[House Report 111-560]
[From the U.S. Government Publishing Office]
111th Congress Rept. 111-560
HOUSE OF REPRESENTATIVES
2d Session Part 1
======================================================================
JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010
_______
July 22, 2010.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Waxman, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
together with
DISSENTING VIEWS
[To accompany H.R. 847]
[Including cost estimate of the Congressional Budget Office]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 847) to amend the Public Health Service Act to
extend and improve protections and services to individuals
directly impacted by the terrorist attack in New York City on
September 11, 2001, and for other purposes, having considered
the same, report favorably thereon with an amendment and
recommend that the bill as amended do pass.
CONTENTS
Page
Amendment........................................................ 2
Purpose and Summary.............................................. 28
Background and Need for Legislation.............................. 28
Legislative History.............................................. 32
Committee Consideration.......................................... 32
Committee Votes.................................................. 33
Committee Oversight Findings and Recommendations................. 46
New Budget Authority, Entitlement Authority, and Tax Expenditures 46
Statement of General Performance Goals and Objectives............ 46
Constitutional Authority Statement............................... 46
Earmarks and Tax and Tariff Benefits............................. 46
Advisory Committee Statement..................................... 46
Applicability of Law to the Legislative Branch................... 46
Federal Mandates Statement....................................... 46
Committee Cost Estimate.......................................... 47
Congressional Budget Office Estimate............................. 47
Section-by-Section Analysis of the Legislation................... 61
Changes in Existing Law Made by the Bill, as Reported............ 67
Dissenting Views................................................. 103
Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``James Zadroga
9/11 Health and Compensation Act of 2010''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
TITLE I--WORLD TRADE CENTER HEALTH PROGRAM
Sec. 101. World Trade Center Health Program.
``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM
``Subtitle A--Establishment of Program; Advisory Committee
``Sec. 3301. Establishment of World Trade Center Health
Program.
``Sec. 3302. WTC Health Program Scientific/Technical Advisory
Committee; WTC Health Program Steering
Committees.
``Sec. 3303. Education and outreach.
``Sec. 3304. Uniform data collection and analysis.
``Sec. 3305. Clinical Centers of Excellence and Data Centers.
``Sec. 3306. Definitions.
``Subtitle B--Program of Monitoring, Initial Health Evaluations, and
Treatment
``Part 1--WTC Responders
``Sec. 3311. Identification of WTC responders and provision of
WTC-related monitoring services.
``Sec. 3312. Treatment of enrolled WTC responders for WTC-
related health conditions.
``Sec. 3313. National arrangement for benefits for eligible
individuals outside New York.
``Part 2--WTC Survivors
``Sec. 3321. Identification and initial health evaluation of
screening-eligible and certified-eligible WTC
survivors.
``Sec. 3322. Followup monitoring and treatment of certified-
eligible WTC survivors for WTC-related health
conditions.
``Sec. 3323. Followup monitoring and treatment of other
individuals with WTC-related health conditions.
``Part 3--Payor Provisions
``Sec. 3331. Payment of claims.
``Sec. 3332. Administrative arrangement authority.
``Subtitle C--Research Into Conditions
``Sec. 3341. Research regarding certain health conditions
related to September 11 terrorist attacks in
New York City.
``Sec. 3342. World Trade Center Health Registry.
``Subtitle D--Funding
``Sec. 3351. World Trade Center Health Program Fund.
TITLE II--SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001
Sec. 201. Definitions.
Sec. 202. Extended and expanded eligibility for compensation.
Sec. 203. Requirement to update regulations.
Sec. 204. Limited liability for certain claims.
TITLE I--WORLD TRADE CENTER HEALTH PROGRAM
SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM.
The Public Health Service Act is amended by adding at the end the
following new title:
``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM
``Subtitle A--Establishment of Program; Advisory Committee
``SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM.
``(a) In General.--There is hereby established within the Department
of Health and Human Services a program to be known as the World Trade
Center Health Program, which shall be administered by the WTC Program
Administrator, to provide beginning on July 1, 2011--
``(1) medical monitoring and treatment benefits to eligible
emergency responders and recovery and cleanup workers
(including those who are Federal employees) who responded to
the September 11, 2001, terrorist attacks; and
``(2) initial health evaluation, monitoring, and treatment
benefits to residents and other building occupants and area
workers in New York City who were directly impacted and
adversely affected by such attacks.
``(b) Components of Program.--The WTC Program includes the following
components:
``(1) Medical monitoring for responders.--Medical monitoring
under section 3311, including clinical examinations and long-
term health monitoring and analysis for enrolled WTC responders
who were likely to have been exposed to airborne toxins that
were released, or to other hazards, as a result of the
September 11, 2001, terrorist attacks.
``(2) Initial health evaluation for survivors.--An initial
health evaluation under section 3321, including an evaluation
to determine eligibility for followup monitoring and treatment.
``(3) Followup monitoring and treatment for wtc-related
health conditions for responders and survivors.--Provision
under sections 3312, 3322, and 3323 of followup monitoring and
treatment and payment, subject to the provisions of subsection
(d), for all medically necessary health and mental health care
expenses of an individual with respect to a WTC-related health
condition (including necessary prescription drugs).
``(4) Outreach.--Establishment under section 3303 of an
education and outreach program to potentially eligible
individuals concerning the benefits under this title.
``(5) Clinical data collection and analysis.--Collection and
analysis under section 3304 of health and mental health data
relating to individuals receiving monitoring or treatment
benefits in a uniform manner in collaboration with the
collection of epidemiological data under section 3342.
``(6) Research on health conditions.--Establishment under
subtitle C of a research program on health conditions resulting
from the September 11, 2001, terrorist attacks.
``(c) No Cost Sharing.--Monitoring and treatment benefits and initial
health evaluation benefits are provided under subtitle B without any
deductibles, copayments, or other cost sharing to an enrolled WTC
responder or certified-eligible WTC survivor. Initial health evaluation
benefits are provided under subtitle B without any deductibles,
copayments, or other cost sharing to a screening-eligible WTC survivor.
``(d) Preventing Fraud and Unreasonable Administrative Costs.--
``(1) Fraud.--The Inspector General of the Department of
Health and Human Services shall develop and implement a program
to review the WTC Program's health care expenditures to detect
fraudulent or duplicate billing and payment for inappropriate
services. This title is a Federal health care program (as
defined in section 1128B(f) of the Social Security Act) and is
a health plan (as defined in section 1128C(c) of such Act) for
purposes of applying sections 1128 through 1128E of such Act.
``(2) Unreasonable administrative costs.--The Inspector
General of the Department of Health and Human Services shall
develop and implement a program to review the WTC Program for
unreasonable administrative costs, including with respect to
infrastructure, administration, and claims processing.
``(e) Quality Assurance.--The WTC Program Administrator working with
the Clinical Centers of Excellence shall develop and implement a
quality assurance program for the monitoring and treatment delivered by
such Centers of Excellence and any other participating health care
providers. Such program shall include--
``(1) adherence to monitoring and treatment protocols;
``(2) appropriate diagnostic and treatment referrals for
participants;
``(3) prompt communication of test results to participants;
and
``(4) such other elements as the Administrator specifies in
consultation with the Clinical Centers of Excellence.
``(f) Annual Program Report.--
``(1) In general.--Not later than 6 months after the end of
each fiscal year in which the WTC Program is in operation, the
WTC Program Administrator shall submit an annual report to the
Congress on the operations of this title for such fiscal year
and for the entire period of operation of the program.
``(2) Contents included in report.--Each annual report under
paragraph (1) shall include at least the following:
``(A) Eligible individuals.--Information for each
clinical program described in paragraph (3)--
``(i) on the number of individuals who
applied for certification under subtitle B and
the number of such individuals who were so
certified;
``(ii) of the individuals who were certified,
on the number who received monitoring under the
program and the number of such individuals who
received medical treatment under the program;
``(iii) with respect to individuals so
certified who received such treatment, on the
WTC-related health conditions for which they
were treated; and
``(iv) on the projected number of individuals
who will be certified under subtitle B in the
succeeding fiscal year and the succeeding 10-
year period.
``(B) Monitoring, initial health evaluation, and
treatment costs.--For each clinical program so
described--
``(i) information on the costs of monitoring
and initial health evaluation and the costs of
treatment and on the estimated costs of such
monitoring, evaluation, and treatment in the
succeeding fiscal year; and
``(ii) an estimate of the cost of medical
treatment for WTC-related health conditions
that have been paid for or reimbursed by
workers' compensation, by public or private
health plans, or by New York City under section
3331.
``(C) Administrative costs.--Information on the cost
of administering the program, including costs of
program support, data collection and analysis, and
research conducted under the program.
``(D) Administrative experience.--Information on the
administrative performance of the program, including--
``(i) the performance of the program in
providing timely evaluation of and treatment to
eligible individuals; and
``(ii) a list of the Clinical Centers of
Excellence and other providers that are
participating in the program.
``(E) Scientific reports.--A summary of the findings
of any new scientific reports or studies on the health
effects associated with exposure described in section
3306(1), including the findings of research conducted
under section 3341(a).
``(F) Advisory committee recommendations.--A list of
recommendations by the WTC Scientific/Technical
Advisory Committee on additional WTC Program
eligibility criteria and on additional WTC-related
health conditions and the action of the WTC Program
Administrator concerning each such recommendation.
``(3) Separate clinical programs described.--In paragraph
(2), each of the following shall be treated as a separate
clinical program of the WTC Program:
``(A) Firefighters and related personnel.--The
benefits provided for enrolled WTC responders described
in section 3311(a)(2)(A).
``(B) Other wtc responders.--The benefits provided
for enrolled WTC responders not described in
subparagraph (A).
``(C) WTC survivors.--The benefits provided for
screening-eligible WTC survivors and certified-eligible
WTC survivors in section 3321(a).
``(g) Notification to Congress Upon Reaching 80 Percent of
Eligibility Numerical Limits.--The Secretary shall promptly notify the
Congress of each of the following:
``(1) When the number of enrollments of WTC responders
subject to the limit established under section 3311(a)(4) has
reached 80 percent of such limit.
``(2) When the number of certifications for certified-
eligible WTC survivors subject to the limit established under
section 3321(a)(3) has reached 80 percent of such limit.
``(h) Consultation.--The WTC Program Administrator shall engage in
ongoing outreach and consultation with relevant stakeholders, including
the WTC Health Program Steering Committees and the Advisory Committee
under section 3302, regarding the implementation and improvement of
programs under this title.
``SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY
COMMITTEE; WTC HEALTH PROGRAM STEERING COMMITTEES.
``(a) Advisory Committee.--
``(1) Establishment.--The WTC Program Administrator shall
establish an advisory committee to be known as the WTC Health
Program Scientific/Technical Advisory Committee (in this
subsection referred to as the `Advisory Committee') to review
scientific and medical evidence and to make recommendations to
the Administrator on additional WTC Program eligibility
criteria and on additional WTC-related health conditions.
``(2) Composition.--The WTC Program Administrator shall
appoint the members of the Advisory Committee and shall include
at least--
``(A) 4 occupational physicians, at least 2 of whom
have experience treating WTC rescue and recovery
workers;
``(B) 1 physician with expertise in pulmonary
medicine;
``(C) 2 environmental medicine or environmental
health specialists;
``(D) 2 representatives of WTC responders;
``(E) 2 representatives of certified-eligible WTC
survivors;
``(F) an industrial hygienist;
``(G) a toxicologist;
``(H) an epidemiologist; and
``(I) a mental health professional.
``(3) Meetings.--The Advisory Committee shall meet at such
frequency as may be required to carry out its duties.
``(4) Reports.--The WTC Program Administrator shall provide
for publication of recommendations of the Advisory Committee on
the public Web site established for the WTC Program.
``(5) Duration.--Notwithstanding any other provision of law,
the Advisory Committee shall continue in operation during the
period in which the WTC Program is in operation.
``(6) Application of faca.--Except as otherwise specifically
provided, the Advisory Committee shall be subject to the
Federal Advisory Committee Act.
``(b) WTC Health Program Steering Committees.--
``(1) Consultation.--The WTC Program Administrator shall
consult with 2 steering committees (each in this section
referred to as a `Steering Committee') that are established as
follows:
``(A) WTC responders steering committee.--One
Steering Committee, to be known as the WTC Responders
Steering Committee, for the purpose of receiving input
from affected stakeholders and facilitating the
coordination of monitoring and treatment programs for
the enrolled WTC responders under part 1 of subtitle B.
``(B) WTC survivors steering committee.--One Steering
Committee, to be known as the WTC Survivors Steering
Committee, for the purpose of receiving input from
affected stakeholders and facilitating the coordination
of initial health evaluations, monitoring, and
treatment programs for screening-eligible and
certified-eligible WTC survivors under part 2 of
subtitle B.
``(2) Membership.--
``(A) WTC responders steering committee.--
``(i) Representation.--The WTC Responders
Steering Committee shall include--
``(I) representatives of the Centers
of Excellence providing services to WTC
responders;
``(II) representatives of labor
organizations representing
firefighters, police, other New York
City employees, and recovery and
cleanup workers who responded to the
September 11, 2001, terrorist attacks;
and
``(III) 3 representatives of New York
City, 1 of whom will be selected by the
police commissioner of New York City, 1
by the health commissioner of New York
City, and 1 by the mayor of New York
City.
``(ii) Initial membership.--The WTC
Responders Steering Committee shall initially
be composed of members of the WTC Monitoring
and Treatment Program Steering Committee (as in
existence on the day before the date of the
enactment of this title).
``(B) WTC survivors steering committee.--
``(i) Representation.--The WTC Survivors
Steering Committee shall include
representatives of--
``(I) the Centers of Excellence
providing services to screening-
eligible and certified-eligible WTC
survivors;
``(II) the population of residents,
students, and area and other workers
affected by the September 11, 2001,
terrorist attacks;
``(III) screening-eligible and
certified-eligible survivors receiving
initial health evaluations, monitoring,
or treatment under part 2 of subtitle B
and organizations advocating on their
behalf; and
``(IV) New York City.
``(ii) Initial membership.--The WTC Survivors
Steering Committee shall initially be composed
of members of the WTC Environmental Health
Center Survivor Advisory Committee (as in
existence on the day before the date of the
enactment of this title).
``(C) Additional appointments.--Each Steering
Committee may recommend, if approved by a majority of
voting members of the Committee, additional members to
the Committee.
``(D) Vacancies.--A vacancy in a Steering Committee
shall be filled by an individual recommended by the
Steering Committee.
``SEC. 3303. EDUCATION AND OUTREACH.
``The WTC Program Administrator shall institute a program that
provides education and outreach on the existence and availability of
services under the WTC Program. The outreach and education program--
``(1) shall include--
``(A) the establishment of a public Web site with
information about the WTC Program;
``(B) meetings with potentially eligible populations;
``(C) development and dissemination of outreach
materials informing people about the program; and
``(D) the establishment of phone information
services; and
``(2) shall be conducted in a manner intended--
``(A) to reach all affected populations; and
``(B) to include materials for culturally and
linguistically diverse populations.
``SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS.
``(a) In General.--The WTC Program Administrator shall provide for
the uniform collection of data (and analysis of data and regular
reports to the Administrator) on the prevalence of WTC-related health
conditions and the identification of new WTC-related health conditions.
Such data shall be collected for all individuals provided monitoring or
treatment benefits under subtitle B and regardless of their place of
residence or Clinical Center of Excellence through which the benefits
are provided. The WTC Program Administrator shall provide, through the
Data Centers or otherwise, for the integration of such data into the
monitoring and treatment program activities under this title.
``(b) Coordinating Through Centers of Excellence.--Each Clinical
Center of Excellence shall collect data described in subsection (a) and
report such data to the corresponding Data Center for analysis by such
Data Center.
``(c) Collaboration With WTC Health Registry.--The WTC Program
Administrator shall provide for collaboration between the Data Centers
and the World Trade Center Health Registry described in section 3342.
``(d) Privacy.--The data collection and analysis under this section
shall be conducted and maintained in a manner that protects the
confidentiality of individually identifiable health information
consistent with applicable statutes and regulations, including, as
applicable, HIPAA privacy and security law (as defined in section
3009(a)(2)) and section 552a of title 5, United States Code.
``SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA CENTERS.
``(a) In General.--
``(1) Contracts with clinical centers of excellence.--The WTC
Program Administrator shall, subject to subsection (b)(1)(B),
enter into contracts with Clinical Centers of Excellence (as
defined in subsection (b)(1)(A))--
``(A) for the provision of monitoring and treatment
benefits and initial health evaluation benefits under
subtitle B;
``(B) for the provision of outreach activities to
individuals eligible for such monitoring and treatment
benefits, for initial health evaluation benefits, and
for followup to individuals who are enrolled in the
monitoring program;
``(C) for the provision of counseling for benefits
under subtitle B, with respect to WTC-related health
conditions, for individuals eligible for such benefits;
``(D) for the provision of counseling for benefits
for WTC-related health conditions that may be available
under workers' compensation or other benefit programs
for work-related injuries or illnesses, health
insurance, disability insurance, or other insurance
plans or through public or private social service
agencies and assisting eligible individuals in applying
for such benefits;
``(E) for the provision of translational and
interpretive services for program participants who are
not English language proficient; and
``(F) for the collection and reporting of data in
accordance with section 3304.
``(2) Contracts with data centers.--
``(A) In general.--The WTC Program Administrator
shall enter into contracts with Data Centers (as
defined in subsection (b)(2))--
``(i) for receiving, analyzing, and reporting
to the WTC Program Administrator on data, in
accordance with section 3304, that have been
collected and reported to such Data Centers by
the corresponding Clinical Centers of
Excellence under subsection (b)(1)(B)(iii);
``(ii) for the development of monitoring,
initial health evaluation, and treatment
protocols, with respect to WTC-related health
conditions;
``(iii) for coordinating the outreach
activities conducted under paragraph (1)(B) by
each corresponding Clinical Center of
Excellence;
``(iv) for establishing criteria for the
credentialing of medical providers
participating in the nationwide network under
section 3313;
``(v) for coordinating and administering the
activities of the WTC Health Program Steering
Committees established under section 3002(b);
and
``(vi) for meeting periodically with the
corresponding Clinical Centers of Excellence to
obtain input on the analysis and reporting of
data collected under clause (i) and on the
development of monitoring, initial health
evaluation, and treatment protocols under
clause (ii).
``(B) Medical provider selection.--The medical
providers under subparagraph (A)(iv) shall be selected
by the WTC Program Administrator on the basis of their
experience treating or diagnosing the health conditions
included in the list of WTC-related health conditions.
``(C) Clinical discussions.--In carrying out
subparagraph (A)(ii), a Data Center shall engage in
clinical discussions across the WTC Program to guide
treatment approaches for individuals with a WTC-related
health condition.
``(D) Transparency of data.--A contract entered into
under this subsection with a Data Center shall require
the Data Center to make any data collected and reported
to such Center under subsection (b)(1)(B)(iii)
available to health researchers and others as provided
in the CDC/ATSDR Policy on Releasing and Sharing Data.
``(3) Authority for contracts to be class specific.--A
contract entered into under this subsection with a Clinical
Center of Excellence or a Data Center may be with respect to
one or more class of enrolled WTC responders, screening-
eligible WTC survivors, or certified-eligible WTC survivors.
``(4) Use of cooperative agreements.--Any contract under this
title between the WTC Program Administrator and a Data Center
or a Clinical Center of Excellence may be in the form of a
cooperative agreement.
``(b) Centers of Excellence.--
``(1) Clinical centers of excellence.--
``(A) Definition.--For purposes of this title, the
term `Clinical Center of Excellence' means a Center
that demonstrates to the satisfaction of the
Administrator that the Center--
``(i) uses an integrated, centralized health
care provider approach to create a
comprehensive suite of health services under
this title that are accessible to enrolled WTC
responders, screening-eligible WTC survivors,
or certified-eligible WTC survivors;
``(ii) has experience in caring for WTC
responders and screening-eligible WTC survivors
or includes health care providers who have been
trained pursuant to section 3313(c);
``(iii) employs health care provider staff
with expertise that includes, at a minimum,
occupational medicine, environmental medicine,
trauma-related psychiatry and psychology, and
social services counseling; and
``(iv) meets such other requirements as
specified by the Administrator.
``(B) Contract requirements.--The WTC Program
Administrator shall not enter into a contract with a
Clinical Center of Excellence under subsection (a)(1)
unless the Center agrees to do each of the following:
``(i) Establish a formal mechanism for
consulting with and receiving input from
representatives of eligible populations
receiving monitoring and treatment benefits
under subtitle B from such Center.
``(ii) Coordinate monitoring and treatment
benefits under subtitle B with routine medical
care provided for the treatment of conditions
other than WTC-related health conditions.
``(iii) Collect and report to the
corresponding Data Center data in accordance
with section 3304(b).
``(iv) Have in place safeguards against fraud
that are satisfactory to the Administrator, in
consultation with the Inspector General of the
Department of Health and Human Services.
``(v) Treat or refer for treatment all
individuals who are enrolled WTC responders or
certified-eligible WTC survivors with respect
to such Center who present themselves for
treatment of a WTC-related health condition.
``(vi) Have in place safeguards, consistent
with section 3304(c), to ensure the
confidentiality of an individual's individually
identifiable health information, including
requiring that such information not be
disclosed to the individual's employer without
the authorization of the individual.
``(vii) Use amounts paid under subsection
(c)(1) only for costs incurred in carrying out
the activities described in subsection (a),
other than those described in subsection
(a)(1)(A).
``(viii) Utilize health care providers with
occupational and environmental medicine
expertise to conduct physical and mental health
assessments, in accordance with protocols
developed under subsection (a)(2)(A)(ii).
``(ix) Communicate with WTC responders and
screening-eligible and certified-eligible WTC
survivors in appropriate languages and conduct
outreach activities with relevant stakeholder
worker or community associations.
``(x) Meet all the other applicable
requirements of this title, including
regulations implementing such requirements.
``(C) Transition rule to ensure continuity of care.--
The WTC Program Administrator shall to the maximum
extent feasible ensure continuity of care in any period
of transition from monitoring and treatment of an
enrolled WTC responder or certified-eligible WTC
survivor by a provider to a Clinical Center of
Excellence or a health care provider participating in
the nationwide network under section 3313.
``(2) Data centers.--For purposes of this title, the term
`Data Center' means a Center that the WTC Program Administrator
determines has the capacity to carry out the responsibilities
for a Data Center under subsection (a)(2).
``(3) Corresponding centers.--For purposes of this title, a
Clinical Center of Excellence and a Data Center shall be
treated as `corresponding' to the extent that such Clinical
Center and Data Center serve the same population group.
``(c) Payment for Infrastructure Costs.--
``(1) In general.--The WTC Program Administrator shall
reimburse a Clinical Center of Excellence for the fixed
infrastructure costs of such Center in carrying out the
activities described in subtitle B at a rate negotiated by the
Administrator and such Centers. Such negotiated rate shall be
fair and appropriate and take into account the number of
enrolled WTC responders receiving services from such Center
under this title.
``(2) Fixed infrastructure costs.--For purposes of paragraph
(1), the term `fixed infrastructure costs' means, with respect
to a Clinical Center of Excellence, the costs incurred by such
Center that are not reimbursable by the WTC Program
Administrator under section 3312(c).
``SEC. 3306. DEFINITIONS.
``In this title:
``(1) The term `aggravating' means, with respect to a health
condition, a health condition that existed on September 11,
2001, and that, as a result of exposure to airborne toxins, any
other hazard, or any other adverse condition resulting from the
September 11, 2001, terrorist attacks, requires medical
treatment that is (or will be) in addition to, more frequent
than, or of longer duration than the medical treatment that
would have been required for such condition in the absence of
such exposure.
``(2) The term `certified-eligible WTC survivor' has the
meaning given such term in section 3321(a)(2).
``(3) The terms `Clinical Center of Excellence' and `Data
Center' have the meanings given such terms in section 3305.
``(4) The term `enrolled WTC responder' means a WTC responder
enrolled under section 3311(a)(3).
``(5) The term `initial health evaluation' includes, with
respect to an individual, a medical and exposure history, a
physical examination, and additional medical testing as needed
to evaluate whether the individual has a WTC-related health
condition and is eligible for treatment under the WTC Program.
``(6) The term `list of WTC-related health conditions'
means--
``(A) for WTC responders, the health conditions
listed in section 3312(a)(3); and
``(B) for screening-eligible and certified-eligible
WTC survivors, the health conditions listed in section
3322(b).
``(7) The term `New York City disaster area' means the area
within New York City that is--
``(A) the area of Manhattan that is south of Houston
Street; and
``(B) any block in Brooklyn that is wholly or
partially contained within a 1.5-mile radius of the
former World Trade Center site.
``(8) The term `New York metropolitan area' means an area,
specified by the WTC Program Administrator, within which WTC
responders and eligible WTC screening-eligible survivors who
reside in such area are reasonably able to access monitoring
and treatment benefits and initial health evaluation benefits
under this title through a Clinical Center of Excellence
described in subparagraphs (A), (B), or (C) of section
3305(b)(1).
``(9) The term `screening-eligible WTC survivor' has the
meaning given such term in section 3321(a)(1).
``(10) Any reference to `September 11, 2001' shall be deemed
a reference to the period on such date subsequent to the
terrorist attacks at the World Trade Center, Shanksville,
Pennsylvania, or the Pentagon, as applicable, on such date.
``(11) The term `September 11, 2001, terrorist attacks' means
the terrorist attacks that occurred on September 11, 2001, in
New York City, in Shanksville, Pennsylvania, and at the
Pentagon, and includes the aftermath of such attacks.
``(12) The term `WTC Health Program Steering Committee' means
such a Steering Committee established under section 3302(b).
``(13) The term `WTC Program' means the Word Trade Center
Health Program established under section 3301(a).
``(14) The term `WTC Program Administrator' means--
``(A) with respect to paragraphs (3) and (4) of
section 3311(a) (relating to enrollment of WTC
responders), section 3312(c) and the corresponding
provisions of section 3322 (relating to payment for
initial health evaluation, monitoring, and treatment),
paragraphs (1)(C), (2)(B), and (3) of section 3321(a)
(relating to determination or certification of
screening-eligible or certified-eligible WTC
responders), and part 3 of subtitle B (relating to
payor provisions), an official in the Department of
Health and Human Services, to be designated by the
Secretary; and
``(B) with respect to any other provision of this
title, the Director of the National Institute for
Occupational Safety and Health, or a designee of such
Director.
``(15) The term `WTC-related health condition' is defined in
section 3312(a).
``(16) The term `WTC responder' is defined in section
3311(a).
``(17) The term `WTC Scientific/Technical Advisory Committee'
means such Committee established under section 3302(a).
``Subtitle B--Program of Monitoring, Initial Health Evaluations, and
Treatment
``PART 1--WTC RESPONDERS
``SEC. 3311. IDENTIFICATION OF WTC RESPONDERS AND PROVISION OF WTC-
RELATED MONITORING SERVICES.
``(a) WTC Responder Defined.--
``(1) In general.--For purposes of this title, the term `WTC
responder' means any of the following individuals, subject to
paragraph (4):
``(A) Currently identified responder.--An individual
who has been identified as eligible for monitoring
under the arrangements as in effect on the date of the
enactment of this title between the National Institute
for Occupational Safety and Health and--
``(i) the consortium coordinated by Mt. Sinai
Hospital in New York City that coordinates the
monitoring and treatment for enrolled WTC
responders other than with respect to those
covered under the arrangement with the Fire
Department of New York City; or
``(ii) the Fire Department of New York City.
``(B) Responder who meets current eligibility
criteria.--An individual who meets the current
eligibility criteria described in paragraph (2).
``(C) Responder who meets modified eligibility
criteria.--An individual who--
``(i) performed rescue, recovery, demolition,
debris cleanup, or other related services in
the New York City disaster area in response to
the September 11, 2001, terrorist attacks,
regardless of whether such services were
performed by a State or Federal employee or
member of the National Guard or otherwise; and
``(ii) meets such eligibility criteria
relating to exposure to airborne toxins, other
hazards, or adverse conditions resulting from
the September 11, 2001, terrorist attacks as
the WTC Program Administrator, after
consultation with the WTC Scientific/Technical
Advisory Committee, determines appropriate.
The WTC Program Administrator shall not modify such
eligibility criteria on or after the date that the
number of enrollments of WTC responders has reached 80
percent of the limit described in paragraph (4) or on
or after the date that the number of certifications for
certified-eligible WTC survivors under section
3321(a)(2)(B) has reached 80 percent of the limit
described in section 3321(a)(3).
``(2) Current eligibility criteria.--The eligibility criteria
described in this paragraph for an individual is that the
individual is described in any of the following categories:
``(A) Firefighters and related personnel.--The
individual--
``(i) was a member of the Fire Department of
New York City (whether fire or emergency
personnel, active or retired) who participated
at least one day in the rescue and recovery
effort at any of the former World Trade Center
sites (including Ground Zero, Staten Island
Landfill, and the New York City Chief Medical
Examiner's Office) for any time during the
period beginning on September 11, 2001, and
ending on July 31, 2002; or
``(ii)(I) is a surviving immediate family
member of an individual who was a member of the
Fire Department of New York City (whether fire
or emergency personnel, active or retired) and
was killed at the World Trade site on September
11, 2001; and
``(II) received any treatment for a WTC-
related health condition described in section
3312(a)(1)(A)(ii) (relating to mental health
conditions) on or before September 1, 2008.
