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[111th Congress Public Law 347]
[From the U.S. Government Printing Office]

[[Page 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. <<NOTE: Jan. 2, 2011 -  [H.R. 847]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled, <<NOTE: James Zadroga 9/
11 Health and Compensation Act of 2010.>> 
SECTION 1. <<NOTE: 42 USC 201 note.>> SHORT TITLE; TABLE OF 
                              CONTENTS.

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

Sec. 1. Short title; table of contents.

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

Sec. 101. World Trade Center Health Program.

            ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM

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

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

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

                        ``PART 1--WTC Responders

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

                         ``PART 2--WTC Survivors

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

                       ``PART 3--Payor Provisions

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

                 ``Subtitle C--Research Into Conditions

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

[[Page 124 STAT. 3624]]

        ``Sec. 3342. World Trade Center Health Registry.

                          ``Subtitle D--Funding

        ``Sec. 3351. World Trade Center Health Program Fund.

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

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

                  TITLE III--REVENUE RELATED PROVISIONS

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

                       TITLE IV--BUDGETARY EFFECTS

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

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM.

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

            ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM

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

``SEC. 3301. <<NOTE: 42 USC 300mm.>> ESTABLISHMENT OF WORLD TRADE 
                          CENTER HEALTH PROGRAM.

    ``(a) In General.--There is hereby established within the Department 
of Health and Human Services a program to be known as the World Trade 
Center Health Program, which shall be administered by the WTC Program 
Administrator, to provide beginning on July 1, 2011--
            ``(1) medical monitoring and treatment benefits to eligible 
        emergency responders and recovery and cleanup workers (including 
        those who are Federal employees) who responded to the September 
        11, 2001, terrorist attacks; and
            ``(2) initial health evaluation, monitoring, and treatment 
        benefits to residents and other building occupants and area 
        workers in New York City who were directly impacted and 
        adversely affected by such attacks.

    ``(b) Components of Program.--The WTC Program includes the following 
components:
            ``(1) Medical monitoring for responders.--Medical monitoring 
        under section 3311, including clinical examinations and long-
        term health monitoring and analysis for enrolled WTC responders 
        who were likely to have been exposed to airborne toxins that 
        were released, or to other hazards, as a result of the September 
        11, 2001, terrorist attacks.

[[Page 124 STAT. 3625]]

            ``(2) Initial health evaluation for survivors.--An initial 
        health evaluation under section 3321, including an evaluation to 
        determine eligibility for followup monitoring and treatment.
            ``(3) Followup monitoring and treatment for wtc-related 
        health conditions for responders and survivors.--Provision under 
        sections 3312, 3322, and 3323 of followup monitoring and 
        treatment and payment, subject to the provisions of subsection 
        (d), for all medically necessary health and mental health care 
        expenses of an individual with respect to a WTC-related health 
        condition (including necessary prescription drugs).
            ``(4) Outreach.--Establishment under section 3303 of an 
        education and outreach program to potentially eligible 
        individuals concerning the benefits under this title.
            ``(5) Clinical data collection and analysis.--Collection and 
        analysis under section 3304 of health and mental health data 
        relating to individuals receiving monitoring or treatment 
        benefits in a uniform manner in collaboration with the 
        collection of epidemiological data under section 3342.
            ``(6) Research on health conditions.--Establishment under 
        subtitle C of a research program on health conditions resulting 
        from the September 11, 2001, terrorist attacks.

    ``(c) No Cost Sharing.--Monitoring and treatment benefits and 
initial health evaluation benefits are provided under subtitle B without 
any deductibles, copayments, or other cost sharing to an enrolled WTC 
responder or certified-eligible WTC survivor. Initial health evaluation 
benefits are provided under subtitle B without any deductibles, 
copayments, or other cost sharing to a screening-eligible WTC survivor.
    ``(d) Preventing Fraud and Unreasonable Administrative Costs.--
            ``(1) Fraud.--The Inspector General of the Department of 
        Health and Human Services shall develop and implement a program 
        to review the WTC Program's health care expenditures to detect 
        fraudulent or duplicate billing and payment for inappropriate 
        services. This title is a Federal health care program (as 
        defined in section 1128B(f) of the Social Security Act) and is a 
        health plan (as defined in section 1128C(c) of such Act) for 
        purposes of applying sections 1128 through 1128E of such Act.
            ``(2) Unreasonable administrative costs.--The Inspector 
        General of the Department of Health and Human Services shall 
        develop and implement a program to review the WTC Program for 
        unreasonable administrative costs, including with respect to 
        infrastructure, administration, and claims processing.

    ``(e) Quality Assurance.--The WTC Program Administrator working with 
the Clinical Centers of Excellence shall develop and implement a quality 
assurance program for the monitoring and treatment delivered by such 
Centers of Excellence and any other participating health care providers. 
Such program shall include--
            ``(1) adherence to monitoring and treatment protocols;
            ``(2) appropriate diagnostic and treatment referrals for 
        participants;
            ``(3) prompt communication of test results to participants; 
        and

[[Page 124 STAT. 3626]]

            ``(4) such other elements as the Administrator specifies in 
        consultation with the Clinical Centers of Excellence.

    ``(f) Annual Program Report.--
            ``(1) In general.--Not later than 6 months after the end of 
        each fiscal year in which the WTC Program is in operation, the 
        WTC Program Administrator shall submit an annual report to the 
        Congress on the operations of this title for such fiscal year 
        and for the entire period of operation of the program.
            ``(2) Contents included in report.--Each annual report under 
        paragraph (1) shall include at least the following:
                    ``(A) Eligible individuals.--Information for each 
                clinical program described in paragraph (3)--
                          ``(i) on the number of individuals who applied 
                      for certification under subtitle B and the number 
                      of such individuals who were so certified;
                          ``(ii) of the individuals who were certified, 
                      on the number who received monitoring under the 
                      program and the number of such individuals who 
                      received medical treatment under the program;
                          ``(iii) with respect to individuals so 
                      certified who received such treatment, on the WTC-
                      related health conditions for which they were 
                      treated; and
                          ``(iv) on the projected number of individuals 
                      who will be certified under subtitle B in the 
                      succeeding fiscal year and the succeeding 10-year 
                      period.
                    ``(B) Monitoring, initial health evaluation, and 
                treatment costs.--For each clinical program so 
                described--
                          ``(i) information on the costs of monitoring 
                      and initial health evaluation and the costs of 
                      treatment and on the estimated costs of such 
                      monitoring, evaluation, and treatment in the 
                      succeeding fiscal year; and
                          ``(ii) an estimate of the cost of medical 
                      treatment for WTC-related health conditions that 
                      have been paid for or reimbursed by workers' 
                      compensation, by public or private health plans, 
                      or by New York City under section 3331.
                    ``(C) Administrative costs.--Information on the cost 
                of administering the program, including costs of program 
                support, data collection and analysis, and research 
                conducted under the program.
                    ``(D) Administrative experience.--Information on the 
                administrative performance of the program, including--
                          ``(i) the performance of the program in 
                      providing timely evaluation of and treatment to 
                      eligible individuals; and
                          ``(ii) a list of the Clinical Centers of 
                      Excellence and other providers that are 
                      participating in the program.
                    ``(E) Scientific reports.--A summary of the findings 
                of any new scientific reports or studies on the health 
                effects associated with exposure described in section 
                3306(1), including the findings of research conducted 
                under section 3341(a).
                    ``(F) Advisory committee recommendations.--A list of 
                recommendations by the WTC Scientific/Technical Advisory 
                Committee on additional WTC Program eligibility

[[Page 124 STAT. 3627]]

                criteria and on additional WTC-related health conditions 
                and the action of the WTC Program Administrator 
                concerning each such recommendation.
            ``(3) Separate clinical programs described.--In paragraph 
        (2), each of the following shall be treated as a separate 
        clinical program of the WTC Program:
                    ``(A) Firefighters and related personnel.--The 
                benefits provided for enrolled WTC responders described 
                in section 3311(a)(2)(A).
                    ``(B) Other wtc responders.--The benefits provided 
                for enrolled WTC responders not described in 
                subparagraph (A).
                    ``(C) WTC survivors.--The benefits provided for 
                screening-eligible WTC survivors and certified-eligible 
                WTC survivors in section 3321(a).

    ``(g) Notification to Congress Upon Reaching 80 Percent of 
Eligibility Numerical Limits.--The Secretary shall promptly notify the 
Congress of each of the following:
            ``(1) When the number of enrollments of WTC responders 
        subject to the limit established under section 3311(a)(4) has 
        reached 80 percent of such limit.
            ``(2) When the number of certifications for certified-
        eligible WTC survivors subject to the limit established under 
        section 3321(a)(3) has reached 80 percent of such limit.

    ``(h) Consultation.--The WTC Program Administrator shall engage in 
ongoing outreach and consultation with relevant stakeholders, including 
the WTC Health Program Steering Committees and the Advisory Committee 
under section 3302, regarding the implementation and improvement of 
programs under this title.
``SEC. 3302. <<NOTE: 42 USC 300mm-1.>> WTC HEALTH PROGRAM 
                          SCIENTIFIC/TECHNICAL ADVISORY COMMITTEE; 
                          WTC HEALTH PROGRAM STEERING COMMITTEES.

    ``(a) Advisory Committee.--
            ``(1) Establishment.--The WTC Program Administrator shall 
        establish an advisory committee to be known as the WTC Health 
        Program Scientific/Technical Advisory Committee (in this 
        subsection referred to as the `Advisory Committee') to review 
        scientific and medical evidence and to make recommendations to 
        the Administrator on additional WTC Program eligibility criteria 
        and on additional WTC-related health conditions.
            ``(2) Composition.--The WTC Program Administrator shall 
        appoint the members of the Advisory Committee and shall include 
        at least--
                    ``(A) 4 occupational physicians, at least 2 of whom 
                have experience treating WTC rescue and recovery 
                workers;
                    ``(B) 1 physician with expertise in pulmonary 
                medicine;
                    ``(C) 2 environmental medicine or environmental 
                health specialists;
                    ``(D) 2 representatives of WTC responders;
                    ``(E) 2 representatives of certified-eligible WTC 
                survivors;
                    ``(F) an industrial hygienist;
                    ``(G) a toxicologist;
                    ``(H) an epidemiologist; and
                    ``(I) a mental health professional.

[[Page 124 STAT. 3628]]

            ``(3) Meetings.--The Advisory Committee shall meet at such 
        frequency as may be required to carry out its duties.
            ``(4) Reports.--The <<NOTE: Public information. Web 
        posting.>> WTC Program Administrator shall provide for 
        publication of recommendations of the Advisory Committee on the 
        public Web site established for the WTC Program.
            ``(5) Duration.--Notwithstanding any other provision of law, 
        the Advisory Committee shall continue in operation during the 
        period in which the WTC Program is in operation.
            ``(6) Application of faca.--Except as otherwise specifically 
        provided, the Advisory Committee shall be subject to the Federal 
        Advisory Committee Act.

