    [United States Statutes at Large, Volume 124, 111th Congress, 2nd Session]
    [From the U.S. Government Publishing Office, www.gpo.gov]

    Public Law 111-347
    111th Congress

    An Act

    To amend the Public Health Service Act to extend and improve protections
    and services to individuals directly impacted by the terrorist attack in
    New York City on September 11, 2001, and for other
    purposes. <>

    Be it enacted by the Senate and House of Representatives of the
    United States of America in Congress assembled, <>
    SECTION 1. <> SHORT TITLE; TABLE OF
    CONTENTS.

    (a) Short Title.--This Act may be cited as the ``James Zadroga 9/11
    Health and Compensation Act of 2010''.
    (b) Table of Contents.--The table of contents of this Act is as
    follows:

    Sec. 1. Short title; table of contents.

    TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

    Sec. 101. World Trade Center Health Program.

    ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM

    ``Subtitle A--Establishment of Program; Advisory Committee

    ``Sec. 3301. Establishment of World Trade Center Health Program.
    ``Sec. 3302. WTC Health Program Scientific/Technical Advisory
    Committee; WTC Health Program Steering
    Committees.
    ``Sec. 3303. Education and outreach.
    ``Sec. 3304. Uniform data collection and analysis.
    ``Sec. 3305. Clinical Centers of Excellence and Data Centers.
    ``Sec. 3306. Definitions.

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

    ``PART 1--WTC Responders

    ``Sec. 3311. Identification of WTC responders and provision of
    WTC-related monitoring services.
    ``Sec. 3312. Treatment of enrolled WTC responders for WTC-
    related health conditions.
    ``Sec. 3313. National arrangement for benefits for eligible
    individuals outside New York.

    ``PART 2--WTC Survivors

    ``Sec. 3321. Identification and initial health evaluation of
    screening-eligible and certified-eligible
    WTC survivors.
    ``Sec. 3322. Followup monitoring and treatment of certified-
    eligible WTC survivors for WTC-related
    health conditions.
    ``Sec. 3323. Followup monitoring and treatment of other
    individuals with WTC-related health
    conditions.

    ``PART 3--Payor Provisions

    ``Sec. 3331. Payment of claims.
    ``Sec. 3332. Administrative arrangement authority.

    ``Subtitle C--Research Into Conditions

    ``Sec. 3341. Research regarding certain health conditions
    related to September 11 terrorist attacks.

    [[Page 3624]]

    ``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.
    Sec. 205. Funding; attorney fees.

    TITLE III--REVENUE RELATED PROVISIONS

    Sec. 301. Excise tax on foreign procurement.
    Sec. 302. Renewal of fees for visa-dependent employers.

    TITLE IV--BUDGETARY EFFECTS

    Sec. 401. Compliance with Statutory Pay-As-You-Go Act of 2010.

    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.

    [[Page 3625]]

    ``(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

    [[Page 3626]]

    ``(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

    [[Page 3627]]

    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.

    [[Page 3628]]

    ``(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;

    [[Page 3629]]

    ``(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, including claims 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

    [[Page 3630]]

    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,
    including claims data, in accordance with section 3304.
    ``(2) Contracts with data centers.--
    ``(A) In general.--The WTC Program Administrator
    shall enter into contracts with one or more 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;

    [[Page 3631]]

    ``(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.
    ``(5) Review <> on feasibility of
    consolidating data centers.--Not later than July 1, 2011, the
    Comptroller General of the United States shall submit to the
    Committee on Energy and Commerce of the House of Representatives
    and the Committee on Health, Education, Labor, and Pensions of
    the Senate a report on the feasibility of consolidating Data
    Centers into a single Data Center.

    ``(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);

    [[Page 3632]]

    ``(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, including claims
    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

    [[Page 3633]]

    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 otherwise
    reimbursable by the WTC Program Administrator under section
    3312(c) for patient evaluation, monitoring, or treatment but
    which are needed to operate the WTC program such as the costs
    involved in outreach to participants or recruiting participants,
    data collection and analysis, social services for counseling
    patients on other available assistance outside the WTC program,
    and the development of treatment protocols. Such term does not
    include costs for new construction or other capital costs.

