--Research Into Conditions

    ``SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO
                        SEPTEMBER 11 TERRORIST ATTACKS IN NEW YORK CITY.

      ``(a) In General.--With respect to individuals, including eligible
    WTC responders and eligible WTC community members, receiving monitoring
    or treatment under subtitle B, the WTC Program Administrator shall
    conduct or support--
              ``(1) research on physical and mental health conditions that
            may be related to the September 11, 2001, terrorist attacks;
              ``(2) research on diagnosing WTC-related health conditions of
            such individuals, in the case of conditions for which there has
            been diagnostic uncertainty; and
              ``(3) research on treating WTC-related health conditions of
            such individuals, in the case of conditions for which there has
            been treatment uncertainty.
    The Administrator may provide such support through continuation and
    expansion of research that was initiated before the date of the
    enactment of this title and through the World Trade Center Health
    Registry (referred to in section 3051), through a Clinical Center of
    Excellence, or through a Coordinating Center of Excellence.
      ``(b) Types of Research.--The research under subsection (a)(1) shall
    include epidemiologic and other research studies on WTC-related
    conditions or emerging conditions--
              ``(1) among WTC responders and community members under
            treatment; and
              ``(2) in sampled populations outside the New York City
            disaster area in Manhattan as far north as 14th Street and in
            Brooklyn, along with control populations, to identify potential
            for long-term adverse health effects in less exposed
            populations.
      ``(c) Consultation.--The WTC Program Administrator shall carry out
    this section in consultation with the WTC Health Program Steering
    Committees and the WTC Scientific/Technical Advisory Committee.
      ``(d) Application of Privacy and Human Subject Protections.--The
    privacy and human subject protections applicable to research conducted
    under this section shall not be less than such protections applicable
    to research otherwise conducted by the National Institutes of Health.
      ``(e) Authorization of Appropriations.--For the purpose of carrying
    out this section, there are authorized to be appropriated $15,000,000
    for each fiscal year, in addition to any other authorizations of
    appropriations that are available for such purpose.

     ``Subtitle D--Programs of the New York City Department of Health and
                                 Mental Hygiene

    ``SEC. 3051. WORLD TRADE CENTER HEALTH REGISTRY.

      ``(a) Program Extension.--For the purpose of ensuring on-going data
    collection for victims of the September 11, 2001, terrorist attacks on
    the World Trade Center, the WTC Program Administrator, shall extend and
    expand the arrangements in effect as of January 1, 2008, with the New
    York City Department of Health and Mental Hygiene that provide for the
    World Trade Center Health Registry.
      ``(b) Authorization of Appropriations.--There are authorized to be
    appropriated $7,000,000 for each fiscal year to carry out this section.

    ``SEC. 3052. MENTAL HEALTH SERVICES.

      ``(a) In General.--The WTC Program Administrator may make grants to
    the New York City Department of Health and Mental Hygiene to provide
    mental health services to address mental health needs relating to the
    September 11, 2001, terrorist attacks on the World Trade Center.
      ``(b) Authorization of Appropriations.--There are authorized to be
    appropriated $8,500,000 for each fiscal year to carry out this
    section.''.

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

    SEC. 201. DEFINITIONS.

      Section 402 of the Air Transportation Safety and System Stabilization
    Act (49 U.S.C. 40101 note) is amended--
              (1) in paragraph (6) by inserting ``, or debris removal,
            including under the World Trade Center Health Program
            established under section 3001 of the Public Health Service
            Act'' after ``September 11, 2001'';
              (2) by inserting after paragraph (6) the following new
            paragraphs and redesignating subsequent paragraphs accordingly:
              ``(7) Contractor and subcontractor.--The term `contractor and
            subcontractor' means any contractor or subcontractor (at any
            tier of a subcontracting relationship), including any general
            contractor, construction manager, prime contractor, consultant,
            or any parent, subsidiary, associated or allied company,
            affiliated company, corporation, firm, organization, or joint
            venture thereof that participated in debris removal at any 9/11
            crash site. Such term shall not include any entity, including
            the Port Authority of New York and New Jersey, with a property
            interest in the World Trade Center, on September 11, 2001,
            whether fee simple, leasehold or easement, direct or indirect.
              ``(8) Debris removal.--The term `debris removal' means rescue
            and recovery efforts, removal of debris, cleanup, remediation,
            and response during the immediate aftermath of the terrorist-
            related aircraft crashes of September 11, 2001, with respect to
            a 9/11 crash site.'';
              (3) by inserting after paragraph (10), as so redesignated,
            the following new paragraph and redesignating the subsequent
            paragraphs accordingly:
              ``(11) Immediate aftermath.--The term `immediate aftermath'
            means any period beginning with the terrorist-related aircraft
            crashes of September 11, 2001, and ending on August 30,
            2002.''; and
              (4) by adding at the end the following new paragraph:
              ``(14) 9/11 crash site.--The term `9/11 crash site' means--
                      ``(A) the World Trade Center site, Pentagon site, and
                    Shanksville, Pennsylvania site;
                      ``(B) the buildings or portions of buildings that
                    were destroyed as a result of the terrorist-related
                    aircraft crashes of September 11, 2001;
                      ``(C) any area contiguous to a site of such crashes
                    that the Special Master determines was sufficiently
                    close to the site that there was a demonstrable risk of
                    physical harm resulting from the impact of the aircraft
                    or any subsequent fire, explosions, or building
                    collapses (including the immediate area in which the
                    impact occurred, fire occurred, portions of buildings
                    fell, or debris fell upon and injured individuals); and
                      ``(D) any area related to, or along, routes of debris
                    removal, such as barges and Fresh Kills.''.

    SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.

      (a) Information on Losses Resulting From Debris Removal Included in
    Contents of Claim Form.--Section 405(a)(2)(B) of the Air Transportation
    Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended--
              (1) in clause (i), by inserting ``, or debris removal during
            the immediate aftermath'' after ``September 11, 2001'';
              (2) in clause (ii), by inserting ``or debris removal during
            the immediate aftermath'' after ``crashes''; and
              (3) in clause (iii), by inserting ``or debris removal during
            the immediate aftermath'' after ``crashes''.
      (b) Extension of Deadline for Claims Under September 11th Victim
    Compensation Fund of 2001.--Section 405(a)(3) of such Act is amended to
    read as follows:
              ``(3) Limitation.--
                      ``(A) In general.--Except as provided by subparagraph
                    (B), no claim may be filed under paragraph (1) after
                    the date that is 2 years after the date on which
                    regulations are promulgated under section 407(a).
                      ``(B) Exception.--A claim may be filed under
                    paragraph (1), in accordance with subsection
                    (c)(3)(A)(i), by an individual (or by a personal
                    representative on behalf of a deceased individual)
                    during the period beginning on the date on which the
                    regulations are updated under section 407(b) and ending
                    on December 22, 2031.''.
      (c) Requirements for Filing Claims During Extended Filing Period.--
    Section 405(c)(3) of such Act is amended--
              (1) by redesignating subparagraphs (A) and (B) as
            subparagraphs (B) and (C), respectively; and
              (2) by inserting before subparagraph (B), as so redesignated,
            the following new subparagraph:
                      ``(A) Requirements for filing claims during extended
                    filing period.--
                              ``(i) Timing requirements for filing
                            claims.--An individual (or a personal
                            representative on behalf of a deceased
                            individual) may file a claim during the period
                            described in subsection (a)(3)(B) as follows:
                                      ``(I) In the case that the Special
                                    Master determines the individual knew
                                    (or reasonably should have known)
                                    before the date specified in clause
                                    (iii) that the individual suffered a
                                    physical harm at a 9/11 crash site as a
                                    result of the terrorist-related
                                    aircraft crashes of September 11, 2001,
                                    or as a result of debris removal, and
                                    that the individual knew (or should
                                    have known) before such specified date
                                    that the individual was eligible to
                                    file a claim under this title, the
                                    individual may file a claim not later
                                    than the date that is 2 years after
                                    such specified date.
                                      ``(II) In the case that the Special
                                    Master determines the individual first
                                    knew (or reasonably should have known)
                                    on or after the date specified in
                                    clause (iii) that the individual
                                    suffered such a physical harm or that
                                    the individual first knew (or should
                                    have known) on or after such specified
                                    date that the individual was eligible
                                    to file a claim under this title, the
                                    individual may file a claim not later
                                    than the last day of the 2-year period
                                    beginning on the date the Special
                                    Master determines the individual first
                                    knew (or should have known) that the
                                    individual both suffered from such harm
                                    and was eligible to file a claim under
                                    this title.
                              ``(ii) Other eligibility requirements for
                            filing claims.--An individual may file a claim
                            during the period described in subsection
                            (a)(3)(B) only if--
                                      ``(I) the individual was treated by a
                                    medical professional for suffering from
                                    a physical harm described in clause
                                    (i)(I) within a reasonable time from
                                    the date of discovering such harm; and
                                      ``(II) the individual's physical harm
                                    is verified by contemporaneous medical
                                    records created by or at the direction
                                    of the medical professional who
                                    provided the medical care.
                              ``(iii) Date specified.--The date specified
                            in this clause is the date on which the
                            regulations are updated under section
                            407(a).''.
      (d) Clarifying Applicability to All 9/11 Crash Sites.--Section
    405(c)(2)(A)(i) of such Act is amended by striking ``or the site of the
    aircraft crash at Shanksville, Pennsylvania'' and inserting ``the site
    of the aircraft crash at Shanksville, Pennsylvania, or any other 9/11
    crash site''.
      (e) Inclusion of Physical Harm Resulting From Debris Removal.--
    Section 405(c) of such Act is amended in paragraph (2)(A)(ii), by
    inserting ``or debris removal'' after ``air crash''.
      (f) Limitations on Civil Actions.--
              (1) Application to damages related to debris removal.--Clause
            (i) of section 405(c)(3)(C) of such Act, as redesignated by
            subsection (c), is amended by inserting ``, or for damages
            arising from or related to debris removal'' after ``September
            11, 2001''.
              (2) Pending actions.--Clause (ii) of such section, as so
            redesignated, is amended to read as follows:
                              ``(ii) Pending actions.--In the case of an
                            individual who is a party to a civil action
                            described in clause (i), such individual may
                            not submit a claim under this title--
                                      ``(I) during the period described in
                                    subsection (a)(3)(A) unless such
                                    individual withdraws from such action
                                    by the date that is 90 days after the
                                    date on which regulations are
                                    promulgated under section 407(a); and
                                      ``(II) during the period described in
                                    subsection (a)(3)(B) unless such
                                    individual withdraws from such action
                                    by the date that is 90 days after the
                                    date on which the regulations are
                                    updated under section 407(b).''.
              (3) Authority to reinstitute certain lawsuits.--Such section,
            as so redesignated, is further amended by adding at the end the
            following new clause:
                              ``(iii) Authority to reinstitute certain
                            lawsuits.--In the case of a claimant who was a
                            party to a civil action described in clause
                            (i), who withdrew from such action pursuant to
                            clause (ii), and who is subsequently determined
                            to not be an eligible individual for purposes
                            of this subsection, such claimant may
                            reinstitute such action without prejudice
                            during the 90-day period beginning after the
                            date of such ineligibility determination.''.

    SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.