    ``(b) WTC Health Program Steering Committees.--
            ``(1) Consultation.--The WTC Program Administrator shall 
        consult with 2 steering committees (each in this section 
        referred to as a `Steering Committee') that are established as 
        follows:
                    ``(A) WTC responders steering committee.--One 
                Steering Committee, to be known as the WTC Responders 
                Steering Committee, for the purpose of receiving input 
                from affected stakeholders and facilitating the 
                coordination of monitoring and treatment programs for 
                the enrolled WTC responders under part 1 of subtitle B.
                    ``(B) WTC survivors steering committee.--One 
                Steering Committee, to be known as the WTC Survivors 
                Steering Committee, for the purpose of receiving input 
                from affected stakeholders and facilitating the 
                coordination of initial health evaluations, monitoring, 
                and treatment programs for screening-eligible and 
                certified-eligible WTC survivors under part 2 of 
                subtitle B.
            ``(2) Membership.--
                    ``(A) WTC responders steering committee.--
                          ``(i) Representation.--The WTC Responders 
                      Steering Committee shall include--
                                    ``(I) representatives of the Centers 
                                of Excellence providing services to WTC 
                                responders;
                                    ``(II) representatives of labor 
                                organizations representing firefighters, 
                                police, other New York City employees, 
                                and recovery and cleanup workers who 
                                responded to the September 11, 2001, 
                                terrorist attacks; and
                                    ``(III) 3 representatives of New 
                                York City, 1 of whom will be selected by 
                                the police commissioner of New York 
                                City, 1 by the health commissioner of 
                                New York City, and 1 by the mayor of New 
                                York City.
                          ``(ii) Initial membership.--The WTC Responders 
                      Steering Committee shall initially be composed of 
                      members of the WTC Monitoring and Treatment 
                      Program Steering Committee (as in existence on the 
                      day before the date of the enactment of this 
                      title).
                    ``(B) WTC survivors steering committee.--
                          ``(i) Representation.--The WTC Survivors 
                      Steering Committee shall include representatives 
                      of--
                                    ``(I) the Centers of Excellence 
                                providing services to screening-eligible 
                                and certified-eligible WTC survivors;

[[Page 124 STAT. 3629]]

                                    ``(II) the population of residents, 
                                students, and area and other workers 
                                affected by the September 11, 2001, 
                                terrorist attacks;
                                    ``(III) screening-eligible and 
                                certified-eligible survivors receiving 
                                initial health evaluations, monitoring, 
                                or treatment under part 2 of subtitle B 
                                and organizations advocating on their 
                                behalf; and
                                    ``(IV) New York City.
                          ``(ii) Initial membership.--The WTC Survivors 
                      Steering Committee shall initially be composed of 
                      members of the WTC Environmental Health Center 
                      Survivor Advisory Committee (as in existence on 
                      the day before the date of the enactment of this 
                      title).
                    ``(C) Additional appointments.--Each Steering 
                Committee may recommend, if approved by a majority of 
                voting members of the Committee, additional members to 
                the Committee.
                    ``(D) Vacancies.--A vacancy in a Steering Committee 
                shall be filled by an individual recommended by the 
                Steering Committee.
``SEC. 3303. <<NOTE: 42 USC 300mm-2.>> 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) <<NOTE: Web site.>> 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. <<NOTE: Reports. 42 USC 300mm-3.>> UNIFORM DATA 
                          COLLECTION AND ANALYSIS.

    ``(a) In General.--The WTC Program Administrator shall provide for 
the uniform collection of data, including claims data (and analysis of 
data and regular reports to the Administrator) on the prevalence of WTC-
related health conditions and the identification of new WTC-related 
health conditions. Such data shall be collected for all individuals 
provided monitoring or treatment benefits under subtitle B and 
regardless of their place of residence or Clinical Center of Excellence 
through which the benefits are provided. The WTC Program Administrator 
shall provide, through the Data Centers or otherwise, for the 
integration of such data into the monitoring and treatment program 
activities under this title.
    ``(b) Coordinating Through Centers of Excellence.--Each Clinical 
Center of Excellence shall collect data described in subsection (a) and 
report such data to the corresponding Data Center for analysis by such 
Data Center.
    ``(c) Collaboration With WTC Health Registry.--The WTC Program 
Administrator shall provide for collaboration between the

[[Page 124 STAT. 3630]]

Data Centers and the World Trade Center Health Registry described in 
section 3342.
    ``(d) Privacy.--The data collection and analysis under this section 
shall be conducted and maintained in a manner that protects the 
confidentiality of individually identifiable health information 
consistent with applicable statutes and regulations, including, as 
applicable, HIPAA privacy and security law (as defined in section 
3009(a)(2)) and section 552a of title 5, United States Code.
``SEC. <<NOTE: 42 USC 300mm-4.>> 3305. CLINICAL CENTERS OF 
                          EXCELLENCE AND DATA CENTERS.

    ``(a) In General.--
            ``(1) Contracts with clinical centers of excellence.--The 
        WTC Program Administrator shall, subject to subsection 
        (b)(1)(B), enter into contracts with Clinical Centers of 
        Excellence (as defined in subsection (b)(1)(A))--
                    ``(A) for the provision of monitoring and treatment 
                benefits and initial health evaluation benefits under 
                subtitle B;
                    ``(B) for the provision of outreach activities to 
                individuals eligible for such monitoring and treatment 
                benefits, for initial health evaluation benefits, and 
                for followup to individuals who are enrolled in the 
                monitoring program;
                    ``(C) for the provision of counseling for benefits 
                under subtitle B, with respect to WTC-related health 
                conditions, for individuals eligible for such benefits;
                    ``(D) for the provision of counseling for benefits 
                for WTC-related health conditions that may be available 
                under workers' compensation or other benefit programs 
                for work-related injuries or illnesses, health 
                insurance, disability insurance, or other insurance 
                plans or through public or private social service 
                agencies and assisting eligible individuals in applying 
                for such benefits;
                    ``(E) for the provision of translational and 
                interpretive services for program participants who are 
                not English language proficient; and
                    ``(F) for the collection and reporting of data, 
                including claims data, in accordance with section 3304.
            ``(2) Contracts with data centers.--
                    ``(A) In general.--The WTC Program Administrator 
                shall enter into contracts with one or more Data Centers 
                (as defined in subsection (b)(2))--
                          ``(i) for receiving, analyzing, and reporting 
                      to the WTC Program Administrator on data, in 
                      accordance with section 3304, that have been 
                      collected and reported to such Data Centers by the 
                      corresponding Clinical Centers of Excellence under 
                      subsection (b)(1)(B)(iii);
                          ``(ii) for the development of monitoring, 
                      initial health evaluation, and treatment 
                      protocols, with respect to WTC-related health 
                      conditions;
                          ``(iii) for coordinating the outreach 
                      activities conducted under paragraph (1)(B) by 
                      each corresponding Clinical Center of Excellence;
                          ``(iv) for establishing criteria for the 
                      credentialing of medical providers participating 
                      in the nationwide network under section 3313;

[[Page 124 STAT. 3631]]

                          ``(v) for coordinating and administering the 
                      activities of the WTC Health Program Steering 
                      Committees established under section 3002(b); and
                          ``(vi) for meeting periodically with the 
                      corresponding Clinical Centers of Excellence to 
                      obtain input on the analysis and reporting of data 
                      collected under clause (i) and on the development 
                      of monitoring, initial health evaluation, and 
                      treatment protocols under clause (ii).
                    ``(B) Medical provider selection.--The medical 
                providers under subparagraph (A)(iv) shall be selected 
                by the WTC Program Administrator on the basis of their 
                experience treating or diagnosing the health conditions 
                included in the list of WTC-related health conditions.
                    ``(C) Clinical discussions.--In carrying out 
                subparagraph (A)(ii), a Data Center shall engage in 
                clinical discussions across the WTC Program to guide 
                treatment approaches for individuals with a WTC-related 
                health condition.
                    ``(D) Transparency of data.--A contract entered into 
                under this subsection with a Data Center shall require 
                the Data Center to make any data collected and reported 
                to such Center under subsection (b)(1)(B)(iii) available 
                to health researchers and others as provided in the CDC/
                ATSDR Policy on Releasing and Sharing Data.
            ``(3) Authority for contracts to be class specific.--A 
        contract entered into under this subsection with a Clinical 
        Center of Excellence or a Data Center may be with respect to one 
        or more class of enrolled WTC responders, screening-eligible WTC 
        survivors, or certified-eligible WTC survivors.
            ``(4) Use of cooperative agreements.--Any contract under 
        this title between the WTC Program Administrator and a Data 
        Center or a Clinical Center of Excellence may be in the form of 
        a cooperative agreement.
            ``(5) Review <<NOTE: Deadline. Reports.>> on feasibility of 
        consolidating data centers.--Not later than July 1, 2011, the 
        Comptroller General of the United States shall submit to the 
        Committee on Energy and Commerce of the House of Representatives 
        and the Committee on Health, Education, Labor, and Pensions of 
        the Senate a report on the feasibility of consolidating Data 
        Centers into a single Data Center.

    ``(b) Centers of Excellence.--
            ``(1) Clinical centers of excellence.--
                    ``(A) Definition.--For purposes of this title, the 
                term `Clinical Center of Excellence' means a Center that 
                demonstrates to the satisfaction of the Administrator 
                that the Center--
                          ``(i) uses an integrated, centralized health 
                      care provider approach to create a comprehensive 
                      suite of health services under this title that are 
                      accessible to enrolled WTC responders, screening-
                      eligible WTC survivors, or certified-eligible WTC 
                      survivors;
                          ``(ii) has experience in caring for WTC 
                      responders and screening-eligible WTC survivors or 
                      includes health care providers who have been 
                      trained pursuant to section 3313(c);

[[Page 124 STAT. 3632]]

                          ``(iii) employs health care provider staff 
                      with expertise that includes, at a minimum, 
                      occupational medicine, environmental medicine, 
                      trauma-related psychiatry and psychology, and 
                      social services counseling; and
                          ``(iv) meets such other requirements as 
                      specified by the Administrator.
                    ``(B) Contract requirements.--The WTC Program 
                Administrator shall not enter into a contract with a 
                Clinical Center of Excellence under subsection (a)(1) 
                unless the Center agrees to do each of the following:
                          ``(i) Establish a formal mechanism for 
                      consulting with and receiving input from 
                      representatives of eligible populations receiving 
                      monitoring and treatment benefits under subtitle B 
                      from such Center.
                          ``(ii) Coordinate monitoring and treatment 
                      benefits under subtitle B with routine medical 
                      care provided for the treatment of conditions 
                      other than WTC-related health conditions.
                          ``(iii) Collect and report to the 
                      corresponding Data Center data, including claims 
                      data, in accordance with section 3304(b).
                          ``(iv) Have in place safeguards against fraud 
                      that are satisfactory to the Administrator, in 
                      consultation with the Inspector General of the 
                      Department of Health and Human Services.
                          ``(v) Treat or refer for treatment all 
                      individuals who are enrolled WTC responders or 
                      certified-eligible WTC survivors with respect to 
                      such Center who present themselves for treatment 
                      of a WTC-related health condition.
                          ``(vi) Have in place safeguards, consistent 
                      with section 3304(c), to ensure the 
                      confidentiality of an individual's individually 
                      identifiable health information, including 
                      requiring that such information not be disclosed 
                      to the individual's employer without the 
                      authorization of the individual.
                          ``(vii) Use amounts paid under subsection 
                      (c)(1) only for costs incurred in carrying out the 
                      activities described in subsection (a), other than 
                      those described in subsection (a)(1)(A).
                          ``(viii) Utilize health care providers with 
                      occupational and environmental medicine expertise 
                      to conduct physical and mental health assessments, 
                      in accordance with protocols developed under 
                      subsection (a)(2)(A)(ii).
                          ``(ix) Communicate with WTC responders and 
                      screening-eligible and certified-eligible WTC 
                      survivors in appropriate languages and conduct 
                      outreach activities with relevant stakeholder 
                      worker or community associations.
                          ``(x) Meet all the other applicable 
                      requirements of this title, including regulations 
                      implementing such requirements.
                    ``(C) Transition rule to ensure continuity of 
                care.--The WTC Program Administrator shall to the 
                maximum extent feasible ensure continuity of care in any 
                period of transition from monitoring and treatment of an 
                enrolled

[[Page 124 STAT. 3633]]

                WTC responder or certified-eligible WTC survivor by a 
                provider to a Clinical Center of Excellence or a health 
                care provider participating in the nationwide network 
                under section 3313.
            ``(2) Data centers.--For <<NOTE: Definition.>> 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 <<NOTE: Definition.>> 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 <<NOTE: Deadline.>> 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. <<NOTE: 42 USC 300mm-5.>> DEFINITIONS.