``(B) Law enforcement officers and wtc rescue,
recovery, and cleanup workers.--The individual--
``(i) worked or volunteered onsite in rescue,
recovery, debris cleanup, or related support
services in lower Manhattan (south of Canal
St.), the Staten Island Landfill, or the barge
loading piers, for at least 4 hours during the
period beginning on September 11, 2001, and
ending on September 14, 2001, for at least 24
hours during the period beginning on September
11, 2001, and ending on September 30, 2001, or
for at least 80 hours during the period
beginning on September 11, 2001, and ending on
July 31, 2002;
``(ii)(I) was a member of the Police
Department of New York City (whether active or
retired) or a member of the Port Authority
Police of the Port Authority of New York and
New Jersey (whether active or retired) who
participated onsite in rescue, recovery, debris
cleanup, or related services in lower Manhattan
(south of Canal St.), including Ground Zero,
the Staten Island Landfill, or the barge
loading piers, for at least 4 hours during the
period beginning September 11, 2001, and ending
on September 14, 2001;
``(II) participated onsite in rescue,
recovery, debris cleanup, or related services
in at Ground Zero, the Staten Island Landfill,
or the barge loading piers, for at least one
day during the period beginning on September
11, 2001, and ending on July 31, 2002;
``(III) participated onsite in rescue,
recovery, debris cleanup, or related services
in lower Manhattan (south of Canal St.) for at
least 24 hours during the period beginning on
September 11, 2001, and ending on September 30,
2001; or
``(IV) participated onsite in rescue,
recovery, debris cleanup, or related services
in lower Manhattan (south of Canal St.) for at
least 80 hours during the period beginning on
September 11, 2001, and ending on July 31,
2002;
``(iii) was an employee of the Office of the
Chief Medical Examiner of New York City
involved in the examination and handling of
human remains from the World Trade Center
attacks, or other morgue worker who performed
similar post-September 11 functions for such
Office staff, during the period beginning on
September 11, 2001, and ending on July 31,
2002;
``(iv) was a worker in the Port Authority
Trans-Hudson Corporation Tunnel for at least 24
hours during the period beginning on February
1, 2002, and ending on July 1, 2002; or
``(v) was a vehicle-maintenance worker who
was exposed to debris from the former World
Trade Center while retrieving, driving,
cleaning, repairing, and maintaining vehicles
contaminated by airborne toxins from the
September 11, 2001, terrorist attacks during a
duration and period described in subparagraph
(A).
``(C) Responders to the september 11 attacks at the
pentagon and shanksville, pennsylvania.--The
individual--
``(i)(I) was a member of a fire or police
department (whether fire or emergency
personnel, active or retired), worked for a
recovery or cleanup contractor, or was a
volunteer; and performed rescue, recovery,
demolition, debris cleanup, or other related
services at the Pentagon site of the terrorist-
related aircraft crash of September 11, 2001,
during the period beginning on September 11,
2001, and ending on the date on which the
cleanup of the site was concluded, as
determined by the WTC Program Administrator; or
``(II) was a member of a fire or police
department (whether fire or emergency
personnel, active or retired), worked for a
recovery or cleanup contractor, or was a
volunteer; and performed rescue, recovery,
demolition, debris cleanup, or other related
services at the Shanksville, Pennsylvania, site
of the terrorist-related aircraft crash of
September 11, 2001, during the period beginning
on September 11, 2001, and ending on the date
on which the cleanup of the site was concluded,
as determined by the WTC Program Administrator;
and
``(ii) is determined by the WTC Program
Administrator to be at an increased risk of
developing a WTC-related health condition as a
result of exposure to airborne toxins, other
hazards, or adverse conditions resulting from
the September 11, 2001, terrorist attacks, and
meets such eligibility criteria related to such
exposures, as the WTC Program Administrator
determines are appropriate, after consultation
with the WTC Scientific/Technical Advisory
Committee.
``(3) Enrollment process.--
``(A) In general.--The WTC Program Administrator
shall establish a process for enrolling WTC responders
in the WTC Program. Under such process--
``(i) WTC responders described in paragraph
(1)(A) shall be deemed to be enrolled in such
Program;
``(ii) subject to clause (iii), the
Administrator shall enroll in such program
individuals who are determined to be WTC
responders;
``(iii) the Administrator shall deny such
enrollment to an individual if the
Administrator determines that the numerical
limitation in paragraph (4) on enrollment of
WTC responders has been met;
``(iv) there shall be no fee charged to the
applicant for making an application for such
enrollment;
``(v) the Administrator shall make a
determination on such an application not later
than 60 days after the date of filing the
application; and
``(vi) an individual who is denied enrollment
in such Program shall have an opportunity to
appeal such determination in a manner
established under such process.
``(B) Timing.--
``(i) Currently identified responders.--In
accordance with subparagraph (A)(i), the WTC
Program Administrator shall enroll an
individual described in paragraph (1)(A) in the
WTC Program not later than July 1, 2011.
``(ii) Other responders.--In accordance with
subparagraph (A)(ii) and consistent with
paragraph (4), the WTC Program Administrator
shall enroll any other individual who is
determined to be a WTC responder in the WTC
Program at the time of such determination.
``(4) Numerical limitation on eligible wtc responders.--
``(A) In general.--The total number of individuals
not described in paragraph (1)(A) or (2)(A)(ii) who may
be enrolled under paragraph (3)(A)(ii) shall not exceed
25,000 at any time, of which no more than 2,500 may be
individuals enrolled based on modified eligibility
criteria established under paragraph (1)(C).
``(B) Process.--In implementing subparagraph (A), the
WTC Program Administrator shall--
``(i) limit the number of enrollments made
under paragraph (3)--
``(I) in accordance with such
subparagraph; and
``(II) to such number, as determined
by the Administrator based on the best
available information and subject to
amounts available under section 3351,
that will ensure sufficient funds will
be available to provide treatment and
monitoring benefits under this title,
with respect to all individuals who are
enrolled through the end of fiscal year
2020; and
``(ii) provide priority (subject to paragraph
(3)(A)(i)) in such enrollments in the order in
which individuals apply for enrollment under
paragraph (3).
``(5) Disqualification of individuals on terrorist watch
list.--No individual who is on the terrorist watch list
maintained by the Department of Homeland Security shall qualify
as an eligible WTC responder. Before enrolling any individual
as a WTC responder in the WTC Program under paragraph (3), the
Administrator, in consultation with the Secretary of Homeland
Security, shall determine whether the individual is on such
list.
``(b) Monitoring Benefits.--
``(1) In general.--In the case of an enrolled WTC responder
(other than one described in subsection (a)(2)(A)(ii)), the WTC
Program shall provide for monitoring benefits that include
monitoring consistent with protocols approved by the WTC
Program Administrator and including clinical examinations and
long-term health monitoring and analysis. In the case of an
enrolled WTC responder who is an active member of the Fire
Department of New York City, the responder shall receive such
benefits as part of the individual's periodic company medical
exams.
``(2) Provision of monitoring benefits.--The monitoring
benefits under paragraph (1) shall be provided through the
Clinical Center of Excellence for the type of individual
involved or, in the case of an individual residing outside the
New York metropolitan area, under an arrangement under section
3313.
``SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS FOR WTC-RELATED
HEALTH CONDITIONS.
``(a) WTC-Related Health Condition Defined.--
``(1) In general.--For purposes of this title, the term `WTC-
related health condition' means a condition that--
``(A)(i) is an illness or health condition for which
exposure to airborne toxins, any other hazard, or any
other adverse condition resulting from the September
11, 2001, terrorist attacks, based on an examination by
a medical professional with experience in treating or
diagnosing the health conditions included in the
applicable list of WTC-related health conditions, is
substantially likely to be a significant factor in
aggravating, contributing to, or causing the illness or
health condition, as determined under paragraph (2); or
``(ii) is a mental health condition for which such
attacks, based on an examination by a medical
professional with experience in treating or diagnosing
the health conditions included in the applicable list
of WTC-related health conditions, is substantially
likely to be a significant factor in aggravating,
contributing to, or causing the condition, as
determined under paragraph (2); and
``(B) is included in the applicable list of WTC-
related health conditions or--
``(i) with respect to a WTC responder, is
provided certification of coverage under
subsection (b)(2)(B)(iii); or
``(ii) with respect to a screening-eligible
WTC survivor or certified-eligible WTC
survivor, is provided certification of coverage
under subsection (b)(2)(B)(iii), as applied
under section 3322(a).
In the case of a WTC responder described in section
3311(a)(2)(A)(ii) (relating to a surviving immediate family
member of a firefighter), such term does not include an illness
or health condition described in subparagraph (A)(i).
``(2) Determination.--The determination under paragraph (1)
or subsection (b) of whether the September 11, 2001, terrorist
attacks were substantially likely to be a significant factor in
aggravating, contributing to, or causing an individual's
illness or health condition shall be made based on an
assessment of the following:
``(A) The individual's exposure to airborne toxins,
any other hazard, or any other adverse condition
resulting from the terrorist attacks. Such exposure
shall be--
``(i) evaluated and characterized through the
use of a standardized, population-appropriate
questionnaire approved by the Director of the
National Institute for Occupational Safety and
Health; and
``(ii) assessed and documented by a medical
professional with experience in treating or
diagnosing health conditions included on the
list of WTC-related health conditions.
``(B) The type of symptoms and temporal sequence of
symptoms. Such symptoms shall be--
``(i) assessed through the use of a
standardized, population-appropriate medical
questionnaire approved by the Director of the
National Institute for Occupational Safety and
Health and a medical examination; and
``(ii) diagnosed and documented by a medical
professional described in subparagraph (A)(ii).
``(3) List of health conditions for wtc responders.--The list
of health conditions for WTC responders consists of the
following:
``(A) Aerodigestive disorders.--
``(i) Interstitial lung diseases.
``(ii) Chronic respiratory disorder--fumes/
vapors.
``(iii) Asthma.
``(iv) Reactive airways dysfunction syndrome
(RADS).
``(v) WTC-exacerbated chronic obstructive
pulmonary disease (COPD).
``(vi) Chronic cough syndrome.
``(vii) Upper airway hyperreactivity.
``(viii) Chronic rhinosinusitis.
``(ix) Chronic nasopharyngitis.
``(x) Chronic laryngitis.
``(xi) Gastroesophageal reflux disorder
(GERD).
``(xii) Sleep apnea exacerbated by or related
to a condition described in a previous clause.
``(B) Mental health conditions.--
``(i) Posttraumatic stress disorder (PTSD).
``(ii) Major depressive disorder.
``(iii) Panic disorder.
``(iv) Generalized anxiety disorder.
``(v) Anxiety disorder (not otherwise
specified).
``(vi) Depression (not otherwise specified).
``(vii) Acute stress disorder.
``(viii) Dysthymic disorder.
``(ix) Adjustment disorder.
``(x) Substance abuse.
``(C) Musculoskeletal disorders for certain wtc
responders.--In the case of a WTC responder described
in paragraph (4), a condition described in such
paragraph.
``(D) Additional conditions.--Any cancer (or type of
cancer) or other condition added, pursuant to paragraph
(5) or (6), to the list under this paragraph.
``(4) Musculoskeletal disorders.--
``(A) In general.--For purposes of this title, in the
case of a WTC responder who received any treatment for
a WTC-related musculoskeletal disorder on or before
September 11, 2003, the list of health conditions in
paragraph (3) shall include:
``(i) Low back pain.
``(ii) Carpal tunnel syndrome (CTS).
``(iii) Other musculoskeletal disorders.
``(B) Definition.--The term `WTC-related
musculoskeletal disorder' means a chronic or recurrent
disorder of the musculoskeletal system caused by heavy
lifting or repetitive strain on the joints or
musculoskeletal system occurring during rescue or
recovery efforts in the New York City disaster area in
the aftermath of the September 11, 2001, terrorist
attacks.
``(5) Cancer.--
``(A) In general.--The WTC Program Administrator
shall periodically conduct a review of all available
scientific and medical evidence, including findings and
recommendations of Clinical Centers of Excellence,
published in peer-reviewed journals to determine if,
based on such evidence, cancer or a certain type of
cancer should be added to the applicable list of WTC-
related health conditions. The WTC Program
Administrator shall conduct the first review under this
subparagraph not later than 180 days after the date of
the enactment of this title.
``(B) Proposed regulations and rulemaking.--Based on
the periodic reviews under subparagraph (A), if the WTC
Program Administrator determines that cancer or a
certain type of cancer should be added to such list of
WTC-related health conditions, the WTC Program
Administrator shall propose regulations, through
rulemaking, to add cancer or the certain type of cancer
to such list.
``(C) Final regulations.--Based on all the available
evidence in the rulemaking record, the WTC Program
Administrator shall make a final determination of
whether cancer or a certain type of cancer should be
added to such list of WTC-related health conditions. If
such a determination is made to make such an addition,
the WTC Program Administrator shall by regulation add
cancer or the certain type of cancer to such list.
``(D) Determinations not to add cancer or certain
types of cancer.--In the case that the WTC Program
Administrator determines under subparagraph (B) or (C)
that cancer or a certain type of cancer should not be
added to such list of WTC-related health conditions,
the WTC Program Administrator shall publish an
explanation for such determination in the Federal
Register. Any such determination to not make such an
addition shall not preclude the addition of cancer or
the certain type of cancer to such list at a later
date.
``(6) Addition of health conditions to list for wtc
responders.--
``(A) In general.--Whenever the WTC Program
Administrator determines that a proposed rule should be
promulgated to add a health condition to the list of
health conditions in paragraph (3), the Administrator
may request a recommendation of the Advisory Committee
or may publish such a proposed rule in the Federal
Register in accordance with subparagraph (D).
``(B) Administrator's options after receipt of
petition.--In the case that the WTC Program
Administrator receives a written petition by an
interested party to add a health condition to the list
of health conditions in paragraph (3), not later than
60 days after the date of receipt of such petition the
Administrator shall--
``(i) request a recommendation of the
Advisory Committee;
``(ii) publish a proposed rule in the Federal
Register to add such health condition, in
accordance with subparagraph (D);
``(iii) publish in the Federal Register the
Administrator's determination not to publish
such a proposed rule and the basis for such
determination; or
``(iv) publish in the Federal Register a
determination that insufficient evidence exists
to take action under clauses (i) through (iii).
``(C) Action by advisory committee.--In the case that
the Administrator requests a recommendation of the
Advisory Committee under this paragraph, with respect
to adding a health condition to the list in paragraph
(3), the Advisory Committee shall submit to the
Administrator such recommendation not later than 60
days after the date of such request or by such date
(not to exceed 180 days after such date of request) as
specified by the Administrator. Not later than 60 days
after the date of receipt of such recommendation, the
Administrator shall, in accordance with subparagraph
(D), publish in the Federal Register a proposed rule
with respect to such recommendation or a determination
not to propose such a proposed rule and the basis for
such determination.
``(D) Publication.--The WTC Program Administrator
shall, with respect to any proposed rule under this
paragraph--
``(i) publish such proposed rule in
accordance with section 553 of title 5, United
States Code; and
``(ii) provide interested parties a period of
30 days after such publication to submit
written comments on the proposed rule.
The WTC Program Administrator may extend the period
described in clause (ii) upon a finding of good cause.
In the case of such an extension, the Administrator
shall publish such extension in the Federal Register.
``(E) Interested party defined.--For purposes of this
paragraph, the term `interested party' includes a
representative of any organization representing WTC
responders, a nationally recognized medical
association, a Clinical or Data Center, a State or
political subdivision, or any other interested person.
``(b) Coverage of Treatment for WTC-Related Health Conditions.--
``(1) Determination for enrolled wtc responders based on a
wtc-related health condition.--
``(A) In general.--If a physician at a Clinical
Center of Excellence that is providing monitoring
benefits under section 3311 for an enrolled WTC
responder makes a determination that the responder has
a WTC-related health condition that is in the list in
subsection (a)(3) and that exposure to airborne toxins,
other hazards, or adverse conditions resulting from the
September 1, 2001, terrorist attacks is substantially
likely to be a significant factor in aggravating,
contributing to, or causing the condition--
``(i) the physician shall promptly transmit
such determination to the WTC Program
Administrator and provide the Administrator
with the medical facts supporting such
determination; and
``(ii) on and after the date of such
transmittal and subject to subparagraph (B),
the WTC Program shall provide for payment under
subsection (c) for medically necessary
treatment for such condition.
``(B) Review; certification; appeals.--
``(i) Review.--A Federal employee designated
by the WTC Program Administrator shall review
determinations made under subparagraph (A).
``(ii) Certification.--The Administrator
shall provide a certification of such condition
based upon reviews conducted under clause (i).
Such a certification shall be provided unless
the Administrator determines that the
responder's condition is not a WTC-related
health condition in the list in subsection
(a)(3) or that exposure to airborne toxins,
other hazards, or adverse conditions resulting
from the September 1, 2001, terrorist attacks
is not substantially likely to be a significant
factor in aggravating, contributing to, or
causing the condition.
``(iii) Appeal process.--The Administrator
shall establish, by rule, a process for the
appeal of determinations under clause (ii).
``(2) Determination based on medically associated wtc-related
health conditions.--
``(A) In general.--If a physician at a Clinical
Center of Excellence determines pursuant to subsection
(a) that the enrolled WTC responder has a health
condition described in subsection (a)(1)(A) that is not
in the list in subsection (a)(3) but which is medically
associated with a WTC-related health condition--
``(i) the physician shall promptly transmit
such determination to the WTC Program
Administrator and provide the Administrator
with the facts supporting such determination;
and
``(ii) the Administrator shall make a
determination under subparagraph (B) with
respect to such physician's determination.
``(B) Procedures for review, certification, and
appeal.--The WTC Program Administrator shall, by rule,
establish procedures for the review and certification
of physician determinations under subparagraph (A).
Such rule shall provide for--
``(i) the timely review of such a
determination by a physician panel with
appropriate expertise for the condition and
recommendations to the WTC Program
Administrator;
``(ii) not later than 60 days after the date
of the transmittal under subparagraph (A)(i), a
determination by the WTC Program Administrator
on whether or not the condition involved is
described in subsection (a)(1)(A) and is
medically associated with a WTC-related health
condition;
``(iii) certification in accordance with
paragraph (1)(B)(ii) of coverage of such
condition if determined to be described in
subsection (a)(1)(A) and medically associated
with a WTC-related health condition; and
``(iv) a process for appeals of
determinations relating to such conditions.
``(C) Inclusion in list of health conditions.--If the
WTC Program Administrator provides certification under
subparagraph (B)(iii) for coverage of a condition, the
Administrator may, pursuant to subsection (a)(6), add
the condition to the list in subsection (a)(3).
``(D) Conditions already declined for inclusion in
list.--If the WTC Program Administrator publishes a
determination under subsection (a)(6)(B) not to include
a condition in the list in subsection (a)(3), the WTC
Program Administrator shall not provide certification
under subparagraph (B)(iii) for coverage of the
condition. In the case of an individual who is
certified under subparagraph (B)(iii) with respect to
such condition before the date of the publication of
such determination the previous sentence shall not
apply.
``(3) Requirement of medical necessity.--
``(A) In general.--In providing treatment for a WTC-
related health condition, a physician or other provider
shall provide treatment that is medically necessary and
in accordance with medical treatment protocols
established under subsection (d).
``(B) Regulations relating to medical necessity.--For
the purpose of this title, the WTC Program
Administrator shall issue regulations specifying a
standard for determining medical necessity with respect
to health care services and prescription
pharmaceuticals, a process for determining whether
treatment furnished and pharmaceuticals prescribed
under this title meet such standard (including any
prior authorization requirement), and a process for
appeal of a determination under subsection (c)(3).
``(4) Scope of treatment covered.--
``(A) In general.--The scope of treatment covered
under this subsection includes services of physicians
and other health care providers, diagnostic and
laboratory tests, prescription drugs, inpatient and
outpatient hospital services, and other medically
necessary treatment.
``(B) Pharmaceutical coverage.--With respect to
ensuring coverage of medically necessary outpatient
prescription drugs, such drugs shall be provided, under
arrangements made by the WTC Program Administrator,
directly through participating Clinical Centers of
Excellence or through one or more outside vendors.
``(C) Transportation expenses for nationwide
network.--The WTC Program Administrator may provide for
necessary and reasonable transportation and expenses
incident to the securing of medically necessary
treatment through the nationwide network under section
3313 involving travel of more than 250 miles and for
which payment is made under this section in the same
manner in which individuals may be furnished necessary
and reasonable transportation and expenses incident to
services involving travel of more than 250 miles under
regulations implementing section 3629(c) of the Energy
Employees Occupational Illness Compensation Program Act
of 2000 (title XXXVI of Public Law 106-398; 42 U.S.C.
7384t(c)).
``(5) Provision of treatment pending certification.--With
respect to an enrolled WTC responder for whom a determination
is made by an examining physician under paragraph (1) or (2),
but for whom the WTC Program Administrator has not yet
determined whether to certify the determination, the WTC
Program Administrator may establish by rule a process through
which the Administrator may approve the provision of medical
treatment under this subsection (and payment under subsection
(c)) with respect to such responder and such responder's WTC-
related health condition (under such terms and conditions as
the Administrator may provide) until the Administrator makes a
decision on whether to certify the determination.
``(c) Payment for Initial Health Evaluation, Monitoring, and
Treatment of WTC-Related Health Conditions.--
``(1) Medical treatment.--
``(A) Use of feca payment rates.--Subject to
subparagraphs (B) and (C), the WTC Program
Administrator shall reimburse costs for medically
necessary treatment under this title for WTC-related
health conditions according to the payment rates that
would apply to the provision of such treatment and
services by the facility under the Federal Employees
Compensation Act. For treatment not covered under the
previous sentence or subparagraph (B), the WTC Program
Administrator shall establish by regulation a
reimbursement rate for such treatment.
``(B) Pharmaceuticals.--
``(i) In general.--The WTC Program
Administrator shall establish a program for
paying for the medically necessary outpatient
prescription pharmaceuticals prescribed under
this title for WTC-related health conditions
through one or more contracts with outside
vendors.
``(ii) Competitive bidding.--Under such
program the Administrator shall--
``(I) select one or more appropriate
vendors through a Federal competitive
bid process; and
``(II) select the lowest bidder (or
bidders) meeting the requirements for
providing pharmaceutical benefits for
participants in the WTC Program.
``(iii) Treatment of fdny participants.--
Under such program the Administrator may enter
into an agreement with a separate vendor to
provide pharmaceutical benefits to enrolled WTC
responders for whom the Clinical Center of
Excellence is described in section 3305 if such
an arrangement is deemed necessary and
beneficial to the program by the WTC Program
Administrator.
``(C) Improving quality and efficiency through
modification of payment amounts and methodologies.--The
WTC Program Administrator may modify the amounts and
methodologies for making payments for initial health
evaluations, monitoring, or treatment, if, taking into
account utilization and quality data furnished by the
Clinical Centers of Excellence under section
3305(b)(1)(B)(iii), the Administrator determines that a
bundling, capitation, pay for performance, or other
payment methodology would better ensure high quality
and efficient delivery of initial health evaluations,
monitoring, or treatment to an enrolled WTC responder,
screening-eligible WTC survivor, or certified-eligible
WTC survivor.
``(2) Monitoring and initial health evaluation.--The WTC
Program Administrator shall reimburse the costs of monitoring
and the costs of an initial health evaluation provided under
this title at a rate set by the Administrator by regulation.
``(3) Determination of medical necessity.--
``(A) Review of medical necessity and protocols.--As
part of the process for reimbursement or payment under
this subsection, the WTC Program Administrator shall
provide for the review of claims for reimbursement or
payment for the provision of medical treatment to
determine if such treatment is medically necessary and
in accordance with medical treatment protocols
established under subsection (d).
``(B) Withholding of payment for medically
unnecessary treatment.--The Administrator shall
withhold such reimbursement or payment for treatment
that the Administrator determines is not medically
necessary or is not in accordance with such medical
treatment protocols.
``(d) Medical Treatment Protocols.--
``(1) Development.--The Data Centers shall develop medical
treatment protocols for the treatment of enrolled WTC
responders and certified-eligible WTC survivors for health
conditions included in the applicable list of WTC-related
health conditions.
``(2) Approval.--The medical treatment protocols developed
under paragraph (1) shall be subject to approval by the WTC
Program Administrator.
``SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS
OUTSIDE NEW YORK.
``(a) In General.--In order to ensure reasonable access to benefits
under this subtitle for individuals who are enrolled WTC responders,
screening-eligible WTC survivors, or certified-eligible WTC survivors
and who reside in any State, as defined in section 2(f), outside the
New York metropolitan area, the WTC Program Administrator shall
establish a nationwide network of health care providers to provide
monitoring and treatment benefits and initial health evaluations near
such individuals' areas of residence in such States. Nothing in this
subsection shall be construed as preventing such individuals from being
provided such monitoring and treatment benefits or initial health
evaluation through any Clinical Center of Excellence.
``(b) Network Requirements.--Any health care provider participating
in the network under subsection (a) shall--
``(1) meet criteria for credentialing established by the Data
Centers;
``(2) follow the monitoring, initial health evaluation, and
treatment protocols developed under section 3305(a)(2)(A)(ii);
``(3) collect and report data in accordance with section
3304; and
``(4) meet such fraud, quality assurance, and other
requirements as the WTC Program Administrator establishes,
including sections 1128 through 1128E of the Social Security
Act, as applied by section 3301(d).
``(c) Training and Technical Assistance.--The WTC Program Administer
may provide, including through contract, for the provision of training
and technical assistance to health care providers participating in the
network under subsection (a).
``PART 2--WTC SURVIVORS
``SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF SCREENING-
ELIGIBLE AND CERTIFIED-ELIGIBLE WTC SURVIVORS.
``(a) Identification of Screening-Eligible WTC Survivors and
Certified-Eligible WTC Survivors.--
``(1) Screening-eligible wtc survivors.--
``(A) Definition.--In this title, the term
`screening-eligible WTC survivor' means, subject to
subparagraph (C) and paragraph (3), an individual who
is described in any of the following clauses:
``(i) Currently identified survivor.--An
individual, including a WTC responder, who has
been identified as eligible for medical
treatment and monitoring by the WTC
Environmental Health Center as of the date of
enactment of this title.
``(ii) Survivor who meets current eligibility
criteria.--An individual who is not a WTC
responder, for purposes of the initial health
evaluation under subsection (b), claims
symptoms of a WTC-related health condition and
meets any of the current eligibility criteria
described in subparagraph (B).
``(iii) Survivor who meets modified
eligibility criteria.--An individual who is not
a WTC responder, for purposes of the initial
health evaluation under subsection (b), claims
symptoms of a WTC-related health condition and
meets such eligibility criteria relating to
exposure to airborne toxins, other hazards, or
adverse conditions resulting from the September
11, 2001, terrorist attacks as the WTC
Administrator determines, after consultation
with the Data Centers described in section 3305
and the WTC Scientific/Technical Advisory
Committee and WTC Health Program Steering
Committees under section 3302.
The Administrator shall not modify such criteria under
clause (iii) on or after the date that the number of
certifications for certified-eligible WTC survivors
under paragraph (2)(B) has reached 80 percent of the
limit described in paragraph (3) or on or after the
date that the number of enrollments of WTC responders
has reached 80 percent of the limit described in
section 3311(a)(4).
``(B) Current eligibility criteria.--The eligibility
criteria described in this subparagraph for an
individual are that the individual is described in any
of the following clauses:
``(i) A person who was present in the New
York City disaster area in the dust or dust
cloud on September 11, 2001.
``(ii) A person who worked, resided, or
attended school, childcare, or adult daycare in
the New York City disaster area for--
``(I) at least 4 days during the 4-
month period beginning on September 11,
2001, and ending on January 10, 2002;
or
``(II) at least 30 days during the
period beginning on September 11, 2001,
and ending on July 31, 2002.
``(iii) Any person who worked as a cleanup
worker or performed maintenance work in the New
York City disaster area during the 4-month
period described in subparagraph (B)(i) and had
extensive exposure to WTC dust as a result of
such work.
``(iv) A person who was deemed eligible to
receive a grant from the Lower Manhattan
Development Corporation Residential Grant
Program, who possessed a lease for a residence
or purchased a residence in the New York City
disaster area, and who resided in such
residence during the period beginning on
September 11, 2001, and ending on May 31, 2003.
``(v) A person whose place of employment--
``(I) at any time during the period
beginning on September 11, 2001, and
ending on May 31, 2003, was in the New
York City disaster area; and
``(II) was deemed eligible to receive
a grant from the Lower Manhattan
Development Corporation WTC Small Firms
Attraction and Retention Act program or
other government incentive program
designed to revitalize the lower
Manhattan economy after the September
11, 2001, terrorist attacks.
``(C) Application and determination process for
screening eligibility.--
``(i) In general.--The WTC Program
Administrator in consultation with the Data
Centers shall establish a process for
individuals, other than individuals described
in subparagraph (A)(i), to be determined to be
screening-eligible WTC survivors. Under such
process--
``(I) there shall be no fee charged
to the applicant for making an
application for such determination;
``(II) the Administrator shall make a
determination on such an application
not later than 60 days after the date
of filing the application;
``(III) the Administrator shall make
such a determination relating to an
applicant's compliance with this title
and shall not determine that an
individual is not so eligible or deny
written documentation under clause (ii)
to such individual unless the
Administrator determines that--
``(aa) based on the
application submitted, the
individual does not meet the
eligibility criteria; or
``(bb) the numerical
limitation on certifications of
certified-eligible WTC
survivors set forth in
paragraph (3) has been met; and
``(IV) an individual who is
determined not to be a screening-
eligible WTC survivor shall have an
opportunity to appeal such
determination in a manner established
under such process.
``(ii) Written documentation of screening-
eligibility.--
``(I) In general.--In the case of an
individual who is described in
subparagraph (A)(i) or who is
determined under clause (i) (consistent
with paragraph (3)) to be a screening-
eligible WTC survivor, the WTC Program
Administrator shall provide an
appropriate written documentation of
such fact.
``(II) Timing.--
``(aa) Currently identified
survivors.--In the case of an
individual who is described in
subparagraph (A)(i), the WTC
Program Administrator shall
provide the written
documentation under subclause
(I) not later than July 1,
2011.
``(bb) Other members.--In the
case of another individual who
is determined under clause (i)
and consistent with paragraph
(3) to be a screening-eligible
WTC survivor, the WTC Program
Administrator shall provide the
written documentation under
subclause (I) at the time of
such determination.
``(2) Certified-eligible wtc survivors.--
``(A) Definition.--The term `certified-eligible WTC
survivor' means, subject to paragraph (3), a screening-
eligible WTC survivor who the WTC Program Administrator
certifies under subparagraph (B) to be eligible for
followup monitoring and treatment under this part.
``(B) Certification of eligibility for monitoring and
treatment.--
``(i) In general.--The WTC Program
Administrator shall establish a certification
process under which the Administrator shall
provide appropriate certification to screening-
eligible WTC survivors who, pursuant to the
initial health evaluation under subsection (b),
are determined to be eligible for followup
monitoring and treatment under this part.