      Section 407 of the Air Transportation Safety and System Stabilization
    Act (49 U.S.C. 40101 note) is amended--
              (1) by striking ``Not later than'' and inserting ``(a) In
            General.--Not later than''; and
              (2) by adding at the end the following new subsection:
      ``(b) Updated Regulations.--Not later than 90 days after the date of
    the enactment of the James Zadroga 9/11 Health and Compensation Act of
    2010, the Special Master shall update the regulations promulgated under
    subsection (a) to the extent necessary to comply with the provisions of
    title II of such Act.''.

    SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.

      Section 408(a) of the Air Transportation Safety and System
    Stabilization Act (49 U.S.C. 40101 note) is amended by adding at the
    end the following new paragraphs:
              ``(4) Liability for certain claims.--Notwithstanding any
            other provision of law, liability for all claims and actions
            (including claims or actions that have been previously
            resolved, that are currently pending, and that may be filed
            through December 22, 2031) for compensatory damages,
            contribution or indemnity, or any other form or type of relief,
            arising from or related to debris removal, against the City of
            New York, any entity (including the Port Authority of New York
            and New Jersey) with a property interest in the World Trade
            Center on September 11, 2001 (whether fee simple, leasehold or
            easement, or direct or indirect) and any contractors and
            subcontractors, shall not be in an amount that exceeds the sum
            of the following, as may be applicable:
                      ``(A) The amount of funds of the WTC Captive
                    Insurance Company, including the cumulative interest.
                      ``(B) The amount of all available insurance
                    identified in schedule 2 of the WTC Captive Insurance
                    Company insurance policy.
                      ``(C) As it relates to the limitation of liability of
                    the City of New York, the amount that is the greater of
                    the City of New York's insurance coverage or
                    $350,000,000. In determining the amount of the City's
                    insurance coverage for purposes of the previous
                    sentence, any amount described in clauses (i) and (ii)
                    shall not be included.
                      ``(D) As it relates to the limitation of liability of
                    any entity, including the Port Authority of New York
                    and New Jersey, with a property interest in the World
                    Trade Center on September 11, 2001 (whether fee simple,
                    leasehold or easement, or direct or indirect), the
                    amount of all available liability insurance coverage
                    maintained by any such entity.
                      ``(E) As it relates to the limitation of liability of
                    any individual contractor or subcontractor, the amount
                    of all available liability insurance coverage
                    maintained by such contractor or subcontractor on
                    September 11, 2001.
              ``(5) Priority of claims payments.--Payments to plaintiffs
            who obtain a settlement or judgment with respect to a claim or
            action to which paragraph (4)(A) applies, shall be paid solely
            from the following funds in the following order, as may be
            applicable:
                      ``(A) The funds described in clause (i) or (ii) of
                    paragraph (4)(A).
                      ``(B) If there are no funds available as described in
                    clause (i) or (ii) of paragraph (4)(A), the funds
                    described in clause (iii) of such paragraph.
                      ``(C) If there are no funds available as described in
                    clause (i), (ii), or (iii) of paragraph (4)(A), the
                    funds described in clause (iv) of such paragraph.
                      ``(D) If there are no funds available as described in
                    clause (i), (ii), (iii), or (iv) of paragraph (4)(A),
                    the funds described in clause (v) of such paragraph.
              ``(6) Declaratory judgment actions and direct action.--Any
            party to a claim or action to which paragraph (4)(A) applies
            may, with respect to such claim or action, either file an
            action for a declaratory judgment for insurance coverage or
            bring a direct action against the insurance company
            involved.''.

    SEC. 205. FUNDING; ATTORNEY FEES.

      Section 406 of the Air Transportation Safety and System Stabilization
    Act (49 U.S.C. 40101 note) is amended--
              (1) in subsection (a), by striking ``Not later than'' and
            inserting ``Subject to subsection (d), not later than'';
              (2) in subsection (b), by striking ``This title'' and
            inserting ``Subject to subsection (d), this title''; and
              (3) by adding at the end the following new subsections:
      ``(d) Limitation.--The total payment of amounts for compensation
    under this title, with respect to claims filed on or after the date on
    which the regulations are updated under section 407(b), shall not
    exceed $8,400,000,000.
      ``(e) Attorney Fees.--
              ``(1) In general.--Notwithstanding any contract, and except
            as provided in paragraph (2), the representative of an
            individual may not charge, for services rendered in connection
            with the claim of an individual under this title, more than 10
            percent of an award made under this title on such claim.
              ``(2) Exception.--With respect to a claim made on behalf of
            an individual for whom a lawsuit was filed in the Southern
            District of New York prior to January 1, 2009, in the event
            that the representative believes in good faith that the fee
            limit set by paragraph (1) will not provide adequate
            compensation for services rendered in connection with such
            claim because of the substantial amount of legal work provided
            on behalf of the claimant (including work performed before the
            enactment of this legislation), application for greater
            compensation may be made to the Special Master. Upon such
            application, the Special Master may, in his or her discretion,
            award as reasonable compensation for services rendered an
            amount greater than that allowed for in paragraph (1). Such fee
            award will be final, binding, and non-appealable.''.

                              Purpose and Summary

        H.R. 847 establishes the World Trade Center Health Program
    to provide medical monitoring and treatment benefits to
    emergency responders, recovery and cleanup workers, area
    residents, and others who were directly impacted by the attacks
    of September 11, 2001. The bill also reopens the September 11
    Victim Compensation Fund of 2001 to provide compensation to
    anyone who was injured in the aftermath of the attacks,
    including persons who were injured during debris removal at the
    September 11 crash sites. The bill extends the deadline for
    making claims under the fund, and it provides certain liability
    protections for the City of New York and other entities that
    engaged in recovery efforts and debris removal following the
    September 11 attacks.

                    Background and Need for the Legislation

                      SEPTEMBER 11, 2001 AND ITS AFTERMATH

        On September 11, 2001, terrorists flew two hijacked
    commercial jets into the World Trade Center towers in New York
    City. Almost 3,000 people were killed in the collapse of the
    towers, including hundreds of first responders, police
    officers, and firefighters. Beyond this immediate loss of life,
    thousands of other persons are now suffering debilitating and
    even deadly illnesses due to their proximity to the World Trade
    Center site in the aftermath of the attacks.
        It is now well documented that the collapse of the World
    Trade Center towers and the adjacent buildings released
    numerous hazardous substances into the environment. These
    substances included hundreds of tons of asbestos, nearly half a
    million pounds of lead, and large amounts of glass fibers,
    various heavy metals, dioxin, benzene, polychlorinated
    biphenyls (PCBs) and other potentially deadly chemicals and
    materials.\1\ These substances formed a large cloud of toxic
    dust and smoke, which blanketed parts of New York City and New
    Jersey and spread into many of the surrounding office
    buildings, schools, and residences. All together, the collapse
    of the towers dispersed about one million tons of dust on the
    area around Lower Manhattan.
    ---------------------------------------------------------------------------
        \1\See ``World Trade Center USGS Bulk Chemistry Results,'' U.S.
    Geological Survey, Open-File Report 01-0429, available at:
    pubs.usgs.gov/of/2001/ofr-01-0429/chem1/index.html; ``Characterization
    of the Dust/Smoke Aerosol that Settled East of the World Trade Center
    (WTC) in Lower Manhattan after the Collapse of the WTC 11 September
    2001,'' 110 Environmental Health Perspectives 7 (July 2002), available
    at: www.ehponline.org/members/2002/110p703-714lioy/lioy-full.html;
    Office of Inspector General, Environmental Protection Agency, EPA's
    Response to the World Trade Center Collapse: Challenges, Successes, and
    Areas for Improvement, Rpt. No. 2003-P-00012, at 65 (Aug. 21, 2003).
    ---------------------------------------------------------------------------
        Many of those who worked and lived in this area are now
    experiencing serious and life-threatening illnesses due to
    their exposure to ``World Trade Center dust.'' Evidence
    accumulated since the collapse of the World Trade Center
    buildings indicates that the air in Lower Manhattan was
    hazardous, notwithstanding safety assurances from the
    Environmental Protection Agency (EPA), and that exposure to
    World Trade Center dust has caused adverse health effects in
    thousands of responders, recovery workers, and others at or
    near Ground Zero in the immediate aftermath of the September 11
    attacks.\2\ Such effects include pulmonary fibrosis,
    sarcoidosis, interstitial lung disease, chronic sinusitis,
    severe asthma and other conditions resulting in significant
    loss of lung function.\3\ There is also growing evidence that
    exposure to World Trade Center dust is resulting in other
    serious diseases, including respiratory tract cancer, lymphoma,
    and a range of blood cell cancers.\4\ Medical monitoring has
    been put in place for thousands of workers at the World Trade
    Center site to track cancer rates among this population into
    the future.
    ---------------------------------------------------------------------------
        \2\See Id.; Megan Nordgren, Eric Goldstein, and Mark Izeman, The
    Environmental Impacts of the World Trade Center Attacks, Natural
    Resources Defense Council, at 3 (2002); Office of the Inspector
    General, Federal Emergency Management Agency, FEMA's Delivery of
    Individual Assistance Program, at 25 (Dec. 18, 2002).
        \3\Levin, S.M., Physical Health Status of World Trade Center Rescue
    and Recovery Workers and Volunteers--New York City, July 2002--August
    2004, Centers for Disease Control and Prevention (Sept. 10, 2004); Mt.
    Sinai WTC Medical Monitoring Program, The World Trade Center Disaster
    and the Health of Workers: Five-Year Assessment of a Unique Medical
    Screening Program (Sept. 6, 2006).
        \4\See, e.g., Cancer may be ``third wave'' of WTC illnesses,
    Associated Press (May 31, 2007), available at: http://
    www.msnbc.msn.com/id/18969197/; Gabriel Izbicki, M.D., et al., World
    Trade Center ``Sarcoid-Like'' Granulomatous Pulmonary Disease in New
    York City Fire Depart-
    ment Rescue Workers, Chest Journal (Jan. 26, 2007), abstract available
    at:
    http://www.chestjournal.org/content/131/5/1414.abstract; Jonathan M.
    Samet, M.D., et al., The Legacy of World Trade Center Dust, The New
    England Journal of Medicine (May 31, 2007), available at: http://
    content.nejm.org/cgi/content/full/356/22/2233.
    ---------------------------------------------------------------------------
        Such illnesses have caused major financial strains on those
    who, exposed to the toxins during the aftermath of the
    September 11 attacks, are no longer able to work, and face the
    high price of health care without assistance. While some of the
    above diseases can improve with medical treatment, the ultimate
    medical outcome for people currently being treated or who will
    become ill in the future is uncertain. In many cases,
    individuals suffer from progressive loss of pulmonary capacity,
    resulting in incapacitation, and an inability to perform job
    duties or everyday activities. Many others suffer from
    recurrent episodes of lung infections leading to frequent
    hospitalizations.