    ``In this title:
            ``(1) The term `aggravating' means, with respect to a health 
        condition, a health condition that existed on September 11, 
        2001, and that, as a result of exposure to airborne toxins, any 
        other hazard, or any other adverse condition resulting from the 
        September 11, 2001, terrorist attacks, requires medical 
        treatment that is (or will be) in addition to, more frequent 
        than, or of longer duration than the medical treatment that 
        would have been required for such condition in the absence of 
        such exposure.
            ``(2) The term `certified-eligible WTC survivor' has the 
        meaning given such term in section 3321(a)(2).
            ``(3) The terms `Clinical Center of Excellence' and `Data 
        Center' have the meanings given such terms in section 3305.

[[Page 124 STAT. 3634]]

            ``(4) The term `enrolled WTC responder' means a WTC 
        responder enrolled under section 3311(a)(3).
            ``(5) The term `initial health evaluation' includes, with 
        respect to an individual, a medical and exposure history, a 
        physical examination, and additional medical testing as needed 
        to evaluate whether the individual has a WTC-related health 
        condition and is eligible for treatment under the WTC Program.
            ``(6) The term `list of WTC-related health conditions' 
        means--
                    ``(A) for WTC responders, the health conditions 
                listed in section 3312(a)(3); and
                    ``(B) for screening-eligible and certified-eligible 
                WTC survivors, the health conditions listed in section 
                3322(b).
            ``(7) The term `New York City disaster area' means the area 
        within New York City that is--
                    ``(A) the area of Manhattan that is south of Houston 
                Street; and
                    ``(B) any block in Brooklyn that is wholly or 
                partially contained within a 1.5-mile radius of the 
                former World Trade Center site.
            ``(8) The term `New York metropolitan area' means an area, 
        specified by the WTC Program Administrator, within which WTC 
        responders and eligible WTC screening-eligible survivors who 
        reside in such area are reasonably able to access monitoring and 
        treatment benefits and initial health evaluation benefits under 
        this title through a Clinical Center of Excellence described in 
        subparagraphs (A), (B), or (C) of section 3305(b)(1).
            ``(9) The term `screening-eligible WTC survivor' has the 
        meaning given such term in section 3321(a)(1).
            ``(10) Any reference to `September 11, 2001' shall be deemed 
        a reference to the period on such date subsequent to the 
        terrorist attacks at the World Trade Center, Shanksville, 
        Pennsylvania, or the Pentagon, as applicable, on such date.
            ``(11) The term `September 11, 2001, terrorist attacks' 
        means the terrorist attacks that occurred on September 11, 2001, 
        in New York City, in Shanksville, Pennsylvania, and at the 
        Pentagon, and includes the aftermath of such attacks.
            ``(12) The term `WTC Health Program Steering Committee' 
        means such a Steering Committee established under section 
        3302(b).
            ``(13) The term `WTC Program' means the Word Trade Center 
        Health Program established under section 3301(a).
            ``(14)(A) The term `WTC Program Administrator' means--
                    ``(i) subject to subparagraph (B), with respect to 
                paragraphs (3) and (4) of section 3311(a) (relating to 
                enrollment of WTC responders), section 3312(c) and the 
                corresponding provisions of section 3322 (relating to 
                payment for initial health evaluation, monitoring, and 
                treatment, paragraphs (1)(C), (2)(B), and (3) of section 
                3321(a) (relating to determination or certification of 
                screening-eligible or certified-eligible WTC 
                responders), and part 3 of subtitle B (relating to payor 
                provisions), an official in the Department of Health and 
                Human Services, to be designated by the Secretary; and
                    ``(ii) with respect to any other provision of this 
                title, the Director of the National Institute for 
                Occupational Safety and Health, or a designee of such 
                Director.

[[Page 124 STAT. 3635]]

            ``(B) In no case may the Secretary designate under 
        subparagraph (A)(i) the Director of the National Institute for 
        Occupational Safety and Health or a designee of such Director 
        with respect to section 3322 (relating to payment for initial 
        health evaluation, monitoring, and treatment).
            ``(15) The term `WTC-related health condition' is defined in 
        section 3312(a).
            ``(16) The term `WTC responder' is defined in section 
        3311(a).
            ``(17) The term `WTC Scientific/Technical Advisory 
        Committee' means such Committee established under section 
        3302(a).

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

                        ``PART 1--WTC RESPONDERS

``SEC. <<NOTE: 42 USC 300mm-21.>> 3311. IDENTIFICATION OF WTC 
                          RESPONDERS AND PROVISION OF WTC-RELATED 
                          MONITORING SERVICES.

    ``(a) WTC Responder Defined.--
            ``(1) In general.--For purposes of this title, the term `WTC 
        responder' means any of the following individuals, subject to 
        paragraph (4):
                    ``(A) Currently identified responder.--An individual 
                who has been identified as eligible for monitoring under 
                the arrangements as in effect on the date of the 
                enactment of this title between the National Institute 
                for Occupational Safety and Health and--
                          ``(i) the consortium coordinated by Mt. Sinai 
                      Hospital in New York City that coordinates the 
                      monitoring and treatment for enrolled WTC 
                      responders other than with respect to those 
                      covered under the arrangement with the Fire 
                      Department of New York City; or
                          ``(ii) the Fire Department of New York City.
                    ``(B) Responder who meets current eligibility 
                criteria.--An individual who meets the current 
                eligibility criteria described in paragraph (2).
                    ``(C) Responder who meets modified eligibility 
                criteria.--An individual who--
                          ``(i) performed rescue, recovery, demolition, 
                      debris cleanup, or other related services in the 
                      New York City disaster area in response to the 
                      September 11, 2001, terrorist attacks, regardless 
                      of whether such services were performed by a State 
                      or Federal employee or member of the National 
                      Guard or otherwise; and
                          ``(ii) meets such eligibility criteria 
                      relating to exposure to airborne toxins, other 
                      hazards, or adverse conditions resulting from the 
                      September 11, 2001, terrorist attacks as the WTC 
                      Program Administrator, after consultation with the 
                      WTC Scientific/Technical Advisory Committee, 
                      determines appropriate.
                The WTC Program Administrator shall not modify such 
                eligibility criteria on or after the date that the 
                number of enrollments of WTC responders has reached 80 
                percent of the limit described in paragraph (4) or on or 
                after the

[[Page 124 STAT. 3636]]

                date that the number of certifications for certified-
                eligible WTC survivors under section 3321(a)(2)(B) has 
                reached 80 percent of the limit described in section 
                3321(a)(3).
            ``(2) Current eligibility <<NOTE: Time 
        periods.>> criteria.--The eligibility criteria described in this 
        paragraph for an individual is that the individual is described 
        in any of the following categories:
                    ``(A) Firefighters and related personnel.--The 
                individual--
                          ``(i) was a member of the Fire Department of 
                      New York City (whether fireor emergency personnel, 
                      active or retired) who participated at least one 
                      day in the rescue and recovery effort at any of 
                      the former World Trade Center sites (including 
                      Ground Zero, Staten Island Landfill, and the New 
                      York City Chief Medical Examiner's Office) for any 
                      time during the period beginning on September 11, 
                      2001, and ending on July 31, 2002; or
                          ``(ii)(I) is a surviving immediate family 
                      member of an individual who was a member of the 
                      Fire Department of New York City (whether fire or 
                      emergency personnel, active or retired) and was 
                      killed at the World Trade site on September 11, 
                      2001; and
                          ``(II) received any treatment for a WTC-
                      related health condition described in section 
                      3312(a)(1)(A)(ii) (relating to mental health 
                      conditions) on or before September 1, 2008.
                    ``(B) Law enforcement officers and wtc rescue, 
                recovery, and cleanup workers.--The individual--
                          ``(i) worked or volunteered onsite in rescue, 
                      recovery, debris cleanup, or related support 
                      services in lower Manhattan (south of Canal St.), 
                      the Staten Island Landfill, or the barge loading 
                      piers, for at least 4 hours during the period 
                      beginning on September 11, 2001, and ending on 
                      September 14, 2001, for at least 24 hours during 
                      the period beginning on September 11, 2001, and 
                      ending on September 30, 2001, or for at least 80 
                      hours during the period beginning on September 11, 
                      2001, and ending on July 31, 2002;
                          ``(ii)(I) was a member of the Police 
                      Department of New York City (whether active or 
                      retired) or a member of the Port Authority Police 
                      of the Port Authority of New York and New Jersey 
                      (whether active or retired) who participated 
                      onsite in rescue, recovery, debris cleanup, or 
                      related services in lower Manhattan (south of 
                      Canal St.), including Ground Zero, the Staten 
                      Island Landfill, or the barge loading piers, for 
                      at least 4 hours during the period beginning 
                      September 11, 2001, and ending on September 14, 
                      2001;
                          ``(II) participated onsite in rescue, 
                      recovery, debris cleanup, or related services at 
                      Ground Zero, the Staten Island Landfill, or the 
                      barge loading piers, for at least one day during 
                      the period beginning on September 11, 2001, and 
                      ending on July 31, 2002;
                          ``(III) participated onsite in rescue, 
                      recovery, debris cleanup, or related services in 
                      lower Manhattan (south of Canal St.) for at least 
                      24 hours during the period

[[Page 124 STAT. 3637]]

                      beginning on September 11, 2001, and ending on 
                      September 30, 2001; or
                          ``(IV) participated onsite in rescue, 
                      recovery, debris cleanup, or related services in 
                      lower Manhattan (south of Canal St.) for at least 
                      80 hours during the period beginning on September 
                      11, 2001, and ending on July 31, 2002;
                          ``(iii) was an employee of the Office of the 
                      Chief Medical Examiner of New York City involved 
                      in the examination and handling of human remains 
                      from the World Trade Center attacks, or other 
                      morgue worker who performed similar post-September 
                      11 functions for such Office staff, during the 
                      period beginning on September 11, 2001, and ending 
                      on July 31, 2002;
                          ``(iv) was a worker in the Port Authority 
                      Trans-Hudson Corporation Tunnel for at least 24 
                      hours during the period beginning on February 1, 
                      2002, and ending on July 1, 2002; or
                          ``(v) was a vehicle-maintenance worker who was 
                      exposed to debris from the former World Trade 
                      Center while retrieving, driving, cleaning, 
                      repairing, and maintaining vehicles contaminated 
                      by airborne toxins from the September 11, 2001, 
                      terrorist attacks during a duration and period 
                      described in subparagraph (A).
                    ``(C) Responders to the september 11 attacks at the 
                pentagon and shanksville, pennsylvania.--The 
                individual--
                          ``(i)(I) was a member of a fire or police 
                      department (whether fire or emergency personnel, 
                      active or retired), worked for a recovery or 
                      cleanup contractor, or was a volunteer; and 
                      performed rescue, recovery, demolition, debris 
                      cleanup, or other related services at the Pentagon 
                      site of the terrorist-related aircraft crash of 
                      September 11, 2001, during the period beginning on 
                      September 11, 2001, and ending on the date on 
                      which the cleanup of the site was concluded, as 
                      determined by the WTC Program Administrator; or
                          ``(II) was a member of a fire or police 
                      department (whether fire or emergency personnel, 
                      active or retired), worked for a recovery or 
                      cleanup contractor, or was a volunteer; and 
                      performed rescue, recovery, demolition, debris 
                      cleanup, or other related services at the 
                      Shanksville, Pennsylvania, site of the terrorist-
                      related aircraft crash of September 11, 2001, 
                      during the period beginning on September 11, 2001, 
                      and ending on the date on which the cleanup of the 
                      site was concluded, as determined by the WTC 
                      Program Administrator; and
                          ``(ii) is determined by the WTC Program 
                      Administrator to be at an increased risk of 
                      developing a WTC-related health condition as a 
                      result of exposure to airborne toxins, other 
                      hazards, or adverse conditions resulting from the 
                      September 11, 2001, terrorist attacks, and meets 
                      such eligibility criteria related to such 
                      exposures, as the WTC Program Administrator 
                      determines are appropriate, after consultation 
                      with the WTC Scientific/Technical Advisory 
                      Committee.