``(ii) Timing.--
``(I) Currently identified
survivors.--In the case of an
individual who is described in
paragraph (1)(A)(i), the WTC Program
Administrator shall provide the
certification under clause (i) not
later than July 1, 2011.
``(II) Other members.--In the case of
another individual who is determined
under clause (i) to be eligible for
followup monitoring and treatment, the
WTC Program Administrator shall provide
the certification under such clause at
the time of such determination.
``(3) Numerical limitation on certified-eligible wtc
survivors.--
``(A) In general.--The total number of individuals
not described in paragraph (1)(A)(i) who may be
certified as certified-eligible WTC survivors under
paragraph (2)(B) shall not exceed 25,000 at any time.
``(B) Process.--In implementing subparagraph (A), the
WTC Program Administrator shall--
``(i) limit the number of certifications
provided under paragraph (2)(B)--
``(I) in accordance with such
subparagraph; and
``(II) to such number, as determined
by the Administrator based on the best
available information and subject to
amounts made available under section
3351, that will ensure sufficient funds
will be available to provide treatment
and monitoring benefits under this
title, with respect to all individuals
receiving such certifications through
the end of fiscal year 2020; and
``(ii) provide priority in such
certifications in the order in which
individuals apply for a determination under
paragraph (2)(B).
``(4) Disqualification of individuals on terrorist watch
list.--No individual who is on the terrorist watch list
maintained by the Department of Homeland Security shall qualify
as a screening-eligible WTC survivor or a certified-eligible
WTC survivor. Before determining any individual to be a
screening-eligible WTC survivor under paragraph (1) or
certifying any individual as a certified eligible WTC survivor
under paragraph (2), the Administrator, in consultation with
the Secretary of Homeland Security, shall determine whether the
individual is on such list.
``(b) Initial Health Evaluation To Determine Eligibility for Followup
Monitoring or Treatment.--
``(1) In general.--In the case of a screening-eligible WTC
survivor, the WTC Program shall provide for an initial health
evaluation to determine if the survivor has a WTC-related
health condition and is eligible for followup monitoring and
treatment benefits under the WTC Program. Initial health
evaluation protocols under section 3305(a)(2)(A)(ii) shall be
subject to approval by the WTC Program Administrator.
``(2) Initial health evaluation providers.--The initial
health evaluation described in paragraph (1) shall be provided
through a Clinical Center of Excellence with respect to the
individual involved.
``(3) Limitation on initial health evaluation benefits.--
Benefits for an initial health evaluation under this part for a
screening-eligible WTC survivor shall consist only of a single
medical initial health evaluation consistent with initial
health evaluation protocols described in paragraph (1). Nothing
in this paragraph shall be construed as preventing such an
individual from seeking additional medical initial health
evaluations at the expense of the individual.
``SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED-ELIGIBLE
WTC SURVIVORS FOR WTC-RELATED HEALTH CONDITIONS.
``(a) In General.--Subject to subsection (b), the provisions of
sections 3311 and 3312 shall apply to followup monitoring and treatment
of WTC-related health conditions for certified-eligible WTC survivors
in the same manner as such provisions apply to the monitoring and
treatment of WTC-related health conditions for enrolled WTC responders.
``(b) List of WTC-Related Health Conditions for Survivors.--The list
of health conditions for screening-eligible WTC survivors and
certified-eligible WTC survivors consists of the following:
``(1) Aerodigestive disorders.--
``(A) Interstitial lung diseases.
``(B) Chronic respiratory disorder--fumes/vapors.
``(C) Asthma.
``(D) Reactive airways dysfunction syndrome (RADS).
``(E) WTC-exacerbated chronic obstructive pulmonary
disease (COPD).
``(F) Chronic cough syndrome.
``(G) Upper airway hyperreactivity.
``(H) Chronic rhinosinusitis.
``(I) Chronic nasopharyngitis.
``(J) Chronic laryngitis.
``(K) Gastroesophageal reflux disorder (GERD).
``(L) Sleep apnea exacerbated by or related to a
condition described in a previous clause.
``(2) Mental health conditions.--
``(A) Posttraumatic stress disorder (PTSD).
``(B) Major depressive disorder.
``(C) Panic disorder.
``(D) Generalized anxiety disorder.
``(E) Anxiety disorder (not otherwise specified).
``(F) Depression (not otherwise specified).
``(G) Acute stress disorder.
``(H) Dysthymic disorder.
``(I) Adjustment disorder.
``(J) Substance abuse.
``(3) Additional conditions.--Any cancer (or type of cancer)
or other condition added to the list in section 3312(a)(3)
pursuant to paragraph (5) or (6) of section 3312(a), as such
provisions are applied under subsection (a) with respect to
certified-eligible WTC survivors.
``SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS
WITH WTC-RELATED HEALTH CONDITIONS.
``(a) In General.--Subject to subsection (c), the provisions of
section 3322 shall apply to the followup monitoring and treatment of
WTC-related health conditions in the case of individuals described in
subsection (b) in the same manner as such provisions apply to the
followup monitoring and treatment of WTC-related health conditions for
certified-eligible WTC survivors.
``(b) Individuals Described.--An individual described in this
subsection is an individual who, regardless of location of residence--
``(1) is not an enrolled WTC responder or a certified-
eligible WTC survivor; and
``(2) is diagnosed at a Clinical Center of Excellence with a
WTC-related health condition for certified-eligible WTC
survivors.
``(c) Limitation.--
``(1) In general.--The WTC Program Administrator shall limit
benefits for any fiscal year under subsection (a) in a manner
so that payments under this section for such fiscal year do not
exceed the amount specified in paragraph (2) for such fiscal
year.
``(2) Limitation.--The amount specified in this paragraph
for--
``(A) the last calendar quarter of fiscal year 2011
is $5,000,000;
``(B) fiscal year 2012 is $20,000,000; or
``(C) a succeeding fiscal year is the amount
specified in this paragraph for the previous fiscal
year increased by the annual percentage increase in the
medical care component of the consumer price index for
all urban consumers.
``PART 3--PAYOR PROVISIONS
``SEC. 3331. PAYMENT OF CLAIMS.
``(a) In General.--Except as provided in subsections (b) and (c), the
cost of monitoring and treatment benefits and initial health evaluation
benefits provided under parts 1 and 2 of this subtitle shall be paid
for by the WTC Program from the World Trade Center Health Program Fund.
``(b) Workers' Compensation Payment.--
``(1) In general.--Subject to paragraph (2), payment for
treatment under parts 1 and 2 of this subtitle of a WTC-related
health condition of an individual that is work-related shall be
reduced or recouped to the extent that the WTC Program
Administrator determines that payment has been made, or can
reasonably be expected to be made, under a workers'
compensation law or plan of the United States, a State, or a
locality, or other work-related injury or illness benefit plan
of the employer of such individual, for such treatment. The
provisions of clauses (iii), (iv), (v), and (vi) of paragraph
(2)(B) of section 1862(b) of the Social Security Act and
paragraphs (3) and (4) of such section shall apply to the
recoupment under this subsection of a payment to the WTC
Program (with respect to a workers' compensation law or plan,
or other work-related injury or illness plan of the employer
involved, and such individual) in the same manner as such
provisions apply to the reimbursement of a payment under
section 1862(b)(2) of such Act to the Secretary (with respect
to such a law or plan and an individual entitled to benefits
under title XVIII of such Act) except that any reference in
such paragraph (4) to payment rates under title XVIII of the
Social Security Act shall be deemed a reference to payment
rates under this title.
``(2) Exception.--Paragraph (1) shall not apply for any
quarter, with respect to any workers' compensation law or plan,
including line of duty compensation, to which New York City is
obligated to make payments, if, in accordance with terms
specified under the contract under subsection (d)(1)(A), New
York City has made the full payment required under such
contract for such quarter.
``(3) Rules of construction.--Nothing in this title shall be
construed to affect, modify, or relieve any obligations under a
worker's compensation law or plan, other work-related injury or
illness benefit plan of an employer, or any health insurance
plan.
``(c) Health Insurance Coverage.--
``(1) In general.--In the case of an individual who has a
WTC-related health condition that is not work-related and has
health coverage for such condition through any public or
private health plan (including health benefits under title
XVIII, XIX, or XXI of the Social Security Act) the provisions
of section 1862(b) of the Social Security Act shall apply to
such a health plan and such individual in the same manner as
they apply to group health plan and an individual entitled to
benefits under title XVIII of such Act pursuant to section
226(a) of such Act. Any costs for items and services covered
under such plan that are not reimbursed by such health plan,
due to the application of deductibles, copayments, coinsurance,
other cost sharing, or otherwise, are reimbursable under this
title to the extent that they are covered under the WTC
Program. The program under this title shall not be treated as a
legally liable party for purposes of applying section
1902(a)(25) of the Social Security Act.
``(2) Recovery by individual providers.--Nothing in paragraph
(1) shall be construed as requiring an entity providing
monitoring and treatment under this title to seek reimbursement
under a health plan with which the entity has no contract for
reimbursement.
``(3) Maintenance of required minimum essential coverage.--No
payment may be made for monitoring and treatment under this
title for an individual for a month (beginning with July 2014)
if with respect to such month the individual--
``(A) is an applicable individual (as defined in
subsection (d) of section 5000A of Internal Revenue
Code of 1986) for whom the exemption under subsection
(e) of such section does not apply; and
``(B) is not covered under minimum essential
coverage, as required under subsection (a) of such
section.
``(d) Required Contribution by New York City in Program Costs.--
``(1) Contract requirement.--
``(A) In general.--No funds may be disbursed from the
World Trade Center Health Program Fund under section
3351 unless New York City has entered into a contract
with the WTC Program Administrator under which New York
City agrees, in a form and manner specified by the
Administrator, to pay the full contribution described
in subparagraph (B) in accordance with this subsection
on a timely basis, plus any interest owed pursuant to
subparagraph (E)(i). Such contract shall specify the
terms under which New York City shall be considered to
have made the full payment required for a quarter for
purposes of subsection (b)(2).
``(B) Full contribution amount.--Under such contract,
with respect to the last calendar quarter of fiscal
year 2011 and each calendar quarter in fiscal years
2012 through 2020 the full contribution amount under
this subparagraph shall be equal to 10 percent of the
expenditures in carrying out this title for the
respective quarter.
``(C) Satisfaction of payment obligation.--The
payment obligation under such contract may not be
satisfied through any of the following:
``(i) An amount derived from Federal sources.
``(ii) An amount paid before the date of the
enactment of this title.
``(iii) An amount paid to satisfy a judgment
or as part of a settlement related to injuries
or illnesses arising out of the September 11,
2001, terrorist attacks.
``(D) Timing of contribution.--The payment obligation
under such contract for a calendar quarter in a fiscal
year shall be paid not later than the last day of the
second succeeding calendar quarter.
``(E) Compliance.--
``(i) Interest for late payment.--If New York
City fails to pay to the WTC Program
Administrator pursuant to such contract the
amount required for any calendar quarter by the
day specified in subparagraph (D), interest
shall accrue on the amount not so paid at the
rate (determined by the Administrator) based on
the average yield to maturity, plus 1
percentage point, on outstanding municipal
bonds issued by New York City with a remaining
maturity of at least 1 year.
``(ii) Recovery of amounts owed.-- The
amounts owed to the WTC Program Administrator
under such contract shall be recoverable by the
United States in an action in the same manner
as payments made under title XVIII of the
Social Security Act may be recoverable in an
action brought under section 1862(b)(2)(B)(iii)
of such Act.
``(F) Deposit in fund.--The WTC Program Administer
shall deposit amounts paid under such contract into the
World Trade Center Health Program Fund under section
3351.
``(2) Payment of new york city share of monitoring and
treatment costs.--With respect to each calendar quarter for
which a contribution is required by New York City under the
contract under paragraph (1), the WTC Program Administrator
shall--
``(A) provide New York City with an estimate of such
amount of the required contribution at the beginning of
such quarter and with an updated estimate of such
amount at the beginning of each of the subsequent 2
quarters;
``(B) bill such amount directly to New York City; and
``(C) certify periodically, for purposes of this
subsection, whether or not New York City has paid the
amount so billed.
Such amount shall initially be estimated by the WTC Program
Administrator and shall be subject to adjustment and
reconciliation based upon actual expenditures in carrying out
this title.
``(3) Rule of construction.--Nothing in this subsection shall
be construed as authorizing the WTC Administrator, with respect
to a fiscal year, to reduce the numerical limitation under
section 3311(a)(4) or 3321(a)(3) for such fiscal year if New
York City fails to comply with paragraph (1) for a calendar
quarter in such fiscal year.
``(e) Work-Related Described.--For the purposes of this section, a
WTC-related health condition shall be treated as a condition that is
work-related if--
``(1) the condition is diagnosed in an enrolled WTC
responder, or in an individual who qualifies as a certified-
eligible WTC survivor on the basis of being a rescue, recovery,
or cleanup worker; or
``(2) with respect to the condition the individual has filed
and had established a claim under a workers' compensation law
or plan of the United States or a State, or other work-related
injury or illness benefit plan of the employer of such
individual.
``SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY.
``The WTC Program Administrator may enter into arrangements with
other government agencies, insurance companies, or other third-party
administrators to provide for timely and accurate processing of claims
under sections 3312, 3313, 3322, and 3323.
``Subtitle C--Research Into Conditions
``SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO
SEPTEMBER 11 TERRORIST ATTACKS.
``(a) In General.--With respect to individuals, including enrolled
WTC responders and certified-eligible WTC survivors, receiving
monitoring or treatment under subtitle B, the WTC Program Administrator
shall conduct or support--
``(1) research on physical and mental health conditions that
may be related to the September 11, 2001, terrorist attacks;
``(2) research on diagnosing WTC-related health conditions of
such individuals, in the case of conditions for which there has
been diagnostic uncertainty; and
``(3) research on treating WTC-related health conditions of
such individuals, in the case of conditions for which there has
been treatment uncertainty.
The Administrator may provide such support through continuation and
expansion of research that was initiated before the date of the
enactment of this title and through the World Trade Center Health
Registry (referred to in section 3342), through a Clinical Center of
Excellence, or through a Data Center.
``(b) Types of Research.--The research under subsection (a)(1) shall
include epidemiologic and other research studies on WTC-related health
conditions or emerging conditions--
``(1) among enrolled WTC responders and certified-eligible
WTC survivors under treatment; and
``(2) in sampled populations outside the New York City
disaster area in Manhattan as far north as 14th Street and in
Brooklyn, along with control populations, to identify potential
for long-term adverse health effects in less exposed
populations.
``(c) Consultation.--The WTC Program Administrator shall carry out
this section in consultation with the WTC Scientific/Technical Advisory
Committee.
``(d) Application of Privacy and Human Subject Protections.--The
privacy and human subject protections applicable to research conducted
under this section shall not be less than such protections applicable
to research conducted or funded by the Department of Health and Human
Services.
``SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY.
``For the purpose of ensuring ongoing data collection relating to
victims of the September 11, 2001, terrorist attacks, the WTC Program
Administrator shall ensure that a registry of such victims is
maintained that is at least as comprehensive as the World Trade Center
Health Registry maintained under the arrangements in effect as of April
20, 2009, with the New York City Department of Health and Mental
Hygiene.
``Subtitle D--Funding
``SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM FUND.
``(a) Establishment of Fund.--
``(1) In general.--There is established a fund to be known as
the World Trade Center Health Program Fund (referred to in this
section as the `Fund').
``(2) Funding.--Out of any money in the Treasury not
otherwise appropriated, there shall be deposited into the Fund
for each of fiscal years 2012 through 2020 (and the last
calendar quarter of fiscal year 2011)--
``(A) the Federal share, consisting of an amount
equal to the lesser of--
``(i) 90 percent of the expenditures in
carrying out this title for the respective
fiscal year (initially based on estimates,
subject to subsequent reconciliation based on
actual expenditures); or
``(ii) $71,000,000 for the last calendar
quarter of fiscal year 2011, $318,000,000 for
fiscal year 2012, $354,000,000 for fiscal year
2013, $382,000,000 for fiscal year 2014,
$431,000,000 for fiscal year 2015, $481,000,000
for fiscal year 2016, $537,000,000 for fiscal
year 2017, $601,000,000 for fiscal year 2018,
$672,000,000 for fiscal year 2019, and
$743,000,000 for fiscal year 2020; plus
``(B) the New York City share, consisting of the
amount contributed under the contract under section
3331(d).
``(3) Contract requirement.--
``(A) In general.--No funds may be disbursed from the
Fund unless New York City has entered into a contract
with the WTC Program Administrator under section
3331(d)(1).
``(B) Breach of contract.-- In the case of a failure
to pay the amount so required under the contract--
``(i) the amount is recoverable under
subparagraph (E)(ii) of such section;
``(ii) such failure shall not affect the
disbursement of amounts from the Fund; and
``(iii) the Federal share described in
paragraph (2)(A) shall not be increased by the
amount so unpaid.
``(b) Mandatory Funds for Monitoring, Initial Health Evaluations,
Treatment, and Claims Processing.--
``(1) In general.--The amounts deposited into the Fund under
subsection (a)(2) shall be available, without further
appropriation, consistent with paragraph (2) and subsection
(c), to carry out subtitle B and sections 3302(a), 3303, 3304,
3305(a)(2), 3305(c), 3341, and 3342.
``(2) Limitation on mandatory funding.--This title does not
establish any Federal obligation for payment of amounts in
excess of the amounts available from the Fund for such purpose.
``(3) Limitation on authorization for further
appropriations.--This title does not establish any
authorization for appropriation of amounts in excess of the
amounts available from the Fund under paragraph (1).
``(c) Limits on Spending for Certain Purposes.--Of the amounts made
available under subsection (b)(1), not more than each of the following
amounts may be available for each of the following purposes:
``(1) Surviving immediate family members of firefighters.--
For the purposes of carrying out subtitle B with respect to WTC
responders described in section 3311(a)(2)(A)(ii)--
``(A) for the last calendar quarter of fiscal year
2011, $100,000;
``(B) for fiscal year 2012, $400,000; and
``(C) for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal
year increased by the percentage increase in the
consumer price index for all urban consumers (all
items; United States city average) as estimated by the
Secretary for the 12-month period ending with March of
the previous year.
``(2) WTC health program scientific/technical advisory
committee.--For the purpose of carrying out section 3302(a)--
``(A) for the last calendar quarter of fiscal year
2011, $25,000;
``(B) for fiscal year 2012, $100,000; and
``(C) for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal
year increased by the percentage increase in the
consumer price index for all urban consumers (all
items; United States city average) as estimated by the
Secretary for the 12-month period ending with March of
the previous year.
``(3) Education and outreach.--For the purpose of carrying
out section 3303--
``(A) for the last calendar quarter of fiscal year
2011, $500,000;
``(B) for fiscal year 2012, $2,000,000; and
``(C) for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal
year increased by the percentage increase in the
consumer price index for all urban consumers (all
items; United States city average) as estimated by the
Secretary for the 12-month period ending with March of
the previous year.
``(4) Uniform data collection.--For the purpose of carrying
out section 3304 and for reimbursing Data Centers (as defined
in section 3305(b)(2)) for the costs incurred by such Centers
in carrying out activities under contracts entered into under
section 3305(a)(2)--
``(A) for the last calendar quarter of fiscal year
2011, $2,500,000;
``(B) for fiscal year 2012, $10,000,000; and
``(C) for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal
year increased by the percentage increase in the
consumer price index for all urban consumers (all
items; United States city average) as estimated by the
Secretary for the 12-month period ending with March of
the previous year.
``(5) Research regarding certain health conditions.--For the
purpose of carrying out section 3341--
``(A) for the last calendar quarter of fiscal year
2011, $3,750,000;
``(B) for fiscal year 2012, $15,000,000; and
``(C) for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal
year increased by the percentage increase in the
consumer price index for all urban consumers (all
items; United States city average) as estimated by the
Secretary for the 12-month period ending with March of
the previous year.
``(6) World trade center health registry.--For the purpose of
carrying out section 3342--
``(A) for the last calendar quarter of fiscal year
2011, $1,750,000;
``(B) for fiscal year 2012, $7,000,000; and
``(C) for each subsequent fiscal year, the amount
specified under this paragraph for the previous fiscal
year increased by the percentage increase in the
consumer price index for all urban consumers (all
items; United States city average) as estimated by the
Secretary for the 12-month period ending with March of
the previous year.''.
TITLE II--SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001
SEC. 201. DEFINITIONS.
Section 402 of the Air Transportation Safety and System Stabilization
Act (49 U.S.C. 40101 note) is amended--
(1) in paragraph (6) by inserting ``, or debris removal,
including under the World Trade Center Health Program
established under section 3001 of the Public Health Service
Act,'' after ``September 11, 2001'';
(2) by inserting after paragraph (6) the following new
paragraphs and redesignating subsequent paragraphs accordingly:
``(7) Contractor and subcontractor.--The term `contractor and
subcontractor' means any contractor or subcontractor (at any
tier of a subcontracting relationship), including any general
contractor, construction manager, prime contractor, consultant,
or any parent, subsidiary, associated or allied company,
affiliated company, corporation, firm, organization, or joint
venture thereof that participated in debris removal at any 9/11
crash site. Such term shall not include any entity, including
the Port Authority of New York and New Jersey, with a property
interest in the World Trade Center, on September 11, 2001,
whether fee simple, leasehold or easement, direct or indirect.
``(8) Debris removal.--The term `debris removal' means rescue
and recovery efforts, removal of debris, cleanup, remediation,
and response during the immediate aftermath of the terrorist-
related aircraft crashes of September 11, 2001, with respect to
a 9/11 crash site.'';
(3) by inserting after paragraph (10), as so redesignated,
the following new paragraph and redesignating the subsequent
paragraphs accordingly:
``(11) Immediate aftermath.--The term `immediate aftermath'
means any period beginning with the terrorist-related aircraft
crashes of September 11, 2001, and ending on August 30,
2002.''; and
(4) by adding at the end the following new paragraph:
``(14) 9/11 crash site.--The term `9/11 crash site' means--
``(A) the World Trade Center site, Pentagon site, and
Shanksville, Pennsylvania site;
``(B) the buildings or portions of buildings that
were destroyed as a result of the terrorist-related
aircraft crashes of September 11, 2001;
``(C) any area contiguous to a site of such crashes
that the Special Master determines was sufficiently
close to the site that there was a demonstrable risk of
physical harm resulting from the impact of the aircraft
or any subsequent fire, explosions, or building
collapses (including the immediate area in which the
impact occurred, fire occurred, portions of buildings
fell, or debris fell upon and injured individuals); and
``(D) any area related to, or along, routes of debris
removal, such as barges and Fresh Kills.''.
SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.
(a) Information on Losses Resulting From Debris Removal Included in
Contents of Claim Form.--Section 405(a)(2)(B) of the Air Transportation
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended--
(1) in clause (i), by inserting ``, or debris removal during
the immediate aftermath'' after ``September 11, 2001'';
(2) in clause (ii), by inserting ``or debris removal during
the immediate aftermath'' after ``crashes''; and
(3) in clause (iii), by inserting ``or debris removal during
the immediate aftermath'' after ``crashes''.
(b) Extension of Deadline for Claims Under September 11th Victim
Compensation Fund of 2001.--Section 405(a)(3) of such Act is amended to
read as follows:
``(3) Limitation.--
``(A) In general.--Except as provided by subparagraph
(B), no claim may be filed under paragraph (1) after
the date that is 2 years after the date on which
regulations are promulgated under section 407(a).
``(B) Exception.--A claim may be filed under
paragraph (1), in accordance with subsection
(c)(3)(A)(i), by an individual (or by a personal
representative on behalf of a deceased individual)
during the period beginning on the date on which the
regulations are updated under section 407(b) and ending
on December 22, 2031.''.
(c) Requirements for Filing Claims During Extended Filing Period.--
Section 405(c)(3) of such Act is amended--
(1) by redesignating subparagraphs (A) and (B) as
subparagraphs (B) and (C), respectively; and
(2) by inserting before subparagraph (B), as so redesignated,
the following new subparagraph:
``(A) Requirements for filing claims during extended
filing period.--
``(i) Timing requirements for filing
claims.--An individual (or a personal
representative on behalf of a deceased
individual) may file a claim during the period
described in subsection (a)(3)(B) as follows:
``(I) In the case that the Special
Master determines the individual knew
(or reasonably should have known)
before the date specified in clause
(iii) that the individual suffered a
physical harm at a 9/11 crash site as a
result of the terrorist-related
aircraft crashes of September 11, 2001,
or as a result of debris removal, and
that the individual knew (or should
have known) before such specified date
that the individual was eligible to
file a claim under this title, the
individual may file a claim not later
than the date that is 2 years after
such specified date.
``(II) In the case that the Special
Master determines the individual first
knew (or reasonably should have known)
on or after the date specified in
clause (iii) that the individual
suffered such a physical harm or that
the individual first knew (or should
have known) on or after such specified
date that the individual was eligible
to file a claim under this title, the
individual may file a claim not later
than the last day of the 2-year period
beginning on the date the Special
Master determines the individual first
knew (or should have known) that the
individual both suffered from such harm
and was eligible to file a claim under
this title.
``(ii) Other eligibility requirements for
filing claims.--An individual may file a claim
during the period described in subsection
(a)(3)(B) only if--
``(I) the individual was treated by a
medical professional for suffering from
a physical harm described in clause
(i)(I) within a reasonable time from
the date of discovering such harm; and
``(II) the individual's physical harm
is verified by contemporaneous medical
records created by or at the direction
of the medical professional who
provided the medical care.
``(iii) Date specified.--The date specified
in this clause is the date on which the
regulations are updated under section
407(a).''.
(d) Clarifying Applicability to All 9/11 Crash Sites.--Section
405(c)(2)(A)(i) of such Act is amended by striking ``or the site of the
aircraft crash at Shanksville, Pennsylvania'' and inserting ``the site
of the aircraft crash at Shanksville, Pennsylvania, or any other 9/11
crash site''.
(e) Inclusion of Physical Harm Resulting From Debris Removal.--
Section 405(c) of such Act is amended in paragraph (2)(A)(ii), by
inserting ``or debris removal'' after ``air crash''.
(f) Limitations on Civil Actions.--
(1) Application to damages related to debris removal.--Clause
(i) of section 405(c)(3)(C) of such Act, as redesignated by
subsection (c), is amended by inserting ``, or for damages
arising from or related to debris removal'' after ``September
11, 2001''.
(2) Pending actions.--Clause (ii) of such section, as so
redesignated, is amended to read as follows:
``(ii) Pending actions.--In the case of an
individual who is a party to a civil action
described in clause (i), such individual may
not submit a claim under this title--
``(I) during the period described in
subsection (a)(3)(A) unless such
individual withdraws from such action
by the date that is 90 days after the
date on which regulations are
promulgated under section 407(a); and
``(II) during the period described in
subsection (a)(3)(B) unless such
individual withdraws from such action
by the date that is 90 days after the
date on which the regulations are
updated under section 407(b).''.
(3) Authority to reinstitute certain lawsuits.--Such section,
as so redesignated, is further amended by adding at the end the
following new clause:
``(iii) Authority to reinstitute certain
lawsuits.--In the case of a claimant who was a
party to a civil action described in clause
(i), who withdrew from such action pursuant to
clause (ii), and who is subsequently determined
to not be an eligible individual for purposes
of this subsection, such claimant may
reinstitute such action without prejudice
during the 90-day period beginning after the
date of such ineligibility determination.''.
SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.
Section 407 of the Air Transportation Safety and System Stabilization
Act (49 U.S.C. 40101 note) is amended--
(1) by striking ``Not later than'' and inserting ``(a) In
General.--Not later than''; and
(2) by adding at the end the following new subsection:
``(b) Updated Regulations.--Not later than 90 days after the date of
the enactment of the James Zadroga 9/11 Health and Compensation Act of
2008, the Special Master shall update the regulations promulgated under
subsection (a) to the extent necessary to comply with the provisions of
title II of such Act.''.
SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.
Section 408(a) of the Air Transportation Safety and System
Stabilization Act (49 U.S.C. 40101 note) is amended by adding at the
end the following new paragraphs:
``(4) Liability for certain claims.--
``(A) In general.--Notwithstanding any other
provision of law, subject to subparagraph (B),
liability for all claims and actions (including claims
or actions that have been previously resolved, that are
currently pending, and that may be filed through
December 22, 2031) for compensatory damages,
contribution or indemnity, or any other form or type of
relief, arising from or related to debris removal,
against New York City, any entity (including the Port
Authority of New York and New Jersey) with a property
interest in the World Trade Center on September 11,
2001 (whether fee simple, leasehold or easement, or
direct or indirect) and any contractors and
subcontractors thereof, shall not be in an amount that
exceeds the sum of the following:
``(i) The amount of funds of the WTC Captive
Insurance Company, including the cumulative
interest.
``(ii) The amount of all available insurance
identified in schedule 2 of the WTC Captive
Insurance Company insurance policy.
``(iii) The amount that is the greater of New
York City's insurance coverage or $350,000,000.
In determining the amount of the City's
insurance coverage for purposes of the previous
sentence, any amount described in clauses (i)
and (ii) shall not be included.
``(iv) The amount of all available liability
insurance coverage maintained by any entity,
including the Port Authority of New York and
New Jersey, with a property interest in the
World Trade Center, on September 11, 2001,
whether fee simple, leasehold or easement, or
direct or indirect.
``(v) The amount of all available liability
insurance coverage maintained by contractors
and subcontractors.
``(B) Exception.--Subparagraph (A) shall not apply to
claims or actions based upon conduct held to be
intentionally tortious in nature or to acts of gross
negligence or other such acts to the extent to which
punitive damages are awarded as a result of such
conduct or acts.
``(5) Priority of claims payments.--Payments to plaintiffs
who obtain a settlement or judgment with respect to a claim or
action to which paragraph (4)(A) applies, shall be paid solely
from the following funds in the following order:
``(A) The funds described in clause (i) or (ii) of
paragraph (4)(A).