               THE SEPTEMBER 11 VICTIM COMPENSATION FUND OF 2001

        In the immediate aftermath of the September 11 terrorist
    attacks, Congress created the September 11 Victim Compensation
    Fund (VCF), a unique program designed to compensate people for
    losses sustained as a result of the attacks on the World Trade
    Center and other 9/11 crash sites. The VCF provided aid to the
    families of September 11 victims and to individuals who
    suffered personal injury. In return for accepting VCF funds,
    recipients relinquished their right to sue the airlines, whose
    liability was limited to the value of their insurance. Victims
    or their personal representatives were offered the choice to
    seek no-fault compensation through the VCF or to bring a civil
    tort action against an airline or other parties. For those who
    chose to enter the fund, the VCF required that applications be
    filed before December 22, 2003.
        The special master of the VCF, Kenneth Feinberg, was given
    wide latitude to determine eligibility and the amount of
    compensation to be paid individuals on a case-by-case basis.
    Over a 33-month period, the VCF distributed over $7 billion to
    the surviving family members of 2,880 of those who were killed
    on September 11 and to 2,680 of those who were injured in the
    attacks or the immediate rescue efforts. Families of the
    deceased were paid in amounts ranging from $800,000 to $6.5
    million. People who had sustained physical injuries were paid
    amounts ranging from $500 for a broken finger to $7.1 million
    for severe burns over 85% of the victim's body. Awards were
    reduced to offset other forms of compensation such as workers
    compensation, pension awards and life insurance.
        The VCF provided an attractive alternative to the
    uncertainty and delay of litigation, and the program was widely
    considered to be a success. Most families of deceased victims
    chose to participate in the VCF, and 97% of those who submitted
    claims received compensation through the program.
        While the VCF did an excellent job in handling claims
    involving people who died or had an immediate and easily
    diagnosable ailment (such as a broken leg), the fund was not as
    suitable for dealing with other kinds of injuries. The Fund's
    regulations, for example, limited compensation to workers who
    were injured in the ``immediate aftermath'' of the attacks,
    which was defined as the 96-hour time period immediately
    following the attacks. This time-frame was sufficient to deal
    with workers who suffered immediate injuries. However, it left
    no recourse for individuals with late-onset injuries or for
    those who arrived after September 15, 2001 to assist in
    recovery and cleanup efforts and are now suffering injuries as
    a result of those efforts.
        Additionally, some injured persons either did not know they
    were eligible to file claims or were unaware of ailments that
    had yet to manifest prior to expiration of the deadline. Such
    persons include thousands of first responders, construction
    workers, local residents and other individuals who are now
    developing a range of diseases because of their exposure to
    World Trade Center toxins. Many of these individuals are now
    developing career-ending injuries, such as pulmonary and
    respiratory ailments, but are not eligible to receive
    assistance because their symptoms developed after the VCF
    filing deadline had passed.

           THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010

        The James Zadroga 9/11 Health and Compensation Act of 2010
    addresses the above concerns by establishing a program to
    provide health care to those injured during recovery and
    cleanup efforts at September 11 crash sites and by reopening
    the September 11 Victim Compensation Fund to provide
    compensation for such injured individuals.
        Specifically, title I of the bill amends the Public Health
    Service Act to establish the World Trade Center Health Program
    within the National Institute for Occupational Safety and
    Health. This program will provide medical monitoring and
    treatment benefits to eligible emergency responders and
    recovery and cleanup workers who worked at the World Trade
    Center crash site. It will also provide initial health
    evaluation, monitoring, and treatment benefits to residents and
    other building occupants and area workers who were directly
    impacted and adversely affected by the September 11 attacks.
    The program will ensure that every person at risk of illness
    from exposure to World Trade Center toxins can obtain medical
    monitoring and that all those who are injured or sick as a
    result of such exposure can obtain treatment.
        Title II of the bill reopens the VCF to provide
    compensation for economic damages and losses to persons injured
    during recovery efforts and debris removal, including workers
    and area residents injured by toxins released during the
    collapse of the World Trade Center towers. To this end, the
    bill redefines a number of terms in the original VCF
    legislation so as to expand coverage to persons exposed to
    World Trade Center toxins. The bill expands coverage to all
    injuries occurring during recovery efforts and debris removal,
    including injuries occurring near the World Trade Center site
    and along the routes used to remove debris from that site. The
    bill defines ``debris removal'' comprehensively, so as to
    include the wide range of activities performed at the World
    Trade Center site and debris-removal routes, including, but not
    limited to, the assessment of damaged structures and the debris
    pile, the development of temporary stabilization procedures and
    mechanisms, demolition of unsafe structures, and removal of the
    debris pile. The bill also defines the term ``immediate
    aftermath'' as any period beginning with the terrorist-related
    aircraft crashes of September 11, 2001 and ending on August 30,
    2002.
        The bill reopens the VCF until December 22, 2031, allowing
    individuals who did not previously file a claim, or who became
    ill after the original December 22, 2003 deadline, to be
    compensated for economic damages and losses stemming from their
    injuries. The purpose behind reopening the fund for over 20
    years is to protect to the greatest extent possible those
    persons who were exposed to World Trade Center toxins during
    recovery and cleanup efforts but whose resulting injuries are
    latent and will manifest over the next two decades.
        While extending protection to injured individuals, the bill
    also provides protection from liability to certain entities
    that participated in recovery efforts and debris removal. The
    bill provides that their liability for all claims and actions
    arising from, or related to, recovery efforts and debris
    removal (including claims and actions previously resolved,
    currently pending, or filed through December 22, 2031) is
    limited to the amount of funds held by the World Trade Center
    Captive Insurance Company, the amount of available insurance
    coverage identified by the Captive Insurance Company, and the
    amount of insurance coverage held by certain other entities.
        The bill provides that the liability of the City of New
    York is limited to the City's insurance coverage or
    $350,000,000, whichever is greater. It further provides that
    the liability of the Port Authority of New York and New Jersey,
    and any other entity with a property interest in the World
    Trade Center on September 11, 2001, is limited to the amount of
    all available insurance coverage maintained by any such entity.
    The bill also limits liability of any individual contractor or
    subcontractor that participated in recovery efforts and debris
    removal to the amount of available liability insurance
    maintained by such contractor or subcontractor.
        The bill establishes a priority of funds from which
    plaintiffs may satisfy judgments or settlements obtained in
    civil claims or actions related to recovery and cleanup
    efforts. The priority requires exhaustion of amounts held by
    the Captive Insurance Company and identified insurance
    policies, followed by exhaustion of the amount for which the
    City of New York is liable, followed by exhaustion of the
    available insurance coverage maintained by the Port Authority
    and other entities with a property interest in the World Trade
    Center on September 11, 2001, followed by exhaustion of the
    available insurance coverage maintained by individual
    contractors and subcontractors.
        As amended in Committee, the bill caps the total amount of
    new compensation that could be awarded by the VCF to $8.4
    billion. The bill also caps the amount of such compensation
    that could be used to pay attorney's fees at 10 percent, except
    that the Special Master is given the discretion to raise this
    percentage for certain cases filed in the Southern District of
    New York prior to January 1, 2009. This discretion is provided
    to the Special Master to address cases where the 10 percent cap
    on attorney's fees may not provide adequate compensation for
    services rendered in connection with a claim because of the
    substantial amount of legal work expended on that claim during
    the period after which the initial period for filing claims
    under the VCF expired.
        The bill also requires the Special Master to update
    regulations consistent with revisions to the Victim
    Compensation Fund under this bill.

                                    Hearings

        The Committee's Subcommittee on Immigration, Citizenship,
    Refugees, Border Security, and International Law and
    Subcommittee on the Constitution, Civil Rights, and Civil
    Liberties held a joint hearing on H.R. 847 on March 31, 2009.
    Testimony was received from Kenneth R. Feinberg, former Special
    Master, Victim Compensation Fund; Barbara Burnette, former
    Detective, New York City Police Department; James Melius, MD.,
    Administrator, New York State Laborers' Health and Safety Trust
    Fund; Christine LaSala, Chief Executive Officer, World Trade
    Center Captive Insurance Fund; Michael A. Cardozo, Corporation
    Counsel, City of New York; Theodore H. Frank, American
    Enterprise Institute; and Richard Wood, President, Plaza
    Construction Corporation. Additional materials were submitted
    by the Associated Builders and Contractors (ABC) and Christine
    C. Quinn, Speaker, New York City Council.

                            Committee Consideration

        On July 29, 2009, the Committee met in open session and
    ordered the bill H.R. 847 favorably reported with an amendment,
    by a rollcall vote of 22 to 9, a quorum being present.

                                Committee Votes

        In compliance with clause 3(b) of rule XIII of the Rules of
    the House of Representatives, the Committee advises that the
    following rollcall vote occurred during the Committee's
    consideration of H.R. 847:
        1. An amendment by Mr. Smith to: (a) reduce the life of the
    Victim Compensation Fund from 22 to 5 years; (b) reduce the cap
    on the Fund from $8.4 billion to $5.5 billion; and (c) strike
    several provisions intended to expand eligibility under the VCF
    to first responders, recovery workers, and others injured as a
    result of exposure to World Trade Center toxins during recovery
    efforts and debris removal. Defeated 9 to 21.

                                                     ROLLCALL NO. 1
    ----------------------------------------------------------------------------------------------------------------
                                                                           Ayes            Nays           Present
    ----------------------------------------------------------------------------------------------------------------
    Mr. Conyers, Jr., Chairman......................................                              X
    Mr. Berman......................................................
    Mr. Boucher.....................................................
    Mr. Nadler......................................................                              X
    Mr. Scott.......................................................                              X
    Mr. Watt........................................................                              X
    Ms. Lofgren.....................................................                              X
    Ms. Jackson Lee.................................................                              X
    Ms. Waters......................................................
    Mr. Delahunt....................................................
    Mr. Wexler......................................................                              X
    Mr. Cohen.......................................................                              X
    Mr. Johnson.....................................................                              X
    Mr. Pierluisi...................................................                              X
    Mr. Quigley.....................................................                              X
    Mr. Gutierrez...................................................
    Mr. Sherman.....................................................                              X
    Ms. Baldwin.....................................................                              X
    Mr. Gonzalez....................................................                              X
    Mr. Weiner......................................................                              X
    Mr. Schiff......................................................                              X
    Ms. Sanchez.....................................................                              X
    Ms. Wasserman Schultz...........................................
    Mr. Maffei......................................................                              X
    Mr. Smith, Ranking Member.......................................              X
    Mr. Sensenbrenner, Jr...........................................              X
    Mr. Coble.......................................................              X
    Mr. Gallegly....................................................
    Mr. Goodlatte...................................................
    Mr. Lungren.....................................................                              X
    Mr. Issa........................................................              X
    Mr. Forbes......................................................              X
    Mr. King........................................................              X
    Mr. Franks......................................................              X
    Mr. Gohmert.....................................................              X
    Mr. Jordan......................................................              X
    Mr. Poe.........................................................                              X
    Mr. Chaffetz....................................................
    Mr. Rooney......................................................                              X
    Mr. Harper......................................................
                                                                     -----------------------------------------------
        Total.......................................................              9              21
    ----------------------------------------------------------------------------------------------------------------

        2. Motion to order the bill favorably reported as amended.
    Approved 22-9.

                                                     ROLLCALL NO. 2
    ----------------------------------------------------------------------------------------------------------------
                                                                           Ayes            Nays           Present
    ----------------------------------------------------------------------------------------------------------------
    Mr. Conyers, Jr., Chairman......................................              X
    Mr. Berman......................................................
    Mr. Boucher.....................................................
    Mr. Nadler......................................................              X
    Mr. Scott.......................................................              X
    Mr. Watt........................................................              X
    Ms. Lofgren.....................................................              X
    Ms. Jackson Lee.................................................              X
    Ms. Waters......................................................
    Mr. Delahunt....................................................
    Mr. Wexler......................................................              X
    Mr. Cohen.......................................................              X
    Mr. Johnson.....................................................              X
    Mr. Pierluisi...................................................              X
    Mr. Quigley.....................................................              X
    Mr. Gutierrez...................................................
    Mr. Sherman.....................................................              X
    Ms. Baldwin.....................................................              X
    Mr. Gonzalez....................................................              X
    Mr. Weiner......................................................              X
    Mr. Schiff......................................................              X
    Ms. Sanchez.....................................................              X
    Ms. Wasserman Schultz...........................................              X
    Mr. Maffei......................................................              X
    Mr. Smith, Ranking Member.......................................                              X
    Mr. Sensenbrenner, Jr...........................................                              X
    Mr. Coble.......................................................                              X
    Mr. Gallegly....................................................
    Mr. Goodlatte...................................................
    Mr. Lungren.....................................................              X
    Mr. Issa........................................................                              X
    Mr. Forbes......................................................                              X
    Mr. King........................................................                              X
    Mr. Franks......................................................                              X
    Mr. Gohmert.....................................................
    Mr. Jordan......................................................                              X
    Mr. Poe.........................................................              X
    Mr. Chaffetz....................................................                              X
    Mr. Rooney......................................................              X
    Mr. Harper......................................................
                                                                     -----------------------------------------------
        Total.......................................................             22               9
    ----------------------------------------------------------------------------------------------------------------

                          Committee Oversight Findings

        In compliance with clause 3(c)(1) of rule XIII of the Rules
    of the House of Representatives, the Committee advises that the
    findings and recommendations of the Committee, based on
    oversight activities under clause 2(b)(1) of rule X of the
    Rules of the House of Representatives, are incorporated in the
    descriptive portions of this report.