[[Page 124 STAT. 3638]]

            ``(3) Enrollment process.--
                    ``(A) In general.--The WTC Program Administrator 
                shall establish a process for enrolling WTC responders 
                in the WTC Program. Under such process--
                          ``(i) WTC responders described in paragraph 
                      (1)(A) shall be deemed to be enrolled in such 
                      Program;
                          ``(ii) subject to clause (iii), the 
                      Administrator shall enroll in such program 
                      individuals who are determined to be WTC 
                      responders;
                          ``(iii) the Administrator shall deny such 
                      enrollment to an individual if the Administrator 
                      determines that the numerical limitation in 
                      paragraph (4) on enrollment of WTC responders has 
                      been met;
                          ``(iv) there shall be no fee charged to the 
                      applicant for making an application for such 
                      enrollment;
                          ``(v) <<NOTE: Determination. Deadline.>> 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 <<NOTE: Deadline.>> responders.--In 
                      accordance with subparagraph (A)(i), the WTC 
                      Program Administrator shall enroll an individual 
                      described in paragraph (1)(A) in the WTC Program 
                      not later than July 1, 2011.
                          ``(ii) Other responders.--In accordance with 
                      subparagraph (A)(ii) and consistent with paragraph 
                      (4), the WTC Program Administrator shall enroll 
                      any other individual who is determined to be a WTC 
                      responder in the WTC Program at the time of such 
                      determination.
            ``(4) Numerical limitation on eligible wtc responders.--
                    ``(A) In general.--The total number of individuals 
                not described in paragraph (1)(A) or (2)(A)(ii) who may 
                be enrolled under paragraph (3)(A)(ii) shall not exceed 
                25,000 at any time, of which no more than 2,500 may be 
                individuals enrolled based on modified eligibility 
                criteria established under paragraph (1)(C).
                    ``(B) Process.--In implementing subparagraph (A), 
                the WTC Program Administrator shall--
                          ``(i) limit the number of enrollments made 
                      under paragraph (3)--
                                    ``(I) in accordance with such 
                                subparagraph; and
                                    ``(II) to such number, as determined 
                                by the Administrator based on the best 
                                available information and subject to 
                                amounts available under section 3351, 
                                that will ensure sufficient funds will 
                                be available to provide treatment and 
                                monitoring benefits under this title, 
                                with respect to all individuals who are 
                                enrolled through the end of fiscal year 
                                2020; and

[[Page 124 STAT. 3639]]

                          ``(ii) provide priority (subject to paragraph 
                      (3)(A)(i)) in such enrollments in the order in 
                      which individuals apply for enrollment under 
                      paragraph (3).
            ``(5) Disqualification of individuals on terrorist watch 
        list.--No individual who is on the terrorist watch list 
        maintained by the Department of Homeland Security shall qualify 
        as an eligible WTC responder. <<NOTE: Determination.>> Before 
        enrolling any individual as a WTC responder in the WTC Program 
        under paragraph (3), the Administrator, in consultation with the 
        Secretary of Homeland Security, shall determine whether the 
        individual is on such list.

    ``(b) Monitoring Benefits.--
            ``(1) In general.--In the case of an enrolled WTC responder 
        (other than one described in subsection (a)(2)(A)(ii)), the WTC 
        Program shall provide for monitoring benefits that include 
        monitoring consistent with protocols approved by the WTC Program 
        Administrator and including clinical examinations and long-term 
        health monitoring and analysis. In the case of an enrolled WTC 
        responder who is an active member of the Fire Department of New 
        York City, the responder shall receive such benefits as part of 
        the individual's periodic company medical exams.
            ``(2) Provision of monitoring benefits.--The monitoring 
        benefits under paragraph (1) shall be provided through the 
        Clinical Center of Excellence for the type of individual 
        involved or, in the case of an individual residing outside the 
        New York metropolitan area, under an arrangement under section 
        3313.
``SEC. 3312. <<NOTE: 42 USC 300mm-22.>> TREATMENT OF ENROLLED WTC 
                          RESPONDERS FOR WTC-RELATED HEALTH 
                          CONDITIONS.

    ``(a) WTC-Related Health Condition Defined.--
            ``(1) In general.--For purposes of this title, the term 
        `WTC-related health condition' means a condition that--
                    ``(A)(i) is an illness or health condition for which 
                exposure to airborne toxins, any other hazard, or any 
                other adverse condition resulting from the September 11, 
                2001, terrorist attacks, based on an examination by a 
                medical professional with experience in treating or 
                diagnosing the health conditions included in the 
                applicable list of WTC-related health conditions, is 
                substantially likely to be a significant factor in 
                aggravating, contributing to, or causing the illness or 
                health condition, as determined under paragraph (2); or
                    ``(ii) is a mental health condition for which such 
                attacks, based on an examination by a medical 
                professional with experience in treating or diagnosing 
                the health conditions included in the applicable list of 
                WTC-related health conditions, is substantially likely 
                to be a significant factor in aggravating, contributing 
                to, or causing the condition, as determined under 
                paragraph (2); and
                    ``(B) is included in the applicable list of WTC-
                related health conditions or--
                          ``(i) with respect to a WTC responder, is 
                      provided certification of coverage under 
                      subsection (b)(2)(B)(iii); or
                          ``(ii) with respect to a screening-eligible 
                      WTC survivor or certified-eligible WTC survivor, 
                      is provided

[[Page 124 STAT. 3640]]

                      certification of coverage under subsection 
                      (b)(2)(B)(iii), as applied under section 3322(a).
        In the case of a WTC responder described in section 
        3311(a)(2)(A)(ii) (relating to a surviving immediate family 
        member of a firefighter), such term does not include an illness 
        or health condition described in subparagraph (A)(i).
            ``(2) Determination.--The determination under paragraph (1) 
        or subsection (b) of whether the September 11, 2001, terrorist 
        attacks were substantially likely to be a significant factor in 
        aggravating, contributing to, or causing an individual's illness 
        or health condition shall be made based on an assessment of the 
        following:
                    ``(A) The individual's exposure to airborne toxins, 
                any other hazard, or any other adverse condition 
                resulting from the terrorist attacks. Such exposure 
                shall be--
                          ``(i) evaluated and characterized through the 
                      use of a standardized, population-appropriate 
                      questionnaire approved by the Director of the 
                      National Institute for Occupational Safety and 
                      Health; and
                          ``(ii) assessed and documented by a medical 
                      professional with experience in treating or 
                      diagnosing health conditions included on the list 
                      of WTC-related health conditions.
                    ``(B) The type of symptoms and temporal sequence of 
                symptoms. Such symptoms shall be--
                          ``(i) assessed through the use of a 
                      standardized, population-appropriate medical 
                      questionnaire approved by the Director of the 
                      National Institute for Occupational Safety and 
                      Health and a medical examination; and
                          ``(ii) diagnosed and documented by a medical 
                      professional described in subparagraph (A)(ii).
            ``(3) List of health conditions for wtc responders.--The 
        list of health conditions for WTC responders consists of the 
        following:
                    ``(A) Aerodigestive disorders.--
                          ``(i) Interstitial lung diseases.
                          ``(ii) Chronic respiratory disorder--fumes/
                      vapors.
                          ``(iii) Asthma.
                          ``(iv) Reactive airways dysfunction syndrome 
                      (RADS).
                          ``(v) WTC-exacerbated chronic obstructive 
                      pulmonary disease (COPD).
                          ``(vi) Chronic cough syndrome.
                          ``(vii) Upper airway hyperreactivity.
                          ``(viii) Chronic rhinosinusitis.
                          ``(ix) Chronic nasopharyngitis.
                          ``(x) Chronic laryngitis.
                          ``(xi) Gastroesophageal reflux disorder 
                      (GERD).
                          ``(xii) Sleep apnea exacerbated by or related 
                      to a condition described in a previous clause.
                    ``(B) Mental health conditions.--
                          ``(i) Posttraumatic stress disorder (PTSD).
                          ``(ii) Major depressive disorder.
                          ``(iii) Panic disorder.
                          ``(iv) Generalized anxiety disorder.
                          ``(v) Anxiety disorder (not otherwise 
                      specified).

[[Page 124 STAT. 3641]]

                          ``(vi) Depression (not otherwise specified).
                          ``(vii) Acute stress disorder.
                          ``(viii) Dysthymic disorder.
                          ``(ix) Adjustment disorder.
                          ``(x) Substance abuse.
                    ``(C) Musculoskeletal disorders for certain wtc 
                responders.--In the case of a WTC responder described in 
                paragraph (4), a condition described in such paragraph.
                    ``(D) Additional conditions.--Any cancer (or type of 
                cancer) or other condition added, pursuant to paragraph 
                (5) or (6), to the list under this paragraph.
            ``(4) Musculoskeletal disorders.--
                    ``(A) In general.--For purposes of this title, in 
                the case of a WTC responder who received any treatment 
                for a WTC-related musculoskeletal disorder on or before 
                September 11, 2003, the list of health conditions in 
                paragraph (3) shall include:
                          ``(i) Low back pain.
                          ``(ii) Carpal tunnel syndrome (CTS).
                          ``(iii) Other musculoskeletal disorders.
                    ``(B) Definition.--The term `WTC-related 
                musculoskeletal disorder' means a chronic or recurrent 
                disorder of the musculoskeletal system caused by heavy 
                lifting or repetitive strain on the joints or 
                musculoskeletal system occurring during rescue or 
                recovery efforts in the New York City disaster area in 
                the aftermath of the September 11, 2001, terrorist 
                attacks.
            ``(5) Cancer.--
                    ``(A) In general.--
                The <<NOTE: Deadlines. Review.>> WTC Program 
                Administrator shall periodically conduct a review of all 
                available scientific and medical evidence, including 
                findings and recommendations of Clinical Centers of 
                Excellence, published in peer-reviewed journals to 
                determine if, based on such evidence, cancer or a 
                certain type of cancer should be added to the applicable 
                list of WTC-related health conditions. The WTC Program 
                Administrator shall conduct the first review under this 
                subparagraph not later than 180 days after the date of 
                the enactment of this title.
                    ``(B) Proposed regulations and rulemaking.--Based on 
                the periodic reviews under subparagraph (A), if the WTC 
                Program Administrator determines that cancer or a 
                certain type of cancer should be added to such list of 
                WTC-related health conditions, the WTC Program 
                Administrator shall propose regulations, through 
                rulemaking, to add cancer or the certain type of cancer 
                to such list.
                    ``(C) Final regulations.--
                Based <<NOTE: Determination.>> 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 <<NOTE: Federal Register, 
                publication.>> the case that the WTC Program 
                Administrator determines under subparagraph (B) or (C) 
                that cancer or a certain type of cancer should not be 
                added

[[Page 124 STAT. 3642]]

                to such list of WTC-related health conditions, the WTC 
                Program Administrator shall publish an explanation for 
                such determination in the Federal Register. Any such 
                determination to not make such an addition shall not 
                preclude the addition of cancer or the certain type of 
                cancer to such list at a later date.
            ``(6) Addition of health conditions to list for wtc 
        responders.--
                    ``(A) In general.--Whenever the WTC Program 
                Administrator determines that a proposed rule should be 
                promulgated to add a health condition to the list of 
                health conditions in paragraph (3), the Administrator 
                may request a recommendation of the Advisory Committee 
                or may publish such a proposed rule in the Federal 
                Register in accordance with subparagraph (D).
                    ``(B) Administrator's options after receipt of 
                petition.--In the <<NOTE: Deadline. Recommenda- 
                tion. Federal Register, publication.>> 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 <<NOTE: Recommenda- tion. Deadlines.>> 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 <<NOTE: Federal Register, 
                publication.>> 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) <<NOTE: Comment period.>> provide 
                      interested parties a period of 30 days after such 
                      publication to submit written comments on the 
                      proposed rule.
                The WTC Program Administrator may <<NOTE: Federal 
                Register, publication.>> extend the period described in 
                clause (ii) upon a finding of good cause. In