``(B) If there are no funds available as described in
clause (i) or (ii) of paragraph (4)(A), the funds
described in clause (iii) of such paragraph.
``(C) If there are no funds available as described in
clause (i), (ii), or (iii) of paragraph (4)(A), the
funds described in clause (iv) of such paragraph.
``(D) If there are no funds available as described in
clause (i), (ii), (iii), or (iv) of paragraph (4)(A),
the funds described in clause (v) of such paragraph.
``(6) Declaratory judgment actions and direct action.--Any
party to a claim or action to which paragraph (4)(A) applies
may, with respect to such claim or action, either file an
action for a declaratory judgment for insurance coverage or
bring a direct action against the insurance company
involved.''.
Purpose and Summary
Title I of H.R. 847, the James Zadroga 9/11 Health and
Compensation Act of 2010, amends the Public Health Service Act
to provide monitoring and treatment services to individuals
with health conditions resulting from the September 11, 2001,
terrorist attacks at the World Trade Center (WTC), the
Pentagon, and Shanksville, Pennsylvania, including rescue
personnel, workers who participated in clean-up, and residents
and others present in the area near the World Trade Center.
Title II of H.R. 847 amends the Air Transportation Safety and
System Stabilization Act to reopen the September 11 Victim
Compensation Fund of 2001 to provide monetary compensation to
eligible individuals for physical harm resulting from the
terrorist attacks.
Background and Need for Legislation
THE TERRORIST ATTACKS OF SEPTEMBER 11, 2001
On September 11, 2001, terrorists flying four airplanes
attacked the United States. One plane flew into the Pentagon,
one crashed in a field in Shanksville, Pennsylvania, en route
to Washington, D.C., and two planes were crashed into the World
Trade Center Twin Towers in New York City.
The resulting collapse of the Twin Towers (and a third
building) killed more than 2,751 people, including 343
firefighters and rescue workers. It also produced ``a complex
and unprecedented mix of toxic chemicals.''\1\ Burning jet fuel
resulted in a plume of black smoke containing benzene, metals,
and polycyclic aromatic hydrocarbons. From the wreckage of the
Twin Towers arose an enormous dust cloud consisting of
pulverized cement, microscopic glass fibers and shards,
asbestos, lead, hydrochloric acid, polychlorinated biphenyls
(PCBs), organochlorine pesticides, furans, and dioxins. The
pulverized cement accounted for 60% to 65% of the total dust
mass, making it extremely caustic, with a pH between 9 and 11
similar to lye.\2\
---------------------------------------------------------------------------
\1\Testimony of Jacqueline Moline, M.D. M. Sc., Director, World
Trade Center Medical Monitoring and Treatment Program at Mount Sinai
School of Medicine, before the House Committee on Energy and Commerce
Subcommittee on Health, Hearing on H.R. 847 (Apr. 22, 2009).
\2\Landrigan et al., Health and Environmental Consequences of the
World Trade Center Disaster, Environ Health Perspect, pp. 731-739
(2004).
---------------------------------------------------------------------------
An estimated 60,000 to 70,000 first responders and
volunteers from all 50 states converged on the World Trade
Center site to help in the rescue and recovery and debris
removal and clean-up efforts. Some of these responders worked
at the site for days, weeks, and even months. Fires burned
above and below ground until December 2001. The debris removal
and cleanup continued until May 2002. During much of this time,
the air around the site remained toxic.
Exposure to the dust and toxic chemicals, and to the death
and devastation at the site, had long-term health effects on
the responders and on those who returned to the area around the
site to live and to work. The Subcommittee on Health heard
testimony from the Director of the World Trade Center Medical
Monitoring and Treatment Program at the Mount Sinai School of
Medicine that the following conditions were common among the
responders being treated there: sinus disorders, asthma,
gastro-esophageal reflux disorder, post-traumatic stress
disorder (PTSD), and major depression. A study recently
published in the New England Journal of Medicine reported that
firefighters and EMS workers who were at the World Trade Center
site during the first two weeks after the attacks lost about
10% of their lung function in the first year, and that this
loss persisted during the subsequent 6 years.\3\ This decrease
in ventilatory function is equivalent to 12 years of age-
related decline.\4\
---------------------------------------------------------------------------
\3\Aldrich et al., Lung Function in Rescue Workers at the World
Trade Center after 7 Years, New England Journal of Medicine (April 8,
2010), pp. 1263-1272.
\4\Banauch et al., Pulmonary Function after Exposure to the World
Trade Center in the New York City Fire Department, Am J Respir Crit
Care Med, pp. 312-319 (2006).
---------------------------------------------------------------------------
THE WORLD TRADE CENTER HEALTH PROGRAMS
The World Trade Center Health Programs provide medical
screening, monitoring, and treatment services for responders as
well as for non-responders who resided, worked, or went to
school in the community directly affected by the September 11,
2001, attacks. The programs are administered by the National
Institute for Occupational Safety and Health (NIOSH), an agency
of the Centers for Disease Control and Prevention (CDC) within
the Department of Health and Human Services (HHS). NIOSH
supports six clinical centers and two data coordination centers
as well as the WTC Health Registry. A total of $71 million is
appropriated in FY2010 to support these activities. The
President's budget requests $150 million in FY2011. Since
FY2003, a total of $326 million has been obligated for these
purposes.
There are three WTC Responder programs: a program operated
by the Fire Department of New York (FDNY); a consortium
coordinated by Mt. Sinai School of Medicine; and a national
program for responders outside of the New York City/New Jersey
metropolitan area managed by Logistics Health, Inc., under
contract to NIOSH. As of March 31, 2010, a total of 52,700
individuals were enrolled in the WTC Responders programs (about
4,500 of these were enrolled in the national program). During
the previous year, 24,100 of these enrolled responders received
monitoring exams, and 13,300 received treatment through five
clinical centers of excellence: Bellevue Hospital/New York
University School of Medicine; City University of New York/
Queens College; Mount Sinai School of Medicine; State
University of New York at Stony Brook; and the University of
Medicine and Dentistry of New Jersey/Robert Wood Johnson
Medical School. These clinical centers are supported by two
data and coordination centers: one located at the FDNY, the
other at Mt. Sinai. The Responder programs have been funded by
the federal government since FY2003; in FY2009, $104 million
was obligated for this purpose.
Federal funding for the WTC Community Program began in
September 2008. The program is operated by the New York City
Health and Hospitals Corporation through three locations:
Bellevue Hospital Center on the East Side of Manhattan;
Gouverneur Healthcare Services in Lower Manhattan; and Elmhurst
Hospital in Queens. About 4,600 individuals were enrolled in
the WTC Community Program as of March 31, 2010. Of these, 1,200
received monitoring exams and 2,600 received treatment during
the previous year. In FY2009, $10 million was obligated for the
Community Program.
In addition to providing initial screening, monitoring, and
treatment services, the WTC Health Programs have supported
research on the health effects of exposure to the toxic dust
cloud by rescue workers and others at the World Trade Center
site. This developing science is used to inform the treatment
of enrollees in the Responder and Community programs and is
posted on the NIOSH website.\5\ In addition, the New York City
Department of Health and Mental Hygiene established the WTC
Health Registry, which includes individuals at risk for
possible near and long term physical and mental health effects
from the attacks. Before it closed to new registrants in 2004,
the WTC Health Registry had enrolled more than 70,000
residents, workers, students, and responders. NIOSH funding
helps to support the Registry.
---------------------------------------------------------------------------
\5\http://www.cdc.gov/niosh/topics/wtc/SciSumAllByYear.html.
---------------------------------------------------------------------------
NEED FOR LEGISLATION
The WTC Health Programs currently funded by the federal
government are not authorized in statute. That is, there is no
legislation authorizing the appropriation of funds to NIOSH to
support these programs. The absence of such legislation has not
precluded--and should not preclude--the funding of these
programs. It is far preferable, however, for Congress to set
forth in an authorizing statute the purpose and scope of the
programs needed, the individuals intended to be assisted, and
the resources necessary. An authorizing statute can improve
accountability of the agency responsible for administering the
programs, transparency in operation, and stability of funding
over time.
In the case of the September 11, 2001, terrorist attacks,
the need for monitoring and treatment will not end this fiscal
year or anytime in the near future. The evidence from the
current WTC Health Program is overwhelming: many responders and
non-responders in the affected communities have developed
complex health conditions resulting from exposures at the sites
of the attacks that require specialized treatment, and more
health conditions requiring such treatment are likely to emerge
among these populations in the future.
The September 11, 2001, terrorist attacks at the Pentagon,
the World Trade Center, and Shanksville were an attack on this
nation. The Committee believes the federal government has a
moral obligation to ensure that those who participated in the
rescue and recovery and debris removal and clean-up operations
at these sites receive the services necessary to treat the
health conditions resulting from their participation. In the
case of the World Trade Center site, this obligation extends to
those who returned to the affected neighborhoods shortly after
the attack to live, work, and go to school and, as a result,
were exposed to the toxic dust.
To fulfill this moral obligation, the federal government
must make a long-term commitment to the monitoring and
treatment of health and mental health conditions resulting from
the terrorist attacks. The Committee bill represents that
commitment.
The bill would amend the Public Health Service Act to
establish a new World Trade Center Health Program to monitor
and treat the health conditions developed by responders and
community residents as the result of the September 11, 2001,
attacks. The new WTC Program, to be administered primarily by
NIOSH, would build upon and improve the existing WTC health
programs. The federal government would provide funding on a
mandatory basis over the next 10 years for 90% of the costs of
operating the new program. The remaining 10% of the costs of
the program would be the responsibility of New York City.
The federal government's contribution to the new program
would not be open-ended. Federal funds would be capped at the
lower of 90% of the costs or a specified amount each fiscal
year beginning in FY2011 and ending in FY2020. Over this 10-
year period, federal outlays for all aspects of the new
program--education and outreach, initial evaluation,
monitoring, treatment, data collection, and research--could not
exceed $4.59 billion. No federal funds would be available for
the program after FY2020. The bill prohibits the disbursement
of any federal funds for the program unless New York City has
entered into an enforceable contract with the WTC Program
Administrator in which it agrees to pay its share of program
costs on a timely basis.
The bill contains a number of provisions designed to ensure
that federal funds committed to the WTC Program are spent
efficiently and effectively. Payment may not be made for
treatment services unless they are medically necessary as
determined under regulations issued by the WTC Program
Administrator. In addition, treatment services must be
consistent with protocols developed by the Data Centers and
approved by the Administrator. Monitoring services must also be
consistent with protocols approved by the Administrator in
order to qualify for payment. The bill also authorizes the WTC
Program Administrator, based on utilization and quality data
furnished by the Clinical Centers of Excellence, to modify
amounts and methodologies for payments to providers in order to
improve quality and efficient delivery of services. To ensure
accountability, the bill directs the Inspector General of HHS
to review the program's expenditures to detect fraudulent or
duplicate billing, payment for inappropriate services, or
unreasonable administrative costs.
Finally, the bill strengthens the federal government's
commitment to uniform data collection through Data Centers
designated by the Program Administrator, epidemiological
surveillance through the WTC Registry, and ongoing research
into health conditions that may be related to exposures to the
toxic dust at the World Trade Center site. The bill sets aside
mandatory funding, up to specified amounts, for these
activities for each fiscal year through FY2020. This clinical
and epidemiological data, and the research on WTC-related
health conditions, will provide information about medical
trends, patterns of disease, outcomes, and efficacy of
treatments essential to improving the treatment of responders
and survivors and their health outcomes.
The September 11, 2001, attacks at the Pentagon and
Shanksville, Pennsylvania sites have been less well documented
than the World Trade Center site. The Office of the Secretary
of Defense estimates that there were less than 1,000 responders
in the first few days following the attack at the Pentagon site
and approximately 3,500 individuals who participated in the
cleanup of that site in the year after it occurred.
Legislative History
On February 4, 2009, Reps. Carolyn B. Maloney (D-NY) and
Jerrold Nadler (D-NY) and other members of the New York
delegation introduced H.R. 847, the ``James Zadroga 9/11 Health
and Compensation Act of 2009''. The bill was referred to the
Committee on Energy and Commerce, and in addition to the
Committee on the Judiciary, for a period to be subsequently
determined by the Speaker. H.R. 847 is a revision of H.R. 7174,
the bill from the 110th Congress that was introduced on
September 27, 2008.
H.R. 847 was referred to the Subcommittee on Health on
February 9, 2010, and a legislative hearing on the bill was
held April 22, 2009. Testimony was heard from sponsors of the
legislation; a construction worker who volunteered to help with
debris removal in the immediate aftermath of the attack on the
World Trade Center; the Directors of the WTC Environmental
Health Center at Bellevue Hospital and the WTC Medical
Monitoring and Treatment Center at Mt. Sinai Medical School;
and a representative from the City of New York.
Committee Consideration
On March 16, 2010, the Subcommittee on Health met in open
markup session to consider H.R. 847. Subcommittee Chairman
Pallone offered a manager's amendment in the form of an
amendment in the nature of a substitute, which was approved by
a voice vote. Subsequently, the Subcommittee approved a motion
to forward H.R. 847, amended, favorably to the full Committee
by a roll call vote: 25-8.
On May 25, 2010, the Committee on Energy and Commerce met
in open markup session to consider H.R. 847 as approved by the
Subcommittee on Health. Chairman Waxman offered a manager's
amendment in the form of an amendment in the nature of a
substitute. The Committee agreed to four amendments offered to
the substitute amendment. The Committee adopted the Waxman
manager's amendment, as amended, by a voice vote. Subsequently,
the Committee ordered H.R. 847 favorably reported to the House,
amended, by a roll call vote: 33-12.
Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list each record vote
on the motion to report legislation and amendments thereto. A
motion by Mr. Waxman to order H.R. 847 favorably reported to
the House, amended, was approved by a record vote of 33 yeas
and 12 nays. The following is the record vote taken during
Committee consideration, including the names of those members
voting for and against:
Committee Oversight Findings and Recommendations
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the findings and
recommendations of the Committee are reflected in the
descriptive portions of this report.
New Budget Authority, Entitlement Authority, and Tax Expenditures
Regarding compliance with clause 3(c)(2) of rule XIII of
the Rules of the House of Representatives, the Committee adopts
as its own the estimate prepared by the Director of the
Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
Statement of General Performance Goals and Objectives
In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the performance goals and
objectives of H.R. 847 are reflected in the descriptive
portions of this report.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds that the
constitutional authority for H.R. 847 is provided in Article I,
section 8, clauses 1, 3, and 18 of the Constitution of the
United States.
Earmarks and Tax and Tariff Benefits
H.R. 847 does not contain any congressional earmarks,
limited tax benefits, or limited tariff benefits as defined in
clause 9 of rule XXI of the Rules of the House of
Representatives.
Advisory Committee Statement
The Committee finds that the legislation establishes or
authorizes the establishment of an advisory committee within
the meaning of section 5 U.S.C. App., 5(b) of the Federal
Advisory Committee Act. Title I of H.R. 847 provides for the
creation of the WTC Health Program Scientific Technical
Advisory Committee to review scientific and medical evidence
and make recommendations to the Administrator of the WTC Health
Program. The Committee finds that this Advisory Committee is
needed to assist the Administrator in evaluating WTC Program
eligibility criteria and whether there are additional WTC-
related health conditions.
Applicability of Law to the Legislative Branch
The Committee finds that Title I of H.R. 847 does not
relate to the terms and conditions of employment or access to
public services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act of 1985.
Federal Mandates Statement
The Committee adopts as its own the estimates of federal
mandates relating to Title I of H.R. 847 prepared by the
Director of the Congressional Budget Office pursuant to section
423 of the Unfunded Mandate Reform Act.
Committee Cost Estimate
Pursuant to clause 3(d) of rule XIII of the Rules of the
House of Representatives, the Committee adopts as its own the
cost estimate of Title I of H.R. 847 prepared by the Director
of the Congressional Budget Office pursuant to section 402 of
the Congressional Budget Act.
Congressional Budget Office Estimate
Pursuant to clause 3(c)(3) of rule XIII of the Rules of the
House of Representatives, the following is the cost estimate on
H.R. 847 provided by the Congressional Budget Office pursuant
to section 402 of the Congressional Budget Act of 1974:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 25, 2010.
Hon. Henry A. Waxman,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 847, the James
Zadroga 9/11 Health and Compensation Act of 2010. As you
requested, CBO has completed an estimate that reflects Title I
of the bill as ordered reported by the Committee on Energy and
Commerce and Title II as ordered reported by the Committee on
the Judiciary.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Stephanie
Cameron (Title I), and Leigh Angres (Title II).
Sincerely,
Robert A. Sunshine
(For Douglas W. Elmendorf, Director).
Enclosure.
H.R. 847--James Zadroga 9/11 Health and Compensation Act of 2010
Summary: H.R. 847 would establish the World Trade Center
(WTC) Health Program and extend and expand eligibility for
compensation under the September 11th Victim Compensation Fund
(VCF) of 2001. Specifically, H.R. 847 would provide:
Health care benefits for eligible emergency
personnel who responded to the September 11, 2001,
terrorist attacks (the terrorist attacks) in New York
City, the Pentagon, and Shanksville, Pennsylvania, and
for workers who participated in recovery and cleanup
following the attacks (collectively referred to as
responders in this estimate);
Health care benefits for eligible residents
and others present in the area of New York City near
the World Trade Center (defined as survivors under the
bill); and
Monetary compensation to individuals
eligible under the bill to submit claims for death and
physical injury claims resulting from the attacks.
CBO estimates that enacting H.R. 847 would increase direct
spending by $7.2 billion over the 2011-2015 period and $10.5
billion over the 2011-2020 period. Pay-as-you-go procedures
apply because enacting the legislation would affect direct
spending.
In addition, we estimate that, subject to appropriation of
the necessary amounts, administering the VCF awards process
would cost $514 million over the next 10 years. However,
assuming appropriation actions consistent with title I of the
bill, CBO estimates a $688 million reduction in discretionary
outlays over the 2011-2020 period because some spending that is
currently funded by annual appropriations would become direct
spending under the bill. On balance, CBO estimates that
discretionary spending would decrease by $174 million over 10
years.
H.R. 847 contains no intergovernmental mandates as defined
in the Unfunded Mandates Reform Act (UMRA).
H.R. 847 would impose a private-sector mandate as defined
in UMRA. The bill would impose a mandate on individuals seeking
compensatory damages or other relief arising from or related to
debris removal from sites of the terrorist attacks by limiting
the liability of entities from which individuals might win
compensation. CBO cannot determine whether the aggregate cost
of complying with that mandate would exceed the threshold
established by UMRA for private-sector mandates in 2011 ($141
million in 2010, adjusted annually for inflation).
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 847 is shown in the following table.
The costs of this legislation fall within budget functions 550
(health), 570 (Medicare), and 750 (administration of justice).
Basis of estimate: For this estimate, CBO assumes that H.R.
847 will be enacted by the end of fiscal year 2010. H.R. 847
would provide health benefits and compensation to those who
qualify based on a combination of factors, including where they
were exposed to hazardous conditions following the terrorist
attacks, and their current and expected future health
conditions. CBO's estimate is based on an analysis of the size
of the potentially affected populations, the prevalence of
certain health conditions in those populations, the propensity
to seek health services or compensation from the program, and
the monetary damages previously awarded by the VCF through
2004.
Under H.R. 847, spending for the WTC Health Program and VCF
awards would increase direct spending, while the administrative
costs associated with the VCF would be subject to future
appropriations. Expenditures related to the WTC Health Program
would be subject to annual spending caps totaling about $4.6
billion through 2020, when the program would sunset. Award
payments under the VCF would be subject to a lifetime spending
cap of $8.4 billion through 2032, when the program would cease
operation.
ESTIMATED BUDGETARY EFFECTS OF H.R. 847, THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-----------------------------------------------------------------------------------------------------
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2011-2015 2011-2020
--------------------------------------------------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Title I: World Trade Center Health Program
WTC Health Program:
Estimated Budget Authority.................... 70 318 349 380 424 469 521 578 639 706 1,541 4,454
Estimated Outlays............................. 63 306 345 376 418 464 515 571 632 698 1,508 4,388
Medicare and Medicaid:
Estimated Budget Authority.................... 0 -5 -10 -10 -10 -20 -20 -30 -40 -40 -35 -185
Estimated Outlays............................. 0 -5 -10 -10 -10 -20 -20 -30 -40 -40 -35 -185
Subtotal, Title I:
Estimated Budget Authority.................... 70 313 339 370 414 449 501 548 599 666 1,506 4,269
Estimated Outlays............................. 63 301 335 366 408 444 495 541 592 658 1,473 4,203
Title II: September 11th Victim Compensation Fund
Estimated Budget Authority.................... 500 1,000 3,500 500 200 150 150 100 100 100 5,700 6,300
Estimated Outlays............................. 450 950 3,250 800 230 155 150 105 100 100 5,680 6,290
Total Changes in Direct Spending: Titles I and II
Estimated Budget Authority.................... 570 1,313 3,839 870 614 599 651 648 699 766 7,206 10,569
Estimated Outlays............................. 513 1,251 3,585 1,166 638 599 645 646 692 763 7,153 10,498
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
Administration of the September 11th Victim
Compensation Fund:
Estimated Authorization Level................. 75 100 200 100 10 10 5 5 5 5 485 515
Estimated Outlays............................. 56 94 175 125 33 10 6 5 5 5 483 514
Appropriation for NIOSH World Trade Center Health
Program:
Estimated Authorization Level................. -71 -72 -73 -74 -75 -77 -78 -80 -81 -83 -365 -764
Estimated Outlays............................. -26 -60 -69 -71 -73 -75 -76 -78 -79 -81 -299 -688
Total Changes in Discretionary Spending
Estimated Authorization Level................. 4 28 127 26 -65 -67 -73 -75 -76 -78 120 -249
Estimated Outlays............................. 30 34 106 54 -40 -65 70 -73 -74 -76 184 -174
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: NIOSH = National Institute of Occupational Safety and Health.
On June 10, 2010, a federal district court judge approved a
settlement between firefighters, police, contractors, and
others who worked at the World Trade Center site, and New York
City and its contractors for claims of injuries associated with
their rescue and cleanup work. To become final, the settlement
requires the participation of 95 percent of the plaintiffs, who
have yet to agree to the terms. Should that settlement become
final, CBO expects that the number and value of compensation
awards provided through the VCF would be lower than presented
in this cost estimate for H.R. 847.
Eligible Population
CBO's analysis focused on two populations--responders and
survivors. The responder population includes those who were
involved in the rescue, recovery, and cleanup efforts following
the terrorist attacks in 2001. Survivors include commuters,
residents, ``passers-by,'' and students who were in the New
York City (NYC) disaster area around the time of the attacks
and in the months following. Under H.R. 847, CBO estimates that
roughly 650,000 individuals from the NYC disaster area--
approximately 75,000 responders and 575,000 survivors--would
meet the exposure requirements specified in the legislation,
along with potentially another 10,000 responders from the
Pentagon and Shanksville, Pennsylvania, sites. Although many of
those individuals may have or develop health conditions related
to the terrorist attacks, CBO estimates that only a portion
would participate in the WTC Health Program and apply for an
award under the VCF. Overall, CBO expects that of the total
population that meets the exposure requirements, slightly less
than 15 percent would enroll in the WTC Health Program by 2020
and slightly more than 5 percent would receive awards from the
VCF. Those estimated participation rates reflect people's
willingness to enroll in government programs as well as
additional requirements that would have to be met to receive a
VCF award.
Geographic and Time-Period Requirements. Title I specifies
that individuals must have been present in the following
locations following the terrorist attacks to be eligible for
the new health program: NYC disaster area, the Pentagon site,
and the Shanksville, Pennsylvania, site. Title II would give
discretion to the VCF Special Master (appointed by the U.S.
Attorney General to administer the fund) to define the
geographic area for awards from that fund; for this estimate,
CBO assumes that the geographic areas of exposure specified in
title I would also be used as the criteria for compensation
payments under title II. Title I defines the NYC disaster area
as the part of Manhattan that is south of Houston Street and
any block in Brooklyn that is wholly or partially contained
within a 1.5-mile radius of the former World Trade Center site.
H.R. 847 would also base eligibility on the amount of time an
individual spent in the specified region. Based on those
requirements, CBO estimates that about 75,000 responders and
575,000 survivors from the NYC disaster area would meet the
geographic-eligibility and time-period requirements specified
in H.R. 847, as well as potentially another 10,000 responders
from the Pentagon and Shanksville, Pensylvania, sites.
Those estimates are based on information collected by
certain hospitals (known as the Centers of Excellence) in the
NYC area that are treating responders, New York City's
Department of Health and Mental Hygiene, the U.S. Department of
Health and Human Services, Research Triangle International, and
New York State Laborers' Tri-Fund. In particular, CBO's
analysis relies heavily on the WTC Health Registry which was
developed by New York City's Department of Health and Mental
Hygiene and the U.S. Department of Health and Human Services
(HHS) to document and evaluate the short- and long-term
physical and mental health issues associated with the terrorist
attacks and recovery efforts. The Registry established
eligibility criteria that considered an individual's residence,
location at the time of attacks, and intensity and duration of
exposure to hazardous conditions. About 71,000 individuals
enrolled voluntarily in this Registry before it closed in
November 2004.
Diseases. The bill would require a determination that the
terrorist attacks were substantially likely to be a significant
factor in aggravating, contributing to, or causing the
condition or illness prior to receiving treatment through the
WTC Health Program. Title I would specify certain physical and
mental health conditions deemed WTC-related for both responders
and survivors. Title II would give discretion to the Special
Master to determine what physical conditions would be eligible
for an award; for this estimate, CBO assumes that the diseases
specified in title I would also be used as criteria for
compensation payments.
In general, individuals whose health conditions developed
or were aggravated as a result of the terrorist attacks cannot
easily be distinguished from individuals whose conditions would
have developed or worsened in the absence of those attacks.
Therefore, CBO considered the entire population that may
develop and seek treatment for eligible physical and mental
health conditions that might be associated with the aftermath
of the terrorist attacks. The existence of a causal
relationship between the attacks and specific diseases
generally would be difficult to establish or disprove.
CBO analyzed more than a dozen studies on the incidence and
prevalence of the WTC-related health conditions in both
responders and survivors. We also analyzed data collected in
the Morbidity and Mortality Weekly Report (MMWR) and population
level data collected by the Medical Expenditure Panel Survey
(MEPS). The MEPS collects annual data pertaining to the use of
health care services, sources of payment for those services,
and health insurance coverage. Based on those analyses, CBO
estimates that about 280,000 of the individuals (about 40
percent) who meet the exposure criteria defined in the
legislation have or will develop a health condition that meets
the criteria set in the bill.
Responders who meet the geographic-eligibility criteria and
survivors who both meet the geographic-eligibility criteria and
develop a qualifying physical or mental health condition, as
defined in the bill, would be eligible to enroll in the WTC
Health Program.
CBO estimates that about 50,000 responders and 230,000
survivors would develop at least one qualifying physical or
mental health condition. That estimate reflects the prevalence
of the eligible conditions among the general population as well
as the increase in prevalence attributable to the attacks
themselves.
Eligibility for an award under the VCF would differ from
that for the WTC Health Program. The VCF would only compensate
individuals with physical health conditions who have received
treatment. CBO estimates that about 100,000 responders and
survivors would meet those criteria.
Direct Spending
CBO estimates that enacting H.R. 847 would increase direct
spending by $10.5 billion over the 2011-2020 period. About $4.2
billion of that amount would result from spending for health
care benefits provided under title I. The remaining $6.3
billion would be spent on compensation payments provided under
title II.
Title I: Health Care Benefits. Under current law, the
National Institute of Occupational Safety and Health (NIOSH)
provides funding to several programs that offer medical
monitoring and treatment to responders and survivors with
conditions associated with the September 11, 2001, terrorist
attacks under the umbrella of the WTC Medical Monitoring and
Treatment Program. Those programs treat or have enrolled
approximately 60,000 individuals: about 40,000 in the Mt. Sinai
Coordinated Consortium Responder Health Program and the
National Responder Program; about 16,000 in the Fire Department
City of New York Responder Health Program; and about 4,600
survivors in the WTC Environmental Health Center Program.
Funding for those programs is subject to annual appropriation.
For 2010, $70 million was appropriated to NIOSH through the
Centers for Disease Control and Prevention (CDC) to support
those programs.
H.R. 847 would establish the WTC Health Program within HHS
to replace and expand the NIOSH programs. The WTC Health
Program would provide monitoring and treatment benefits for
qualifying health conditions to individuals who were engaged in
emergency response, recovery, and cleanup operations related to
the terrorist attacks. It also would provide monitoring and
treatment benefits to certain residents and others with a
qualifying health condition who were working, visiting, or
residing near the WTC during the year following the attacks.
H.R. 847 would replace annual appropriations for the NIOSH
programs with mandatory funding for the WTC Health Program. (An
estimated reduction in authorized discretionary spending is
discussed below under ``Spending Subject to Appropriation.'')
CBO estimates that, if unconstrained, the WTC Health
Program would cost between $5 billion and $6 billion over the
2011-2020 period. In contrast, the cap on federal spending
specified in H.R. 847 is about $4.6 billion over that same
period. Taking that spending cap into consideration, CBO
estimates that gross spending would total $4.4 billion over the
2011-2020 period. The WTC Health Program also would result in
some savings for Medicare and Medicaid, yielding a net increase
in direct spending of $4.2 billion over the 2011-2020 period,
as shown in the table on page 3. CBO also estimates that New
York City would contribute $0.5 billion to the WTC Health
Program over the 2011-2020 period.
Program Participation. The WTC Health Program would cover
individuals enrolled in the existing programs as of the date of
enactment and would allow up to an additional 25,000 responders
and 25,000 survivors to enroll in the program. H.R. 847 defines
exposure and health criteria for an eligible WTC responder and
an eligible WTC survivor. The program's administrator would be
allowed to expand those eligibility criteria until 80 percent
of the numerical limitation is reached.