                   New Budget Authority and Tax Expenditures

        In compliance with clause 3(c)(2) of rule XIII of the House
    of Representatives, the Committee adopts the estimate prepared
    by the Director of the Congressional Budget Office printed
    below.

                   Congressional Budget Office Cost Estimate

        In compliance with clause 3(c)(3) of rule XIII of the House
    of Representatives, the Committee sets forth, with respect to
    the bill, H.R. 847, the following estimate and comparison
    prepared by the Director of the Congressional Budget Office
    under section 402 of the Congressional Budget Act of 1974:

                                         U.S. Congress,
                                   Congressional Budget Office,
                                         Washington, DC, June 25, 2010.
    Hon. John Conyers, Jr., Chairman,
    Committee on the Judiciary,
    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), who can be reached at 226-9010, and Leigh
    Angres (Title II), who can be reached at 226-2700.
                Sincerely,
                                          Douglas W. Elmendorf,
                                                      Director.

    Enclosure

    cc:
            Honorable Lamar S. Smith.
            Ranking Member

    Identical letter sent to the Honorable Henry A. Waxman.

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

        Title I as ordered reported by the House Committee on
    Energy and Commerce on May 25, 2010, and

        Title II as ordered reported by the House Committee on the
    Judiciary on July 29, 2009.

                                    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:

             LHealth 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);

             LHealth 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

             LMonetary 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.

        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 Heath 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:

             LMental health benefits for surviving family
            members of responders who died at the WTC site on
            September 11, 2001;

             LCreation of a scientific committee and
            technical advisory committee;

             LEducation and outreach;

             LUniform data collection;

             LResearch pertaining to conditions related to
            the September 11, 2001, terrorist attacks; and

             LMaintaining 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:

             LTime 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.

             LGeographical 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.

             LExtended 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.

             LNumber of Awards: CBO expects that the number
            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.
              L  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.
              L  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.

             LAverage 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.
              L  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.

        NOISH 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.

            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

                        Performance Goals and Objectives

        The Committee states that pursuant to clause 3(c)(4) of
    rule XIII of the Rules of the House of Representatives, H.R.
    847 will establish a program to provide health care monitoring
    and treatment to persons injured during recovery efforts and
    debris removal at September 11, 2001 crash sites, and it will
    reopen the September 11 Victim Compensation Fund to provide
    compensation for such injured individuals.

                       Constitutional Authority Statement

        Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
    House of Representatives, the Committee finds the authority for
    this legislation in article I, section 8, clause 3 of the
    Constitution.

                              Advisory on Earmarks

        In accordance with clause 9 of rule XXI of the Rules of the
    House of Representatives, H.R. 847 does not contain any
    congressional earmarks, limited tax benefits, or limited tariff
    benefits as defined in clause 9(d), 9(e), or 9(f) of Rule XXI.

                          Section-by-Section Analysis

        The following discussion describes the bill as reported by
    the Committee.
        Sec. 1. Short Title; Table of Contents. Section 1 sets
    forth the short title of the bill as the ``James Zadroga 9/11
    Health and Compensation Act of 2010.'' The section also sets
    forth the table of contents of the bill.
        Sec. 2. Findings. Section 2 sets forth several findings of
    Congress.
        Sec. 101. World Trade Center Health Program. Section 101
    amends the Public Health Service Act to establish the World
    Trade Center Health Program (WTC program) within the National
    Institute for Occupational Safety and Health to provide medical
    monitoring and treatment benefits to emergency responders,
    recovery and cleanup workers, area residents and others who
    were directly impacted and adversely affected by the attacks of
    September 11, 2001.
        Sec. 201. Definitions. Section 201 amends the original
    Victim Compensation Fund provisions within the Air
    Transportation Safety and System Stabilization Act as follows:

             Lamends the definition of ``collateral
            source'' by including payments related to debris
            removal;

             Ldefines ``contractor and subcontractor'' to
            mean any entity that participated in debris removal at
            any September 11 crash site, except for any such entity
            with a property interest in the World Trade Center on
            September 11, 2001;

             Ldefines ``debris removal'' to mean rescue and
            recovery efforts, removal of debris, cleanup,
            remediation, and response during the immediate
            aftermath of the September 11 attacks;

             Ldefines ``immediate aftermath'' to mean any
            period beginning with the terrorist-related aircraft
            crashes of September 11, 2001, and ending on August 30,
            2002; and

             Ldefines ``9/11 crash site'' to mean: (1) the
            World Trade Center, Pentagon, and Shanksville,
            Pennsylvania crash sites; (2) the buildings or portions
            of buildings destroyed as a result of the September 11
            aircraft crashes; (3) any areas contiguous to the site
            of such crashes that the Special Master determines are
            sufficiently close to the site so that there was a
            demonstrable risk of physical harm resulting from the
            impact of the aircraft or any subsequent fire,
            explosions, or building collapses; and (4) any area
            related to, or along, routes of debris removal, such as
            barges and Fresh Kills.

        Sec. 202. Extended and Expanded Eligibility for
    Compensation. Section 202 amends the Air Transportation Safety
    and System Stabilization Act to generally extend and expand
    eligibility for compensation under the Victim Compensation
    Fund.
        Subsection (a) requires that the eligibility claim form for
    compensation benefits be amended to also request information
    concerning physical harm or death resulting from debris removal
    related to the September 11 attacks.
        Subsection (b) provides new deadlines for claims related to
    physical harm or death from debris removal at the crash sites
    that would extend to December 22, 2031.
        Subsection (c) establishes timing and proof requirements
    for claims filed during the extended filing period.
        Subsection (d) makes a technical correction to the original
    Victims Compensation Fund to clarify that claimants may include
    individuals who were present at other September 11 aircraft
    crash sites at the time of, or in the immediate aftermath of,
    the aircraft crashes.
        Subsection (e) amends the eligibility requirements for
    claimants to include individuals who suffered physical harm
    resulting from debris removal.
        Subsection (f) requires an individual filing a claim for
    compensation related to debris removal to waive his or her
    right to file a civil action or be party to such action in any
    Federal or state court for damages sustained as the result of
    the September 11 terrorist attacks. Any individual who was a
    party to such action, withdrew from such action in order to
    submit a claim for compensation, and was found ineligible for
    compensation, is permitted to reinstitute the civil action
    without prejudice during the 90-day period after ineligibility
    is determined.
        Sec. 203. Requirement to Update Regulations. Section 203
    amends the Air Transportation Safety and System Stabilization
    Act to require the Special Master to update, within 90 days of
    enactment, VCF regulations to reflect the changes made by this
    Act.
        Sec. 204. Limited Liability for Certain Claims. Section 204
    amends the Air Transportation Safety and System Stabilization
    Act to limit the liability of certain entities for civil claims
    and actions arising from or related to debris removal,
    including claims or actions previously resolved, currently
    pending, and that may be filed through December 22, 2031.
    Liability for such claims or actions is limited to the amount
    of funds held by the World Trade Center Captive Insurance
    Company, the amount of available insurance coverage identified
    in schedule 2 of the Captive Insurance Company insurance
    policy, and the amount of insurance coverage held by the City
    of New York, by entities with a property interest in the World
    Trade Center on September 11, 2001, and by contractors and
    subcontractors that participated in debris removal.
        Section 204 specifically provides that the individual
    liability of the City of New York is limited to the City's
    insurance coverage or $350,000,000, whichever is greater. The
    liability of the Port Authority of New York and New Jersey and
    any other entity with a property interest in the World Trade
    Center on September 11, 2001 is limited to the amount of all
    available insurance coverage maintained by any such entity. The
    liability of any contractor or subcontractor that participated
    in debris removal is limited to the amount of available
    liability insurance maintained by such contractor or
    subcontractor.
        Section 204 also establishes a priority of funds from which
    plaintiffs may satisfy judgments or settlements obtained for
    civil claims or actions related to debris removal. The priority
    requires exhaustion of amounts held by the Captive Insurance
    Company and identified insurance policies, followed by
    exhaustion of the amount for which the City of New York is
    liable, followed by exhaustion of the available insurance
    coverage maintained by the Port Authority and other entities
    with a property interest in the World Trade Center on September
    11, 2001, followed by exhaustion of the available insurance
    coverage maintained by contractors and subcontractors. In
    addition, section 204 specifies that any party to a claim or
    action can file an action for a declaratory judgment for
    insurance coverage or bring a direct action against the
    insurance company involved.
        Sec. 205. Funding; Attorney Fees. Section 205 amends the
    Air Transportation Safety and System Stabilization Act to cap
    the total payment of amounts for compensation from the VCF to
    $8.4 billion with respect to claims filed on or after the
    Special Master updates the Fund's regulations. Section 205
    would also cap at 10 percent the percentage of compensation
    that attorneys could receive in fees, except that the Special
    Master is given the discretion to raise this percentage for
    certain cases filed in the Southern District of New York prior
    to January 1, 2009. This discretion is provided to the Special
    Master to address cases where the 10 percent cap on attorneys'
    fees may not provide adequate compensation for services
    rendered in connection with a claim because of the substantial
    amount of legal work expended on that claim during the period
    after which the initial period for filing claims under the VCF
    expired.

             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 the bill, as reported, are shown as
    follows (existing law proposed to be omitted is enclosed in
    black brackets, new matter is printed in italics, existing law
    in which no change is proposed is shown in roman):

             AIR TRANSPORTATION SAFETY AND SYSTEM STABILIZATION ACT

    TITLE IV--VICTIM COMPENSATION

               *       *       *       *       *       *       *

    SEC. 402. DEFINITIONS.

