PUBLIC LAW 111–347—JAN. 2, 2011 124 STAT. 3623 

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 WTCrelated 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. 

42 USC 201 note. 

James Zadroga 

9/11 Health and 

Compensation 

Act of 2010. 

Jan. 2, 2011 

[H.R. 847] 


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‘‘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. 

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‘‘(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 WTCRELATED 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 screeningeligible 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; 

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‘‘(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 


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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. 

42 USC 

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‘‘(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; 

Public 

information. 

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‘‘(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 

Reports. 

42 USC 

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Web site. 

42 USC 

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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 workrelated 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; 

42 USC 

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‘‘(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, screeningeligible 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); 

Deadline. 

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‘‘(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 


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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. 

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‘‘(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 certifiedeligible 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. 


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‘‘(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 

42 USC 

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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 

Time periods. 


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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 TransHudson 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 terroristrelated 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 WTCrelated 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. 


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‘‘(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 

Deadline. 

Determination. 

Deadline. 


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‘‘(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 longterm 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 WTCRELATED HEALTH CONDITIONS. 

‘‘(a) WTC-RELATED HEALTH CONDITION DEFINED.— 

‘‘(1) IN GENERAL.—For purposes of this title, the term ‘WTCrelated 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 WTCrelated 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 

42 USC 

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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). 


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‘‘(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 peerreviewed 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 

Federal Register, 

publication. 

Determination. 

Deadlines. 

Review. 


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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 

Federal Register, 

publication. 

Comment period. 

Federal Register, 

publication. 

Recommendation. 

Deadlines. 

Deadline. 

Recommendation. 

Federal Register, 

publication. 


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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 WTCRELATED 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 

Regulations. 

Definition. 


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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 WTCrelated 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 WTCrelated 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). 

Deadline. 

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‘‘(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 NET- WORK.—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 

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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 

Deadline. 

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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 

Deadline. 

Reports. 

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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 ‘screeningeligible 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. 

Time periods. 

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‘‘(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 

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‘‘(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. 


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‘‘(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 certifiedeligible 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. 

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‘‘SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIEDELIGIBLE 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 

Applicability. 

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‘‘(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 WTCrelated 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), 

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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 

Applicability. 


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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. 

Certification. 

Deadline. 


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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 certifiedeligible 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 workrelated 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 WTCrelated health conditions or emerging conditions— 

‘‘(1) among enrolled WTC responders and certified-eligible 

WTC survivors under treatment; and 

42 USC 

300mm–51. 

42 USC 

300mm–42. 


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‘‘(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 PROTEC- TIONS.—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— 

42 USC 

300mm–61. 

42 USC 

300mm–52. 


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‘‘(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— 


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‘‘(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, 


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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 


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(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 terroristrelated 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. 

49 USC 

40101 note. 

Time period. 

49 USC 40101 

note. 


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‘‘(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.’’. 

49 USC 

40101 note. 

49 USC 

40101 note. 

49 USC 

40101 note. 


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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). 

Applicability. 

Deadline. 


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‘‘(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 

Deadline. 

Time period. 

Time period. 


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(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: 


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124 STAT. 3666 PUBLIC LAW 111–347—JAN. 2, 2011 

‘‘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. 

26 USC 5000C 

note. 

Definition. 

26 USC 5000C 

note. 

Applicability. 

26 USC 5000C 

note. 

Definition. 

26 USC 5000C. 


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PUBLIC LAW 111–347—JAN. 2, 2011 124 STAT. 3667 

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. 

Æ 

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. 

Ante, p. 2487. 


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