[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.

                                  
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