      In this title, the following definitions apply:
              (1) * * *

               *       *       *       *       *       *       *

              (6) Collateral source.--The term ``collateral
            source'' means all collateral sources, including life
            insurance, pension funds, death benefit programs, and
            payments by Federal, State, or local governments
            related to the terrorist-related aircraft crashes of
            September 11, 2001, or debris removal, including under
            the World Trade Center Health Program established under
            section 3001 of the Public Health Service Act.
              (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.
              [(7)] (9) Economic loss.--The term ``economic loss''
            means any pecuniary loss resulting from harm (including
            the loss of earnings or other benefits related to
            employment, medical expense loss, replacement services
            loss, loss due to death, burial costs, and loss of
            business or employment opportunities) to the extent
            recovery for such loss is allowed under applicable
            State law.
              [(8)] (10) Eligible individual.--The term ``eligible
            individual'' means an individual determined to be
            eligible for compensation under section 405(c).
              (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.
              [(9)] (12) Noneconomic losses.--The term
            ``noneconomic losses'' means losses for physical and
            emotional pain, suffering, inconvenience, physical
            impairment, mental anguish, disfigurement, loss of
            enjoyment of life, loss of society and companionship,
            loss of consortium (other than loss of domestic
            service), hedonic damages, injury to reputation, and
            all other nonpecuniary losses of any kind or nature.
              [(10)] (13) Special master.--The term ``Special
            Master'' means the Special Master appointed under
            section 404(a).
              (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. 405. DETERMINATION OF ELIGIBILITY FOR COMPENSATION.

      (a) Filing of Claim.--
              (1) * * *
              (2) Claim form.--
                      (A) * * *
                      (B) Contents.--The form developed under
                    subparagraph (A) shall request--
                              (i) information from the claimant
                            concerning the physical harm that the
                            claimant suffered, or in the case of a
                            claim filed on behalf of a decedent
                            information confirming the decedent's
                            death, as a result of the terrorist-
                            related aircraft crashes of September
                            11, 2001, or debris removal during the
                            immediate aftermath;
                              (ii) information from the claimant
                            concerning any possible economic and
                            noneconomic losses that the claimant
                            suffered as a result of such crashes or
                            debris removal during the immediate
                            aftermath; and
                              (iii) information regarding
                            collateral sources of compensation the
                            claimant has received or is entitled to
                            receive as a result of such crashes or
                            debris removal during the immediate
                            aftermath.
              [(3) Limitation.--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.]
              (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) Eligibility.--
              (1) * * *
              (2) Individuals.--A claimant is an individual
            described in this paragraph if the claimant is--
                      (A) an individual who--
                              (i) was present at the World Trade
                            Center, (New York, New York), the
                            Pentagon (Arlington, Virginia), [or the
                            site of the aircraft crash at
                            Shanksville, Pennsylvania] the site of
                            the aircraft crash at Shanksville,
                            Pennsylvania, or any other 9/11 crash
                            site at the time, or in the immediate
                            aftermath, of the terrorist-related
                            aircraft crashes of September 11, 2001;
                            and
                              (ii) suffered physical harm or death
                            as a result of such an air crash or
                            debris removal;

               *       *       *       *       *       *       *

              (3) Requirements.--
                      (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).
                      [(A)] (B) Single claim.--Not more than one
                    claim may be submitted under this title by an
                    individual or on behalf of a deceased
                    individual.
                      [(B)] (C) Limitation on civil action.--
                              (i) In general.--Upon the submission
                            of a claim under this title, the
                            claimant waives the right to file a
                            civil action (or to be a party to an
                            action) in any Federal or State court
                            for damages sustained as a result of
                            the terrorist-related aircraft crashes
                            of September 11, 2001, or for damages
                            arising from or related to debris
                            removal. The preceding sentence does
                            not apply to a civil action to recover
                            collateral source obligations, or to a
                            civil action against any person who is
                            a knowing participant in any conspiracy
                            to hijack any aircraft or commit any
                            terrorist act.
                              [(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 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.]
                              (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).
                              (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. 406. PAYMENTS TO ELIGIBLE INDIVIDUALS.

      (a) In General.--[Not later than] Subject to subsection (d),
    not later than 20 days after the date on which a determination
    is made by the Special Master regarding the amount of
    compensation due a claimant under this title, the Special
    Master shall authorize payment to such claimant of the amount
    determined with respect to the claimant.
      (b) Payment Authority.--[This title] Subject to subsection
    (d), this title constitutes budget authority in advance of
    appropriations Acts and represents the obligation of the
    Federal Government to provide for the payment of amounts for
    compensation under this title.

               *       *       *       *       *       *       *

      (d) Limitation.--The total payment of amounts for
    compensation under this title, with respect to claims filed on
    or after the date on which the regulations are updated under
    section 407(b), shall not exceed $8,400,000,000.
      (e) Attorney Fees.--
              (1) In general.--Notwithstanding any contract, and
            except as provided in paragraph (2), the representative
            of an individual may not charge, for services rendered
            in connection with the claim of an individual under
            this title, more than 10 percent of an award made under
            this title on such claim.
              (2) Exception.--With respect to a claim made on
            behalf of an individual for whom a lawsuit was filed in
            the Southern District of New York prior to January 1,
            2009, in the event that the representative believes in
            good faith that the fee limit set by paragraph (1) will
            not provide adequate compensation for services rendered
            in connection with such claim because of the
            substantial amount of legal work provided on behalf of
            the claimant (including work performed before the
            enactment of this legislation), application for greater
            compensation may be made to the Special Master. Upon
            such application, the Special Master may, in his or her
            discretion, award as reasonable compensation for
            services rendered an amount greater than that allowed
            for in paragraph (1). Such fee award will be final,
            binding, and non-appealable.

    SEC. 407. REGULATIONS.

      [Not later than] (a) In General._Not later than 90 days after
    the date of enactment of this Act, the Attorney General, in
    consultation with the Special Master, shall promulgate
    regulations to carry out this title, including regulations with
    respect to--
              (1) * * *

               *       *       *       *       *       *       *

      (b) Updated Regulations.--Not later than 90 days after the
    date of the enactment of the James Zadroga 9/11 Health and
    Compensation Act of 2010, the Special Master shall update the
    regulations promulgated under subsection (a) to the extent
    necessary to comply with the provisions of title II of such
    Act.

    SEC. 408. LIMITATION ON LIABILITY.

      (a) In General.--
              (1) * * *

               *       *       *       *       *       *       *

              (4) Liability for certain claims.--Notwithstanding
            any other provision of law, liability for all claims
            and actions (including claims or actions that have been
            previously resolved, that are currently pending, and
            that may be filed through December 22, 2031) for
            compensatory damages, contribution or indemnity, or any
            other form or type of relief, arising from or related
            to debris removal, against the City of New York, any
            entity (including the Port Authority of New York and
            New Jersey) with a property interest in the World Trade
            Center on September 11, 2001 (whether fee simple,
            leasehold or easement, or direct or indirect) and any
            contractors and subcontractors, shall not be in an
            amount that exceeds the sum of the following, as may be
            applicable:
                      (A) The amount of funds of the WTC Captive
                    Insurance Company, including the cumulative
                    interest.
                      (B) The amount of all available insurance
                    identified in schedule 2 of the WTC Captive
                    Insurance Company insurance policy.
                      (C) As it relates to the limitation of
                    liability of the City of New York, the amount
                    that is the greater of the City of New York's
                    insurance coverage or $350,000,000. In
                    determining the amount of the City's insurance
                    coverage for purposes of the previous sentence,
                    any amount described in clauses (i) and (ii)
                    shall not be included.
                      (D) As it relates to the limitation of
                    liability of any entity, including the Port
                    Authority of New York and New Jersey, with a
                    property interest in the World Trade Center on
                    September 11, 2001 (whether fee simple,
                    leasehold or easement, or direct or indirect),
                    the amount of all available liability insurance
                    coverage maintained by any such entity.
                      (E) As it relates to the limitation of
                    liability of any individual contractor or
                    subcontractor, the amount of all available
                    liability insurance coverage maintained by such
                    contractor or subcontractor on September 11,
                    2001.
              (5) Priority of claims payments.--Payments to
            plaintiffs who obtain a settlement or judgment with
            respect to a claim or action to which paragraph (4)(A)
            applies, shall be paid solely from the following funds
            in the following order, as may be applicable:
                      (A) The funds described in clause (i) or (ii)
                    of paragraph (4)(A).
                      (B) If there are no funds available as
                    described in clause (i) or (ii) of paragraph
                    (4)(A), the funds described in clause (iii) of
                    such paragraph.
                      (C) If there are no funds available as
                    described in clause (i), (ii), or (iii) of
                    paragraph (4)(A), the funds described in clause
                    (iv) of such paragraph.
                      (D) If there are no funds available as
                    described in clause (i), (ii), (iii), or (iv)
                    of paragraph (4)(A), the funds described in
                    clause (v) of such paragraph.
              (6) Declaratory judgment actions and direct action.--
            Any party to a claim or action to which paragraph
            (4)(A) applies may, with respect to such claim or
            action, either file an action for a declaratory
            judgment for insurance coverage or bring a direct
            action against the insurance company involved.

               *       *       *       *       *       *       *

                                Dissenting Views

              Despite its success, the fund has not set a
            precedent. Congress has not authorized similar
            compensation for the thousands of victims of Hurricane
            Katrina, for those injured by other natural disasters
            or for the families of those killed in such tragedies.
            Nor has Congress exhibited such generosity toward U.S.
            soldiers wounded, or the families of those killed, in
            Iraq and Afghanistan.
              The same is true of victims of terrorist attacks that
            took place before Sept. 11, 2001. The Navy personnel
            who died in the suicide attack on the USS Cole and the
            victims of the Oklahoma City bombing received no such
            public compensation. Even the victims of the first
            terrorist attack on the World Trade Center, in 1993,
            were denied. Cold though it may sound, this is as it
            should be.
              Bad things happen to good people every day; Congress
            does not come to their financial rescue with generous,
            tax-free checks. In our free society, based on notions
            of limited government and equal protection of the laws,
            we simply do not expect the government to step in
            whenever misfortune strikes. This is not out of concern
            about bankrupting the Treasury. It is because our
            heritage teaches that we all must take our chances in
            life.
                                                    --Kenneth R.
                                            Feinberg\1\
    ---------------------------------------------------------------------------
        \1\Kenneth R. Feinberg, 9/11 Fund: Once Was Enough, Wash. Post,
    September 11, 2008, at A17. Kenneth R. Feinberg was the Special Master
    of the September 11th Victim Compensation Fund.