CBO estimates that about 65,000 of the approximately 85,000
responders at the various sites who would meet the exposure
criteria would enroll in the WTC Health Program and that about
20 percent of those enrollees would receive treatment through
the program in a given year. We estimate that about 250,000
individuals, or roughly 40 percent of the approximately 575,000
survivors who would meet those criteria, would also meet the
health condition criteria specified in title I of H.R. 847. CBO
expects that less than 10 percent of those individuals would
enroll in the WTC Health Program by 2020. In part, this
estimate reflects the expectation that most individuals will
continue to receive care from providers who are not affiliated
with a Center of Excellence or the WTC Health Program. CBO
further expects that, in a given year, slightly less than half
of the enrolled survivors would receive treatment through the
WTC Health Program.
Survivor and Responder Health Benefits. H.R. 847 would
provide for health benefits, including monitoring and medically
necessary follow-up treatment for enrolled responders.
Survivors would receive an initial health evaluation to
determine program eligibility. Once eligibility is determined,
H.R. 847 would provide for monitoring and medically necessary
follow-up treatment for survivors. Monitoring, initial health
evaluations, and medically necessary follow-up would only be
covered when provided by Centers of Excellence or by providers
who participate in the nationwide network established by the
WTC program administrator. The WTC Health Program would also
provide funding for coordination and administrative expenses
for the Centers of Excellence. CBO estimates that the cost of
the health benefits program (including initial health
evaluations, monitoring, treatment, and administration) would
total up to $4.5 billion over the 2011-2020 period. That amount
comprises about $4.2 billion for monitoring and medically
necessary treatment and $0.3 billion for administrative costs.
The WTC Health Program would pay for the monitoring and
medically necessary treatment costs associated with a
qualifying health condition that are not covered by a patient's
primary insurer, including deductibles, copayments,
coinsurance, and other cost-sharing requirements. (As a
practical matter, the WTC Health Program would be the primary
insurer for individuals covered by Medicare.) H.R. 847
specifies a series of WTC-related health conditions; however,
H.R. 847 would authorize the administrator to approve
conditions and illnesses not specified in the legislation but
deemed to be a WTC-related health condition for treatment. The
administrator could also add illnesses and conditions to the
list of WTC-related health conditions through the rulemaking
process, which might include requesting a recommendation of the
Advisory Panel. In addition, for an individual, a condition not
on the list would be deemed to be WTC-related if a physician
determines that it was likely to have been caused or aggravated
by exposure to the terrorist attacks.
CBO estimated the cost of treatment for WTC-related health
conditions using data from MEPS, Medicare, and the Federal
Employees Compensation Act (FECA) program. CBO analyzed MEPS
data to estimate the national average cost of treating
qualifying conditions. Those costs were then adjusted to
reflect the relative costs in New York City--spending per
Medicare enrollee is about 20 percent higher in New York City
than the national average--and to account for differences
between payment rates in the FECA program and those underlying
our estimate of national average cost. Those costs were then
projected based on CBO's estimates of growth in per capita
health spending. The administrator would be required to
establish a program for necessary outpatient prescription
pharmaceuticals prescribed under this title through contracts
with one or more vendors. Separately, CBO estimated the cost of
outpatient prescription drugs and assumed that those payment
amounts would be comparable to prices paid in the private
market.
The WTC Health Program would be the secondary payer for
survivors with private insurance or Medicaid coverage and for
responders receiving benefits from a non-NYC worker's
compensation or other work-related injury or illness benefit
plan. For those individuals, the program would pay the
difference between FECA payment rates and the amounts paid by
the primary insurer; the individual would have no out-of-pocket
obligation.\1\ CBO estimates that primary insurers would cover
about 60 percent of the cost of treating WTC-related health
conditions for those individuals, with the WTC Health Program
paying the rest.
---------------------------------------------------------------------------
\1\For responders employed by New York City, all WTC-related
conditions would be considered work-related. The legislation would
relieve the city's worker's compensation program or other work-related
injury or illness benefit plan of the obligation to pay for those
conditions in return for the city's participation in the financing of
the WTC Health Program.
---------------------------------------------------------------------------
CBO estimates that federal spending for Medicaid would be
reduced by about $30 million over the 2011-2020 period. Those
savings would occur largely because, in some cases, providers
would bill the WTC Health Program instead of Medicaid to avoid
the administrative cost of dealing with two payers.
The WTC Health Program would reduce Medicare spending
because it would replace Medicare as the primary payer for
individuals enrolled in Medicare. CBO estimates that Medicare
savings would total about $155 million over the 2011-2020
period.
CBO estimates that costs incurred to administer health
evaluations, monitor, and provide treatment would total up to
$0.3 billion over the 2011-2020 period. H.R. 847 would direct
the administrator to enter into contracts with Clinical Centers
of Excellence to provide monitoring and treatment benefits and
initial health evaluations, counseling, outreach, translational
and interpretive services, and to collect and report on
utilization, incidence, and prevalence data.
Other Health Benefits and Program Funding. H.R. 847 would
provide funding for:
Mental health benefits for surviving family
members of responders who died at the WTC site on
September 11, 2001;
Creation of a scientific committee and
technical advisory committee;
Education and outreach;
Uniform data collection;
Research pertaining to conditions related to
the September 11, 2001, terrorist attacks; and
Maintaining ongoing data collection through
the WTC health registry.
The bill specifies a maximum amount for each of those
activities. CBO estimates that the costs of those activities
would total up to $0.5 billion over the 2011-2020 period. In
addition, H.R. 847 would provide funding for training and
technical assistance, transportation expenses, and claims
processing. CBO estimates that the costs of those activities
would total an additional $0.2 billion over the 2011-2020
period. Thus, the total cost of other activities would total up
to $0.7 billion over the 2011-2020 period.
World Trade Center Health Program Fund. H.R. 847 would
establish the WTC Health Program Fund to pay for the benefits
included under title I. New York City and the federal
government would contribute to the fund based on percentages
and amounts provided in the legislation.
The legislation would authorize implementation of the WTC
Health Program only if New York City enters into a contract
with the WTC program administrator in which the city agrees to
pay 10 percent of program costs. This estimate assumes that the
city would enter into that contract and that the city would
reimburse the WTC Health Program within six to nine months.
(Alternatively, if the city would not enter into a contract
with the administrator, CBO expects that no payments would be
made from the WTC Health Program Fund, resulting in no increase
in direct spending over the 2011-2020 period.)
The federal government would be required to contribute the
lesser of 90 percent of the program expenditures or an annual
amount specified in the legislation. That cap on federal
spending would rise from $71 million in 2011 to $743 million in
2020 and would total about $4.6 billion over the 2011-2020
period.
In the absence of a cap, CBO estimates that the federal
share of annual expenditures for the WTC Health Program would
probably be about 1 percent to 5 percent higher than the annual
caps. However, CBO's cost estimate targets the midpoint of a
distribution of likely spending outcomes. Establishing a cap on
annual spending truncates that distribution of likely outcomes
by eliminating the potential for spending above the cap.
Therefore, the middle of the truncated range of likely spending
outcomes would be slightly below the cap. As a result, CBO
estimates that federal spending would total about $4.4 billion
over the 2011-2020 period.
H.R. 847 would require New York City to cover 10 percent of
the expenditures for carrying out title I. If the city pays its
share, the WTC Health Program would assume responsibility for
treatment costs for responders that would under current law be
the responsibility of the city's worker's compensation or other
work-related injury or illness benefit plan. Late payments from
the city would accrue interest on the unpaid amount. For the
purpose of our estimate, we assume that New York City would
make payments on time. If the city fails to pay pursuant to its
contract with the administrator and interest accrues on the
unpaid amount, the federal expenditures would reach the cap
more quickly.
CBO estimates that the city of New York would contribute
about $0.5 billion over the 2011-2020 period.
Title II: Compensation Payments. Title II would reopen the
September 11, 2001, Victim Compensation Fund, which provided
compensation to any individual (or relatives of a deceased
individual) who was physically injured or killed as a result of
the terrorist attacks. The VCF, which terminated operations in
2004, was established by the Air Transportation Safety and
System Stabilization Act (Public Law 107-42) as an
administrative alternative to litigation. That act created a
Special Master, who determined the compensation levels based on
specified eligibility criteria and subsequent regulations.
Through 2004, the VCF made 2,880 death and 2,680 injury awards,
totaling more than $7 billion (about $6 billion was for death
awards). Public Law 107-42 did not cap the number or amount of
awards that could be issued by the Special Master.
H.R. 847 would establish broader eligibility rules for
compensation than those established for the VCF under Public
Law 107-42. Under the bill, total payments would be capped at
$8.4 billion through 2032. CBO estimates that compensation
payments would total $6.3 billion over the 2011-2020 period,
with about 90 percent ($5.7 billion) of those payments made in
the first five years following enactment. Most of the awards
would be for physical injuries associated with the attacks or
with debris removal and response activities following the
attacks. CBO estimates that the VCF would make additional
payments totalling about $300 million after 2020.
CBO's estimate of those payments is based on a number of
assumptions and projections regarding eligibility, average
award amounts, and attorneys' fees.
Changes in Eligibility. Title II would make many more
individuals who were involved in the rescue, recovery, and
cleanup efforts potentially eligible for compensation. Based on
information provided by the previous Special Master of the VCF,
CBO assumes that the VCF would be administered in the same
manner as it was previously but would reflect new regulations
written after the bill's enactment. Those regulations would
reflect the following changes made by the bill:
Time Present at Site: Eligibility would be
determined in part based on the time an individual was present
or near the sites of the terrorist attacks. Specifically, the
bill would require that an eligible individual must have been
at those sites some time during the period beginning on
September 11, 2001, and ending on August 30, 2002. Prior to the
sunset of the original VCF, the implementing regulations
required that an individual had to have been present at those
sites during the 12 hours immediately following the attacks, or
for responders, 96 hours after the attacks.
Geographical Expansion: Based on regulations
promulgated under Public Law 107-42, the Special Master
originally defined the crash site as a zone bounded by specific
streets very close to the WTC area. H.R. 847 would expand the
definition of the crash site to include routes related to
debris removal (such as barges and landfills). Although the
bill does not specify other changes to the site definition, the
Special Master would have discretion to expand the site if it
is determined that there was demonstrable risk of physical harm
in adjacent areas. For this estimate, CBO assumes that the new
regulations would extend the boundaries to be the same as those
defined for eligibility for the health care benefits authorized
in title I of the bill.
Extended Claims Filing Deadlines: Generally, the
filing deadline under the bill would depend primarily on when
the Special Master determines that a claimant realizes that he
or she suffered some form of physical harm resulting from the
terrorist attacks or associated debris removal. If the Special
Master determines that a claimant was aware (or should have
been aware) of such an injury by the time the regulations are
promulgated, the claimant would have two years to file from
that time (roughly by the end of December 2012). For all
others, if a claimant realizes such an injury after the new
regulations are finalized, the claimant would have two years
from when the Special Master determines that the claimant
should have been aware of such injury. All claims would have to
be filed by December 22, 2031.
Awards and Average Award Amount. CBO expects that the
bill's expanded eligibility criteria would significantly
increase the number of individuals who could seek compensation
from the VCF. CBO expects that most of the awards would be for
injuries associated with the attacks, and therefore our
analysis focused on those claims. Further, the bill would not
provide compensation for mental health conditions although it
would provide treatment for mental illnesses under title I.
Over the next 10 years, CBO estimates that about 35,000 awards
would be made, with an average award amount of about $180,000.
Number of Awards: CBO expects that the number of
awards would depend largely on the estimated number of
responders and survivors who have or will have health
conditions or symptoms associated with the terrorist attacks
and recovery efforts, and are being treated for such
conditions. Under H.R. 847, the VCF would require that all
claimants prove they were treated by medical professionals and
provide contemporaneous medical records to verify that
treatment. CBO estimates that about 100,000 individuals--nearly
25,000 responders and more than 75,000 survivors--would meet
that additional eligibility requirement.
CBO estimated the proportion of those individuals who would
file a claim by reviewing studies on the propensity of
individuals to seek legal remedy for injuries. Although CBO
estimates that the overall claim rate would be a bit under 50
percent, we expect that responders would have a much higher
filing rate than survivors because of their involvement in the
existing treatment programs at the Centers of Excellence and
because of the efforts by certain union organizations to
publicize the possible health issues associated with the
cleanup efforts.
Taking into account the VCF's previous approval rate and
the approval rates of other compensation programs, CBO
estimates that about 35,000 awards would be made, including
payments to nearly 20,000 responders and 15,000 survivors. CBO
expects that the number of death claims would be very small
because there is little evidence that many individuals have
died from injuries caused by the 2001 terrorist attacks after
compensation benefits were first awarded.
Average Award Amount: Under the bill, award
amounts would be determined in the same way as they were before
the sunset of the original VCF. Awards would comprise two
parts--economic and noneconomic loss--adjusted for collateral
offsets such as pensions. For injury victims, economic loss
would reflect the actual lost income or expenses incurred as a
direct result of the injury and future lost income and costs
due to those injuries. Noneconomic loss would reflect
compensation for pain and suffering due to injuries associated
with the attacks. Awards, which would be provided in one
payment, would be determined within 120 days of filing the
claim and paid within 20 days of such determination.
Based on information provided by administrators of the
previous VCF program, CBO estimates that the average injury
award would be about $180,000. (For death claims, the average
award would be about $2 million, the same amount provided under
the original VCF.) CBO estimated the average injury award by
considering the characteristics of the current population
enrolled in WTC Medical Monitoring and Treatment Programs,
including average age, extent of disability, estimated income,
and employer-provided benefits such as pensions and health
insurance. CBO estimates that the average award would be higher
for responders--about $240,000 per claim--because we expect
that a greater proportion of responders have more serious
injuries. In contrast, we estimate that awards for survivors
would average about $100,000. The award estimates also were
adjusted to account for certain health care benefits provided
under title I.
Attorneys' Fees. This estimate does not include any
significant additional costs for attorneys' compensation that
the Special Master could award under the bill. The bill would
give the Special Master discretion to provide compensation to
attorneys for services rendered on cases filed in district
court for injuries associated with the terrorist attacks, but
CBO expects that this authority would be used sparingly, based
on the historical experience of the VCF. Previously, attorneys
provided free legal assistance to claimants.
Spending subject to appropriation
CBO estimates that implementing H.R. 847 would decrease
discretionary spending by $174 million over the 2011-2020
period.
Administering VCF Awards. Under H.R. 847, additional
funding would be required to administer the VCF. The original
compensation program was administered by the Department of
Justice's (DOJ's) Civil Division. About $87 million was spent
to process about 7,400 claims, and the average administrative
cost per claim was about $11,500. Under the bill, CBO assumes
that DOJ would again administer and oversee the program.
Based on information provided by DOJ, CBO estimates that
the average cost to process a claim under H.R. 847 would be
about $10,000. CBO expects that the average cost would be lower
than under the original program because the administrative
infrastructure already exists and because we assume that
certain efficiencies would be achieved with a larger number of
claims. In total, CBO estimates that, assuming appropriation of
the necessary amounts, administrative costs for the program
would total $483 million over 2011-2015 period and $514 million
over the 2011-2020 period to process an estimated 50,000
claims, including many from individuals who would not qualify
for an award. Most of that amount would be for salaries of
hundreds of individuals to process millions of documents,
operate a claims management system, and manage 20 to 30 claims-
assistance sites around the country. Compensation also would be
provided for DOJ attorneys, administrative law judges, and
support staff.
NIOSH World Trade Center Health Program. As discussed
above, the enactment of H.R. 847 would replace annual
appropriations with mandatory funding for NIOSH through CDC.
Under the current-law baseline, CBO projects that discretionary
appropriations will continue at the current level of funding
adjusted annually for anticipated inflation. Assuming
appropriation actions consistent with the bill, CBO estimates
that appropriations for NIOSH would be reduced by $71 million
in 2011 and increasing amounts in subsequent years because that
baseline spending would be replaced by new direct spending
under H.R. 847. We estimate that the reduction in
appropriations would total $764 million over the 2011-2020
period, resulting in a corresponding reduction in outlays of
$688 million over the same period.
Pay-As-You-Go considerations: The Statutory Pay-As-You-Go
Act of 2010 establishes budget reporting and enforcement
procedures for legislation affecting direct spending or
revenues. The net changes in outlays that are subject to those
pay-as-you-go procedures are shown in the following table.
CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR TITLE I OF H.R. 847 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON MAY 25, 2010, AND
TITLE II OF H.R. 847 AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON THE JUDICIARY ON JULY 29, 2009
--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------------------------------------------------------------
2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2010-2015 2010-2020
--------------------------------------------------------------------------------------------------------------------------------------------------------
NET INCREASE OR DECREASE (-) IN THE DEFICIT
Statutory Pay-As-You-Go Impact............ 0 513 1,251 3,585 1,166 638 599 645 646 692 763 7,153 10,498
--------------------------------------------------------------------------------------------------------------------------------------------------------
Estimated impact on state, local, and tribal governments:
H.R. 847 contains no intergovernmental mandates as defined in
UMRA. The bill would place conditions on the city of New York
for participating in the health program authorized by the bill,
but those conditions would not be intergovernmental mandates as
defined in UMRA.
Estimated impact on the private sector: H.R. 847 would
impose a private-sector mandate as defined in UMRA by limiting
the liability of New York City, any entity with a property
interest in the World Trade Center on September 11, 2001, and
any contractors and subcontractors thereof. Liability would be
limited to the total amount of available insurance coverage of
those entities for compensatory damages or other relief arising
from or related to debris removal from sites of the terrorist
attacks. By limiting the liability of those entities, the bill
would impose a mandate on individuals seeking compensatory
damages or other relief. Because of uncertainty about the
potential amount of the awards and the ability of the city of
New York and other entities whose liability would be limited to
pay for any awards in excess of the liability limit, CBO cannot
determine the costs the mandate would impose on the affected
individuals.
Estimate prepared by: Federal Costs: Stephanie Cameron,
Leigh Angres, and Chapin White; Impact on State, Local, and
Tribal Governments: Lisa Ramirez-Branum; Impact on the Private
Sector: Sarah Axeen.
Estimate approved by: Holly Harvey, Deputy Assistant
Director for Budget Analysis.
Section-by-Section Analysis of the Legislation
The following section-by-section analysis describes the
provisions in Title I of the legislation (World Trade Center
Health Program). For the section-by-section analysis of Title
II of the legislation (September 11th Victim Compensation Fund
of 2001), see Part II of this Report.
Section 1. Short title; table of contents
Section 1(a) designates the short title as the ``James
Zadroga
9/11 Health and Compensation Act of 2010''.
Section 1(b) sets forth the table of contents.
Title I--World Trade Center Health Program
Section 101. World Trade Center Health Program
Section 101 amends the Public Health Service Act by adding
a new Title XXXIII that contains the following sections:
Title XXXIII of the Public Health Service Act--World Trade Center
Health Program
SUBTITLE A--ESTABLISHMENT OF PROGRAM ADVISORY COMMITTEE
Section 3301. Establishment of World Trade Center Health
Program. Establishes, effective July 1, 2011, a World Trade
Center Health Program (the WTC Program) within the Department
of Health and Human Services (HHS) to be administered by the
WTC Program Administrator. The WTC Program includes the
following components: (1) medical monitoring for responders to
the September 11, 2001, terrorist attacks on the WTC in New
York City, at the Pentagon and in Shanksville, Pennsylvania;
(2) initial health evaluation for survivors (i.e., residents
and other building occupants and area workers in the area
affected by the terrorist attack on the World Trade Center);
(3) followup monitoring and treatment for WTC-related health
conditions for eligible responders and survivors; (4) outreach
and education to potentially eligible individuals; (5) clinical
data collection and analysis; and (6) research on WTC-related
health conditions. Prohibits the imposition of cost-sharing
with respect to initial health evaluations, monitoring, or
treatment benefits. Directs the Inspector General of HHS to
develop and implement a program to review expenditures by the
WTC Program to detect fraudulent billing and unreasonable
administrative costs. Directs the WTC Program Administrator to
establish a quality assurance program for services delivered by
Centers of Excellence and other participating providers.
Requires the WTC Program Administrator to submit an annual
report to Congress on the operation of the program.
Section 3302. WTC Health Program Scientific/Technical
Advisory Committee; WTC Health Program Steering Committees.
Requires the WTC Program Administrator to establish the WTC
Health Program Scientific/Technical Advisory Committee to
review scientific and medical evidence and make recommendations
on additional WTC Program eligibility criteria and additional
WTC-related health conditions. Requires the Administrator to
consult with the WTC Responders Steering Committee and the WTC
Survivors Steering Committee.
Section 3303. Education and Outreach. Requires the WTC
Program Administrator to institute a program to provide
education and outreach to potentially eligible individuals
regarding the existence of and services available under the WTC
Health Program.
Section 3304. Uniform Data Collection and Analysis.
Requires the WTC Program Administrator to provide for the
collection, analysis, and reporting of data, consistent with
applicable privacy requirements, on the prevalence of WTC-
related health conditions, and the identification of new WTC-
related health conditions. Directs Clinical Centers of
Excellence to collect and report data to a Data Center for
analysis. Requires the Administrator to ensure collaboration
between Data Centers and World Trade Center Health Registry.
Section 3305. Clinical Centers of Excellence and Data
Centers. Requires the WTC Program Administrator to enter into
contracts or cooperative agreements with the Clinical Centers
of Excellence and Data Centers. Requires Clinical Centers of
Excellence to provide monitoring, initial health evaluation,
and treatment benefits; conduct outreach activities; provide
counseling for benefits for eligible individuals; provide
translational and interpretive services for eligible
individuals who are not English language proficient; and
collect and report data to the Data Centers for analysis.
Requires Data Centers to receive and analyze data for the
purposes of developing protocols for monitoring, initial health
evaluation, and treatment of WTC-related health conditions;
conducting outreach activities; and establishing criteria for
credentialing providers in the nationwide network. Sets forth
contract requirements for Clinical Centers of Excellence.
Requires the Administrator to reimburse Clinical Centers of
Excellence for fixed infrastructure costs using a fair and
appropriate negotiated rate.
Section 3306. Definitions. Sets forth definitions for
certain terms used in Title I. In the case of the term ``WTC
Program Administrator,'' authorizes the Secretary of HHS to
designate one or more officials in the Department to carry the
following responsibilities: enrollment of WTC responders;
processing claims for reimbursement for initial health
evaluations, monitoring and treatment; determination of
eligibility of WTC responders; and administering secondary
payor provisions. Specifies that the Director of the National
Institute for Occupational Safety and Health (NIOSH), or a
designee, is responsible for all other activities of the WTC
Health Program.
SUBTITLE B--PROGRAM OF MONITORING, INITIAL HEALTH EVALUATIONS, AND
TREATMENT
PART 1--WTC RESPONDERS
Section 3311. Identification of WTC Responders and
Provision of WTC-Related Monitoring Services. Defines the term
``WTC responder'' as any of the following: (1) a responder who
is identified as eligible for monitoring on the date of
enactment; (2) a responder who meets current eligibility
criteria; and (3) a responder who meets eligibility criteria
modified by the WTC Program Administrator after consultation
with the WTC Scientific/Technical Advisory Committee. Specifies
that current eligibility criteria include firefighters and
emergency personnel; law enforcement officers; rescue,
recovery, and cleanup workers; and the surviving immediate
family members of firefighters or emergency personnel who were
killed as a result of the September 11, 2001, terrorist attacks
on the World Trade Center. Further specifies that current
eligibility criteria include members of fire or police
departments, recovery or cleanup workers, or volunteers who
performed rescue, recovery, debris cleanup, or related services
at the Pentagon and in Shanksville, Pennsylvania, in the
aftermath of the September 11, 2001, terrorist attacks. Directs
the WTC Program Administrator to establish an enrollment
process for WTC responders. Limits enrollment in the WTC
responder program at any time to 25,000 responders in addition
to those identified as eligible for monitoring on the day of
enactment and the surviving immediate family members of
firefighters or emergency personnel killed at the World Trade
Center site. (Of these 25,000, no more than 2,500 may qualify
based on eligibility criteria modified by the Administrator).
Disqualifies individuals on the Department of Homeland
Security's terrorist watch list from receiving benefits as WTC
responders. Requires the WTC Program to provide monitoring
consistent with protocols approved by the Administrator to
enrolled WTC responders (other than surviving immediate family
members of firefighters or emergency personnel).
Section 3312. Treatment of Enrolled WTC Responders for WTC-
Related Health Conditions. Sets forth a list of WTC-related
health conditions, including aerodigestive disorders and mental
health conditions, for which treatment is to be furnished to
WTC responders through Centers of Excellence and the national
program. Establishes a process for the addition of conditions
to the list that includes an option for interested parties to
submit written petitions, recommendations from the WTC Health
Program Scientific/Technical Advisory Committee, and formal
notice and comment rulemaking by the WTC Program Administrator.
Requires the Administrator to periodically review all available
scientific and medical evidence related to cancer to determine
if particular types of cancers should be added to the list of
WTC-related health conditions. Establishes a process for a
physician at a Clinical Center of Excellence to be paid for
treating an enrolled WTC responder for a condition that is not
on the list of WTC-related health conditions but that the
treating physician determines is medically associated with a
WTC-related health condition. Requires physicians and other
providers treating enrolled WTC responders to provide treatment
that is medically necessary and in accordance with medical
treatment protocols approved by the WTC Program Administrator;
requires the Administrator to issue regulations specifying a
standard for determining medical necessity; and prohibits the
Administrator from paying for treatment that the Administrator
determines is not medically necessary or not in accordance with
such medical treatment protocols. Requires the Administrator to
reimburse costs for medically necessary treatment for WTC-
related health conditions at rates applicable under the Federal
Employees Compensation Act (FECA). Authorizes the Administrator
to modify the payment amounts and methodologies if, based on
utilization and quality data furnished by the Clinical Centers
of Excellence, the Administrator determines that another
payment methodology would better ensure high quality and
efficient delivery. In the case of outpatient prescription
drugs, directs the Administrator to establish a program to use
outside vendors selected through a competitive bidding process.
Section 3313. National Arrangement for Benefits for
Eligible Individuals Outside New York. Requires the WTC Program
Administrator to establish a nationwide network of health care
providers to furnish monitoring and treatment benefits and
initial health evaluations to enrolled WTC responders and
eligible WTC survivors who reside outside of the New York City
metropolitan area. Requires that health care providers
participating in this network meet credentialing criteria
specified by the Data Centers, follow the approved protocols,
collect and report data, and comply with program integrity,
quality assurance, and other requirements established by the
Administrator.
PART 2--WTC SURVIVORS
Section 3321. Identification and Initial Health Evaluation
of Screening-Eligible and Certified-Eligible WTC Survivors.
Defines a ``screening-eligible WTC survivor'' as an individual
who (1) has been identified as eligible for medical monitoring
and treatment by the WTC Environmental Health Center as of the
date of enactment, (2) claims symptoms of a WTC-related health
condition and meets current eligibility criteria, or (3) claims
symptoms of a WTC-related health condition and meets
eligibility criteria modified by the WTC Program Administrator
after consultation with the WTC Scientific/Technical Advisory
Committee. Specifies that current eligibility criteria include
individuals present in the New York City disaster area in the
dust or dust cloud on September 11, 2001, and individuals who
worked, resided, or attended school or childcare during the 4-
month period beginning on September 11, 2001. Directs the
Administrator to establish a process for individuals to be
determined to be screening-eligible WTC survivors. Requires the
WTC Program to provide for a single initial health evaluation
for each screening-eligible WTC survivor to determine if the
survivor has a WTC-related health condition and is eligible for
follow-up monitoring and treatment benefits. The initial health
evaluation must be conducted through a Clinical Center of
Excellence consistent with protocols approved by the
Administrator. Defines ``certified-eligible WTC survivor'' as a
screening-eligible WTC survivor who, based on an initial health
evaluation, has been determined to be eligible for follow-up
monitoring and treatment. Directs the Administration to
establish a process for certification of this determination.
Limits to 25,000 at any time the number of certified-
eligible WTC survivors in addition to those who were identified
as eligible for medical monitoring and treatment as of
enactment. Disqualifies individuals on the Department of
Homeland Security's terrorist watch list from receiving
benefits as WTC survivors.
Section 3322. Followup Monitoring and Treatment of
Certified-Eligible WTC Survivors for WTC-Related Health
Conditions. Sets forth a list of WTC-related health conditions,
including aerodigestive disorders and mental health conditions,
for which the WTC Program provides followup monitoring and
treatment to certified-eligible WTC survivors. Provides that
any cancers or other conditions added to the list of WTC-
related health conditions for enrolled WTC responders under
section 3312(a) are included in the list of WTC-related health
conditions applicable to certified-eligible WTC survivors.
Specifies that the provisions applicable to the monitoring and
treatment of WTC-related health conditions for enrolled WTC
responders, including those relating to the use of protocols
and a standard of medical necessity approved by the WTC Program
Administrator, also apply with respect to followup monitoring
and treatment of WTC-related health conditions for certified-
eligible WTC survivors.
Section 3323. Followup Monitoring and Treatment of
Certified-
Eligible WTC Survivors for WTC-Related Health Conditions.
Authorizes the provision of monitoring and treatment services
to individuals who are not enrolled WTC responders or
certified-eligible WTC survivors in certain circumstances but
who are diagnosed at a Clinical Center of Excellence with a
WTC-related health condition for certified-eligible WTC
survivors. Limits the funds available for this purpose to $5
million in FY2011 and $20 million in FY2012, adjusted by the
consumer price index every year thereafter through FY2020.
PART 3--PAYOR PROVISIONS
Section 3331. Payment of Claims. Establishes the general
rule that the WTC Health Program pays the costs of furnishing
monitoring and treatment benefits and initial health
evaluations from the WTC Health Program Fund, subject to
certain exceptions. In the case of treatment for a WTC-related
health condition that is work-related, the bill requires the
WTC Program Administrator to reduce or recoup payment for the
treatment using the Medicare secondary payor procedures if the
Administrator determines that payment for the treatment has
been made or can reasonably be expected to be made under a
worker's compensation law or plan. In the case of treatment for
a WTC-related health condition that is not work-related, the
bill requires the Administrator to apply the Medicare secondary
payor rules. For this purpose, treats Medicaid as primary to
the WTC Program. Effective July 2014, it allows the WTC Program
to make payment for monitoring or treatment only on behalf of
individuals who have minimum essential coverage, unless the
individual is exempt from the requirement to obtain such
coverage. Provides that no funds may be disbursed from the WTC
Health Program Fund until New York City enters into a contract
with the WTC Program Administrator under which it agrees to
contribute 10% of WTC Health Program expenditures in each
calendar quarter. Specifies limits totaling $510 million on the
amount of this 10% contribution owed in each fiscal year
through FY 2020. Specifies interest penalties for late payments
and provides that amounts owed to the WTC Administrator under
the contract are recoverable by the United States. Specifies
that New York City may not satisfy this 10% contribution using
federal funds, payments made prior to enactment, or payments to
satisfy a judgment or as part of a settlement related to
injuries or illnesses related to the September 11, 2001,
terrorist attacks. Provides that, in any quarter in which New
York City makes the full payment it is obligated to make under
the contract, the City is not required to make worker's
compensation or line-of-duty payments toward the treatment of
WTC-related health conditions that are work-related.