    ``(d) GAO Analysis.--Not <> later than July 1,
    2011, the Comptroller General shall submit to the Committee on Energy
    and Commerce of the House of Representatives and the Committee on
    Health, Education, Labor, and Pensions of the Senate an analysis on
    whether Clinical Centers of Excellence with which the WTC Program
    Administrator enters into a contract under this section have financial
    systems that will allow for the timely submission of claims data for
    purposes of section 3304 and subsections (a)(1)(F) and (b)(1)(B)(iii).
    ``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.

    [[Page 3634]]

    ``(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)(A) The term `WTC Program Administrator' means--
    ``(i) subject to subparagraph (B), 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
    ``(ii) 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.

    [[Page 3635]]

    ``(B) In no case may the Secretary designate under
    subparagraph (A)(i) the Director of the National Institute for
    Occupational Safety and Health or a designee of such Director
    with respect to section 3322 (relating to payment for initial
    health evaluation, monitoring, and treatment).
    ``(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

    [[Page 3636]]

    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 fireor 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 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

    [[Page 3637]]

    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.

    [[Page 3638]]

    ``(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

    [[Page 3639]]

    ``(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

    [[Page 3640]]

    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).

    [[Page 3641]]

    ``(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

    [[Page 3642]]

    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

    [[Page 3643]]

    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

    [[Page 3644]]

    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).

    [[Page 3645]]

    ``(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.--
    ``(i) In general.--Subject to clause (ii):
    ``(I) 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.
    ``(II) <> For
    treatment not covered under subclause
    (i) or subparagraph (B), the WTC Program
    Administrator shall establish by
    regulation a reimbursement rate for such
    treatment.
    ``(ii) Exception.--In no case shall payments
    for products or services under clause (i) be made
    at a rate higher than the Office of Worker's
    Compensation

    [[Page 3646]]

    Programs in the Department Labor would pay for
    such products or services rendered at the time
    such products or services were provided.
    ``(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.
    ``(iv) Pharmaceuticals.--
    Not <> later than July
    1, 2011, the Comptroller General of the United
    States shall submit to the Committee on Energy and
    Commerce of the House of Representatives and the
    Committee on Health, Education, Labor, and
    Pensions of the Senate a report on whether
    existing Federal pharmaceutical purchasing
    programs can provide pharmaceutical benefits more
    efficiently and effectively than through the WTC
    program.
    ``(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

    [[Page 3647]]

    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).
    ``(d) Provision of Services Through the VA.--
    ``(1) In general.--The WTC Program Administrator may enter
    into an agreement with the Secretary of Veterans Affairs for the
    Secretary to provide services under this section through
    facilities of the Department of Veterans Affairs.
    ``(2) National program.--
    Not <> later than July 1, 2011, the
    Comptroller General of the United States shall submit

    [[Page 3648]]

    to the Committee on Energy and Commerce of the House of
    Representatives and the Committee on Health, Education, Labor,
    and Pensions of the Senate a report on whether the Department of
    Veterans Affairs can provide monitoring and treatment services
    to individuals under this section more efficiently and
    effectively than through the nationwide network to be
    established 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.

    [[Page 3649]]

    ``(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

    [[Page 3650]]

    ``(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.

    [[Page 3651]]

    ``(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.

    [[Page 3652]]

    ``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

    [[Page 3653]]

    ``(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),

    [[Page 3654]]

    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

    [[Page 3655]]

    year 2011 and each calendar quarter in fiscal years 2012
    through 2015 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 and with respect to calendar quarters
    in fiscal year 2016, such full contribution amount shall
    be equal to \1/9\ of the Federal 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.

    [[Page 3656]]

    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

    [[Page 3657]]

    ``(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 2016 (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)(I) $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, and
    $431,000,000 for fiscal year 2015; and
    ``(II) subject to paragraph (4), an additional
    amount for fiscal year 2016 from unexpended
    amounts for previous fiscal years; 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--

    [[Page 3658]]

    ``(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.
    ``(4) Aggregate limitation on funding beginning with fiscal
    year 2016.--Beginning with fiscal year 2016, in no case shall
    the share of Federal funds deposited into the Fund under
    paragraph (2) for such fiscal year and previous fiscal years and
    quarters exceed the sum of the amounts specified in paragraph
    (2)(A)(ii)(I).