                                  INTRODUCTION

        Eight years ago, just 11 days after the terrorist attacks
    of September 11th, Congress passed the Air Transportation
    Safety and System Stability Act,\2\ which created the September
    11th Victim Compensation Fund, and President Bush quickly
    signed it into law. This bipartisan bill was one-of-a-kind
    legislation, providing generous public compensation to the
    physically injured and to the families of the dead. The
    original 9/11 Fund successfully served its purpose by
    effectively and efficiently providing a short-term,
    administrative, no-fault alternative to tort litigation to
    compensate the victims. The Fund paid out over $7 billion in
    taxpayer dollars to 5,560 eligible claimants.
    ---------------------------------------------------------------------------
        \2\Pub. L. No. 107-42 (2001), 115 Stat. 230 (2001) (codified at 49
    U.S.C. Sec. 40101 note).
    ---------------------------------------------------------------------------
        The original fund reflected national solidarity towards the
    victims and expressed a national sense of compassion not only
    to the victims, but to the rest of the world. It was ``an
    expression of the best in the American character.''\3\ The
    question H.R. 847 raises is whether Congress should pass a new
    9/11 Fund, with different terms than the original fund, or
    whether the original fund should be considered a unique,
    singular response to an unprecedented tragedy. The answer to
    that question--at least with regard to H.R. 847 in its current
    form--is that a new 9/11 Fund should not be enacted.
    ---------------------------------------------------------------------------
        \3\H.R. 847, the ``James Zadroga 9/11 Health and Compensation Act
    of 2009'': Joint Hearing Before the Subcomm. on the Constitution and
    the Subcomm. on Immigration of the House Comm. on the Judiciary, 111th
    Cong. (2009) (statement of Kenneth R. Feinberg).
    ---------------------------------------------------------------------------
        The approach H.R. 847 takes ``does not have the advantages
    that made the [original 9/11 Fund] successful, and magnifies
    the disadvantages and fairness problems of the [original 9/11
    Fund].''\4\ Three of the main problems with H.R. 847 are that
    (1) it leaves the fund open for 22 years, well beyond what is
    needed to take care of any latent claims; (2) gives the Special
    Master virtually unbounded authority, that will not work for a
    long-term (22 years) compensation program involving a
    substantially larger set of potential claimants than the
    original 9/11 Fund with injuries of more ambiguous causation;
    and (3) the nature of the fund will make it highly susceptible
    to waste, fraud, and abuse.
    ---------------------------------------------------------------------------
        \4\H.R. 847, the ``James Zadroga 9/11 Health and Compensation Act
    of 2009'': Joint Hearing Before the Subcomm. on the Constitution and
    the Subcomm. on Immigration of the House Comm. on the Judiciary, 111th
    Cong. (2009) (statement of Theodore H. Frank) (``Frank testimony'') .
    ---------------------------------------------------------------------------
        In short, while there is a sympathetic and potentially
    deserving class of claimants and while there is good reason to
    give the construction contractors that aided after 9/11 in the
    recovery and cleanup efforts liability protection, the fund
    that will be created by H.R. 847 is not narrowly and
    appropriately tailored towards those ends. Accordingly,
    Congress should not create the new 9/11 Fund contained in H.R.
    847.

                                   BACKGROUND

        Title II of H.R. 847 will create a new September 11th
    Victim Compensation Fund (``VCF''), which will be open until
    December 22, 2031, to provide compensation for individuals who
    did not file before, or became ill after, the December 22, 2003
    filing deadline for the original fund. In addition, Title II
    will limit the liability of defendants--including the
    contractors and subcontractors that aided in the rescue,
    recovery, and cleanup efforts--for lawsuits previously
    resolved, currently pending, or filed through December 22,
    2031, related to the rescue, recovery, and cleanup efforts at
    the World Trade Center site.
    A. LOriginal Victim Compensation Fund
        Eleven days after the terrorist attacks on September 11,
    2001, Congress passed the Air Transportation Safety and
    Stabilization Act to protect air carriers from tort lawsuits
    that threatened to cripple air travel in the United States. The
    Act capped damages against the airlines at their pre-existing
    liability insurance limits and limited jurisdiction for tort
    claims to the U.S. District Court for the Southern District of
    New York. Moreover, the Act established the 9/11 Victim
    Compensation Fund, through which victims of the attacks could
    opt to waive all federal and state tort claims and receive
    administrative relief through a predetermined formula, under
    the discretion of the Fund's Special Master.
        The VCF limited recovery to a discrete class of victims,
    determined by time and place. To be eligible for recovery under
    the Fund, victims had to have been on the flights or at the
    World Trade Center or Pentagon sites ``within 12 hours of the
    attacks, suffered a physical injury, and been treated by a
    medical professional within 24 hours of the injury, within 24
    hours of rescue, or within 72 hours of injury or rescue for
    those victims who were unable to realize immediately the extent
    of their injuries or for whom treatment by a medical
    professional was not available on September 11.''\5\ Those who
    died in the attacks and rescue workers who were at the site
    within 96 hours of the attacks were eligible. The VCF thus had
    a clearly defined class of victims whose death or injuries did
    not present complex questions of causation.
    ---------------------------------------------------------------------------
        \5\Lloyd Dixon and Rachel Kaganoff Stern, ``Compensation for Losses
    from the 9/11 Attacks'' (The Rand Institute for Civil Justice: 2004) at
    121.
    ---------------------------------------------------------------------------
        The VCF granted awards for economic loss based on the
    victim's annual income prior to the attack. Awards for non-
    economic losses for death cases were set at $250,000 per victim
    and $100,000 for a spouse and each dependent child; those who
    did not believe that these levels provided adequate
    compensation for non-economic damages could petition for a
    hearing.\6\ The VCF deducted from awards all collateral-source
    benefits, including ``life insurance, pension funds, death
    benefit programs, and payments by Federal, State, or local
    governments related to the terrorist-related aircraft crashes
    of September 11, 2001.''\7\
    ---------------------------------------------------------------------------
        \6\See 67 Fed. Reg. 11,239 (Mar. 13, 2002).
        \7\Pub. L. No. 107-42 (2001), 115 Stat. 230 (2001) (codified at 49
    U.S.C. Sec. 40101 note).
    ---------------------------------------------------------------------------
    B. LCurrent Situation
        Immediately after the terrorist attacks on 9/11, large
    private contracting firms were asked by the City of New York to
    immediately begin cleanup efforts at Ground Zero. They did so
    heroically and in strained circumstances, even though they were
    unable to secure the liability insurance they would normally
    obtain before starting a project. They were unable to obtain
    such insurance because the unprecedented nature of the disaster
    site (containing some 20 stories of debris) caused insurance
    markets to be incapable of pricing such an insurance product.
        Since then, many people who worked and lived in and around
    the cleanup site have developed medical problems alleged to
    have been caused by the toxic particulates in the air around
    the site and by the alleged negligence of the cleanup companies
    to ensure that their workers and those in the area were not
    exposed to such contaminants. The alleged victims of this
    alleged negligence have filed lawsuits (over 10,000 claimants
    so far) which now proceed for huge demands of damages. The
    contractors claim that the vast majority of claimants are not
    contractor employees, but New York City employees such as
    firemen. These lawsuits place the solvency of these firms in
    jeopardy.
        Other major entities affected by the 9/11 attacks,
    including the airlines, the owner of the World Trade Center,
    and the Port Authority of New York and New Jersey, were
    protected from excessive liability exposure following the
    attacks by federal legislation. Unfortunately, the cleanup
    firms, whose liability issues did not arise until many months
    after the attacks, were not. While approximately a billion
    dollars have been appropriated to help pay for the medical
    expenses of those affects by the contaminants in the areas
    around the World Trade Center site, the administrative
    compensation program created to help the immediate victims of
    9/11 (the VCF) did not cover those exposed to subsequent site
    contaminants, and the liability protections passed after 9/11
    do not cover the cleanup and recovery firms.

                                   DISCUSSION

        Title II of H.R. 847 creates a new September 11th Victim
    Compensation Fund to provide compensation to those who were
    injured by air contaminants as a result of rescue, recovery,
    and cleanup efforts following 9/11 but were ineligible for
    compensation under the VCF because their injuries did not
    manifest themselves by the fund's December 22, 2003 filing
    deadline. However, the structure of the original 9/11 Fund,
    which H.R. 847 incorporates, intended for compensating a
    limited set of claimants in time and place with relatively
    uncontroversial claims in a non-adversarial setting, will not
    work for the significantly longer-term fund created by H.R. 847
    involving a substantially larger set of claimants with injuries
    of more ambiguous causation.
        Under the original 9/11 Fund, there was, in general, no
    ambiguity with regard to causation. Someone who was on one of
    the planes or was killed in the World Trade Center or at the
    Pentagon clearly was entitled to compensation from the Fund.
    Accordingly, determining who was eligible for compensation was
    for the most part a ministerial function, which did not require
    adjudication. Moreover, as the number of potential claimants to
    the original fund was limited to several thousand, the Fund was
    able to be administered effectively and efficiently with a
    structure that was relatively thin for a government
    bureaucracy. However, ``[a] longer-term and larger compensation
    fund could not possibly vest that much discretionary authority
    in a single individual, and would need to craft `rigidly
    standardized rules' that the current statutory structure of the
    Fund would not permit.''\8\ Yet, H.R. 847 makes no changes to
    the original Fund's structure to account for the long-term
    nature and increased size and complexity of the new Fund.
    ---------------------------------------------------------------------------
        \8\Frank testimony at 3.
    ---------------------------------------------------------------------------
        Thus, while enacting a new 9/11 Fund is in some ways an
    attractive proposition, the Fund that will be created by H.R.
    847 is highly problematic.
    A. LH.R. 847 extends the 9/11 Compensation Fund over 30 years beyond
            September 11, 2001.
        Under H.R. 847, a claim may be filed at any time during the
    period that begins on the date the Special Master updates the
    VCF regulations and ends on December 22, 2031. The Special
    Master is required to update the regulations within 90 days of
    enactment of H.R. 847. Thus, under this bill, the Fund will be
    open from at least 2010 to 2031--a period of over 21 years and
    over 30 years beyond September 11, 2001.
        The sponsors of the legislation want to leave the VCF open
    for such a long period of time to address potential latent
    claims. However, according to Kenneth Feinberg, Special Master
    of the original VCF, ``no latent claims need such an extended
    date.'' As the original 9/11 Fund paid over $1 billion to 2,680
    eligible physical injury claimants the majority of whom were
    suffering from respiratory ailments, former Special Master
    Feinberg has firsthand knowledge of the types of claims that
    can be expected for the new Fund.
        Based on his experience, Mr. Feinberg has suggested that
    ``Congress could simply reopen the 9/11 Fund to encompass all
    such claims during a `window' of 5 years during which time all
    September 11 related respiratory physical injuries could be
    evaluated and processed.''\9\ Moreover, if latent claims
    present a problem at a later date, victims can sue the
    contractors and the city assuming the liability cap has not
    been reached. Or, if a shorter period (e.g., 5 years) does not
    end up being long enough, Congress could once again consider
    the issue and reenact the fund. This is an obvious solution as
    that is exactly the situation that is occurring here: according
    to the bill's sponsors the original fund was not open long
    enough so this legislation would reenact it.
    ---------------------------------------------------------------------------
        \9\Paying With Their Lives: The Status of Compensation for 9/11
    Health Effects: Joint Hearing Before the Subcomm. on the Constitution
    and the Subcomm. on Immigration of the House Comm. on the Judiciary,
    110th Cong. (2008) (statement of Kenneth R. Feinberg).
    ---------------------------------------------------------------------------
        What is more, the bill extends the time period for when an
    individual's injuries had to have been sustained from the 96
    hours after the 9/11 attacks contained in the original fund to
    almost a full year after September 11, 2001. That is to say,
    claimants will be eligible for the Fund if they were present in
    a covered area between September 11, 2001 and August 30, 2002.
    Inexplicably, however, the last three months of this nearly
    additional year of coverage fall after the cleanup of Ground
    Zero ended on May 30, 2002. Why should taxpayers be providing
    compensation for injuries that were sustained up to three
    months after the cleanup ended?
    B. LH.R. 847 gives the Special Master unchecked and unreviewable
            discretionary power that is inappropriate for the compensation
            fund it creates.
        The compensation fund that will be created by H.R. 847,
    like the original 9/11 Fund, vests tremendous unchecked and
    unreviewable discretionary power in the Fund's special master.
    This may have been acceptable for the original 9/11 Fund, with
    its limited set of claimants in time and place with relatively
    uncontroversial claims. But it is inappropriate for the longer-
    term compensation program created by H.R. 847 involving a
    substantially larger set of potential claimants with injuries
    of more ambiguous causation.
        The country was tremendously lucky that Special Master
    Feinberg exercised the discretion he was given under the
    original fund so ably. The compensation fund that will be
    created by H.R. 847, however, is greater in scope and is of a
    significantly longer duration than the original fund. Thus it
    is highly problematic that H.R. 847 contains very few, if any,
    constraints on the new Special Master's discretion to disburse
    compensation to the tens of thousands of potential claimants.
    This is especially true with regard to medical causation and
    non-economic damages.
        In terms of medical causation, if the Fund is to be anymore
    than a giveaway of taxpayer money to anyone who is suffering a
    respiratory problem and was in the appropriate geographic area,
    the cooperative non-adversarial structure of the original 9/11
    Fund will necessarily have to change. This cooperative non-
    adversarial structure was advantageous in the original fund as
    there was no dispute as to causation and there were a
    relatively limited number of claimants. This structure, which
    H.R. 847 leaves unaltered, however, is not appropriate for the
    type or scope of claims that will be covered by the new fund or
    the larger number of claims that can be expected.
        With regard to non-economic damages, the discretion given
    to the Special Master under H.R. 847 is also problematic. Non-
    economic damages are highly subjective. The original 9/11 Fund
    had a regulatory limitation on presumed non-economic damages,
    but the Special Master could exceed that limitation in
    exceptional cases and ``[a] different Special Master could undo
    those regulatory limitations, and open the Treasury to
    arbitrary non-economic damages awards to thousands of
    claimants.''\10\
    ---------------------------------------------------------------------------
        \10\Frank testimony at 4.
    ---------------------------------------------------------------------------
        In other words, H.R. 847 simply puts too much discretion in
    the hands of what will likely be several Special Masters over
    the duration of the 22-year fund. Although Mr. Feinberg did an
    exceptional job with the original fund, Congress should not
    leave to chance that there will be as able a set of Special
    Masters over the course of the fund created by H.R. 847. Nor
    should Congress treat this larger, more complex and longer-
    lasting fund as though it is simply a carbon copy of the
    original Fund.
    C. LFund will be susceptible to fraud, waste, error, and abuse
        The original 9/11 Fund was designed for a select group of
    claimants who, for the most part, were unquestionably the
    intended recipients and eligible for benefits. In general, this
    narrow focus allowed for a non-adversarial process, involving a
    limited number of claimants, without dispute over causation.
    Indeed, as Special Master Feinberg has noted, ``Claimants did
    not need to present detailed computations or analyses. Instead,
    they only needed to supply the fund easily obtained data.''\11\
    ---------------------------------------------------------------------------
        \11\Kenneth R. Feinberg, 1 Final Report of the Special Master of
    the September 11th Victim Compensation Fund 7 (2004).
    ---------------------------------------------------------------------------
        However, the structure of the original fund, ``left
    unchanged in H.R. 847, is inappropriate for either the broader
    scope of the new Fund or the larger volume of claims the Fund
    can anticipate.''\12\ In order to avoid waste, fraud, and abuse
    of taxpayer dollars, Ted Frank of the American Enterprise
    Institute, a witness at the Committee's hearing on this
    legislation, explained in his written testimony that:
    ---------------------------------------------------------------------------
        \12\Frank testimony at 5.