[[Page 124 STAT. 3643]]

                the case of such an extension, the Administrator shall 
                publish such extension in the Federal Register.
                    ``(E) Interested <<NOTE: Definition.>> 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 <<NOTE: Regulations.>> Administrator shall 
                      establish, by rule, a process for the appeal of 
                      determinations under clause (ii).
            ``(2) Determination based on medically associated wtc-
        related health conditions.--
                    ``(A) In general.--If a physician at a Clinical 
                Center of Excellence determines pursuant to subsection 
                (a) that the enrolled WTC responder has a health 
                condition described in subsection (a)(1)(A) that is not 
                in the list in subsection (a)(3) but which is medically 
                associated with a WTC-related health condition--
                          ``(i) the physician shall promptly transmit 
                      such determination to the WTC Program 
                      Administrator and

[[Page 124 STAT. 3644]]

                      provide the Administrator with the facts 
                      supporting such determination; and
                          ``(ii) the Administrator shall make a 
                      determination under subparagraph (B) with respect 
                      to such physician's determination.
                    ``(B) Procedures <<NOTE: Regulations.>> 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) <<NOTE: Deadline.>> not later than 60 
                      days after the date of the transmittal under 
                      subparagraph (A)(i), a determination by the WTC 
                      Program Administrator on whether or not the 
                      condition involved is described in subsection 
                      (a)(1)(A) and is medically associated with a WTC-
                      related health condition;
                          ``(iii) certification in accordance with 
                      paragraph (1)(B)(ii) of coverage of such condition 
                      if determined to be described in subsection 
                      (a)(1)(A) and medically associated with a WTC-
                      related health condition; and
                          ``(iv) a process for appeals of determinations 
                      relating to such conditions.
                    ``(C) Inclusion in list of health conditions.--If 
                the WTC Program Administrator provides certification 
                under subparagraph (B)(iii) for coverage of a condition, 
                the Administrator may, pursuant to subsection (a)(6), 
                add the condition to the list in subsection (a)(3).
                    ``(D) Conditions already declined for inclusion in 
                list.--If the WTC Program Administrator publishes a 
                determination under subsection (a)(6)(B) not to include 
                a condition in the list in subsection (a)(3), the WTC 
                Program Administrator shall not provide certification 
                under subparagraph (B)(iii) for coverage of the 
                condition. In the case of an individual who is certified 
                under subparagraph (B)(iii) with respect to such 
                condition before the date of the publication of such 
                determination the previous sentence shall not apply.
            ``(3) Requirement of medical necessity.--
                    ``(A) In general.--In providing treatment for a WTC-
                related health condition, a physician or other provider 
                shall provide treatment that is medically necessary and 
                in accordance with medical treatment protocols 
                established under subsection (d).
                    ``(B) Regulations relating to medical necessity.--
                For the purpose of this title, the WTC Program 
                Administrator shall issue regulations specifying a 
                standard for determining medical necessity with respect 
                to health care services and prescription 
                pharmaceuticals, a process for determining whether 
                treatment furnished and pharmaceuticals prescribed under 
                this title meet such standard (including any prior 
                authorization requirement), and a process for appeal of 
                a determination under subsection (c)(3).

[[Page 124 STAT. 3645]]

            ``(4) Scope of treatment covered.--
                    ``(A) In general.--The scope of treatment covered 
                under this subsection includes services of physicians 
                and other health care providers, diagnostic and 
                laboratory tests, prescription drugs, inpatient and 
                outpatient hospital services, and other medically 
                necessary treatment.
                    ``(B) Pharmaceutical coverage.--With respect to 
                ensuring coverage of medically necessary outpatient 
                prescription drugs, such drugs shall be provided, under 
                arrangements made by the WTC Program Administrator, 
                directly through participating Clinical Centers of 
                Excellence or through one or more outside vendors.
                    ``(C) Transportation expenses for nationwide 
                network.--The WTC Program Administrator may provide for 
                necessary and reasonable transportation and expenses 
                incident to the securing of medically necessary 
                treatment through the nationwide network under section 
                3313 involving travel of more than 250 miles and for 
                which payment is made under this section in the same 
                manner in which individuals may be furnished necessary 
                and reasonable transportation and expenses incident to 
                services involving travel of more than 250 miles under 
                regulations implementing section 3629(c) of the Energy 
                Employees Occupational Illness Compensation Program Act 
                of 2000 (title XXXVI of Public Law 106-398; 42 U.S.C. 
                7384t(c)).
            ``(5) Provision of treatment pending certification.--With 
        respect to an enrolled WTC responder for whom a determination is 
        made by an examining physician under paragraph (1) or (2), but 
        for whom the WTC Program Administrator has not yet determined 
        whether to certify the determination, the WTC Program 
        Administrator may establish by rule a process through which the 
        Administrator may approve the provision of medical treatment 
        under this subsection (and payment under subsection (c)) with 
        respect to such responder and such responder's WTC-related 
        health condition (under such terms and conditions as the 
        Administrator may provide) until the Administrator makes a 
        decision on whether to certify the determination.

    ``(c) Payment for Initial Health Evaluation, Monitoring, and 
Treatment of WTC-Related Health Conditions.--
            ``(1) Medical treatment.--
                    ``(A) Use of feca payment rates.--
                          ``(i) In general.--Subject to clause (ii):
                                    ``(I) Subject to subparagraphs (B) 
                                and (C), the WTC Program Administrator 
                                shall reimburse costs for medically 
                                necessary treatment under this title for 
                                WTC-related health conditions according 
                                to the payment rates that would apply to 
                                the provision of such treatment and 
                                services by the facility under the 
                                Federal Employees Compensation Act.
                                    ``(II) <<NOTE: Regulations.>> For 
                                treatment not covered under subclause 
                                (i) or subparagraph (B), the WTC Program 
                                Administrator shall establish by 
                                regulation a reimbursement rate for such 
                                treatment.
                          ``(ii) Exception.--In no case shall payments 
                      for products or services under clause (i) be made 
                      at a rate higher than the Office of Worker's 
                      Compensation

[[Page 124 STAT. 3646]]

                      Programs in the Department Labor would pay for 
                      such products or services rendered at the time 
                      such products or services were provided.
                    ``(B) Pharmaceuticals.--
                          ``(i) In general.--The WTC Program 
                      Administrator shall establish a program for paying 
                      for the medically necessary outpatient 
                      prescription pharmaceuticals prescribed under this 
                      title for WTC-related health conditions through 
                      one or more contracts with outside vendors.
                          ``(ii) Competitive bidding.--Under such 
                      program the Administrator shall--
                                    ``(I) select one or more appropriate 
                                vendors through a Federal competitive 
                                bid process; and
                                    ``(II) select the lowest bidder (or 
                                bidders) meeting the requirements for 
                                providing pharmaceutical benefits for 
                                participants in the WTC Program.
                          ``(iii) Treatment of fdny participants.--Under 
                      such program the Administrator may enter into an 
                      agreement with a separate vendor to provide 
                      pharmaceutical benefits to enrolled WTC responders 
                      for whom the Clinical Center of Excellence is 
                      described in section 3305 if such an arrangement 
                      is deemed necessary and beneficial to the program 
                      by the WTC Program Administrator.
                          ``(iv) Pharmaceuticals.--
                      Not <<NOTE: Deadline. Reports.>> later than July 
                      1, 2011, the Comptroller General of the United 
                      States shall submit to the Committee on Energy and 
                      Commerce of the House of Representatives and the 
                      Committee on Health, Education, Labor, and 
                      Pensions of the Senate a report on whether 
                      existing Federal pharmaceutical purchasing 
                      programs can provide pharmaceutical benefits more 
                      efficiently and effectively than through the WTC 
                      program.
                    ``(C) Improving quality and efficiency through 
                modification of payment amounts and methodologies.--The 
                WTC Program Administrator may modify the amounts and 
                methodologies for making payments for initial health 
                evaluations, monitoring, or treatment, if, taking into 
                account utilization and quality data furnished by the 
                Clinical Centers of Excellence under section 
                3305(b)(1)(B)(iii), the Administrator determines that a 
                bundling, capitation, pay for performance, or other 
                payment methodology would better ensure high quality and 
                efficient delivery of initial health evaluations, 
                monitoring, or treatment to an enrolled WTC responder, 
                screening-eligible WTC survivor, or certified-eligible 
                WTC survivor.
            ``(2) Monitoring and initial health evaluation.--The WTC 
        Program Administrator shall reimburse the costs of monitoring 
        and the costs of an initial health evaluation provided under 
        this title at a rate set by the Administrator by regulation.
            ``(3) Determination of medical necessity.--
                    ``(A) Review of medical necessity and protocols.--As 
                part of the process for reimbursement or payment under 
                this subsection, the WTC Program Administrator shall 
                provide for the review of claims for reimbursement or 
                payment

[[Page 124 STAT. 3647]]

                for the provision of medical treatment to determine if 
                such treatment is medically necessary and in accordance 
                with medical treatment protocols established under 
                subsection (d).
                    ``(B) Withholding of payment for medically 
                unnecessary treatment.--The Administrator shall withhold 
                such reimbursement or payment for treatment that the 
                Administrator determines is not medically necessary or 
                is not in accordance with such medical treatment 
                protocols.

    ``(d) Medical Treatment Protocols.--
            ``(1) Development.--The Data Centers shall develop medical 
        treatment protocols for the treatment of enrolled WTC responders 
        and certified-eligible WTC survivors for health conditions 
        included in the applicable list of WTC-related health 
        conditions.
            ``(2) Approval.--The medical treatment protocols developed 
        under paragraph (1) shall be subject to approval by the WTC 
        Program Administrator.
``SEC. 3313. <<NOTE: 42 USC 300mm-23.>> 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 <<NOTE: Deadline. Reports.>> later than July 1, 2011, the 
        Comptroller General of the United States shall submit

[[Page 124 STAT. 3648]]

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

                         ``PART 2--WTC SURVIVORS

``SEC. 3321. <<NOTE: 42 USC 300mm-31.>> IDENTIFICATION AND INITIAL 
                          HEALTH EVALUATION OF SCREENING-ELIGIBLE 
                          AND CERTIFIED-ELIGIBLE WTC SURVIVORS.

    ``(a) Identification of Screening-Eligible WTC Survivors and 
Certified-Eligible WTC Survivors.--
            ``(1) Screening-eligible wtc survivors.--
                    ``(A) Definition.--In this title, the term 
                `screening-eligible WTC survivor' means, subject to 
                subparagraph (C) and paragraph (3), an individual who is 
                described in any of the following clauses:
                          ``(i) Currently identified survivor.--An 
                      individual, including a WTC responder, who has 
                      been identified as eligible for medical treatment 
                      and monitoring by the WTC Environmental Health 
                      Center as of the date of enactment of this title.
                          ``(ii) Survivor who meets current eligibility 
                      criteria.--An individual who is not a WTC 
                      responder, for purposes of the initial health 
                      evaluation under subsection (b), claims symptoms 
                      of a WTC-related health condition and meets any of 
                      the current eligibility criteria described in 
                      subparagraph (B).
                          ``(iii) Survivor who meets modified 
                      eligibility criteria.--An individual who is not a 
                      WTC responder, for purposes of the initial health 
                      evaluation under subsection (b), claims symptoms 
                      of a WTC-related health condition and meets such 
                      eligibility criteria relating to exposure to 
                      airborne toxins, other hazards, or adverse 
                      conditions resulting from the September 11, 2001, 
                      terrorist attacks as the WTC Administrator 
                      determines, after consultation with the Data 
                      Centers described in section 3305 and the WTC 
                      Scientific/Technical Advisory Committee and WTC 
                      Health Program Steering Committees under section 
                      3302.
                The Administrator shall not modify such criteria under 
                clause (iii) on or after the date that the number of 
                certifications for certified-eligible WTC survivors 
                under paragraph (2)(B) has reached 80 percent of the 
                limit described in paragraph (3) or on or after the date 
                that the number of enrollments of WTC responders has 
                reached 80 percent of the limit described in section 
                3311(a)(4).
                    ``(B) Current <<NOTE: Time periods.>> eligibility 
                criteria.--The eligibility criteria described in this 
                subparagraph for an individual are that the individual 
                is described in any of the following clauses:
                          ``(i) A person who was present in the New York 
                      City disaster area in the dust or dust cloud on 
                      September 11, 2001.