Section 3332. Administrative Arrangement Authority.
Authorizes the WTC Program Administrator to enter into
arrangements with government agencies, insurance companies, or
other third-party administrators for processing of provider
claims for payment for monitoring and treatment services
furnished under the WTC Health Program to eligible WTC
responders or survivors.
SUBTITLE C--RESEARCH INTO CONDITIONS
Section 3341. Research Regarding Certain Health Conditions
Related to September 11 Terrorist Attacks in New York City.
Directs the WTC Program Administrator, in consultation with the
WTC Scientific/Technical Advisory Committee, to conduct or
support research on physical and mental health conditions that
may be related to the September 11, 2001, terrorist attacks,
including research on diagnosing and treating WTC-related
health conditions on which there has been treatment
uncertainty.
Section 3342. World Trade Center Health Registry. Directs
the WTC Program Administrator to ensure the maintenance of a
registry of victims of the September 11 terrorist attacks at
least as comprehensive as the WTC Health Registry in effect as
of April 20, 2009, under arrangements with the New York City
Department of Health and Mental Hygiene.
SUBTITLE D--FUNDING
Section 3351. World Trade Center Health Program Fund.
Establishes the World Trade Center Health Program Fund for
payment of costs of carrying out the WTC Health Program
beginning in the last calendar quarter of FY2011 and continuing
through FY2020. Provides mandatory funding for the federal
contribution to the Fund in amount equal to the lesser of (1)
90% of the expenditures in carrying out the WTC Program in each
fiscal year or (2) a specified annual cap amount for each
fiscal year ($71 million in FY2011, $318 million in FY2012,
$354 million in FY2013, $382 million in FY2014, $431 million in
FY2015, $481 million in FY2016, $537 million in FY2017, $601
million in FY2018, $672 million in FY2019, and $743 million in
FY2020). Provides that no federal dollars be disbursed from the
Fund unless New York City has entered into the contract with
the WTC Program Administrator required under section 3331.
Directs that the City's 10% contribution be deposited into the
Fund, and specifies that any failure of the City to make its
full contribution shall not increase the federal deposit into
the Fund. Makes amounts deposited into the Fund available for
carrying out the WTC Health Program, including payment of the
costs of identification, initial health evaluations,
monitoring, and treatment of WTC-related health conditions of
WTC responders and WTC survivors. Also makes amounts deposited
into the Fund available, subject to specified limits, to
support the WTC Health Program Scientific/Technical Advisory
Committee, education and outreach activities, data collection
and analysis, Data Centers, infrastructure costs of Clinical
Centers of Excellence, research on WTC-related health
conditions, and the WTC Health Registry.
Changes in Existing Law Made by the Bill, as Reported
The bill was referred to this committee for consideration of
such provisions of the bill as fall within the jurisdiction of
this committee pursuant to clause 2 of rule XII of the Rules of
the House of Representatives. In compliance with clause 3(e) of
rule XIII of the Rules of the House of Representatives, changes
in existing law made by such provisions of the bill, as
reported, are shown as follows (new matter is printed in italic
and existing law in which no change is proposed is shown in
roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM
Subtitle A--Establishment of Program; Advisory Committee
SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM.
(a) In General.--There is hereby established within the
Department of Health and Human Services a program to be known
as the World Trade Center Health Program, which shall be
administered by the WTC Program Administrator, to provide
beginning on July 1, 2011--
(1) medical monitoring and treatment benefits to
eligible emergency responders and recovery and cleanup
workers (including those who are Federal employees) who
responded to the September 11, 2001, terrorist attacks;
and
(2) initial health evaluation, monitoring, and
treatment benefits to residents and other building
occupants and area workers in New York City who were
directly impacted and adversely affected by such
attacks.
(b) Components of Program.--The WTC Program includes the
following components:
(1) Medical monitoring for responders.--Medical
monitoring under section 3311, including clinical
examinations and long-term health monitoring and
analysis for enrolled WTC responders who were likely to
have been exposed to airborne toxins that were
released, or to other hazards, as a result of the
September 11, 2001, terrorist attacks.
(2) Initial health evaluation for survivors.--An
initial health evaluation under section 3321, including
an evaluation to determine eligibility for followup
monitoring and treatment.
(3) Followup monitoring and treatment for wtc-related
health conditions for responders and survivors.--
Provision under sections 3312, 3322, and 3323 of
followup monitoring and treatment and payment, subject
to the provisions of subsection (d), for all medically
necessary health and mental health care expenses of an
individual with respect to a WTC-related health
condition (including necessary prescription drugs).
(4) Outreach.--Establishment under section 3303 of an
education and outreach program to potentially eligible
individuals concerning the benefits under this title.
(5) Clinical data collection and analysis.--
Collection and analysis under section 3304 of health
and mental health data relating to individuals
receiving monitoring or treatment benefits in a uniform
manner in collaboration with the collection of
epidemiological data under section 3342.
(6) Research on health conditions.--Establishment
under subtitle C of a research program on health
conditions resulting from the September 11, 2001,
terrorist attacks.
(c) No Cost Sharing.--Monitoring and treatment benefits and
initial health evaluation benefits are provided under subtitle
B without any deductibles, copayments, or other cost sharing to
an enrolled WTC responder or certified-eligible WTC survivor.
Initial health evaluation benefits are provided under subtitle
B without any deductibles, copayments, or other cost sharing to
a screening-eligible WTC survivor.
(d) Preventing Fraud and Unreasonable Administrative Costs.--
(1) Fraud.--The Inspector General of the Department
of Health and Human Services shall develop and
implement a program to review the WTC Program's health
care expenditures to detect fraudulent or duplicate
billing and payment for inappropriate services. This
title is a Federal health care program (as defined in
section 1128B(f) of the Social Security Act) and is a
health plan (as defined in section 1128C(c) of such
Act) for purposes of applying sections 1128 through
1128E of such Act.
(2) Unreasonable administrative costs.--The Inspector
General of the Department of Health and Human Services
shall develop and implement a program to review the WTC
Program for unreasonable administrative costs,
including with respect to infrastructure,
administration, and claims processing.
(e) Quality Assurance.--The WTC Program Administrator working
with the Clinical Centers of Excellence shall develop and
implement a quality assurance program for the monitoring and
treatment delivered by such Centers of Excellence and any other
participating health care providers. Such program shall
include--
(1) adherence to monitoring and treatment protocols;
(2) appropriate diagnostic and treatment referrals
for participants;
(3) prompt communication of test results to
participants; and
(4) such other elements as the Administrator
specifies in consultation with the Clinical Centers of
Excellence.
(f) Annual Program Report.--
(1) In general.--Not later than 6 months after the
end of each fiscal year in which the WTC Program is in
operation, the WTC Program Administrator shall submit
an annual report to the Congress on the operations of
this title for such fiscal year and for the entire
period of operation of the program.
(2) Contents included in report.--Each annual report
under paragraph (1) shall include at least the
following:
(A) Eligible individuals.--Information for
each clinical program described in paragraph
(3)--
(i) on the number of individuals who
applied for certification under
subtitle B and the number of such
individuals who were so certified;
(ii) of the individuals who were
certified, on the number who received
monitoring under the program and the
number of such individuals who received
medical treatment under the program;
(iii) with respect to individuals so
certified who received such treatment,
on the WTC-related health conditions
for which they were treated; and
(iv) on the projected number of
individuals who will be certified under
subtitle B in the succeeding fiscal
year and the succeeding 10-year period.
(B) Monitoring, initial health evaluation,
and treatment costs.--For each clinical program
so described--
(i) information on the costs of
monitoring and initial health
evaluation and the costs of treatment
and on the estimated costs of such
monitoring, evaluation, and treatment
in the succeeding fiscal year; and
(ii) an estimate of the cost of
medical treatment for WTC-related
health conditions that have been paid
for or reimbursed by workers'
compensation, by public or private
health plans, or by New York City under
section 3331.
(C) Administrative costs.--Information on the
cost of administering the program, including
costs of program support, data collection and
analysis, and research conducted under the
program.
(D) Administrative experience.--Information
on the administrative performance of the
program, including--
(i) the performance of the program in
providing timely evaluation of and
treatment to eligible individuals; and
(ii) a list of the Clinical Centers
of Excellence and other providers that
are participating in the program.
(E) Scientific reports.--A summary of the
findings of any new scientific reports or
studies on the health effects associated with
exposure described in section 3306(1),
including the findings of research conducted
under section 3341(a).
(F) Advisory committee recommendations.--A
list of recommendations by the WTC Scientific/
Technical Advisory Committee on additional WTC
Program eligibility criteria and on additional
WTC-related health conditions and the action of
the WTC Program Administrator concerning each
such recommendation.
(3) Separate clinical programs described.--In
paragraph (2), each of the following shall be treated
as a separate clinical program of the WTC Program:
(A) Firefighters and related personnel.--The
benefits provided for enrolled WTC responders
described in section 3311(a)(2)(A).
(B) Other wtc responders.--The benefits
provided for enrolled WTC responders not
described in subparagraph (A).
(C) WTC survivors.--The benefits provided for
screening-eligible WTC survivors and certified-
eligible WTC survivors in section 3321(a).
(g) Notification to Congress Upon Reaching 80 Percent of
Eligibility Numerical Limits.--The Secretary shall promptly
notify the Congress of each of the following:
(1) When the number of enrollments of WTC responders
subject to the limit established under section
3311(a)(4) has reached 80 percent of such limit.
(2) When the number of certifications for certified-
eligible WTC survivors subject to the limit established
under section 3321(a)(3) has reached 80 percent of such
limit.
(h) Consultation.--The WTC Program Administrator shall engage
in ongoing outreach and consultation with relevant
stakeholders, including the WTC Health Program Steering
Committees and the Advisory Committee under section 3302,
regarding the implementation and improvement of programs under
this title.
SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY COMMITTEE;
WTC HEALTH PROGRAM STEERING COMMITTEES.
(a) Advisory Committee.--
(1) Establishment.--The WTC Program Administrator
shall establish an advisory committee to be known as
the WTC Health Program Scientific/Technical Advisory
Committee (in this subsection referred to as the
``Advisory Committee'') to review scientific and
medical evidence and to make recommendations to the
Administrator on additional WTC Program eligibility
criteria and on additional WTC-related health
conditions.
(2) Composition.--The WTC Program Administrator shall
appoint the members of the Advisory Committee and shall
include at least--
(A) 4 occupational physicians, at least 2 of
whom have experience treating WTC rescue and
recovery workers;
(B) 1 physician with expertise in pulmonary
medicine;
(C) 2 environmental medicine or environmental
health specialists;
(D) 2 representatives of WTC responders;
(E) 2 representatives of certified-eligible
WTC survivors;
(F) an industrial hygienist;
(G) a toxicologist;
(H) an epidemiologist; and
(I) a mental health professional.
(3) Meetings.--The Advisory Committee shall meet at
such frequency as may be required to carry out its
duties.
(4) Reports.--The WTC Program Administrator shall
provide for publication of recommendations of the
Advisory Committee on the public Web site established
for the WTC Program.
(5) Duration.--Notwithstanding any other provision of
law, the Advisory Committee shall continue in operation
during the period in which the WTC Program is in
operation.
(6) Application of faca.--Except as otherwise
specifically provided, the Advisory Committee shall be
subject to the Federal Advisory Committee Act.
(b) WTC Health Program Steering Committees.--
(1) Consultation.--The WTC Program Administrator
shall consult with 2 steering committees (each in this
section referred to as a ``Steering Committee'') that
are established as follows:
(A) WTC responders steering committee.--One
Steering Committee, to be known as the WTC
Responders Steering Committee, for the purpose
of receiving input from affected stakeholders
and facilitating the coordination of monitoring
and treatment programs for the enrolled WTC
responders under part 1 of subtitle B.
(B) WTC survivors steering committee.--One
Steering Committee, to be known as the WTC
Survivors Steering Committee, for the purpose
of receiving input from affected stakeholders
and facilitating the coordination of initial
health evaluations, monitoring, and treatment
programs for screening-eligible and certified-
eligible WTC survivors under part 2 of subtitle
B.
(2) Membership.--
(A) WTC responders steering committee.--
(i) Representation.--The WTC
Responders Steering Committee shall
include--
(I) representatives of the
Centers of Excellence providing
services to WTC responders;
(II) representatives of labor
organizations representing
firefighters, police, other New
York City employees, and
recovery and cleanup workers
who responded to the September
11, 2001, terrorist attacks;
and
(III) 3 representatives of
New York City, 1 of whom will
be selected by the police
commissioner of New York City,
1 by the health commissioner of
New York City, and 1 by the
mayor of New York City.
(ii) Initial membership.--The WTC
Responders Steering Committee shall
initially be composed of members of the
WTC Monitoring and Treatment Program
Steering Committee (as in existence on
the day before the date of the
enactment of this title).
(B) WTC survivors steering committee.--
(i) Representation.--The WTC
Survivors Steering Committee shall
include representatives of--
(I) the Centers of Excellence
providing services to
screening-eligible and
certified-eligible WTC
survivors;
(II) the population of
residents, students, and area
and other workers affected by
the September 11, 2001,
terrorist attacks;
(III) screening-eligible and
certified-eligible survivors
receiving initial health
evaluations, monitoring, or
treatment under part 2 of
subtitle B and organizations
advocating on their behalf; and
(IV) New York City.
(ii) Initial membership.--The WTC
Survivors Steering Committee shall
initially be composed of members of the
WTC Environmental Health Center
Survivor Advisory Committee (as in
existence on the day before the date of
the enactment of this title).
(C) Additional appointments.--Each Steering
Committee may recommend, if approved by a
majority of voting members of the Committee,
additional members to the Committee.
(D) Vacancies.--A vacancy in a Steering
Committee shall be filled by an individual
recommended by the Steering Committee.
SEC. 3303. EDUCATION AND OUTREACH.
The WTC Program Administrator shall institute a program that
provides education and outreach on the existence and
availability of services under the WTC Program. The outreach
and education program--
(1) shall include--
(A) the establishment of a public Web site
with information about the WTC Program;
(B) meetings with potentially eligible
populations;
(C) development and dissemination of outreach
materials informing people about the program;
and
(D) the establishment of phone information
services; and
(2) shall be conducted in a manner intended--
(A) to reach all affected populations; and
(B) to include materials for culturally and
linguistically diverse populations.
SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS.
(a) In General.--The WTC Program Administrator shall provide
for the uniform collection of data (and analysis of data and
regular reports to the Administrator) on the prevalence of WTC-
related health conditions and the identification of new WTC-
related health conditions. Such data shall be collected for all
individuals provided monitoring or treatment benefits under
subtitle B and regardless of their place of residence or
Clinical Center of Excellence through which the benefits are
provided. The WTC Program Administrator shall provide, through
the Data Centers or otherwise, for the integration of such data
into the monitoring and treatment program activities under this
title.
(b) Coordinating Through Centers of Excellence.--Each
Clinical Center of Excellence shall collect data described in
subsection (a) and report such data to the corresponding Data
Center for analysis by such Data Center.
(c) Collaboration With WTC Health Registry.--The WTC Program
Administrator shall provide for collaboration between the Data
Centers and the World Trade Center Health Registry described in
section 3342.
(d) Privacy.--The data collection and analysis under this
section shall be conducted and maintained in a manner that
protects the confidentiality of individually identifiable
health information consistent with applicable statutes and
regulations, including, as applicable, HIPAA privacy and
security law (as defined in section 3009(a)(2)) and section
552a of title 5, United States Code.
SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA CENTERS.
(a) In General.--
(1) Contracts with clinical centers of excellence.--
The WTC Program Administrator shall, subject to
subsection (b)(1)(B), enter into contracts with
Clinical Centers of Excellence (as defined in
subsection (b)(1)(A))--
(A) for the provision of monitoring and
treatment benefits and initial health
evaluation benefits under subtitle B;
(B) for the provision of outreach activities
to individuals eligible for such monitoring and
treatment benefits, for initial health
evaluation benefits, and for followup to
individuals who are enrolled in the monitoring
program;
(C) for the provision of counseling for
benefits under subtitle B, with respect to WTC-
related health conditions, for individuals
eligible for such benefits;
(D) for the provision of counseling for
benefits for WTC-related health conditions that
may be available under workers' compensation or
other benefit programs for work-related
injuries or illnesses, health insurance,
disability insurance, or other insurance plans
or through public or private social service
agencies and assisting eligible individuals in
applying for such benefits;
(E) for the provision of translational and
interpretive services for program participants
who are not English language proficient; and
(F) for the collection and reporting of data
in accordance with section 3304.
(2) Contracts with data centers.--
(A) In general.--The WTC Program
Administrator shall enter into contracts with
Data Centers (as defined in subsection
(b)(2))--
(i) for receiving, analyzing, and
reporting to the WTC Program
Administrator on data, in accordance
with section 3304, that have been
collected and reported to such Data
Centers by the corresponding Clinical
Centers of Excellence under subsection
(b)(1)(B)(iii);
(ii) for the development of
monitoring, initial health evaluation,
and treatment protocols, with respect
to WTC-related health conditions;
(iii) for coordinating the outreach
activities conducted under paragraph
(1)(B) by each corresponding Clinical
Center of Excellence;
(iv) for establishing criteria for
the credentialing of medical providers
participating in the nationwide network
under section 3313;
(v) for coordinating and
administering the activities of the WTC
Health Program Steering Committees
established under section 3002(b); and
(vi) for meeting periodically with
the corresponding Clinical Centers of
Excellence to obtain input on the
analysis and reporting of data
collected under clause (i) and on the
development of monitoring, initial
health evaluation, and treatment
protocols under clause (ii).
(B) Medical provider selection.--The medical
providers under subparagraph (A)(iv) shall be
selected by the WTC Program Administrator on
the basis of their experience treating or
diagnosing the health conditions included in
the list of WTC-related health conditions.
(C) Clinical discussions.--In carrying out
subparagraph (A)(ii), a Data Center shall
engage in clinical discussions across the WTC
Program to guide treatment approaches for
individuals with a WTC-related health
condition.
(D) Transparency of data.--A contract entered
into under this subsection with a Data Center
shall require the Data Center to make any data
collected and reported to such Center under
subsection (b)(1)(B)(iii) available to health
researchers and others as provided in the CDC/
ATSDR Policy on Releasing and Sharing Data.
(3) Authority for contracts to be class specific.--A
contract entered into under this subsection with a
Clinical Center of Excellence or a Data Center may be
with respect to one or more class of enrolled WTC
responders, screening-eligible WTC survivors, or
certified-eligible WTC survivors.
(4) Use of cooperative agreements.--Any contract
under this title between the WTC Program Administrator
and a Data Center or a Clinical Center of Excellence
may be in the form of a cooperative agreement.
(b) Centers of Excellence.--
(1) Clinical centers of excellence.--
(A) Definition.--For purposes of this title,
the term ``Clinical Center of Excellence''
means a Center that demonstrates to the
satisfaction of the Administrator that the
Center--
(i) uses an integrated, centralized
health care provider approach to create
a comprehensive suite of health
services under this title that are
accessible to enrolled WTC responders,
screening-eligible WTC survivors, or
certified-eligible WTC survivors;
(ii) has experience in caring for WTC
responders and screening-eligible WTC
survivors or includes health care
providers who have been trained
pursuant to section 3313(c);
(iii) employs health care provider
staff with expertise that includes, at
a minimum, occupational medicine,
environmental medicine, trauma-related
psychiatry and psychology, and social
services counseling; and
(iv) meets such other requirements as
specified by the Administrator.
(B) Contract requirements.--The WTC Program
Administrator shall not enter into a contract
with a Clinical Center of Excellence under
subsection (a)(1) unless the Center agrees to
do each of the following:
(i) Establish a formal mechanism for
consulting with and receiving input
from representatives of eligible
populations receiving monitoring and
treatment benefits under subtitle B
from such Center.
(ii) Coordinate monitoring and
treatment benefits under subtitle B
with routine medical care provided for
the treatment of conditions other than
WTC-related health conditions.
(iii) Collect and report to the
corresponding Data Center data in
accordance with section 3304(b).
(iv) Have in place safeguards against
fraud that are satisfactory to the
Administrator, in consultation with the
Inspector General of the Department of
Health and Human Services.
(v) Treat or refer for treatment all
individuals who are enrolled WTC
responders or certified-eligible WTC
survivors with respect to such Center
who present themselves for treatment of
a WTC-related health condition.
(vi) Have in place safeguards,
consistent with section 3304(c), to
ensure the confidentiality of an
individual's individually identifiable
health information, including requiring
that such information not be disclosed
to the individual's employer without
the authorization of the individual.
(vii) Use amounts paid under
subsection (c)(1) only for costs
incurred in carrying out the activities
described in subsection (a), other than
those described in subsection
(a)(1)(A).
(viii) Utilize health care providers
with occupational and environmental
medicine expertise to conduct physical
and mental health assessments, in
accordance with protocols developed
under subsection (a)(2)(A)(ii).
(ix) Communicate with WTC responders
and screening-eligible and certified-
eligible WTC survivors in appropriate
languages and conduct outreach
activities with relevant stakeholder
worker or community associations.
(x) Meet all the other applicable
requirements of this title, including
regulations implementing such
requirements.
(C) Transition rule to ensure continuity of
care.--The WTC Program Administrator shall to
the maximum extent feasible ensure continuity
of care in any period of transition from
monitoring and treatment of an enrolled WTC
responder or certified-eligible WTC survivor by
a provider to a Clinical Center of Excellence
or a health care provider participating in the
nationwide network under section 3313.
(2) Data centers.--For purposes of this title, the
term ``Data Center'' means a Center that the WTC
Program Administrator determines has the capacity to
carry out the responsibilities for a Data Center under
subsection (a)(2).
(3) Corresponding centers.--For purposes of this
title, a Clinical Center of Excellence and a Data
Center shall be treated as ``corresponding'' to the
extent that such Clinical Center and Data Center serve
the same population group.
(c) Payment for Infrastructure Costs.--
(1) In general.--The WTC Program Administrator shall
reimburse a Clinical Center of Excellence for the fixed
infrastructure costs of such Center in carrying out the
activities described in subtitle B at a rate negotiated
by the Administrator and such Centers. Such negotiated
rate shall be fair and appropriate and take into
account the number of enrolled WTC responders receiving
services from such Center under this title.
(2) Fixed infrastructure costs.--For purposes of
paragraph (1), the term ``fixed infrastructure costs''
means, with respect to a Clinical Center of Excellence,
the costs incurred by such Center that are not
reimbursable by the WTC Program Administrator under
section 3312(c).
SEC. 3306. DEFINITIONS.
In this title:
(1) The term ``aggravating'' means, with respect to a
health condition, a health condition that existed on
September 11, 2001, and that, as a result of exposure
to airborne toxins, any other hazard, or any other
adverse condition resulting from the September 11,
2001, terrorist attacks, requires medical treatment
that is (or will be) in addition to, more frequent
than, or of longer duration than the medical treatment
that would have been required for such condition in the
absence of such exposure.
(2) The term ``certified-eligible WTC survivor'' has
the meaning given such term in section 3321(a)(2).
(3) The terms ``Clinical Center of Excellence'' and
``Data Center'' have the meanings given such terms in
section 3305.
(4) The term ``enrolled WTC responder'' means a WTC
responder enrolled under section 3311(a)(3).
(5) The term ``initial health evaluation'' includes,
with respect to an individual, a medical and exposure
history, a physical examination, and additional medical
testing as needed to evaluate whether the individual
has a WTC-related health condition and is eligible for
treatment under the WTC Program.
(6) The term ``list of WTC-related health
conditions'' means--
(A) for WTC responders, the health conditions
listed in section 3312(a)(3); and
(B) for screening-eligible and certified-
eligible WTC survivors, the health conditions
listed in section 3322(b).
(7) The term ``New York City disaster area'' means
the area within New York City that is--
(A) the area of Manhattan that is south of
Houston Street; and
(B) any block in Brooklyn that is wholly or
partially contained within a 1.5-mile radius of
the former World Trade Center site.
(8) The term ``New York metropolitan area'' means an
area, specified by the WTC Program Administrator,
within which WTC responders and eligible WTC screening-
eligible survivors who reside in such area are
reasonably able to access monitoring and treatment
benefits and initial health evaluation benefits under
this title through a Clinical Center of Excellence
described in subparagraphs (A), (B), or (C) of section
3305(b)(1).
(9) The term ``screening-eligible WTC survivor'' has
the meaning given such term in section 3321(a)(1).
(10) Any reference to ``September 11, 2001'' shall be
deemed a reference to the period on such date
subsequent to the terrorist attacks at the World Trade
Center, Shanksville, Pennsylvania, or the Pentagon, as
applicable, on such date.
(11) The term ``September 11, 2001, terrorist
attacks'' means the terrorist attacks that occurred on
September 11, 2001, in New York City, in Shanksville,
Pennsylvania, and at the Pentagon, and includes the
aftermath of such attacks.
(12) The term ``WTC Health Program Steering
Committee'' means such a Steering Committee established
under section 3302(b).
(13) The term ``WTC Program'' means the Word Trade
Center Health Program established under section
3301(a).
(14) The term ``WTC Program Administrator'' means--
(A) with respect to paragraphs (3) and (4) of
section 3311(a) (relating to enrollment of WTC
responders), section 3312(c) and the
corresponding provisions of section 3322
(relating to payment for initial health
evaluation, monitoring, and treatment),
paragraphs (1)(C), (2)(B), and (3) of section
3321(a) (relating to determination or
certification of screening-eligible or
certified-eligible WTC responders), and part 3
of subtitle B (relating to payor provisions),
an official in the Department of Health and
Human Services, to be designated by the
Secretary; and
(B) with respect to any other provision of
this title, the Director of the National
Institute for Occupational Safety and Health,
or a designee of such Director.
(15) The term ``WTC-related health condition'' is
defined in section 3312(a).
(16) The term ``WTC responder'' is defined in section
3311(a).
(17) The term ``WTC Scientific/Technical Advisory
Committee'' means such Committee established under
section 3302(a).
Subtitle B--Program of Monitoring, Initial Health Evaluations, and
Treatment
PART 1--WTC RESPONDERS
SEC. 3311. IDENTIFICATION OF WTC RESPONDERS AND PROVISION OF WTC-
RELATED MONITORING SERVICES.
(a) WTC Responder Defined.--
(1) In general.--For purposes of this title, the term
``WTC responder'' means any of the following
individuals, subject to paragraph (4):
(A) Currently identified responder.--An
individual who has been identified as eligible
for monitoring under the arrangements as in
effect on the date of the enactment of this
title between the National Institute for
Occupational Safety and Health and--
(i) the consortium coordinated by Mt.
Sinai Hospital in New York City that
coordinates the monitoring and
treatment for enrolled WTC responders
other than with respect to those
covered under the arrangement with the
Fire Department of New York City; or
(ii) the Fire Department of New York
City.
(B) Responder who meets current eligibility
criteria.--An individual who meets the current
eligibility criteria described in paragraph
(2).
(C) Responder who meets modified eligibility
criteria.--An individual who--
(i) performed rescue, recovery,
demolition, debris cleanup, or other
related services in the New York City
disaster area in response to the
September 11, 2001, terrorist attacks,
regardless of whether such services
were performed by a State or Federal
employee or member of the National
Guard or otherwise; and
(ii) meets such eligibility criteria
relating to exposure to airborne
toxins, other hazards, or adverse
conditions resulting from the September
11, 2001, terrorist attacks as the WTC
Program Administrator, after
consultation with the WTC Scientific/
Technical Advisory Committee,
determines appropriate.
The WTC Program Administrator shall not modify
such eligibility criteria on or after the date
that the number of enrollments of WTC
responders has reached 80 percent of the limit
described in paragraph (4) or on or after the
date that the number of certifications for
certified-eligible WTC survivors under section
3321(a)(2)(B) has reached 80 percent of the
limit described in section 3321(a)(3).
(2) Current eligibility criteria.--The eligibility
criteria described in this paragraph for an individual
is that the individual is described in any of the
following categories:
(A) Firefighters and related personnel.--The
individual--
(i) was a member of the Fire
Department of New York City (whether
fire or emergency personnel, active or
retired) who participated at least one
day in the rescue and recovery effort
at any of the former World Trade Center
sites (including Ground Zero, Staten
Island Landfill, and the New York City
Chief Medical Examiner's Office) for
any time during the period beginning on
September 11, 2001, and ending on July
31, 2002; or
(ii)(I) is a surviving immediate
family member of an individual who was
a member of the Fire Department of New
York City (whether fire or emergency
personnel, active or retired) and was
killed at the World Trade site on
September 11, 2001; and
(II) received any treatment for a
WTC-related health condition described
in section 3312(a)(1)(A)(ii) (relating
to mental health conditions) on or
before September 1, 2008.