    ``(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--

    [[Page 3659]]

    ``(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,

    [[Page 3660]]

    and payments made pursuant to the settlement of a civil action
    described in section 405(c)(3)(C)(iii)'' 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 May 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

    [[Page 3661]]

    (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 the date that is 5 years after the date on
    which such regulations are updated.''.

    (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.

    [[Page 3662]]

    ``(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) Settled actions.--Such section, as so redesignated, is
    further amended by adding at the end the following new clause:
    ``(iii) Settled actions.--In the case of an
    individual who settled a civil action described in
    clause (i), such individual may not submit a claim
    under this title unless such action was commenced
    after December 22, 2003, and a release of all
    claims in such action was tendered prior to the
    date on which the James Zadroga 9/11 Health and
    Compensation Act of 2010 was enacted.''.

    [[Page 3663]]

    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 180
    days after the date of the enactment of the James Zadroga 9/11 Health
    and Compensation Act of 2010, the Special Master shall update the
    regulations promulgated under subsection (a) to the extent necessary to
    comply with the provisions of title II of such Act.''.
    SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.

    Section 408(a) of the Air Transportation Safety and System
    Stabilization Act (49 U.S.C. 40101 note) is amended by adding at the end
    the following new paragraphs:
    ``(4) Liability for certain claims.--Notwithstanding any
    other provision of law, liability for all claims and actions
    (including claims or actions that have been previously resolved,
    that are currently pending, and that may be filed) for
    compensatory damages, contribution or indemnity, or any other
    form or type of relief, arising from or related to debris
    removal, against the City of New York, any entity (including the
    Port Authority of New York and New Jersey) with a property
    interest in the World Trade Center on September 11, 2001
    (whether fee simple, leasehold or easement, or direct or
    indirect) and any contractors and subcontractors, shall not be
    in an amount that exceeds the sum of the following, as may be
    applicable:
    ``(A) The amount of funds of the WTC Captive
    Insurance Company, including the cumulative interest.
    ``(B) The amount of all available insurance
    identified in schedule 2 of the WTC Captive Insurance
    Company insurance policy.
    ``(C) As it relates to the limitation of liability
    of the City of New York, the amount that is the greater
    of the City of New York's insurance coverage or
    $350,000,000. In determining the amount of the City's
    insurance coverage for purposes of the previous
    sentence, any amount described in subparagraphs (A) and
    (B) shall not be included.
    ``(D) As it relates to the limitation of liability
    of any entity, including the Port Authority of New York
    and New Jersey, with a property interest in the World
    Trade Center on September 11, 2001 (whether fee simple,
    leasehold or easement, or direct or indirect), the
    amount of all available liability insurance coverage
    maintained by any such entity.
    ``(E) As it relates to the limitation of liability
    of any individual contractor or subcontractor, the
    amount of all available liability insurance coverage
    maintained by such contractor or subcontractor on
    September 11, 2001.
    ``(5) Priority <> of claims
    payments.--Payments to plaintiffs who obtain a settlement or
    judgment with respect to a claim or action to which paragraph
    (4) applies, shall be paid solely from the following funds in
    the following order, as may be applicable:
    ``(A) The funds described in subparagraph (A) or (B)
    of paragraph (4).

    [[Page 3664]]

    ``(B) If there are no funds available as described
    in subparagraph (A) or (B) of paragraph (4), the funds
    described in subparagraph (C) of such paragraph.
    ``(C) If there are no funds available as described
    in subparagraph (A), (B), or (C) of paragraph (4), the
    funds described in subparagraph (D) of such paragraph.
    ``(D) If there are no funds available as described
    in subparagraph (A), (B), (C), or (D) of paragraph (4),
    the funds described in subparagraph (E) of such
    paragraph.
    ``(6) Declaratory judgment actions and direct action.--Any
    claimant to a claim or action to which paragraph (4) 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, except
    that no such action for declaratory judgment or direct action
    may be commenced until after the funds available in subparagraph
    (A), (B), (C), and (D) of paragraph (5) have been exhausted
    consistent with the order described in such paragraph for
    payment.''.
    SEC. 205. FUNDING; ATTORNEY FEES.