[[Page 124 STAT. 3649]]

                          ``(ii) A person who worked, resided, or 
                      attended school, childcare, or adult daycare in 
                      the New York City disaster area for--
                                    ``(I) at least 4 days during the 4-
                                month period beginning on September 11, 
                                2001, and ending on January 10, 2002; or
                                    ``(II) at least 30 days during the 
                                period beginning on September 11, 2001, 
                                and ending on July 31, 2002.
                          ``(iii) Any person who worked as a cleanup 
                      worker or performed maintenance work in the New 
                      York City disaster area during the 4-month period 
                      described in subparagraph (B)(i) and had extensive 
                      exposure to WTC dust as a result of such work.
                          ``(iv) A person who was deemed eligible to 
                      receive a grant from the Lower Manhattan 
                      Development Corporation Residential Grant Program, 
                      who possessed a lease for a residence or purchased 
                      a residence in the New York City disaster area, 
                      and who resided in such residence during the 
                      period beginning on September 11, 2001, and ending 
                      on May 31, 2003.
                          ``(v) A person whose place of employment--
                                    ``(I) at any time during the period 
                                beginning on September 11, 2001, and 
                                ending on May 31, 2003, was in the New 
                                York City disaster area; and
                                    ``(II) was deemed eligible to 
                                receive a grant from the Lower Manhattan 
                                Development Corporation WTC Small Firms 
                                Attraction and Retention Act program or 
                                other government incentive program 
                                designed to revitalize the lower 
                                Manhattan economy after the September 
                                11, 2001, terrorist attacks.
                    ``(C) Application and determination process for 
                screening eligibility.--
                          ``(i) In general.--The WTC Program 
                      Administrator in consultation with the Data 
                      Centers shall establish a process for individuals, 
                      other than individuals described in subparagraph 
                      (A)(i), to be determined to be screening-eligible 
                      WTC survivors. Under such process--
                                    ``(I) there shall be no fee charged 
                                to the applicant for making an 
                                application for such determination;
                                    ``(II) <<NOTE: Deadline.>> the 
                                Administrator shall make a determination 
                                on such an application not later than 60 
                                days after the date of filing the 
                                application;
                                    ``(III) the Administrator shall make 
                                such a determination relating to an 
                                applicant's compliance with this title 
                                and shall not determine that an 
                                individual is not so eligible or deny 
                                written documentation under clause (ii) 
                                to such individual unless the 
                                Administrator determines that--
                                            ``(aa) based on the 
                                        application submitted, the 
                                        individual does not meet the 
                                        eligibility criteria; or

[[Page 124 STAT. 3650]]

                                            ``(bb) the numerical 
                                        limitation on certifications of 
                                        certified-eligible WTC survivors 
                                        set forth in paragraph (3) has 
                                        been met; and
                                    ``(IV) an individual who is 
                                determined not to be a screening-
                                eligible WTC survivor shall have an 
                                opportunity to appeal such determination 
                                in a manner established under such 
                                process.
                          ``(ii) Written documentation of screening-
                      eligibility.--
                                    ``(I) In general.--In the case of an 
                                individual who is described in 
                                subparagraph (A)(i) or who is determined 
                                under clause (i) (consistent with 
                                paragraph (3)) to be a screening-
                                eligible WTC survivor, the WTC Program 
                                Administrator shall provide an 
                                appropriate written documentation of 
                                such fact.
                                    ``(II) Timing.--
                                            ``(aa) Currently identified 
                                        survivors.--In the case of an 
                                        individual who is described in 
                                        subparagraph (A)(i), the WTC 
                                        Program Administrator shall 
                                        provide the written 
                                        documentation under subclause 
                                        (I) not later than July 1, 2011.
                                            ``(bb) Other members.--In 
                                        the case of another individual 
                                        who is determined under clause 
                                        (i) and consistent with 
                                        paragraph (3) to be a screening-
                                        eligible WTC survivor, the WTC 
                                        Program Administrator shall 
                                        provide the written 
                                        documentation under subclause 
                                        (I) at the time of such 
                                        determination.
            ``(2) Certified-eligible wtc survivors.--
                    ``(A) Definition.--The term `certified-eligible WTC 
                survivor' means, subject to paragraph (3), a screening-
                eligible WTC survivor who the WTC Program Administrator 
                certifies under subparagraph (B) to be eligible for 
                followup monitoring and treatment under this part.
                    ``(B) Certification of eligibility for monitoring 
                and treatment.--
                          ``(i) In general.--The WTC Program 
                      Administrator shall establish a certification 
                      process under which the Administrator shall 
                      provide appropriate certification to screening-
                      eligible WTC survivors who, pursuant to the 
                      initial health evaluation under subsection (b), 
                      are determined to be eligible for followup 
                      monitoring and treatment under this part.
                          ``(ii) Timing.--
                                    ``(I) Currently identified 
                                survivors.--In the case of an individual 
                                who is described in paragraph (1)(A)(i), 
                                the WTC Program Administrator shall 
                                provide the certification under clause 
                                (i) not later than July 1, 2011.
                                    ``(II) Other members.--In the case 
                                of another individual who is determined 
                                under clause (i) to be eligible for 
                                followup monitoring and treatment, the 
                                WTC Program Administrator shall provide 
                                the certification under such clause at 
                                the time of such determination.

[[Page 124 STAT. 3651]]

            ``(3) Numerical limitation on certified-eligible wtc 
        survivors.--
                    ``(A) In general.--The total number of individuals 
                not described in paragraph (1)(A)(i) who may be 
                certified as certified-eligible WTC survivors under 
                paragraph (2)(B) shall not exceed 25,000 at any time.
                    ``(B) Process.--In implementing subparagraph (A), 
                the WTC Program Administrator shall--
                          ``(i) limit the number of certifications 
                      provided under paragraph (2)(B)--
                                    ``(I) in accordance with such 
                                subparagraph; and
                                    ``(II) to such number, as determined 
                                by the Administrator based on the best 
                                available information and subject to 
                                amounts made available under section 
                                3351, that will ensure sufficient funds 
                                will be available to provide treatment 
                                and monitoring benefits under this 
                                title, with respect to all individuals 
                                receiving such certifications through 
                                the end of fiscal year 2020; and
                          ``(ii) provide priority in such certifications 
                      in the order in which individuals apply for a 
                      determination under paragraph (2)(B).
            ``(4) Disqualification of individuals on terrorist watch 
        list.--No individual who is on the terrorist watch list 
        maintained by the Department of Homeland Security shall qualify 
        as a screening-eligible WTC survivor or a certified-eligible WTC 
        survivor. <<NOTE: Determination.>> Before determining any 
        individual to be a screening-eligible WTC survivor under 
        paragraph (1) or certifying any individual as a certified 
        eligible WTC survivor under paragraph (2), the Administrator, in 
        consultation with the Secretary of Homeland Security, shall 
        determine whether the individual is on such list.

    ``(b) Initial Health Evaluation To Determine Eligibility for 
Followup Monitoring or Treatment.--
            ``(1) In general.--In the case of a screening-eligible WTC 
        survivor, the WTC Program shall provide for an initial health 
        evaluation to determine if the survivor has a WTC-related health 
        condition and is eligible for followup monitoring and treatment 
        benefits under the WTC Program. Initial health evaluation 
        protocols under section 3305(a)(2)(A)(ii) shall be subject to 
        approval by the WTC Program Administrator.
            ``(2) Initial health evaluation providers.--The initial 
        health evaluation described in paragraph (1) shall be provided 
        through a Clinical Center of Excellence with respect to the 
        individual involved.
            ``(3) Limitation on initial health evaluation benefits.--
        Benefits for an initial health evaluation under this part for a 
        screening-eligible WTC survivor shall consist only of a single 
        medical initial health evaluation consistent with initial health 
        evaluation protocols described in paragraph (1). Nothing in this 
        paragraph shall be construed as preventing such an individual 
        from seeking additional medical initial health evaluations at 
        the expense of the individual.

[[Page 124 STAT. 3652]]

``SEC. 3322. <<NOTE: 42 USC 300mm-32.>> FOLLOWUP MONITORING AND 
                          TREATMENT OF CERTIFIED-ELIGIBLE WTC 
                          SURVIVORS FOR WTC-RELATED HEALTH 
                          CONDITIONS.

    ``(a) In General.--Subject <<NOTE: Applicability.>> 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. <<NOTE: 42 USC 300mm-33.>> FOLLOWUP MONITORING AND 
                          TREATMENT OF OTHER INDIVIDUALS WITH WTC-
                          RELATED HEALTH CONDITIONS.

    ``(a) In General.--Subject <<NOTE: Applicability.>> to subsection 
(c), the provisions of section 3322 shall apply to the followup 
monitoring and treatment of WTC-related health conditions in the case of 
individuals described in subsection (b) in the same manner as such 
provisions apply to the followup monitoring and treatment of WTC-related 
health conditions for certified-eligible WTC survivors.

    ``(b) Individuals Described.--An individual described in this 
subsection is an individual who, regardless of location of residence--
            ``(1) is not an enrolled WTC responder or a certified-
        eligible WTC survivor; and

[[Page 124 STAT. 3653]]

            ``(2) is diagnosed at a Clinical Center of Excellence with a 
        WTC-related health condition for certified-eligible WTC 
        survivors.

    ``(c) Limitation.--
            ``(1) In general.--The WTC Program Administrator shall limit 
        benefits for any fiscal year under subsection (a) in a manner so 
        that payments under this section for such fiscal year do not 
        exceed the amount specified in paragraph (2) for such fiscal 
        year.
            ``(2) Limitation.--The amount specified in this paragraph 
        for--
                    ``(A) the last calendar quarter of fiscal year 2011 
                is $5,000,000;
                    ``(B) fiscal year 2012 is $20,000,000; or
                    ``(C) a succeeding fiscal year is the amount 
                specified in this paragraph for the previous fiscal year 
                increased by the annual percentage increase in the 
                medical care component of the consumer price index for 
                all urban consumers.

                       ``PART 3--PAYOR PROVISIONS

``SEC. 3331. <<NOTE: 42 USC 300mm-41.>> PAYMENT OF CLAIMS.