(B) Law enforcement officers and wtc rescue,
recovery, and cleanup workers.--The
individual--
(i) worked or volunteered onsite in
rescue, recovery, debris cleanup, or
related support services in lower
Manhattan (south of Canal St.), the
Staten Island Landfill, or the barge
loading piers, for at least 4 hours
during the period beginning on
September 11, 2001, and ending on
September 14, 2001, for at least 24
hours during the period beginning on
September 11, 2001, and ending on
September 30, 2001, or for at least 80
hours during the period beginning on
September 11, 2001, and ending on July
31, 2002;
(ii)(I) was a member of the Police
Department of New York City (whether
active or retired) or a member of the
Port Authority Police of the Port
Authority of New York and New Jersey
(whether active or retired) who
participated onsite in rescue,
recovery, debris cleanup, or related
services in lower Manhattan (south of
Canal St.), including Ground Zero, the
Staten Island Landfill, or the barge
loading piers, for at least 4 hours
during the period beginning September
11, 2001, and ending on September 14,
2001;
(II) participated onsite in rescue,
recovery, debris cleanup, or related
services in at Ground Zero, the Staten
Island Landfill, or the barge loading
piers, for at least one day during the
period beginning on September 11, 2001,
and ending on July 31, 2002;
(III) participated onsite in rescue,
recovery, debris cleanup, or related
services in lower Manhattan (south of
Canal St.) for at least 24 hours during
the period beginning on September 11,
2001, and ending on September 30, 2001;
or
(IV) participated onsite in rescue,
recovery, debris cleanup, or related
services in lower Manhattan (south of
Canal St.) for at least 80 hours during
the period beginning on September 11,
2001, and ending on July 31, 2002;
(iii) was an employee of the Office
of the Chief Medical Examiner of New
York City involved in the examination
and handling of human remains from the
World Trade Center attacks, or other
morgue worker who performed similar
post-September 11 functions for such
Office staff, during the period
beginning on September 11, 2001, and
ending on July 31, 2002;
(iv) was a worker in the Port
Authority Trans-Hudson Corporation
Tunnel for at least 24 hours during the
period beginning on February 1, 2002,
and ending on July 1, 2002; or
(v) was a vehicle-maintenance worker
who was exposed to debris from the
former World Trade Center while
retrieving, driving, cleaning,
repairing, and maintaining vehicles
contaminated by airborne toxins from
the September 11, 2001, terrorist
attacks during a duration and period
described in subparagraph (A).
(C) Responders to the september 11 attacks at
the pentagon and shanksville, pennsylvania.--
The individual--
(i)(I) was a member of a fire or
police department (whether fire or
emergency personnel, active or
retired), worked for a recovery or
cleanup contractor, or was a volunteer;
and performed rescue, recovery,
demolition, debris cleanup, or other
related services at the Pentagon site
of the terrorist-related aircraft crash
of September 11, 2001, during the
period beginning on September 11, 2001,
and ending on the date on which the
cleanup of the site was concluded, as
determined by the WTC Program
Administrator; or
(II) was a member of a fire or police
department (whether fire or emergency
personnel, active or retired), worked
for a recovery or cleanup contractor,
or was a volunteer; and performed
rescue, recovery, demolition, debris
cleanup, or other related services at
the Shanksville, Pennsylvania, site of
the terrorist-related aircraft crash of
September 11, 2001, during the period
beginning on September 11, 2001, and
ending on the date on which the cleanup
of the site was concluded, as
determined by the WTC Program
Administrator; and
(ii) is determined by the WTC Program
Administrator to be at an increased
risk of developing a WTC-related health
condition as a result of exposure to
airborne toxins, other hazards, or
adverse conditions resulting from the
September 11, 2001, terrorist attacks,
and meets such eligibility criteria
related to such exposures, as the WTC
Program Administrator determines are
appropriate, after consultation with
the WTC Scientific/Technical Advisory
Committee.
(3) Enrollment process.--
(A) In general.--The WTC Program
Administrator shall establish a process for
enrolling WTC responders in the WTC Program.
Under such process--
(i) WTC responders described in
paragraph (1)(A) shall be deemed to be
enrolled in such Program;
(ii) subject to clause (iii), the
Administrator shall enroll in such
program individuals who are determined
to be WTC responders;
(iii) the Administrator shall deny
such enrollment to an individual if the
Administrator determines that the
numerical limitation in paragraph (4)
on enrollment of WTC responders has
been met;
(iv) there shall be no fee charged to
the applicant for making an application
for such enrollment;
(v) the Administrator shall make a
determination on such an application
not later than 60 days after the date
of filing the application; and
(vi) an individual who is denied
enrollment in such Program shall have
an opportunity to appeal such
determination in a manner established
under such process.
(B) Timing.--
(i) Currently identified
responders.--In accordance with
subparagraph (A)(i), the WTC Program
Administrator shall enroll an
individual described in paragraph
(1)(A) in the WTC Program not later
than July 1, 2011.
(ii) Other responders.--In accordance
with subparagraph (A)(ii) and
consistent with paragraph (4), the WTC
Program Administrator shall enroll any
other individual who is determined to
be a WTC responder in the WTC Program
at the time of such determination.
(4) Numerical limitation on eligible wtc
responders.--
(A) In general.--The total number of
individuals not described in paragraph (1)(A)
or (2)(A)(ii) who may be enrolled under
paragraph (3)(A)(ii) shall not exceed 25,000 at
any time, of which no more than 2,500 may be
individuals enrolled based on modified
eligibility criteria established under
paragraph (1)(C).
(B) Process.--In implementing subparagraph
(A), the WTC Program Administrator shall--
(i) limit the number of enrollments
made under paragraph (3)--
(I) in accordance with such
subparagraph; and
(II) to such number, as
determined by the Administrator
based on the best available
information and subject to
amounts available under section
3351, that will ensure
sufficient funds will be
available to provide treatment
and monitoring benefits under
this title, with respect to all
individuals who are enrolled
through the end of fiscal year
2020; and
(ii) provide priority (subject to
paragraph (3)(A)(i)) in such
enrollments in the order in which
individuals apply for enrollment under
paragraph (3).
(5) Disqualification of individuals on terrorist
watch list.--No individual who is on the terrorist
watch list maintained by the Department of Homeland
Security shall qualify as an eligible WTC responder.
Before enrolling any individual as a WTC responder in
the WTC Program under paragraph (3), the Administrator,
in consultation with the Secretary of Homeland
Security, shall determine whether the individual is on
such list.
(b) Monitoring Benefits.--
(1) In general.--In the case of an enrolled WTC
responder (other than one described in subsection
(a)(2)(A)(ii)), the WTC Program shall provide for
monitoring benefits that include monitoring consistent
with protocols approved by the WTC Program
Administrator and including clinical examinations and
long-term health monitoring and analysis. In the case
of an enrolled WTC responder who is an active member of
the Fire Department of New York City, the responder
shall receive such benefits as part of the individual's
periodic company medical exams.
(2) Provision of monitoring benefits.--The monitoring
benefits under paragraph (1) shall be provided through
the Clinical Center of Excellence for the type of
individual involved or, in the case of an individual
residing outside the New York metropolitan area, under
an arrangement under section 3313.
SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS FOR WTC-RELATED HEALTH
CONDITIONS.
(a) WTC-Related Health Condition Defined.--
(1) In general.--For purposes of this title, the term
``WTC-related health condition'' means a condition
that--
(A)(i) is an illness or health condition for
which exposure to airborne toxins, any other
hazard, or any other adverse condition
resulting from the September 11, 2001,
terrorist attacks, based on an examination by a
medical professional with experience in
treating or diagnosing the health conditions
included in the applicable list of WTC-related
health conditions, is substantially likely to
be a significant factor in aggravating,
contributing to, or causing the illness or
health condition, as determined under paragraph
(2); or
(ii) is a mental health condition for which
such attacks, based on an examination by a
medical professional with experience in
treating or diagnosing the health conditions
included in the applicable list of WTC-related
health conditions, is substantially likely to
be a significant factor in aggravating,
contributing to, or causing the condition, as
determined under paragraph (2); and
(B) is included in the applicable list of
WTC-related health conditions or--
(i) with respect to a WTC responder,
is provided certification of coverage
under subsection (b)(2)(B)(iii); or
(ii) with respect to a screening-
eligible WTC survivor or certified-
eligible WTC survivor, is provided
certification of coverage under
subsection (b)(2)(B)(iii), as applied
under section 3322(a).
In the case of a WTC responder described in section
3311(a)(2)(A)(ii) (relating to a surviving immediate
family member of a firefighter), such term does not
include an illness or health condition described in
subparagraph (A)(i).
(2) Determination.--The determination under paragraph
(1) or subsection (b) of whether the September 11,
2001, terrorist attacks were substantially likely to be
a significant factor in aggravating, contributing to,
or causing an individual's illness or health condition
shall be made based on an assessment of the following:
(A) The individual's exposure to airborne
toxins, any other hazard, or any other adverse
condition resulting from the terrorist attacks.
Such exposure shall be--
(i) evaluated and characterized
through the use of a standardized,
population-appropriate questionnaire
approved by the Director of the
National Institute for Occupational
Safety and Health; and
(ii) assessed and documented by a
medical professional with experience in
treating or diagnosing health
conditions included on the list of WTC-
related health conditions.
(B) The type of symptoms and temporal
sequence of symptoms. Such symptoms shall be--
(i) assessed through the use of a
standardized, population-appropriate
medical questionnaire approved by the
Director of the National Institute for
Occupational Safety and Health and a
medical examination; and
(ii) diagnosed and documented by a
medical professional described in
subparagraph (A)(ii).
(3) List of health conditions for wtc responders.--
The list of health conditions for WTC responders
consists of the following:
(A) Aerodigestive disorders.--
(i) Interstitial lung diseases.
(ii) Chronic respiratory disorder--
fumes/vapors.
(iii) Asthma.
(iv) Reactive airways dysfunction
syndrome (RADS).
(v) WTC-exacerbated chronic
obstructive pulmonary disease (COPD).
(vi) Chronic cough syndrome.
(vii) Upper airway hyperreactivity.
(viii) Chronic rhinosinusitis.
(ix) Chronic nasopharyngitis.
(x) Chronic laryngitis.
(xi) Gastroesophageal reflux disorder
(GERD).
(xii) Sleep apnea exacerbated by or
related to a condition described in a
previous clause.
(B) Mental health conditions.--
(i) Posttraumatic stress disorder
(PTSD).
(ii) Major depressive disorder.
(iii) Panic disorder.
(iv) Generalized anxiety disorder.
(v) Anxiety disorder (not otherwise
specified).
(vi) Depression (not otherwise
specified).
(vii) Acute stress disorder.
(viii) Dysthymic disorder.
(ix) Adjustment disorder.
(x) Substance abuse.
(C) Musculoskeletal disorders for certain wtc
responders.--In the case of a WTC responder
described in paragraph (4), a condition
described in such paragraph.
(D) Additional conditions.--Any cancer (or
type of cancer) or other condition added,
pursuant to paragraph (5) or (6), to the list
under this paragraph.
(4) Musculoskeletal disorders.--
(A) In general.--For purposes of this title,
in the case of a WTC responder who received any
treatment for a WTC-related musculoskeletal
disorder on or before September 11, 2003, the
list of health conditions in paragraph (3)
shall include:
(i) Low back pain.
(ii) Carpal tunnel syndrome (CTS).
(iii) Other musculoskeletal
disorders.
(B) Definition.--The term ``WTC-related
musculoskeletal disorder'' means a chronic or
recurrent disorder of the musculoskeletal
system caused by heavy lifting or repetitive
strain on the joints or musculoskeletal system
occurring during rescue or recovery efforts in
the New York City disaster area in the
aftermath of the September 11, 2001, terrorist
attacks.
(5) Cancer.--
(A) In general.--The WTC Program
Administrator shall periodically conduct a
review of all available scientific and medical
evidence, including findings and
recommendations of Clinical Centers of
Excellence, published in peer-reviewed journals
to determine if, based on such evidence, cancer
or a certain type of cancer should be added to
the applicable list of WTC-related health
conditions. The WTC Program Administrator shall
conduct the first review under this
subparagraph not later than 180 days after the
date of the enactment of this title.
(B) Proposed regulations and rulemaking.--
Based on the periodic reviews under
subparagraph (A), if the WTC Program
Administrator determines that cancer or a
certain type of cancer should be added to such
list of WTC-related health conditions, the WTC
Program Administrator shall propose
regulations, through rulemaking, to add cancer
or the certain type of cancer to such list.
(C) Final regulations.--Based on all the
available evidence in the rulemaking record,
the WTC Program Administrator shall make a
final determination of whether cancer or a
certain type of cancer should be added to such
list of WTC-related health conditions. If such
a determination is made to make such an
addition, the WTC Program Administrator shall
by regulation add cancer or the certain type of
cancer to such list.
(D) Determinations not to add cancer or
certain types of cancer.--In the case that the
WTC Program Administrator determines under
subparagraph (B) or (C) that cancer or a
certain type of cancer should not be added to
such list of WTC-related health conditions, the
WTC Program Administrator shall publish an
explanation for such determination in the
Federal Register. Any such determination to not
make such an addition shall not preclude the
addition of cancer or the certain type of
cancer to such list at a later date.
(6) Addition of health conditions to list for wtc
responders.--
(A) In general.--Whenever the WTC Program
Administrator determines that a proposed rule
should be promulgated to add a health condition
to the list of health conditions in paragraph
(3), the Administrator may request a
recommendation of the Advisory Committee or may
publish such a proposed rule in the Federal
Register in accordance with subparagraph (D).
(B) Administrator's options after receipt of
petition.--In the case that the WTC Program
Administrator receives a written petition by an
interested party to add a health condition to
the list of health conditions in paragraph (3),
not later than 60 days after the date of
receipt of such petition the Administrator
shall--
(i) request a recommendation of the
Advisory Committee;
(ii) publish a proposed rule in the
Federal Register to add such health
condition, in accordance with
subparagraph (D);
(iii) publish in the Federal Register
the Administrator's determination not
to publish such a proposed rule and the
basis for such determination; or
(iv) publish in the Federal Register
a determination that insufficient
evidence exists to take action under
clauses (i) through (iii).
(C) Action by advisory committee.--In the
case that the Administrator requests a
recommendation of the Advisory Committee under
this paragraph, with respect to adding a health
condition to the list in paragraph (3), the
Advisory Committee shall submit to the
Administrator such recommendation not later
than 60 days after the date of such request or
by such date (not to exceed 180 days after such
date of request) as specified by the
Administrator. Not later than 60 days after the
date of receipt of such recommendation, the
Administrator shall, in accordance with
subparagraph (D), publish in the Federal
Register a proposed rule with respect to such
recommendation or a determination not to
propose such a proposed rule and the basis for
such determination.
(D) Publication.--The WTC Program
Administrator shall, with respect to any
proposed rule under this paragraph--
(i) publish such proposed rule in
accordance with section 553 of title 5,
United States Code; and
(ii) provide interested parties a
period of 30 days after such
publication to submit written comments
on the proposed rule.
The WTC Program Administrator may extend the
period described in clause (ii) upon a finding
of good cause. In the case of such an
extension, the Administrator shall publish such
extension in the Federal Register.
(E) Interested party defined.--For purposes
of this paragraph, the term ``interested
party'' includes a representative of any
organization representing WTC responders, a
nationally recognized medical association, a
Clinical or Data Center, a State or political
subdivision, or any other interested person.
(b) Coverage of Treatment for WTC-Related Health
Conditions.--
(1) Determination for enrolled wtc responders based
on a wtc-related health condition.--
(A) In general.--If a physician at a Clinical
Center of Excellence that is providing
monitoring benefits under section 3311 for an
enrolled WTC responder makes a determination
that the responder has a WTC-related health
condition that is in the list in subsection
(a)(3) and that exposure to airborne toxins,
other hazards, or adverse conditions resulting
from the September 1, 2001, terrorist attacks
is substantially likely to be a significant
factor in aggravating, contributing to, or
causing the condition--
(i) the physician shall promptly
transmit such determination to the WTC
Program Administrator and provide the
Administrator with the medical facts
supporting such determination; and
(ii) on and after the date of such
transmittal and subject to subparagraph
(B), the WTC Program shall provide for
payment under subsection (c) for
medically necessary treatment for such
condition.
(B) Review; certification; appeals.--
(i) Review.--A Federal employee
designated by the WTC Program
Administrator shall review
determinations made under subparagraph
(A).
(ii) Certification.--The
Administrator shall provide a
certification of such condition based
upon reviews conducted under clause
(i). Such a certification shall be
provided unless the Administrator
determines that the responder's
condition is not a WTC-related health
condition in the list in subsection
(a)(3) or that exposure to airborne
toxins, other hazards, or adverse
conditions resulting from the September
1, 2001, terrorist attacks is not
substantially likely to be a
significant factor in aggravating,
contributing to, or causing the
condition.
(iii) Appeal process.--The
Administrator shall establish, by rule,
a process for the appeal of
determinations under clause (ii).
(2) Determination based on medically associated wtc-
related health conditions.--
(A) In general.--If a physician at a Clinical
Center of Excellence determines pursuant to
subsection (a) that the enrolled WTC responder
has a health condition described in subsection
(a)(1)(A) that is not in the list in subsection
(a)(3) but which is medically associated with a
WTC-related health condition--
(i) the physician shall promptly
transmit such determination to the WTC
Program Administrator and provide the
Administrator with the facts supporting
such determination; and
(ii) the Administrator shall make a
determination under subparagraph (B)
with respect to such physician's
determination.
(B) Procedures for review, certification, and
appeal.--The WTC Program Administrator shall,
by rule, establish procedures for the review
and certification of physician determinations
under subparagraph (A). Such rule shall provide
for--
(i) the timely review of such a
determination by a physician panel with
appropriate expertise for the condition
and recommendations to the WTC Program
Administrator;
(ii) not later than 60 days after the
date of the transmittal under
subparagraph (A)(i), a determination by
the WTC Program Administrator on
whether or not the condition involved
is described in subsection (a)(1)(A)
and is medically associated with a WTC-
related health condition;
(iii) certification in accordance
with paragraph (1)(B)(ii) of coverage
of such condition if determined to be
described in subsection (a)(1)(A) and
medically associated with a WTC-related
health condition; and
(iv) a process for appeals of
determinations relating to such
conditions.
(C) Inclusion in list of health conditions.--
If the WTC Program Administrator provides
certification under subparagraph (B)(iii) for
coverage of a condition, the Administrator may,
pursuant to subsection (a)(6), add the
condition to the list in subsection (a)(3).
(D) Conditions already declined for inclusion
in list.--If the WTC Program Administrator
publishes a determination under subsection
(a)(6)(B) not to include a condition in the
list in subsection (a)(3), the WTC Program
Administrator shall not provide certification
under subparagraph (B)(iii) for coverage of the
condition. In the case of an individual who is
certified under subparagraph (B)(iii) with
respect to such condition before the date of
the publication of such determination the
previous sentence shall not apply.
(3) Requirement of medical necessity.--
(A) In general.--In providing treatment for a
WTC-related health condition, a physician or
other provider shall provide treatment that is
medically necessary and in accordance with
medical treatment protocols established under
subsection (d).
(B) Regulations relating to medical
necessity.--For the purpose of this title, the
WTC Program Administrator shall issue
regulations specifying a standard for
determining medical necessity with respect to
health care services and prescription
pharmaceuticals, a process for determining
whether treatment furnished and pharmaceuticals
prescribed under this title meet such standard
(including any prior authorization
requirement), and a process for appeal of a
determination under subsection (c)(3).
(4) Scope of treatment covered.--
(A) In general.--The scope of treatment
covered under this subsection includes services
of physicians and other health care providers,
diagnostic and laboratory tests, prescription
drugs, inpatient and outpatient hospital
services, and other medically necessary
treatment.
(B) Pharmaceutical coverage.--With respect to
ensuring coverage of medically necessary
outpatient prescription drugs, such drugs shall
be provided, under arrangements made by the WTC
Program Administrator, directly through
participating Clinical Centers of Excellence or
through one or more outside vendors.
(C) Transportation expenses for nationwide
network.--The WTC Program Administrator may
provide for necessary and reasonable
transportation and expenses incident to the
securing of medically necessary treatment
through the nationwide network under section
3313 involving travel of more than 250 miles
and for which payment is made under this
section in the same manner in which individuals
may be furnished necessary and reasonable
transportation and expenses incident to
services involving travel of more than 250
miles under regulations implementing section
3629(c) of the Energy Employees Occupational
Illness Compensation Program Act of 2000 (title
XXXVI of Public Law 106-398; 42 U.S.C.
7384t(c)).
(5) Provision of treatment pending certification.--
With respect to an enrolled WTC responder for whom a
determination is made by an examining physician under
paragraph (1) or (2), but for whom the WTC Program
Administrator has not yet determined whether to certify
the determination, the WTC Program Administrator may
establish by rule a process through which the
Administrator may approve the provision of medical
treatment under this subsection (and payment under
subsection (c)) with respect to such responder and such
responder's WTC-related health condition (under such
terms and conditions as the Administrator may provide)
until the Administrator makes a decision on whether to
certify the determination.
(c) Payment for Initial Health Evaluation, Monitoring, and
Treatment of WTC-Related Health Conditions.--
(1) Medical treatment.--
(A) Use of feca payment rates.--Subject to
subparagraphs (B) and (C), the WTC Program
Administrator shall reimburse costs for
medically necessary treatment under this title
for WTC-related health conditions according to
the payment rates that would apply to the
provision of such treatment and services by the
facility under the Federal Employees
Compensation Act. For treatment not covered
under the previous sentence or subparagraph
(B), the WTC Program Administrator shall
establish by regulation a reimbursement rate
for such treatment.
(B) Pharmaceuticals.--
(i) In general.--The WTC Program
Administrator shall establish a program
for paying for the medically necessary
outpatient prescription pharmaceuticals
prescribed under this title for WTC-
related health conditions through one
or more contracts with outside vendors.
(ii) Competitive bidding.--Under such
program the Administrator shall--
(I) select one or more
appropriate vendors through a
Federal competitive bid
process; and
(II) select the lowest bidder
(or bidders) meeting the
requirements for providing
pharmaceutical benefits for
participants in the WTC
Program.
(iii) Treatment of fdny
participants.--Under such program the
Administrator may enter into an
agreement with a separate vendor to
provide pharmaceutical benefits to
enrolled WTC responders for whom the
Clinical Center of Excellence is
described in section 3305 if such an
arrangement is deemed necessary and
beneficial to the program by the WTC
Program Administrator.
(C) Improving quality and efficiency through
modification of payment amounts and
methodologies.--The WTC Program Administrator
may modify the amounts and methodologies for
making payments for initial health evaluations,
monitoring, or treatment, if, taking into
account utilization and quality data furnished
by the Clinical Centers of Excellence under
section 3305(b)(1)(B)(iii), the Administrator
determines that a bundling, capitation, pay for
performance, or other payment methodology would
better ensure high quality and efficient
delivery of initial health evaluations,
monitoring, or treatment to an enrolled WTC
responder, screening-eligible WTC survivor, or
certified-eligible WTC survivor.
(2) Monitoring and initial health evaluation.--The
WTC Program Administrator shall reimburse the costs of
monitoring and the costs of an initial health
evaluation provided under this title at a rate set by
the Administrator by regulation.
(3) Determination of medical necessity.--
(A) Review of medical necessity and
protocols.--As part of the process for
reimbursement or payment under this subsection,
the WTC Program Administrator shall provide for
the review of claims for reimbursement or
payment for the provision of medical treatment
to determine if such treatment is medically
necessary and in accordance with medical
treatment protocols established under
subsection (d).
(B) Withholding of payment for medically
unnecessary treatment.--The Administrator shall
withhold such reimbursement or payment for
treatment that the Administrator determines is
not medically necessary or is not in accordance
with such medical treatment protocols.
(d) Medical Treatment Protocols.--
(1) Development.--The Data Centers shall develop
medical treatment protocols for the treatment of
enrolled WTC responders and certified-eligible WTC
survivors for health conditions included in the
applicable list of WTC-related health conditions.
(2) Approval.--The medical treatment protocols
developed under paragraph (1) shall be subject to
approval by the WTC Program Administrator.
SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS
OUTSIDE NEW YORK.
(a) In General.--In order to ensure reasonable access to
benefits under this subtitle for individuals who are enrolled
WTC responders, screening-eligible WTC survivors, or certified-
eligible WTC survivors and who reside in any State, as defined
in section 2(f), outside the New York metropolitan area, the
WTC Program Administrator shall establish a nationwide network
of health care providers to provide monitoring and treatment
benefits and initial health evaluations near such individuals'
areas of residence in such States. Nothing in this subsection
shall be construed as preventing such individuals from being
provided such monitoring and treatment benefits or initial
health evaluation through any Clinical Center of Excellence.
(b) Network Requirements.--Any health care provider
participating in the network under subsection (a) shall--
(1) meet criteria for credentialing established by
the Data Centers;
(2) follow the monitoring, initial health evaluation,
and treatment protocols developed under section
3305(a)(2)(A)(ii);
(3) collect and report data in accordance with
section 3304; and
(4) meet such fraud, quality assurance, and other
requirements as the WTC Program Administrator
establishes, including sections 1128 through 1128E of
the Social Security Act, as applied by section 3301(d).
(c) Training and Technical Assistance.--The WTC Program
Administer may provide, including through contract, for the
provision of training and technical assistance to health care
providers participating in the network under subsection (a).
PART 2--WTC SURVIVORS
SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF SCREENING-
ELIGIBLE AND CERTIFIED-ELIGIBLE WTC SURVIVORS.
(a) Identification of Screening-Eligible WTC Survivors and
Certified-Eligible WTC Survivors.--
(1) Screening-eligible wtc survivors.--
(A) Definition.--In this title, the term
``screening-eligible WTC survivor'' means,
subject to subparagraph (C) and paragraph (3),
an individual who is described in any of the
following clauses:
(i) Currently identified survivor.--
An individual, including a WTC
responder, who has been identified as
eligible for medical treatment and
monitoring by the WTC Environmental
Health Center as of the date of
enactment of this title.
(ii) Survivor who meets current
eligibility criteria.--An individual
who is not a WTC responder, for
purposes of the initial health
evaluation under subsection (b), claims
symptoms of a WTC-related health
condition and meets any of the current
eligibility criteria described in
subparagraph (B).
(iii) Survivor who meets modified
eligibility criteria.--An individual
who is not a WTC responder, for
purposes of the initial health
evaluation under subsection (b), claims
symptoms of a WTC-related health
condition and meets such eligibility
criteria relating to exposure to
airborne toxins, other hazards, or
adverse conditions resulting from the
September 11, 2001, terrorist attacks
as the WTC Administrator determines,
after consultation with the Data
Centers described in section 3305 and
the WTC Scientific/Technical Advisory
Committee and WTC Health Program
Steering Committees under section 3302.
The Administrator shall not modify such
criteria under clause (iii) on or after the
date that the number of certifications for
certified-eligible WTC survivors under
paragraph (2)(B) has reached 80 percent of the
limit described in paragraph (3) or on or after
the date that the number of enrollments of WTC
responders has reached 80 percent of the limit
described in section 3311(a)(4).
(B) Current eligibility criteria.--The
eligibility criteria described in this
subparagraph for an individual are that the
individual is described in any of the following
clauses:
(i) A person who was present in the
New York City disaster area in the dust
or dust cloud on September 11, 2001.
(ii) A person who worked, resided, or
attended school, childcare, or adult
daycare in the New York City disaster
area for--
(I) at least 4 days during
the 4-month period beginning on
September 11, 2001, and ending
on January 10, 2002; or
(II) at least 30 days during
the period beginning on
September 11, 2001, and ending
on July 31, 2002.
(iii) Any person who worked as a
cleanup worker or performed maintenance
work in the New York City disaster area
during the 4-month period described in
subparagraph (B)(i) and had extensive
exposure to WTC dust as a result of
such work.
(iv) A person who was deemed eligible
to receive a grant from the Lower
Manhattan Development Corporation
Residential Grant Program, who
possessed a lease for a residence or
purchased a residence in the New York
City disaster area, and who resided in
such residence during the period
beginning on September 11, 2001, and
ending on May 31, 2003.
(v) A person whose place of
employment--
(I) at any time during the
period beginning on September
11, 2001, and ending on May 31,
2003, was in the New York City
disaster area; and
(II) was deemed eligible to
receive a grant from the Lower
Manhattan Development
Corporation WTC Small Firms
Attraction and Retention Act
program or other government
incentive program designed to
revitalize the lower Manhattan
economy after the September 11,
2001, terrorist attacks.
(C) Application and determination process for
screening eligibility.--
(i) In general.--The WTC Program
Administrator in consultation with the
Data Centers shall establish a process
for individuals, other than individuals
described in subparagraph (A)(i), to be
determined to be screening-eligible WTC
survivors. Under such process--
(I) there shall be no fee
charged to the applicant for
making an application for such
determination;
(II) the Administrator shall
make a determination on such an
application not later than 60
days after the date of filing
the application;
(III) the Administrator shall
make such a determination
relating to an applicant's
compliance with this title and
shall not determine that an
individual is not so eligible
or deny written documentation
under clause (ii) to such
individual unless the
Administrator determines that--
(aa) based on the
application submitted,
the individual does not
meet the eligibility
criteria; or
(bb) the numerical
limitation on
certifications of
certified-eligible WTC
survivors set forth in
paragraph (3) has been
met; and
(IV) an individual who is
determined not to be a
screening-eligible WTC survivor
shall have an opportunity to
appeal such determination in a
manner established under such
process.
(ii) Written documentation of
screening-eligibility.--
(I) In general.--In the case
of an individual who is
described in subparagraph
(A)(i) or who is determined
under clause (i) (consistent
with paragraph (3)) to be a
screening-eligible WTC
survivor, the WTC Program
Administrator shall provide an
appropriate written
documentation of such fact.
(II) Timing.--
(aa) Currently
identified survivors.--
In the case of an
individual who is
described in
subparagraph (A)(i),
the WTC Program
Administrator shall
provide the written
documentation under
subclause (I) not later
than July 1, 2011.
(bb) Other members.--
In the case of another
individual who is
determined under clause
(i) and consistent with
paragraph (3) to be a
screening-eligible WTC
survivor, the WTC
Program Administrator
shall provide the
written documentation
under subclause (I) at
the time of such
determination.
(2) Certified-eligible wtc survivors.--
(A) Definition.--The term ``certified-
eligible WTC survivor'' means, subject to
paragraph (3), a screening-eligible WTC
survivor who the WTC Program Administrator
certifies under subparagraph (B) to be eligible
for followup monitoring and treatment under
this part.