    Section 406 of the Air Transportation Safety and System
    Stabilization Act (49 U.S.C. 40101 note) is amended--
    (1) in subsection (a), by striking ``Not later than'' and
    inserting ``Subject to the limitations under subsection (d), not
    later than'';
    (2) in subsection (b)--
    (A) by inserting ``in the amounts provided under
    subsection (d)(1)'' after ``appropriations Acts''; and
    (B) by inserting ``subject to the limitations under
    subsection (d)'' before the period; and
    (3) by adding at the end the following new subsections:

    ``(d) Limitation.--
    ``(1) In general.--The total amount of Federal funds paid
    for compensation under this title, with respect to claims filed
    on or after the date on which the regulations are updated under
    section 407(b), shall not exceed <> $2,775,000,000. Of such amounts, not to exceed
    $875,000,000 shall be available to pay such claims during the 5-
    year period beginning on such date.
    ``(2) Pro-ration <> and payment of
    remaining claims.--
    ``(A) In general.--The Special Master shall ratably
    reduce the amount of compensation due claimants under
    this title in a manner to ensure, to the extent
    possible, that--
    ``(i) all claimants who, before application of
    the limitation under the second sentence of
    paragraph (1), would have been determined to be
    entitled to a payment under this title during such
    5-year period, receive a payment during such
    period; and
    ``(ii) the total amount of all such payments
    made during such 5-year period do not exceed the
    amount available under the second sentence of
    paragraph (1) to pay claims during such period.
    ``(B) Payment of remainder of claim amounts.--
    In <> any case in which the amount of a
    claim is ratably reduced pursuant to subparagraph (A),
    on or after the first day after the 5-year period
    described in paragraph

    [[Page 3665]]

    (1), but in no event later than 1 year after such 5-year
    period, the Special Master shall pay to the claimant the
    amount that is equal to the difference between--
    ``(i) the amount that the claimant would have
    been paid under this title during such period
    without regard to the limitation under the second
    sentence of paragraph (1) applicable to such
    period; and
    ``(ii) the amount the claimant was paid under
    this title during such period.
    ``(C) Termination.--Upon completion of all payments
    pursuant to this subsection, the Victim's Compensation
    Fund shall be permanently closed.

    ``(e) Attorney Fees.--
    ``(1) In general.--Notwithstanding any contract, the
    representative of an individual may not charge, for services
    rendered in connection with the claim of an individual under
    this title, more than 10 percent of an award made under this
    title on such claim.
    ``(2) Limitation.--
    ``(A) In general.--Except as provided in
    subparagraph (B), in the case of an individual who was
    charged a legal fee in connection with the settlement of
    a civil action described in section 405(c)(3)(C)(iii),
    the representative of the individual may not charge any
    amount for compensation for services rendered in
    connection with a claim filed under this title.
    ``(B) Exception.--If the legal fee charged in
    connection with the settlement of a civil action
    described in section 405(c)(3)(C)(iii) of an individual
    is less than 10 percent of the aggregate amount of
    compensation awarded to such individual through such
    settlement, the representative of such individual may
    charge an amount for compensation for services rendered
    to the extent that such amount charged is not more
    than--
    ``(i) 10 percent of such aggregate amount
    through the settlement, minus
    ``(ii) the total amount of all legal fees
    charged for services rendered in connection with
    such settlement.
    ``(3) Discretion to lower fee.--In the event that the
    special master finds that the fee limit set by paragraph (1) or
    (2) provides excessive compensation for services rendered in
    connection with such claim, the Special Master may, in the
    discretion of the Special Master, award as reasonable
    compensation for services rendered an amount lesser than that
    permitted for in paragraph (1).''.

    TITLE III--REVENUE RELATED PROVISIONS

    SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCUREMENT.