    ``(a) In General.--Except as provided in subsections (b) and (c), 
the cost of monitoring and treatment benefits and initial health 
evaluation benefits provided under parts 1 and 2 of this subtitle shall 
be paid for by the WTC Program from the World Trade Center Health 
Program Fund.
    ``(b) Workers' Compensation Payment.--
            ``(1) In general.--Subject to paragraph (2), payment for 
        treatment under parts 1 and 2 of this subtitle of a WTC-related 
        health condition of an individual that is work-related shall be 
        reduced or recouped to the extent that the WTC Program 
        Administrator determines that payment has been made, or can 
        reasonably be expected to be made, under a workers' compensation 
        law or plan of the United States, a State, or a locality, or 
        other work-related injury or illness benefit plan of the 
        employer of such individual, for such 
        treatment. <<NOTE: Applicability.>> The provisions of clauses 
        (iii), (iv), (v), and (vi) of paragraph (2)(B) of section 
        1862(b) of the Social Security Act and paragraphs (3) and (4) of 
        such section shall apply to the recoupment under this subsection 
        of a payment to the WTC Program (with respect to a workers' 
        compensation law or plan, or other work-related injury or 
        illness plan of the employer involved, and such individual) in 
        the same manner as such provisions apply to the reimbursement of 
        a payment under section 1862(b)(2) of such Act to the Secretary 
        (with respect to such a law or plan and an individual entitled 
        to benefits under title XVIII of such Act) except that any 
        reference in such paragraph (4) to payment rates under title 
        XVIII of the Social Security Act shall be deemed a reference to 
        payment rates under this title.
            ``(2) Exception.--Paragraph (1) shall not apply for any 
        quarter, with respect to any workers' compensation law or plan, 
        including line of duty compensation, to which New York City is 
        obligated to make payments, if, in accordance with terms 
        specified under the contract under subsection (d)(1)(A),

[[Page 124 STAT. 3654]]

        New York City has made the full payment required under such 
        contract for such quarter.
            ``(3) Rules of construction.--Nothing in this title shall be 
        construed to affect, modify, or relieve any obligations under a 
        worker's compensation law or plan, other work-related injury or 
        illness benefit plan of an employer, or any health insurance 
        plan.

    ``(c) Health Insurance Coverage.--
            ``(1) In general.--In <<NOTE: Applicability.>> the case of 
        an individual who has a WTC-related health condition that is not 
        work-related and has health coverage for such condition through 
        any public or private health plan (including health benefits 
        under title XVIII, XIX, or XXI of the Social Security Act) the 
        provisions of section 1862(b) of the Social Security Act shall 
        apply to such a health plan and such individual in the same 
        manner as they apply to group health plan and an individual 
        entitled to benefits under title XVIII of such Act pursuant to 
        section 226(a) of such Act. Any costs for items and services 
        covered under such plan that are not reimbursed by such health 
        plan, due to the application of deductibles, copayments, 
        coinsurance, other cost sharing, or otherwise, are reimbursable 
        under this title to the extent that they are covered under the 
        WTC Program. The program under this title shall not be treated 
        as a legally liable party for purposes of applying section 
        1902(a)(25) of the Social Security Act.
            ``(2) Recovery by individual providers.--Nothing in 
        paragraph (1) shall be construed as requiring an entity 
        providing monitoring and treatment under this title to seek 
        reimbursement under a health plan with which the entity has no 
        contract for reimbursement.
            ``(3) Maintenance of required minimum essential coverage.--
        No payment may be made for monitoring and treatment under this 
        title for an individual for a month (beginning with July 2014) 
        if with respect to such month the individual--
                    ``(A) is an applicable individual (as defined in 
                subsection (d) of section 5000A of Internal Revenue Code 
                of 1986) for whom the exemption under subsection (e) of 
                such section does not apply; and
                    ``(B) is not covered under minimum essential 
                coverage, as required under subsection (a) of such 
                section.

    ``(d) Required Contribution by New York City in Program Costs.--
            ``(1) Contract requirement.--
                    ``(A) In general.--No funds may be disbursed from 
                the World Trade Center Health Program Fund under section 
                3351 unless New York City has entered into a contract 
                with the WTC Program Administrator under which New York 
                City agrees, in a form and manner specified by the 
                Administrator, to pay the full contribution described in 
                subparagraph (B) in accordance with this subsection on a 
                timely basis, plus any interest owed pursuant to 
                subparagraph (E)(i). Such contract shall specify the 
                terms under which New York City shall be considered to 
                have made the full payment required for a quarter for 
                purposes of subsection (b)(2).
                    ``(B) Full contribution amount.--Under such 
                contract, with respect to the last calendar quarter of 
                fiscal

[[Page 124 STAT. 3655]]

                year 2011 and each calendar quarter in fiscal years 2012 
                through 2015 the full contribution amount under this 
                subparagraph shall be equal to 10 percent of the 
                expenditures in carrying out this title for the 
                respective quarter and with respect to calendar quarters 
                in fiscal year 2016, such full contribution amount shall 
                be equal to \1/9\ of the Federal expenditures in 
                carrying out this title for the respective quarter.
                    ``(C) Satisfaction of payment obligation.--The 
                payment obligation under such contract may not be 
                satisfied through any of the following:
                          ``(i) An amount derived from Federal sources.
                          ``(ii) An amount paid before the date of the 
                      enactment of this title.
                          ``(iii) An amount paid to satisfy a judgment 
                      or as part of a settlement related to injuries or 
                      illnesses arising out of the September 11, 2001, 
                      terrorist attacks.
                    ``(D) Timing of contribution.--The payment 
                obligation under such contract for a calendar quarter in 
                a fiscal year shall be paid not later than the last day 
                of the second succeeding calendar quarter.
                    ``(E) Compliance.--
                          ``(i) Interest for late payment.--If New York 
                      City fails to pay to the WTC Program Administrator 
                      pursuant to such contract the amount required for 
                      any calendar quarter by the day specified in 
                      subparagraph (D), interest shall accrue on the 
                      amount not so paid at the rate (determined by the 
                      Administrator) based on the average yield to 
                      maturity, plus 1 percentage point, on outstanding 
                      municipal bonds issued by New York City with a 
                      remaining maturity of at least 1 year.
                          ``(ii) Recovery of amounts owed.--The amounts 
                      owed to the WTC Program Administrator under such 
                      contract shall be recoverable by the United States 
                      in an action in the same manner as payments made 
                      under title XVIII of the Social Security Act may 
                      be recoverable in an action brought under section 
                      1862(b)(2)(B)(iii) of such Act.
                    ``(F) Deposit in fund.--The WTC Program Administer 
                shall deposit amounts paid under such contract into the 
                World Trade Center Health Program Fund under section 
                3351.
            ``(2) Payment of new york city share of monitoring and 
        treatment costs.--With respect to each calendar quarter for 
        which a contribution is required by New York City under the 
        contract under paragraph (1), the WTC Program Administrator 
        shall--
                    ``(A) provide New York City with an estimate of such 
                amount of the required contribution at the beginning of 
                such quarter and with an updated estimate of such amount 
                at the beginning of each of the subsequent 2 quarters;
                    ``(B) bill such amount directly to New York City; 
                and
                    ``(C) 
                certify <<NOTE: Certification. Deadline.>> periodically, 
                for purposes of this subsection, whether or not New York 
                City has paid the amount so billed.

[[Page 124 STAT. 3656]]

        Such amount shall initially be estimated by the WTC Program 
        Administrator and shall be subject to adjustment and 
        reconciliation based upon actual expenditures in carrying out 
        this title.
            ``(3) Rule of construction.--Nothing in this subsection 
        shall be construed as authorizing the WTC Administrator, with 
        respect to a fiscal year, to reduce the numerical limitation 
        under section 3311(a)(4) or 3321(a)(3) for such fiscal year if 
        New York City fails to comply with paragraph (1) for a calendar 
        quarter in such fiscal year.

    ``(e) Work-Related Described.--For the purposes of this section, a 
WTC-related health condition shall be treated as a condition that is 
work-related if--
            ``(1) the condition is diagnosed in an enrolled WTC 
        responder, or in an individual who qualifies as a certified-
        eligible WTC survivor on the basis of being a rescue, recovery, 
        or cleanup worker; or
            ``(2) with respect to the condition the individual has filed 
        and had established a claim under a workers' compensation law or 
        plan of the United States or a State, or other work-related 
        injury or illness benefit plan of the employer of such 
        individual.
``SEC. 3332. <<NOTE: 42 USC 300mm-42.>> 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. <<NOTE: 42 USC 300mm-51.>> RESEARCH REGARDING CERTAIN 
                          HEALTH CONDITIONS RELATED TO SEPTEMBER 
                          11 TERRORIST ATTACKS.

    ``(a) In General.--With respect to individuals, including enrolled 
WTC responders and certified-eligible WTC survivors, receiving 
monitoring or treatment under subtitle B, the WTC Program Administrator 
shall conduct or support--
            ``(1) research on physical and mental health conditions that 
        may be related to the September 11, 2001, terrorist attacks;
            ``(2) research on diagnosing WTC-related health conditions 
        of such individuals, in the case of conditions for which there 
        has been diagnostic uncertainty; and
            ``(3) research on treating WTC-related health conditions of 
        such individuals, in the case of conditions for which there has 
        been treatment uncertainty.

The Administrator may provide such support through continuation and 
expansion of research that was initiated before the date of the 
enactment of this title and through the World Trade Center Health 
Registry (referred to in section 3342), through a Clinical Center of 
Excellence, or through a Data Center.
    ``(b) Types of Research.--The research under subsection (a)(1) shall 
include epidemiologic and other research studies on WTC-related health 
conditions or emerging conditions--
            ``(1) among enrolled WTC responders and certified-eligible 
        WTC survivors under treatment; and

[[Page 124 STAT. 3657]]

            ``(2) in sampled populations outside the New York City 
        disaster area in Manhattan as far north as 14th Street and in 
        Brooklyn, along with control populations, to identify potential 
        for long-term adverse health effects in less exposed 
        populations.

    ``(c) Consultation.--The WTC Program Administrator shall carry out 
this section in consultation with the WTC Scientific/Technical Advisory 
Committee.
    ``(d) Application of Privacy and Human Subject Protections.--The 
privacy and human subject protections applicable to research conducted 
under this section shall not be less than such protections applicable to 
research conducted or funded by the Department of Health and Human 
Services.
``SEC. 3342. <<NOTE: 42 USC 300mm-52.>> 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. <<NOTE: 42 USC 300mm-61.>> WORLD TRADE CENTER HEALTH 
                          PROGRAM FUND.

    ``(a) Establishment of Fund.--
            ``(1) In general.--There is established a fund to be known 
        as the World Trade Center Health Program Fund (referred to in 
        this section as the `Fund').
            ``(2) Funding.--Out of any money in the Treasury not 
        otherwise appropriated, there shall be deposited into the Fund 
        for each of fiscal years 2012 through 2016 (and the last 
        calendar quarter of fiscal year 2011)--
                    ``(A) the Federal share, consisting of an amount 
                equal to the lesser of--
                          ``(i) 90 percent of the expenditures in 
                      carrying out this title for the respective fiscal 
                      year (initially based on estimates, subject to 
                      subsequent reconciliation based on actual 
                      expenditures); or
                          ``(ii)(I) $71,000,000 for the last calendar 
                      quarter of fiscal year 2011, $318,000,000 for 
                      fiscal year 2012, $354,000,000 for fiscal year 
                      2013, $382,000,000 for fiscal year 2014, and 
                      $431,000,000 for fiscal year 2015; and
                          ``(II) subject to paragraph (4), an additional 
                      amount for fiscal year 2016 from unexpended 
                      amounts for previous fiscal years; plus
                    ``(B) the New York City share, consisting of the 
                amount contributed under the contract under section 
                3331(d).
            ``(3) Contract requirement.--
                    ``(A) In general.--No funds may be disbursed from 
                the Fund unless New York City has entered into a 
                contract with the WTC Program Administrator under 
                section 3331(d)(1).
                    ``(B) Breach of contract.--In the case of a failure 
                to pay the amount so required under the contract--

[[Page 124 STAT. 3658]]

                          ``(i) the amount is recoverable under 
                      subparagraph (E)(ii) of such section;
                          ``(ii) such failure shall not affect the 
                      disbursement of amounts from the Fund; and
                          ``(iii) the Federal share described in 
                      paragraph (2)(A) shall not be increased by the 
                      amount so unpaid.
            ``(4) Aggregate limitation on funding beginning with fiscal 
        year 2016.--Beginning with fiscal year 2016, in no case shall 
        the share of Federal funds deposited into the Fund under 
        paragraph (2) for such fiscal year and previous fiscal years and 
        quarters exceed the sum of the amounts specified in paragraph 
        (2)(A)(ii)(I).