(B) Certification of eligibility for
monitoring and treatment.--
(i) In general.--The WTC Program
Administrator shall establish a
certification process under which the
Administrator shall provide appropriate
certification to screening-eligible WTC
survivors who, pursuant to the initial
health evaluation under subsection (b),
are determined to be eligible for
followup monitoring and treatment under
this part.
(ii) Timing.--
(I) Currently identified
survivors.--In the case of an
individual who is described in
paragraph (1)(A)(i), the WTC
Program Administrator shall
provide the certification under
clause (i) not later than July
1, 2011.
(II) Other members.--In the
case of another individual who
is determined under clause (i)
to be eligible for followup
monitoring and treatment, the
WTC Program Administrator shall
provide the certification under
such clause at the time of such
determination.
(3) Numerical limitation on certified-eligible wtc
survivors.--
(A) In general.--The total number of
individuals not described in paragraph
(1)(A)(i) who may be certified as certified-
eligible WTC survivors under paragraph (2)(B)
shall not exceed 25,000 at any time.
(B) Process.--In implementing subparagraph
(A), the WTC Program Administrator shall--
(i) limit the number of
certifications provided under paragraph
(2)(B)--
(I) in accordance with such
subparagraph; and
(II) to such number, as
determined by the Administrator
based on the best available
information and subject to
amounts made available under
section 3351, that will ensure
sufficient funds will be
available to provide treatment
and monitoring benefits under
this title, with respect to all
individuals receiving such
certifications through the end
of fiscal year 2020; and
(ii) provide priority in such
certifications in the order in which
individuals apply for a determination
under paragraph (2)(B).
(4) Disqualification of individuals on terrorist
watch list.--No individual who is on the terrorist
watch list maintained by the Department of Homeland
Security shall qualify as a screening-eligible WTC
survivor or a certified-eligible WTC survivor. Before
determining any individual to be a screening-eligible
WTC survivor under paragraph (1) or certifying any
individual as a certified eligible WTC survivor under
paragraph (2), the Administrator, in consultation with
the Secretary of Homeland Security, shall determine
whether the individual is on such list.
(b) Initial Health Evaluation To Determine Eligibility for
Followup Monitoring or Treatment.--
(1) In general.--In the case of a screening-eligible
WTC survivor, the WTC Program shall provide for an
initial health evaluation to determine if the survivor
has a WTC-related health condition and is eligible for
followup monitoring and treatment benefits under the
WTC Program. Initial health evaluation protocols under
section 3305(a)(2)(A)(ii) shall be subject to approval
by the WTC Program Administrator.
(2) Initial health evaluation providers.--The initial
health evaluation described in paragraph (1) shall be
provided through a Clinical Center of Excellence with
respect to the individual involved.
(3) Limitation on initial health evaluation
benefits.--Benefits for an initial health evaluation
under this part for a screening-eligible WTC survivor
shall consist only of a single medical initial health
evaluation consistent with initial health evaluation
protocols described in paragraph (1). Nothing in this
paragraph shall be construed as preventing such an
individual from seeking additional medical initial
health evaluations at the expense of the individual.
SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED-ELIGIBLE WTC
SURVIVORS FOR WTC-RELATED HEALTH CONDITIONS.
(a) In General.--Subject to subsection (b), the provisions of
sections 3311 and 3312 shall apply to followup monitoring and
treatment of WTC-related health conditions for certified-
eligible WTC survivors in the same manner as such provisions
apply to the monitoring and treatment of WTC-related health
conditions for enrolled WTC responders.
(b) List of WTC-Related Health Conditions for Survivors.--The
list of health conditions for screening-eligible WTC survivors
and certified-eligible WTC survivors consists of the following:
(1) Aerodigestive disorders.--
(A) Interstitial lung diseases.
(B) Chronic respiratory disorder--fumes/
vapors.
(C) Asthma.
(D) Reactive airways dysfunction syndrome
(RADS).
(E) WTC-exacerbated chronic obstructive
pulmonary disease (COPD).
(F) Chronic cough syndrome.
(G) Upper airway hyperreactivity.
(H) Chronic rhinosinusitis.
(I) Chronic nasopharyngitis.
(J) Chronic laryngitis.
(K) Gastroesophageal reflux disorder (GERD).
(L) Sleep apnea exacerbated by or related to
a condition described in a previous clause.
(2) Mental health conditions.--
(A) Posttraumatic stress disorder (PTSD).
(B) Major depressive disorder.
(C) Panic disorder.
(D) Generalized anxiety disorder.
(E) Anxiety disorder (not otherwise
specified).
(F) Depression (not otherwise specified).
(G) Acute stress disorder.
(H) Dysthymic disorder.
(I) Adjustment disorder.
(J) Substance abuse.
(3) Additional conditions.--Any cancer (or type of
cancer) or other condition added to the list in section
3312(a)(3) pursuant to paragraph (5) or (6) of section
3312(a), as such provisions are applied under
subsection (a) with respect to certified-eligible WTC
survivors.
SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS WITH
WTC-RELATED HEALTH CONDITIONS.
(a) In General.--Subject to subsection (c), the provisions of
section 3322 shall apply to the followup monitoring and
treatment of WTC-related health conditions in the case of
individuals described in subsection (b) in the same manner as
such provisions apply to the followup monitoring and treatment
of WTC-related health conditions for certified-eligible WTC
survivors.
(b) Individuals Described.--An individual described in this
subsection is an individual who, regardless of location of
residence--
(1) is not an enrolled WTC responder or a certified-
eligible WTC survivor; and
(2) is diagnosed at a Clinical Center of Excellence
with a WTC-related health condition for certified-
eligible WTC survivors.
(c) Limitation.--
(1) In general.--The WTC Program Administrator shall
limit benefits for any fiscal year under subsection (a)
in a manner so that payments under this section for
such fiscal year do not exceed the amount specified in
paragraph (2) for such fiscal year.
(2) Limitation.--The amount specified in this
paragraph for--
(A) the last calendar quarter of fiscal year
2011 is $5,000,000;
(B) fiscal year 2012 is $20,000,000; or
(C) a succeeding fiscal year is the amount
specified in this paragraph for the previous
fiscal year increased by the annual percentage
increase in the medical care component of the
consumer price index for all urban consumers.
PART 3--PAYOR PROVISIONS
SEC. 3331. PAYMENT OF CLAIMS.
(a) In General.--Except as provided in subsections (b) and
(c), the cost of monitoring and treatment benefits and initial
health evaluation benefits provided under parts 1 and 2 of this
subtitle shall be paid for by the WTC Program from the World
Trade Center Health Program Fund.
(b) Workers' Compensation Payment.--
(1) In general.--Subject to paragraph (2), payment
for treatment under parts 1 and 2 of this subtitle of a
WTC-related health condition of an individual that is
work-related shall be reduced or recouped to the extent
that the WTC Program Administrator determines that
payment has been made, or can reasonably be expected to
be made, under a workers' compensation law or plan of
the United States, a State, or a locality, or other
work-related injury or illness benefit plan of the
employer of such individual, for such treatment. The
provisions of clauses (iii), (iv), (v), and (vi) of
paragraph (2)(B) of section 1862(b) of the Social
Security Act and paragraphs (3) and (4) of such section
shall apply to the recoupment under this subsection of
a payment to the WTC Program (with respect to a
workers' compensation law or plan, or other work-
related injury or illness plan of the employer
involved, and such individual) in the same manner as
such provisions apply to the reimbursement of a payment
under section 1862(b)(2) of such Act to the Secretary
(with respect to such a law or plan and an individual
entitled to benefits under title XVIII of such Act)
except that any reference in such paragraph (4) to
payment rates under title XVIII of the Social Security
Act shall be deemed a reference to payment rates under
this title.
(2) Exception.--Paragraph (1) shall not apply for any
quarter, with respect to any workers' compensation law
or plan, including line of duty compensation, to which
New York City is obligated to make payments, if, in
accordance with terms specified under the contract
under subsection (d)(1)(A), New York City has made the
full payment required under such contract for such
quarter.
(3) Rules of construction.--Nothing in this title
shall be construed to affect, modify, or relieve any
obligations under a worker's compensation law or plan,
other work-related injury or illness benefit plan of an
employer, or any health insurance plan.
(c) Health Insurance Coverage.--
(1) In general.--In the case of an individual who has
a WTC-related health condition that is not work-related
and has health coverage for such condition through any
public or private health plan (including health
benefits under title XVIII, XIX, or XXI of the Social
Security Act) the provisions of section 1862(b) of the
Social Security Act shall apply to such a health plan
and such individual in the same manner as they apply to
group health plan and an individual entitled to
benefits under title XVIII of such Act pursuant to
section 226(a) of such Act. Any costs for items and
services covered under such plan that are not
reimbursed by such health plan, due to the application
of deductibles, copayments, coinsurance, other cost
sharing, or otherwise, are reimbursable under this
title to the extent that they are covered under the WTC
Program. The program under this title shall not be
treated as a legally liable party for purposes of
applying section 1902(a)(25) of the Social Security
Act.
(2) Recovery by individual providers.--Nothing in
paragraph (1) shall be construed as requiring an entity
providing monitoring and treatment under this title to
seek reimbursement under a health plan with which the
entity has no contract for reimbursement.
(3) Maintenance of required minimum essential
coverage.--No payment may be made for monitoring and
treatment under this title for an individual for a
month (beginning with July 2014) if with respect to
such month the individual--
(A) is an applicable individual (as defined
in subsection (d) of section 5000A of Internal
Revenue Code of 1986) for whom the exemption
under subsection (e) of such section does not
apply; and
(B) is not covered under minimum essential
coverage, as required under subsection (a) of
such section.
(d) Required Contribution by New York City in Program
Costs.--
(1) Contract requirement.--
(A) In general.--No funds may be disbursed
from the World Trade Center Health Program Fund
under section 3351 unless New York City has
entered into a contract with the WTC Program
Administrator under which New York City agrees,
in a form and manner specified by the
Administrator, to pay the full contribution
described in subparagraph (B) in accordance
with this subsection on a timely basis, plus
any interest owed pursuant to subparagraph
(E)(i). Such contract shall specify the terms
under which New York City shall be considered
to have made the full payment required for a
quarter for purposes of subsection (b)(2).
(B) Full contribution amount.--Under such
contract, with respect to the last calendar
quarter of fiscal year 2011 and each calendar
quarter in fiscal years 2012 through 2020 the
full contribution amount under this
subparagraph shall be equal to 10 percent of
the expenditures in carrying out this title for
the respective quarter.
(C) Satisfaction of payment obligation.--The
payment obligation under such contract may not
be satisfied through any of the following:
(i) An amount derived from Federal
sources.
(ii) An amount paid before the date
of the enactment of this title.
(iii) An amount paid to satisfy a
judgment or as part of a settlement
related to injuries or illnesses
arising out of the September 11, 2001,
terrorist attacks.
(D) Timing of contribution.--The payment
obligation under such contract for a calendar
quarter in a fiscal year shall be paid not
later than the last day of the second
succeeding calendar quarter.
(E) Compliance.--
(i) Interest for late payment.--If
New York City fails to pay to the WTC
Program Administrator pursuant to such
contract the amount required for any
calendar quarter by the day specified
in subparagraph (D), interest shall
accrue on the amount not so paid at the
rate (determined by the Administrator)
based on the average yield to maturity,
plus 1 percentage point, on outstanding
municipal bonds issued by New York City
with a remaining maturity of at least 1
year.
(ii) Recovery of amounts owed.-- The
amounts owed to the WTC Program
Administrator under such contract shall
be recoverable by the United States in
an action in the same manner as
payments made under title XVIII of the
Social Security Act may be recoverable
in an action brought under section
1862(b)(2)(B)(iii) of such Act.
(F) Deposit in fund.--The WTC Program
Administer shall deposit amounts paid under
such contract into the World Trade Center
Health Program Fund under section 3351.
(2) Payment of new york city share of monitoring and
treatment costs.--With respect to each calendar quarter
for which a contribution is required by New York City
under the contract under paragraph (1), the WTC Program
Administrator shall--
(A) provide New York City with an estimate of
such amount of the required contribution at the
beginning of such quarter and with an updated
estimate of such amount at the beginning of
each of the subsequent 2 quarters;
(B) bill such amount directly to New York
City; and
(C) certify periodically, for purposes of
this subsection, whether or not New York City
has paid the amount so billed.
Such amount shall initially be estimated by the WTC
Program Administrator and shall be subject to
adjustment and reconciliation based upon actual
expenditures in carrying out this title.
(3) Rule of construction.--Nothing in this subsection
shall be construed as authorizing the WTC
Administrator, with respect to a fiscal year, to reduce
the numerical limitation under section 3311(a)(4) or
3321(a)(3) for such fiscal year if New York City fails
to comply with paragraph (1) for a calendar quarter in
such fiscal year.
(e) Work-Related Described.--For the purposes of this
section, a WTC-related health condition shall be treated as a
condition that is work-related if--
(1) the condition is diagnosed in an enrolled WTC
responder, or in an individual who qualifies as a
certified-eligible WTC survivor on the basis of being a
rescue, recovery, or cleanup worker; or
(2) with respect to the condition the individual has
filed and had established a claim under a workers'
compensation law or plan of the United States or a
State, or other work-related injury or illness benefit
plan of the employer of such individual.
SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY.
The WTC Program Administrator may enter into arrangements
with other government agencies, insurance companies, or other
third-party administrators to provide for timely and accurate
processing of claims under sections 3312, 3313, 3322, and 3323.
Subtitle C--Research Into Conditions
SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO
SEPTEMBER 11 TERRORIST ATTACKS.
(a) In General.--With respect to individuals, including
enrolled WTC responders and certified-eligible WTC survivors,
receiving monitoring or treatment under subtitle B, the WTC
Program Administrator shall conduct or support--
(1) research on physical and mental health conditions
that may be related to the September 11, 2001,
terrorist attacks;
(2) research on diagnosing WTC-related health
conditions of such individuals, in the case of
conditions for which there has been diagnostic
uncertainty; and
(3) research on treating WTC-related health
conditions of such individuals, in the case of
conditions for which there has been treatment
uncertainty.
The Administrator may provide such support through continuation
and expansion of research that was initiated before the date of
the enactment of this title and through the World Trade Center
Health Registry (referred to in section 3342), through a
Clinical Center of Excellence, or through a Data Center.
(b) Types of Research.--The research under subsection (a)(1)
shall include epidemiologic and other research studies on WTC-
related health conditions or emerging conditions--
(1) among enrolled WTC responders and certified-
eligible WTC survivors under treatment; and
(2) in sampled populations outside the New York City
disaster area in Manhattan as far north as 14th Street
and in Brooklyn, along with control populations, to
identify potential for long-term adverse health effects
in less exposed populations.
(c) Consultation.--The WTC Program Administrator shall carry
out this section in consultation with the WTC Scientific/
Technical Advisory Committee.
(d) Application of Privacy and Human Subject Protections.--
The privacy and human subject protections applicable to
research conducted under this section shall not be less than
such protections applicable to research conducted or funded by
the Department of Health and Human Services.
SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY.
For the purpose of ensuring ongoing data collection relating
to victims of the September 11, 2001, terrorist attacks, the
WTC Program Administrator shall ensure that a registry of such
victims is maintained that is at least as comprehensive as the
World Trade Center Health Registry maintained under the
arrangements in effect as of April 20, 2009, with the New York
City Department of Health and Mental Hygiene.
Subtitle D--Funding
SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM FUND.
(a) Establishment of Fund.--
(1) In general.--There is established a fund to be
known as the World Trade Center Health Program Fund
(referred to in this section as the ``Fund'').
(2) Funding.--Out of any money in the Treasury not
otherwise appropriated, there shall be deposited into
the Fund for each of fiscal years 2012 through 2020
(and the last calendar quarter of fiscal year 2011)--
(A) the Federal share, consisting of an
amount equal to the lesser of--
(i) 90 percent of the expenditures in
carrying out this title for the
respective fiscal year (initially based
on estimates, subject to subsequent
reconciliation based on actual
expenditures); or
(ii) $71,000,000 for the last
calendar quarter of fiscal year 2011,
$318,000,000 for fiscal year 2012,
$354,000,000 for fiscal year 2013,
$382,000,000 for fiscal year 2014,
$431,000,000 for fiscal year 2015,
$481,000,000 for fiscal year 2016,
$537,000,000 for fiscal year 2017,
$601,000,000 for fiscal year 2018,
$672,000,000 for fiscal year 2019, and
$743,000,000 for fiscal year 2020; plus
(B) the New York City share, consisting of
the amount contributed under the contract under
section 3331(d).
(3) Contract requirement.--
(A) In general.--No funds may be disbursed
from the Fund unless New York City has entered
into a contract with the WTC Program
Administrator under section 3331(d)(1).
(B) Breach of contract.-- In the case of a
failure to pay the amount so required under the
contract--
(i) the amount is recoverable under
subparagraph (E)(ii) of such section;
(ii) such failure shall not affect
the disbursement of amounts from the
Fund; and
(iii) the Federal share described in
paragraph (2)(A) shall not be increased
by the amount so unpaid.
(b) Mandatory Funds for Monitoring, Initial Health
Evaluations, Treatment, and Claims Processing.--
(1) In general.--The amounts deposited into the Fund
under subsection (a)(2) shall be available, without
further appropriation, consistent with paragraph (2)
and subsection (c), to carry out subtitle B and
sections 3302(a), 3303, 3304, 3305(a)(2), 3305(c),
3341, and 3342.
(2) Limitation on mandatory funding.--This title does
not establish any Federal obligation for payment of
amounts in excess of the amounts available from the
Fund for such purpose.
(3) Limitation on authorization for further
appropriations.--This title does not establish any
authorization for appropriation of amounts in excess of
the amounts available from the Fund under paragraph
(1).
(c) Limits on Spending for Certain Purposes.--Of the amounts
made available under subsection (b)(1), not more than each of
the following amounts may be available for each of the
following purposes:
(1) Surviving immediate family members of
firefighters.--For the purposes of carrying out
subtitle B with respect to WTC responders described in
section 3311(a)(2)(A)(ii)--
(A) for the last calendar quarter of fiscal
year 2011, $100,000;
(B) for fiscal year 2012, $400,000; and
(C) for each subsequent fiscal year, the
amount specified under this paragraph for the
previous fiscal year increased by the
percentage increase in the consumer price index
for all urban consumers (all items; United
States city average) as estimated by the
Secretary for the 12-month period ending with
March of the previous year.
(2) WTC health program scientific/technical advisory
committee.--For the purpose of carrying out section
3302(a)--
(A) for the last calendar quarter of fiscal
year 2011, $25,000;
(B) for fiscal year 2012, $100,000; and
(C) for each subsequent fiscal year, the
amount specified under this paragraph for the
previous fiscal year increased by the
percentage increase in the consumer price index
for all urban consumers (all items; United
States city average) as estimated by the
Secretary for the 12-month period ending with
March of the previous year.
(3) Education and outreach.--For the purpose of
carrying out section 3303--
(A) for the last calendar quarter of fiscal
year 2011, $500,000;
(B) for fiscal year 2012, $2,000,000; and
(C) for each subsequent fiscal year, the
amount specified under this paragraph for the
previous fiscal year increased by the
percentage increase in the consumer price index
for all urban consumers (all items; United
States city average) as estimated by the
Secretary for the 12-month period ending with
March of the previous year.
(4) Uniform data collection.--For the purpose of
carrying out section 3304 and for reimbursing Data
Centers (as defined in section 3305(b)(2)) for the
costs incurred by such Centers in carrying out
activities under contracts entered into under section
3305(a)(2)--
(A) for the last calendar quarter of fiscal
year 2011, $2,500,000;
(B) for fiscal year 2012, $10,000,000; and
(C) for each subsequent fiscal year, the
amount specified under this paragraph for the
previous fiscal year increased by the
percentage increase in the consumer price index
for all urban consumers (all items; United
States city average) as estimated by the
Secretary for the 12-month period ending with
March of the previous year.
(5) Research regarding certain health conditions.--
For the purpose of carrying out section 3341--
(A) for the last calendar quarter of fiscal
year 2011, $3,750,000;
(B) for fiscal year 2012, $15,000,000; and
(C) for each subsequent fiscal year, the
amount specified under this paragraph for the
previous fiscal year increased by the
percentage increase in the consumer price index
for all urban consumers (all items; United
States city average) as estimated by the
Secretary for the 12-month period ending with
March of the previous year.
(6) World trade center health registry.--For the
purpose of carrying out section 3342--
(A) for the last calendar quarter of fiscal
year 2011, $1,750,000;
(B) for fiscal year 2012, $7,000,000; and
(C) for each subsequent fiscal year, the
amount specified under this paragraph for the
previous fiscal year increased by the
percentage increase in the consumer price index
for all urban consumers (all items; United
States city average) as estimated by the
Secretary for the 12-month period ending with
March of the previous year.
DISSENTING VIEWS
We, the undersigned Members of the Committee on Energy and
Commerce, offer the following comments on H.R. 847, the ``James
Zadroga 9/11 Health and Compensation Act of 2009.'' Republicans
have supported and continue to support providing monitoring and
treatment of benefits for first responders to the 2001 World
Trade Center (WTC) tragedy. Although this bill has been
represented as merely authorizing in statute the existing WTC-
related program, H.R. 847 in fact changes the program
significantly without providing needed protections to ensure
taxpayer funds are spent properly and effectively. H.R. 847
increases federal spending by creating a new entitlement
program without requiring Congress to find wasteful spending
programs that could be cut or eliminated. The bill provides
incentives to providers to over-utilize services while at the
same time providing inflated reimbursement rates. The
legislation also does not protect taxpayer funds for paying for
benefits for illegal aliens. Republicans offered amendments to
authorize and improve the existing program, but they were
defeated.
The debate over H.R. 847 has been intentionally
mischaracterized by some proponents of the legislation. During
the markup of H.R. 847, some implied that supporters of the
legislation were the only ones who support providing health
care benefits to those who responded to the attack and charged
that those that questioned the structure of the bill opposed
providing help to these heroes. This mischaracterization does a
disservice to the legislative process.
The Majority Committee Report rightfully noted that ``The
WTC Health Programs currently funded by the federal government
are not authorized in statute. That is, there is no legislation
authorizing the appropriation of funds to the National
Institute for Occupational Health and Safety (NIOSH) to support
these programs. The absence of such legislation has not
precluded--and should not preclude--the funding of these
programs. It is far preferable, however, for the Congress to
set forth in an authorizing statute the purpose and scope of
the programs needed, the individuals intended to be assisted,
and the resources necessary to such programs. An authorizing
statute can improve accountability of the agency responsible
for administering the programs, transparency, and stability of
funding over time.''
Although some claim this bill simply authorizes the
existing program at NIOSH, H.R. 847 operates in a significantly
different manner than the current program. The NIOSH does not
have expertise in administering a health care payment program.
The current program functions as a block grant program and
individual grantees must conduct research, monitor conditions,
and provide treatment for those afflicted with World Trade
Center-related conditions. Under the bill, NIOSH could have
vastly expanded functions, many of which it has no expertise in
doing, such as negotiating provider payment rates, approving
treatment protocols, establishing a competitive bidding program
for prescription drugs, and evaluating the health of potential
enrollees in the program. Since the Administration was not
invited to testify on the legislation, we were unable to hear
its position on the proper agency to perform the activities set
forth in the legislation. Republicans advocated that the
Secretary of Health and Human Services have the discretion to
determine which agency had the necessary expertise to
administer the WTC health care program.
Mr. Rogers offered an amendment that would authorize in
statute the current WTC health program at NIOSH while also
providing needed accountability improvements to ensure the
funds were being spent appropriately. In addition to codifying
the existing monitoring and treatment program for first
responders, the Republican amendment would provide for outreach
to educate eligible individuals about the benefits of the
program and allow for continued data collection about 9-11
conditions. The amendment also contained needed accountability
reforms like requiring the Secretary to verify citizenship/
legal residency so that only those lawfully present in the
United States receive services and mandating an annual
accounting of the use of funds by the program. The amendment
set funding for the program in Fiscal Year 2011 at President
Obama's requested level of $150 million. The amendment was not
agreed to by a roll call vote of 19 Yeas to 30 Nays.
Some proponents of the legislation also mischaracterized
the debate over whether the program should be funded on an
annual basis or if the government should set mandatory
obligations for the program for the next ten years. The
Committee on Energy and Commerce is an authorizing committee
with a mission to set policy and specify spending priorities.
It is the function of the Committee on Appropriations to
allocate funds to the program this Committee authorizes.
Republicans find suspect the suggestion that if a program is
funded through the normal appropriations process then the
recipients of those funds must hold out a tin cup each year to
beg for money. Many federal health care programs, including
those that provide health care services to our current military
and veterans, and those that conduct research, are funded
through the regular, yearly appropriations process. This does
not mean these programs are at risk of being eliminated. When
there is agreement that a program is a priority, it gets
funded. Republicans believe that in a time of a $13 trillion
national debt and the expectation that the current budget will
add an additional $10 trillion of debt by the end of the
decade, a new multi-billion program can and should be
accompanied by a reduction in wasteful or unneeded programs.
The only reason to pass a mandatory spending program is to
grow the size of government and excuse Congress of its
obligation to cut or eliminate wasteful spending. The Taxpayers
for Common Sense have calculated that last year almost $16
billion was spent on Congressional earmarks. $772 million was
spent on earmarks in the Labor-Health and Human Services
appropriations bill alone. This demonstrates there are funds in
the annual appropriations bill that can be used to offset the
spending of the new program this bill would create. Proponents
of the legislation have argued that the Committee on
Appropriations will not fund the World Trade Center health care
program even though there would be more than sufficient funds
to cover the expense of the program just by simply eliminating
earmarks. Instead of prioritizing our federal spending, like
eliminating earmarks, the proponents of the legislation offered
a promise to pay for the bill in the future with tax increases.
With scarce federal resources, we must ensure that we spend
the people's money efficiently. Therefore, those funds should
not be used on those who are in the country illegally. The
underlying bill does not require the Secretary to verify
applicants' citizenship. H.R. 847 establishes a cap for the
number of people who may enroll in the program. Due to the lack
of a citizenship verification requirement, American citizens
may be blocked from accessing the program. Such a scenario is
unacceptable. Mr. Buyer offered an amendment that would ensure
only Americans and those in the country legally would be
provided benefits under this program. That amendment was
defeated by a vote of 16 Yeas to 27 Nays.
Dr. Burgess also offered a common sense amendment to ensure
benefits go to those that truly need them. The amendment would
have precluded millionaires from accessing this new health
entitlement program. That amendment was first defeated by a
vote of 16 Yeas to 29 Nays. After a motion to reconsider the
vote, the amendment was defeated again by a vote of 21 Yeas to
22 Nays.
Additionally, the World Trade Center health program should
be about providing benefits to first responders, not about
providing additional revenue for New York area hospitals. But
H.R. 847 increases reimbursement rates only for New York
hospitals and provides incentives for those hospitals to engage
in wasteful behavior. With respect to reimbursement, the bill
actually reimburses New York area hospitals at a rate that is
140% of the Medicare reimbursement rate and provides a perverse
incentive for hospitals to use unnecessary services because it
will result in higher payments from the federal government.
The Patient Protection and Affordable Care Act will slash
over $150 billion in payments to hospitals for care provided to
seniors. The Chief Actuary for the Centers for Medicare and
Medicaid Services concluded in an April 22, 2010, letter that
these Medicare cuts to hospitals and other Part A providers
could lead to 15% of those providers going out of business. The
Actuary stated these cuts could ``possibly jeopardize access to
care for beneficiaries.'' It is difficult to reconcile the
justification to cut hospital payments to every hospital in the
country while at the same time creating a new program that
provides reimbursement rates so far above the Medicare payment
level in the New York City area. Mr. Shimkus offered an
amendment that would have reimbursed these New York area
hospitals at the Medicare reimbursement rate, but that
amendment was defeated by a vote of 17 Yeas to 26 Nays.
H.R. 847 also fails to encourage quality care by those New
York hospitals. During the health care reform debate, there was
universal recognition that our federal health care programs
must start reimbursing providers based on the quality of
services they provide rather than the volume of services they
provide. The health care reform bill failed to make this
transition because existing government programs are slow to
adapt and change. In the creation of the new program under H.R.
847, there were no existing policies to prevent Congress from
demanding this program pay for quality rather than volume.
However, under H.R. 847, hospitals participating in the
program would receive financial windfalls for ordering more
tests regardless of the quality of care. Participants in the
program would have no incentive to question the cost of their
care because imposing any form of cost sharing is prohibited.
We are disappointed the Majority created only a superficial fix
for this issue by giving the Secretary discretion to modify
reimbursement methods after the program is already up and
running. The benefits of the bill are delayed until July 2011,
which is ample time for the Secretary to develop a
reimbursement method that is fair to all taxpayers, does not
reward over-utilization of services, and promotes quality of
care.
Republicans and Democrats share a common goal, which is to
ensure that first responders of the World Trade Center attack
have their conditions monitored and receive treatment for
conditions associated with the attacks. Republicans offered an
amendment to authorize the program and fund it at the
President's requested level. We offered amendments to increase
the accountability of how taxpayer dollars are spent and
offered an amendment that would ensure that Americans and those
in this country legally get care rather than those in the
country illegally. Unfortunately, these amendments were
defeated.
We continue to believe those who responded to the World
Trade Center attack should get the treatment they need because
they dutifully answered a call for help. The opposition to H.R.
847 is not opposition to providing health benefits. Rather, it
is an opposition to the structure and administration of the
program. We believe it is important to pay for our priorities
and eliminate unnecessary spending in other areas. We believe
that federal benefits should not go to those in the country
illegally. We also believe that programs should not provide
incentives to hospitals in the New York City area to order
unnecessary tests while paying those providers rates far beyond
what other federal programs reimburse, particularly when
hospitals in other parts of the country may be forced to close
due to the recently enacted Medicare cuts called for in the
health care reform law. Unfortunately, H.R. 847 fails to meet
these principles shared by most Americans. For these reasons we
encourage a ``no'' vote on H.R. 847.
Joe Barton.
John Shimkus.
Joseph R. Pitts.
Phil Gingrey.
Robert E. Latta.
Cliff Stearns.
Roy Blunt.
John B. Shadegg.
Mike Rogers (MI).
Steve Buyer.