    (a) Imposition of Tax.--
    (1) In general.--Subtitle D of the Internal Revenue Code of
    1986 is amended by adding at the end the following new chapter:

    [[Page 3666]]

    ``CHAPTER 50--FOREIGN PROCUREMENT

    ``Sec. 5000C. Imposition of tax on certain foreign procurement.

    ``SEC. 5000C. <> IMPOSITION OF TAX ON CERTAIN
    FOREIGN PROCUREMENT.

    ``(a) Imposition of Tax.--There is hereby imposed on any foreign
    person that receives a specified Federal procurement payment a tax equal
    to 2 percent of the amount of such specified Federal procurement
    payment.
    ``(b) Specified Federal Procurement <> Payment.--
    For purposes of this section, the term `specified Federal procurement
    payment' means any payment made pursuant to a contract with the
    Government of the United States for--
    ``(1) the provision of goods, if such goods are manufactured
    or produced in any country which is not a party to an
    international procurement agreement with the United States, or
    ``(2) the provision of services, if such services are
    provided in any country which is not a party to an international
    procurement agreement with the United States.

    ``(c) Foreign Person.--For purposes of this section, the term
    `foreign person' means any person other than a United States person.
    ``(d) Administrative Provisions.--
    ``(1) Withholding.--The amount deducted and withheld under
    chapter 3 shall be increased by the amount of tax imposed by
    this section on such payment.
    ``(2) Other administrative provisions.--For purposes of
    subtitle F, any tax imposed by this section shall be treated as
    a tax imposed by subtitle A.''.
    (2) Clerical amendment.--The table of chapters for subtitle
    D of the Internal Revenue Code of 1986 is amended by adding at
    the end the following new item:

    ``Chapter 50--Foreign Procurement''.

    (3) Effective <> date.--The amendments made by this subsection shall
    apply to payments received pursuant to contracts entered into on
    and after the date of the enactment of this Act.

    (b) Prohibition <> on Reimbursement of
    Fees.--
    (1) In general.--The head of each executive agency shall
    take any and all measures necessary to ensure that no funds are
    disbursed to any foreign contractor in order to reimburse the
    tax imposed under section 5000C of the Internal Revenue Code of
    1986.
    (2) Annual review.--The Administrator for Federal
    Procurement Policy shall annually review the contracting
    activities of each executive agency to monitor compliance with
    the requirements of paragraph (1).
    (3) Executive agency.--For <> purposes of
    this subsection, the term ``executive agency'' has the meaning
    given the term in section 4 of the Office of Federal Procurement
    Policy Act (41 U.S.C. 403).

    (c) Application.--This <> section and the
    amendments made by this section shall be applied in a manner consistent
    with United States obligations under international agreements.

    [[Page 3667]]

    SEC. 302. RENEWAL OF FEES FOR VISA-DEPENDENT EMPLOYERS.

    Subsections (a), (b), and (c) of section 402 of Public Law 111-
    230 <> are amended by striking ``2014'' each place
    that such appears and inserting ``2015''.

    TITLE IV--BUDGETARY EFFECTS

    SEC. 401. COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO ACT OF 2010.

    The budgetary effects of this Act, for the purpose of complying with
    the Statutory Pay-As-You-Go Act of 2010, shall be determined by
    reference to the latest statement titled ``Budgetary Effects of PAYGO
    Legislation'' for this Act, submitted for printing in the Congressional
    Record by the Chairman of the Senate Budget Committee, provided that
    such statement has been submitted prior to the vote on passage.

    Approved January 2, 2011.

    LEGISLATIVE HISTORY--H.R. 847:
    ---------------------------------------------------------------------------

    HOUSE REPORTS: No. 111-560, Pt. 1 (Comm. on Energy and Commerce) and
    Pt. 2 (Comm. on the Judiciary).
    CONGRESSIONAL RECORD, Vol. 156 (2010):
    July 29, considered and failed House.
    Sept. 29, considered and passed House.
    Dec. 22, considered and passed Senate, amended. House
    concurred in Senate amendment.
    DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2011):
    Jan. 2, Presidential statement.