    ``(b) Mandatory Funds for Monitoring, Initial Health Evaluations, 
Treatment, and Claims Processing.--
            ``(1) In general.--The amounts deposited into the Fund under 
        subsection (a)(2) shall be available, without further 
        appropriation, consistent with paragraph (2) and subsection (c), 
        to carry out subtitle B and sections 3302(a), 3303, 3304, 
        3305(a)(2), 3305(c), 3341, and 3342.
            ``(2) Limitation on mandatory funding.--This title does not 
        establish any Federal obligation for payment of amounts in 
        excess of the amounts available from the Fund for such purpose.
            ``(3) Limitation on authorization for further 
        appropriations.--This title does not establish any authorization 
        for appropriation of amounts in excess of the amounts available 
        from the Fund under paragraph (1).

    ``(c) Limits on Spending for Certain Purposes.--Of the amounts made 
available under subsection (b)(1), not more than each of the following 
amounts may be available for each of the following purposes:
            ``(1) Surviving immediate family members of firefighters.--
        For the purposes of carrying out subtitle B with respect to WTC 
        responders described in section 3311(a)(2)(A)(ii)--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $100,000;
                    ``(B) for fiscal year 2012, $400,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all items; 
                United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(2) WTC health program scientific/technical advisory 
        committee.--For the purpose of carrying out section 3302(a)--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $25,000;
                    ``(B) for fiscal year 2012, $100,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all items; 
                United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(3) Education and outreach.--For the purpose of carrying 
        out section 3303--

[[Page 124 STAT. 3659]]

                    ``(A) for the last calendar quarter of fiscal year 
                2011, $500,000;
                    ``(B) for fiscal year 2012, $2,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all items; 
                United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(4) Uniform data collection.--For the purpose of carrying 
        out section 3304 and for reimbursing Data Centers (as defined in 
        section 3305(b)(2)) for the costs incurred by such Centers in 
        carrying out activities under contracts entered into under 
        section 3305(a)(2)--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $2,500,000;
                    ``(B) for fiscal year 2012, $10,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all items; 
                United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(5) Research regarding certain health conditions.--For the 
        purpose of carrying out section 3341--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $3,750,000;
                    ``(B) for fiscal year 2012, $15,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all items; 
                United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(6) World trade center health registry.--For the purpose 
        of carrying out section 3342--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $1,750,000;
                    ``(B) for fiscal year 2012, $7,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all items; 
                United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.''.

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

SEC. 201. DEFINITIONS.

    Section 402 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) in paragraph (6) by inserting ``, or debris removal, 
        including under the World Trade Center Health Program 
        established under section 3001 of the Public Health Service Act,

[[Page 124 STAT. 3660]]

        and payments made pursuant to the settlement of a civil action 
        described in section 405(c)(3)(C)(iii)'' after ``September 11, 
        2001'';
            (2) by inserting after paragraph (6) the following new 
        paragraphs and redesignating subsequent paragraphs accordingly:
            ``(7) Contractor and subcontractor.--The term `contractor 
        and subcontractor' means any contractor or subcontractor (at any 
        tier of a subcontracting relationship), including any general 
        contractor, construction manager, prime contractor, consultant, 
        or any parent, subsidiary, associated or allied company, 
        affiliated company, corporation, firm, organization, or joint 
        venture thereof that participated in debris removal at any 9/11 
        crash site. Such term shall not include any entity, including 
        the Port Authority of New York and New Jersey, with a property 
        interest in the World Trade Center, on September 11, 2001, 
        whether fee simple, leasehold or easement, direct or indirect.
            ``(8) Debris removal.--The term `debris removal' means 
        rescue and recovery efforts, removal of debris, cleanup, 
        remediation, and response during the immediate aftermath of the 
        terrorist-related aircraft crashes of September 11, 2001, with 
        respect to a 9/11 crash site.'';
            (3) by inserting after paragraph (10), as so redesignated, 
        the following new paragraph and redesignating the subsequent 
        paragraphs accordingly:
            ``(11) Immediate aftermath.--The term `immediate aftermath' 
        means any period beginning with the terrorist-related aircraft 
        crashes of September 11, 2001, and ending on May 30, 2002.''; 
        and
            (4) by adding at the end the following new paragraph:
            ``(14) 9/11 crash site.--The term `9/11 crash site' means--
                    ``(A) the World Trade Center site, Pentagon site, 
                and Shanksville, Pennsylvania site;
                    ``(B) the buildings or portions of buildings that 
                were destroyed as a result of the terrorist-related 
                aircraft crashes of September 11, 2001;
                    ``(C) any area contiguous to a site of such crashes 
                that the Special Master determines was sufficiently 
                close to the site that there was a demonstrable risk of 
                physical harm resulting from the impact of the aircraft 
                or any subsequent fire, explosions, or building 
                collapses (including the immediate area in which the 
                impact occurred, fire occurred, portions of buildings 
                fell, or debris fell upon and injured individuals); and
                    ``(D) any area related to, or along, routes of 
                debris removal, such as barges and Fresh Kills.''.
SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.

    (a) Information on Losses Resulting From Debris Removal Included in 
Contents of Claim Form.--Section 405(a)(2)(B) of the Air Transportation 
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) in clause (i), by inserting ``, or debris removal during 
        the immediate aftermath'' after ``September 11, 2001'';
            (2) in clause (ii), by inserting ``or debris removal during 
        the immediate aftermath'' after ``crashes''; and

[[Page 124 STAT. 3661]]

            (3) in clause (iii), by inserting ``or debris removal during 
        the immediate aftermath'' after ``crashes''.

    (b) Extension of Deadline for Claims Under September 11th Victim 
Compensation Fund of 2001.--Section 405(a)(3) of such Act <<NOTE: 49 USC 
40101 note.>> 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 <<NOTE: Time period.>> 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 <<NOTE: 49 USC 40101 note.>> amended--
            (1) by redesignating subparagraphs (A) and (B) as 
        subparagraphs (B) and (C), respectively; and
            (2) by inserting before subparagraph (B), as so 
        redesignated, the following new subparagraph:
                    ``(A) Requirements for filing claims during extended 
                filing period.--
                          ``(i) Timing requirements for filing claims.--
                      An individual (or a personal representative on 
                      behalf of a deceased individual) may file a claim 
                      during the period described in subsection 
                      (a)(3)(B) as follows:
                                    ``(I) In the case that the Special 
                                Master determines the individual knew 
                                (or reasonably should have known) before 
                                the date specified in clause (iii) that 
                                the individual suffered a physical harm 
                                at a 9/11 crash site as a result of the 
                                terrorist-related aircraft crashes of 
                                September 11, 2001, or as a result of 
                                debris removal, and that the individual 
                                knew (or should have known) before such 
                                specified date that the individual was 
                                eligible to file a claim under this 
                                title, the individual may file a claim 
                                not later than the date that is 2 years 
                                after such specified date.
                                    ``(II) In the case that the Special 
                                Master determines the individual first 
                                knew (or reasonably should have known) 
                                on or after the date specified in clause 
                                (iii) that the individual suffered such 
                                a physical harm or that the individual 
                                first knew (or should have known) on or 
                                after such specified date that the 
                                individual was eligible to file a claim 
                                under this title, the individual may 
                                file a claim not later than the last day 
                                of the 2-year period beginning on the 
                                date the Special Master determines the 
                                individual first knew (or should have 
                                known) that the individual both suffered 
                                from such harm and was eligible to file 
                                a claim under this title.

[[Page 124 STAT. 3662]]

                          ``(ii) Other eligibility requirements for 
                      filing claims.--An individual may file a claim 
                      during the period described in subsection 
                      (a)(3)(B) only if--
                                    ``(I) the individual was treated by 
                                a medical professional for suffering 
                                from a physical harm described in clause 
                                (i)(I) within a reasonable time from the 
                                date of discovering such harm; and
                                    ``(II) the individual's physical 
                                harm is verified by contemporaneous 
                                medical records created by or at the 
                                direction of the medical professional 
                                who provided the medical care.
                          ``(iii) Date specified.--The date specified in 
                      this clause is the date on which the regulations 
                      are updated under section 407(a).''.

    (d) Clarifying Applicability to All 9/11 Crash Sites.--Section 
405(c)(2)(A)(i) of such Act <<NOTE: 49 USC 40101 note.>> 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 <<NOTE: 49 USC 40101 note.>> 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 <<NOTE: 49 USC 40101 note.>> (c), is amended by 
        inserting ``, or for damages arising from or related to debris 
        removal'' after ``September 11, 2001''.
            (2) Pending actions.--Clause (ii) of such section, as so 
        redesignated, is amended to read as follows:
                          ``(ii) Pending actions.--In the case of an 
                      individual who is a party to a civil action 
                      described in clause (i), such individual may not 
                      submit a claim under this title--
                                    ``(I) during the period described in 
                                subsection (a)(3)(A) unless such 
                                individual withdraws from such action by 
                                the date that is 90 days after the date 
                                on which regulations are promulgated 
                                under section 407(a); and
                                    ``(II) during the period described 
                                in subsection (a)(3)(B) unless such 
                                individual withdraws from such action by 
                                the date that is 90 days after the date 
                                on which the regulations are updated 
                                under section 407(b).''.
            (3) Settled actions.--Such section, as so redesignated, is 
        further amended by adding at the end the following new clause:
                          ``(iii) Settled actions.--In the case of an 
                      individual who settled a civil action described in 
                      clause (i), such individual may not submit a claim 
                      under this title unless such action was commenced 
                      after December 22, 2003, and a release of all 
                      claims in such action was tendered prior to the 
                      date on which the James Zadroga 9/11 Health and 
                      Compensation Act of 2010 was enacted.''.

[[Page 124 STAT. 3663]]

SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.

    Section 407 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) by striking ``Not later than'' and inserting ``(a) In 
        General.--Not later than''; and
            (2) by adding at the end the following new subsection:

    ``(b) Updated Regulations.--Not <<NOTE: Deadline.>> 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 <<NOTE: Applicability.>> of claims 
        payments.--Payments to plaintiffs who obtain a settlement or 
        judgment with respect to a claim or action to which paragraph 
        (4) applies, shall be paid solely from the following funds in 
        the following order, as may be applicable:
                    ``(A) The funds described in subparagraph (A) or (B) 
                of paragraph (4).

[[Page 124 STAT. 3664]]

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

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

    ``(d) Limitation.--
            ``(1) In general.--The total amount of Federal funds paid 
        for compensation under this title, with respect to claims filed 
        on or after the date on which the regulations are updated under 
        section 407(b), shall not exceed <<NOTE: Time 
        period.>> $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 <<NOTE: Time period.>> 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 <<NOTE: Deadline.>> any case in which the amount of a 
                claim is ratably reduced pursuant to subparagraph (A), 
                on or after the first day after the 5-year period 
                described in paragraph

[[Page 124 STAT. 3665]]

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

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

                  TITLE III--REVENUE RELATED PROVISIONS

SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCUREMENT.

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

[[Page 124 STAT. 3666]]

                    ``CHAPTER 50--FOREIGN PROCUREMENT

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

``SEC. 5000C. <<NOTE: 26 USC 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 <<NOTE: Definition.>> 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 <<NOTE: Applicability. 26 USC 5000C 
        note.>> 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 <<NOTE: 26 USC 5000C note.>> 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 <<NOTE: Definition.>> 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 <<NOTE: 26 USC 5000C note.>> section and the 
amendments made by this section shall be applied in a manner consistent 
with United States obligations under international agreements.

[[Page 124 STAT. 3667]]

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

    Subsections (a), (b), and (c) of section 402 of Public Law 111-
230 <<NOTE: Ante, p. 2487.>> are amended by striking ``2014'' each place 
that such appears and inserting ``2015''.

                       TITLE IV--BUDGETARY EFFECTS

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

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

    Approved January 2, 2011.

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

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

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