            If the Fund is to be aimed at a specific set of victims
            of terrorist attack, rather than simply a giveaway of
            taxpayer money to a geographic area and to trial
            lawyers, Section 405 will need to be amended to both
            require the Fund to establish neutral medical criteria
            for demonstrating causation, and to have a more
            realistic timeframe for adjudication of potentially
            controversial claims for compensation. Congress should
            require the Fund to establish appropriate burdens of
            proof and permit for independent medical review to
            ensure that, if taxpayers are to be responsible for
            compensation for injuries caused in the aftermath of
            the September 11 attacks, they are responsible for that
            amount and no more.\13\
    ---------------------------------------------------------------------------
        \13\Frank testimony at 5-6.

        For an example of the potential for fraud, waste, and
    abuse, one need look no further than the namesake of H.R. 847,
    James Zadroga. Detective Zadroga died from pulmonary disease
    and respiratory failure allegedly caused by exposure to dust at
    Ground Zero. The chief New York City medical examiner, however,
    concluded that, ``[i]t is our unequivocal opinion, with
    certainty beyond doubt, that the foreign material in [Detective
    Zadroga's] lungs did not get there as the result of inhaling
    dust at the World Trade Center or elsewhere.''\14\ Although
    Zadroga's family disputes the medical examiner's finding, the
    simple fact that this controversy exists demonstrates that the
    non-adversarial structure of the original fund cannot be
    retained without opening the new Fund up to fraud, waste, and
    abuse.
    ---------------------------------------------------------------------------
        \14\Bill Hutchinson, Coroner Says Hero James Zadroga Didn't Die
    From WTC Dust, N.Y. Daily News (Oct. 19, 2007).
    ---------------------------------------------------------------------------
        As Ted Frank further explained in his written testimony,

              The danger here is not simply the occasional false
            positive of unmerited compensation, but the creation of
            a compensation structure that will be subject to
            pervasive fraud. History has shown in the asbestos and
            silicosis mass tort litigations that claims of lung
            ailments are especially susceptible to fraud. . . .
              The only hurdle the bill creates is Section
            405(c)(3)(A)(ii)--proof that one contemporaneously
            sought medical treatment. This may succeed in winnowing
            out especially meritless claims that have already been
            brought, but the bar is quite low for future claimants.
              Even legitimate medical facilities have a danger of
            suffering from confirmation bias and exaggerating the
            scope of pulmonary injuries, given the millions of
            dollars of federal money at stake. Many of the most
            sensational reports, including congressional testimony,
            have come from the Irving J. Selikoff Center for
            Occupational and Environmental Medicine. . . . But
            critics have complained that ``doctors at the clinic,
            which has strong historical ties to labor unions, have
            allowed their advocacy for workers to trump their
            science by making statements that go beyond what their
            studies have confirmed''; and they have presented
            findings in ``scientifically questionable ways.''\15\
    ---------------------------------------------------------------------------
        \15\Frank testimony at 7 (citations omitted).

        Moreover, as Mr. Frank explains, a fund like the one
    created in H.R. 847 will invariably suffer from the Field of
    Dreams problem: ``if you build it they will come.''\16\ In
    other words, ``[i]f Congress creates a compensation system
    where geographic proximity and a diagnosis are the only
    prerequisites for a large government check and an attorney's
    contingent fee, attorneys will have every incentive to
    manufacture such diagnoses, and have done so in the past, often
    with the cooperation of unions.''\17\ In the case of a new 9/11
    Fund, this concern is more than hypothetical. ``Thousands of
    lawsuits in the September 11 litigation in [federal] court
    alleging pulmonary injury have been filed by Napoli, Kaiser &
    Bern LLP, which was responsible for massive fraud in the fen-
    phen litigation.''\18\
    ---------------------------------------------------------------------------
        \16\Id. at 8 (citing Richard A. Nagareda, Mass Torts in a World of
    Settlement 143 (2007).
        \17\Id. at 8.
        \18\Id.
    ---------------------------------------------------------------------------
        What will stop this same type of fraud from seeping into
    the new 9/11 Fund that is to be created by H.R. 847? As Mr.
    Frank points out, it likely will not be the structure of the
    Fund as it currently stands:

            Given the likely volume of claims and the complexity of
            the underlying causation and timeliness issues, it will
            be extraordinarily unlikely that the next Special
            Master will be able to adequately review claims for
            merit. Without firm medical criteria and the
            opportunity of scrutiny of claims on the front end and
            the promise of criminal penalties for fraud on the back
            end, the reopening of the VCF will be subject to
            substantial fraud and abuse.\19\
    ---------------------------------------------------------------------------
        \19\Id. at 9.
    ---------------------------------------------------------------------------
    D. LThe manager's amendment's $8.4 billion cap is an invitation to
            spend $8.4 billion
        Through the manager's amendment that was adopted in
    Committee, expenditures from the fund will be capped at $8.4
    billion. There are several problems with this cap. First, at
    base, a cap of $8.4 billion is nothing more than an invitation
    for the Fund's Special Master to spend $8.4 billion. Second, it
    is unclear where this $8.4 billion figure came from. The
    Congressional Budget Office (CBO) scored the first 10 years of
    the new Fund at $6.4 billion, but extrapolating CBO's 10-year
    numbers out for a 22-year long fund comes to no more than $7.6
    billion.\20\ Additionally, Special Master Feinberg, who
    probably has as good a grasp on the scope of these claims as
    anyone, has indicated that all existing claims could be settled
    for $1.5 billion.\21\ If $1.5 billion is anywhere close to
    being correct, why then is the cap set at $8.4 billion? It
    should not be. Third, an $8.4 billion cap in H.R. 847 does
    nothing to prevent a future Congress from increasing the cap.
    For instance, if the Special Master pays out $8.4 billion in
    the first 10 years of the Fund, is a future Congress not going
    to be at least tempted to authorize an increase in the cap? Of
    course it will. If a future Congress can increase the cap, why
    then not limit the initial cap to the $1.5 billion figure
    suggested for Mr. Feinberg? The bill's sponsors do not explain
    why they have not chosen that route.
    ---------------------------------------------------------------------------
        \20\The Congressional Budget Office only calculated the cost of an
    uncapped fund for the first 10 years the Fund would be opened. However,
    CBO determined that claims for compensation from the Fund would
    decrease over time. According to CBO's cost estimate, in year 10 annual
    payouts from the fund would only be $100 million. Thus, even assuming
    $100 million in payouts per year for the remaining 12 years the Fund
    will be open, the overall cost only gets to $7.6 billion. It is likely
    though that this number would be lower than $7.6 billion as it does not
    account for a further annual drop in payouts over the remaining 12
    years.
        \21\See, e.g., Feinberg testimony at 8-10.
    ---------------------------------------------------------------------------
        In other words, the $8.4 billion cap has little real
    effect. Had the proponents of H.R. 847 really wanted to put
    safeguards in the legislation to protect taxpayer money, they
    would have eliminated or capped the amount of highly subjective
    non-economic damages that could be awarded; limited the
    duration of the fund; and put in place some concrete rules on
    medical causation. Simply put, the $8.4 billion cap will do
    little, if anything, to protect taxpayers. While the victims
    and the parties that are being sued in federal court are worthy
    of protection, so too are taxpayers.
    E. LA new Fund may reduce Congress' ability to provide funding for
            future disasters or terrorist attacks.
        As the nonpartisan Rand Institute for Civil Justice pointed
    out in 2004, in its report on the original VCF,
    ``precommitments by government programs . . . reduce the
    ability of government, and society more generally, to allocate
    resources to meet the most pressing needs after an
    attack.''\22\ And the Government Accountability Office, in
    2005, also cautioned, in a study of four federal compensation
    programs, that ``the federal role in all four programs has
    expanded significantly over time . . . As might be expected, as
    the federal role for those four programs has grown, so have
    their costs . . . [B]ecause these programs may expand
    significantly beyond the initial cost estimates, policymakers
    must carefully consider the cost and precedent-setting
    implications of establishing any new federal compensation
    programs, particularly in light of the current federal
    deficit.''\23\
    ---------------------------------------------------------------------------
        \22\Lloyd Dixon and Rachel Kaganoff Stern, ``Compensation for
    Losses from the 9/11 Attacks'' (The Rand Institute for Civil Justice:
    2004) at 143.
        \23\Government Accountability Office, ``Federal Compensation
    Programs: Perspectives on Four Programs (November 2005) at 4-5
    (analyzing the Black Lung Program, the Vaccine Injury Compensation
    Program, the Radiation Exposure Compensation Program, and the Energy
    Employees Occupational Illness Compensation Program).
    ---------------------------------------------------------------------------
    F. LH.R. 847 allows attorneys to collect taxpayer funded fees for work
            not directly related to recovery from the Victim Compensation
            Fund.
        Because the 9/11 Fund is a no-fault, administrative scheme
    that does not involve the kind of risks and expense that would
    justify significant contingency fees, attorneys' fees should be
    limited. The entire purpose of the compensation fund is to
    provide victims with compensation without requiring them to
    prove complex legal concepts such as negligence, products
    liability, or other tort theories. Indeed, when Congress was
    considering the original VCF, the Association of Trial Lawyers
    of America sent a letter to Congress stating that ``ATLA
    believes that 100% of the compensation from the fund should go
    directly to these families.''\24\
    ---------------------------------------------------------------------------
        \24\Letter from Leo V. Boyle, President, Association of Trial
    Lawyers of America, to Congressional Leaders reprinted in 147 Cong.
    Rec. H5914 (daily ed. Sept. 21, 2001) (statement of Rep. Delahunt); 147
    Cong. Rec. S9599 (daily ed. Sept. 21, 2001) (statement of Mr. Reid).
    ---------------------------------------------------------------------------
        Through the manager's amendment, the bill will include a
    cap on attorneys' fees; however, the cap is poorly crafted if
    it is truly intended to maximize victims' recoveries by
    limiting attorneys to reasonable fees. What is more, the fee
    cap has an exception that will swallow the rule by allowing
    attorneys to receive fees for work that is not directly related
    to a victim's recovery under the VCF. A true fee cap would have
    given the Special Master the discretion to award less than 10
    percent attorneys' fees depending on the facts of the claim and
    the amount of work the attorney truly put in on that particular
    claim. Indeed, under the first 9/11 Fund, the Special Master
    had a non-binding guideline of 5 percent attorneys' fees and
    many attorneys worked pro bono. It is truly ironic that not
    giving the Special Master the discretion to award less than 10
    percent attorneys' fees is the one area that H.R. 847 puts
    limits on the Special Master's discretion. Surely, taxpayers
    who are providing the money for the new Fund would appreciate
    more meaningful limits on the Special Master's nearly unbounded
    discretion.
        Second, the attorneys' fee cap has an exception that
    provides that attorneys who have worked on civil litigation for
    a claimant prior to January 1, 2009, arising out of the cleanup
    efforts at the Ground Zero, will not be bound by the manager's
    amendment's 10 percent attorneys' fee cap. Essentially, this
    means that some attorneys will be compensated for work that is
    not directly related to filing a claim under the new 9/11 Fund.
    In other words, attorneys will be, for instance, compensated
    with taxpayer dollars for having filed motions in federal
    district court that are wholly unrelated to the no-fault,
    administrative compensation being provided for under the Fund.
    Why should taxpayers be paying attorneys for work that is not
    directly related to a claim under the Fund? The vast majority
    of the money from the Fund should go to the victims, not to
    attorneys that they may have hired. When these attorneys took
    on the civil litigation the manager's amendment intends to
    compensate them for, they did so at the risk (as is the case
    with all contingent fee litigation) that they would receive
    nothing for their work. Why now should Congress offset that
    risk?
        Simply put, the attorneys' fee cap in the manager's
    amendment to H.R. 847 is really not much of a cap at all.
    Attorneys representing World Trade Center cleanup-related
    victims should remember the sentiments of the ATLA right after
    the attacks and not seek fees, or anything more than minimal
    fees, for their representations of victims before the 9/11
    Fund. And Congress should not step in with this so-called
    attorneys' fees cap and invite attorneys to take money from the
    victims for work they did in civil litigation.
    G. LOther disaster victims do not receive this type of federal
            compensation.
        There is also the question of why Congress should reopen
    the 9/11 Fund, providing billions in additional federal
    compensation to the physical injury victims of the 9/11
    attacks, while no such fund exists for the victims of the
    Oklahoma City bombing, the victims of the U.S. embassy
    bombings, the victims of the first World Trade Center Attack in
    1993, or the victims of the unprecedented disaster associated
    with Hurricane Katrina. If this entitlement is approved, how
    does Congress say ``no'' to the victims of future tragedies,
    whether as a result of natural disasters or terrorist attacks?
    Congress must stop and think of the precedent this bill sets
    for future disasters. As former Special Master Feinberg has
    written,

            Why should Congress, which has already enacted
            legislation authorizing over $7 billion in public
            compensation to the families of those who died on
            September 11, or who were physically injured as a
            result of the attacks, now authorize additional
            millions or even billions in compensation for the
            remaining September 11 victims, while failing to do
            anything similar to the other victims of life's
            misfortunes? It is a fundamental question posed to our
            elected officials in a free democratic society. Why
            some victims but not others? On what basis should such
            distinctions be made? Are some victims more ``worthy''
            than others?\25\
    ---------------------------------------------------------------------------
        \25\Feinberg testimony at 7.

        Moreover, it is not just that the VCF compensates the
    victims of one set of terrorist attacks but not victims of
    other terrorist attacks on American and foreign soil. It is
    also that the VCF ``compensates the 9/11 victims while most
    other innocent victims of crime, intentional wrongdoing, or
    negligence must suffer without remedy unless they are `lucky'
    enough to have been injured by someone who can be held liable
    under the tort system's peculiar, often arbitrary rules and who
    is also sufficiently insured or secure financially to pay the
    judgment.''\26\
    ---------------------------------------------------------------------------
        \26\Peter Schuck, Special Dispensation, Am. Lawyer, June 2004.
    ---------------------------------------------------------------------------
    H. LH.R. 847 contains a partially self-defeating provision that allows
            for the reinstatement of lawsuits if a claimant is ineligible
            under the VCF.
        Section 202, paragraph 3 of H.R. 847 provides that if a
    claimant is determined to be ineligible for the compensation
    fund, he may reinstitute his lawsuit. One of the arguments,
    however, for reenacting the Fund is to bring a close to
    litigation against the City and its contractors. If ineligible
    claimants can reinstitute their lawsuits, this legislation is
    providing an avenue for lawsuits to move forward even after the
    Special Master has determined that they do not have an eligible
    claim. Moreover, the bill's limitation of liability provisions
    may not serve to discourage litigation. Those that seek
    compensation in the fund but are denied compensation not only
    will be able to reinstitute their tort cases in federal court;
    the liability caps actually may serve to create an
    approximately $2 billion incentive to sue in federal court
    rather than go through the fund. In other words, creation of
    the Fund may not have the anticipated impact on ending the
    litigation.

                             REPUBLICAN AMENDMENTS

        Republican Members offered two amendments to Title II of
    H.R. 847 at the Committee markup. Neither of the Republican
    amendments was adopted:

             LSmith Amendment. Ranking Member Smith offered
            an amendment, based on the recommendation of former
            Special Master Feinberg, to limit reopening of the fund
            to 5 years on the Fund's original terms. As Special
            Master Feinberg wrote in his written testimony at a
            Judiciary Committee hearing on reenacting the 9/11
            Fund, ``any attempt to reenact and extend the 9/11 Fund
            should be initiated with the understanding that there
            would be no changes in the rules and regulations
            governing the original Fund, that the new law would
            simply be a `one line' extension of reaffirmation of
            the law which established the original 9/11 Fund.''\27\
            According to Special Master Feinberg, ``Congress could
            simply reopen the 9/11 Fund to encompass all such
            claims during a `window' of 5 years during which time
            all September 11 related respiratory injuries could be
            evaluated and processed.''\28\ Ranking Member Smith's
            amendment would have accomplished Special Master
            Feinberg's recommendation of a ``one-line,'' 5-year
            extension of the original 9/11 Fund. This amendment
            would have, in a very simple manner, addressed many of
            the concerns expressed above with regards to the new
            Fund that will be created by H.R. 847. Unfortunately,
            Ranking Member Smith's amendment was not adopted.
    ---------------------------------------------------------------------------
        \27\Feinberg testimony at 6.
        \28\Feinberg testimony at 5.

             LKing Amendment. Mr. King offered an amendment
            to remove the exception in the attorneys' fee cap for
            attorneys who had filed a lawsuit on behalf of a victim
            in federal court prior to January 1, 2009. This
            exception swallows the rule. Had Mr. King's amendment
            been adopted it would have ensured that more of the
            compensation under the Fund would have gone to the
            victims and not to any attorneys they may have hired.
            Given that the VCF is a no-fault, administrative
            scheme, there is no justification for high attorneys'
            fees. Nor is there any reason to provide attorneys with
            compensation under the VCF for work they performed for
            litigation in federal court--the VCF is wholly a
            separate system from that litigation. When attorneys
            took on that representation in that litigation they did
            so at the risk that they would receive no compensation
            at all if the plaintiff lost--such is the nature of a
            contingency fee. Mr. King's amendment was not adopted.

                                   CONCLUSION

        Consideration of creating the new Victim Compensation Fund
    contained in Title II of H.R. 847 raises two questions. First,
    why should Congress reenact and expand the 9/11 Fund, providing
    millions in additional public compensation to the physical
    injury victims of the September 11 attacks, while no such Fund
    exists at all for the victims of the Oklahoma City bombing, the
    victims of the African Embassy bombing, the victims of the
    first World Trade Center attack in 1993 or, for that matter,
    the victims of the unprecedented disaster associated with
    Hurricane Katrina? Underlying this question is the issue of
    whether the federal government, i.e., the taxpayers of the
    United States, are to become in perpetuity the guarantors of
    last resort for all the tragedies that beset people over their
    lives. Members will have to make their own philosophical
    decision as to this first question.
        The second question is whether the 9/11 Fund that will be
    created by H.R. 847 is written in such a manner that it will
    safeguard valuable taxpayer dollars while appropriately
    compensating only the actual victims of the aftermath of the 9/
    11 attacks. The answer to the second question is much more
    clear--the Fund that will be created by H.R. 847 is open for
    much longer than is necessary (at least 21 years); gives far
    too much discretion to the Special Master considering the long-
    term nature of the Fund, which will have a larger set of
    claimants with claims of much more ambiguous causation than
    under the original Fund; and the size and unstructured nature
    of the Fund will make it highly susceptible to waste, fraud,
    and abuse. Simply put, the structure of the original 9/11 Fund
    will not work for the Fund that will be created by H.R. 847.
        There may be a deserving class of claimants who are
    suffering respiratory and other physical ailments as a result
    of their work at Ground Zero. And it may be that the original
    9/11 Fund should be reopened for a limited period of time in
    order to compensate those individuals. But the Fund created in
    H.R. 847 is not the original 9/11 Fund, nor is it being re-
    opened for a brief window. We are unable to support enactment
    of this legislation.

                                       Lamar Smith.
                                       F. James Sensenbrenner, Jr.
                                       Bob Goodlatte.
                                       Gregg Harper.