57–563 

111TH CONGRESS REPT. 111–560 " ! HOUSE OF REPRESENTATIVES 2d Session Part 2 

JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT 

OF 2010 

JULY 22, 2010.—Committed to the Committee of the Whole House on the State of 

the Union and ordered to be printed 

Mr. CONYERS, from the Committee on the Judiciary, 

submitted the following 

R E P O R T 

together with 

DISSENTING VIEWS 

[To accompany H.R. 847] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on the Judiciary, to whom was referred the bill 

(H.R. 847) to amend the Public Health Service Act to extend and 

improve protections and services to individuals directly impacted 

by the terrorist attack in New York City on September 11, 2001, 

and for other purposes, having considered the same, reports favorably thereon with an amendment and recommends that the bill as 

amended do pass. 

CONTENTS 

Page 

The Amendment ...................................................................................................... 3 

Purpose and Summary ............................................................................................ 30 

Background and Need for the Legislation ............................................................. 30 

Hearings ................................................................................................................... 34 

Committee Consideration ........................................................................................ 35 

Committee Votes ...................................................................................................... 35 

Committee Oversight Findings ............................................................................... 36 

New Budget Authority and Tax Expenditures ...................................................... 37 

Congressional Budget Office Cost Estimate .......................................................... 37 

Performance Goals and Objectives ......................................................................... 50 

Constitutional Authority Statement ...................................................................... 50 

Advisory on Earmarks ............................................................................................. 50 

Section-by-Section Analysis .................................................................................... 50 


jbell on DSKDVH8Z91PROD with REPORTS
2 

Changes in Existing Law Made by the Bill, as Reported ..................................... 53 

Dissenting Views ..................................................................................................... 59 


jbell on DSKDVH8Z91PROD with REPORTS
3 

THE AMENDMENT

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

(a) SHORT TITLE.—This Act may be cited as the ‘‘James Zadroga 9/11 Health and 

Compensation Act of 2010’’. 

(b) TABLE OF CONTENTS.—The table of contents of this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 

Sec. 101. World Trade Center Health Program. 

‘‘TITLE XXX—WORLD TRADE CENTER HEALTH PROGRAM 

‘‘Subtitle A—Establishment of Program; Advisory and Steering Committees 

‘‘Sec. 3001. Establishment of World Trade Center Health Program within NIOSH. 

‘‘Sec. 3002. WTC Health Program Scientific/Technical Advisory Committee. 

‘‘Sec. 3003. WTC Health Program Steering Committees. 

‘‘Sec. 3004. Community education and outreach. 

‘‘Sec. 3005. Uniform data collection. 

‘‘Sec. 3006. Centers of excellence. 

‘‘Sec. 3007. Entitlement authorities. 

‘‘Sec. 3008. Definitions. 

‘‘Subtitle B—Program of Monitoring, Initial Health Evaluations, and Treatment 

‘‘PART 1—FOR WTC RESPONDERS

‘‘Sec. 3011. Identification of eligible WTC responders and provision of WTC-related monitoring services. 

‘‘Sec. 3012. Treatment of certified eligible WTC responders for WTC-related health conditions. 

‘‘PART 2—COMMUNITY PROGRAM

‘‘Sec. 3021. Identification and initial health evaluation of eligible WTC community members. 

‘‘Sec. 3022. Followup monitoring and treatment of certified eligible WTC community members for WTC-related health conditions. 

‘‘Sec. 3023. Followup monitoring and treatment of other individuals with WTC-related health conditions. 

‘‘PART 3—NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK

‘‘Sec. 3031. National arrangement for benefits for eligible individuals outside New York. 

‘‘Subtitle C—Research Into Conditions 

‘‘Sec. 3041. Research regarding certain health conditions related to September 11 terrorist attacks in New 

York City. 

‘‘Subtitle D—Programs of the New York City Department of Health and Mental Hygiene 

‘‘Sec. 3051. World Trade Center Health Registry. 

‘‘Sec. 3052. Mental health services. 

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. 

SEC. 2. FINDINGS. 

Congress finds the following: 

(1) Thousands of rescue workers who responded to the areas devastated by 

the terrorist attacks of September 11, local residents, office and area workers, 

and school children continue to suffer significant medical problems as a result 

of compromised air quality and the release of other toxins from the attack sites. 

(2) In a September 2006 peer-reviewed study conducted by the World Trade 

Center Medical Monitoring Program, of 9,500 World Trade Center responders, 

almost 70 percent of World Trade Center responders had a new or worsened 

respiratory symptom that developed during or after their time working at the 

World Trade Center; among the responders who were asymptomatic before 9/ 

11, 61 percent developed respiratory symptoms while working at the World 

Trade Center; close to 60 percent still had a new or worsened respiratory symptom at the time of their examination; one-third had abnormal pulmonary function tests; and severe respiratory conditions including pneumonia were significantly more common in the 6 months after 9/11 than in the prior 6 months. 

(3) An April 2006 study documented that, on average, a New York City firefighter who responded to the World Trade Center has experienced a loss of 12 

years of lung capacity. 


jbell on DSKDVH8Z91PROD with REPORTS
4 

(4) A peer-reviewed study of residents who lived near the World Trade Center 

titled ‘‘The World Trade Center Residents’ Respiratory Health Study: New 

Onset Respiratory Symptoms and Pulmonary Function’’, found that data demonstrated a three-fold increase in new-onset, persistent lower respiratory symptoms in residents near the former World Trade Center as compared to a control 

population. 

(5) Previous research on the health impacts of the devastation caused by the 

September 11 terrorist attacks has shown relationships between the air quality 

from Ground Zero and a host of health impacts, including lower pregnancy 

rates, higher rates of respiratory and lung disorders, and a variety of post-disaster mental health conditions (including posttraumatic stress disorder) in 

workers and residents near Ground Zero. 

(6) A variety of tests conducted by independent scientists have concluded that 

significant WTC contamination settled in indoor environments surrounding the 

disaster site. The Environmental Protection Agency’s (EPA) cleanup programs 

for indoor residential spaces, in 2003 and 2005, though limited, are an acknowledgment that indoor contamination continued after the WTC attacks. 

(7) At the request of the Department of Energy, the Davis DELTA Group at 

the University of California conducted outdoor dust sampling in October 2001 

at Varick and Houston Streets (approximately 1.2 miles north of Ground Zero) 

and found that the contamination from the World Trade Center ‘‘outdid even 

the worst pollution from the Kuwait oil fields fires’’. Further, the United States 

Geological Survey (USGS) reported on November 27, 2001, that dust samples 

collected from indoor surfaces registered at levels that were ‘‘as caustic as liquid 

drain cleaners’’. 

(8) According to both the EPA’s own Inspector General’s (EPA IG) report of 

August 21, 2003 and General Accountability Offices’s (GAO) report of September 2007, no comprehensive program has ever been conducted in order to 

characterize the full extent of WTC contamination, and therefore the full impact 

of that contamination—geographic or otherwise—remains unknown. 

(9) Such reports found that there has never been a comprehensive program 

to remediate WTC toxins from indoor spaces. Thus, area residents, workers and 

students may continue to be exposed to WTC contamination in their homes, 

workplaces and schools. 

(10) Because of the failure to release federally appropriated funds for community care, a lack of sufficient outreach, the fact that many community members 

are receiving care from physicians outside the current City-funded World Trade 

Center Environmental Health Center program and thus fall outside data collection efforts, and other factors, the number of community members being treated 

at the World Trade Center Environmental Health Center underrepresents the 

total number in the community that have been affected by exposure to Ground 

Zero toxins. 

(11) Research by Columbia University’s Center for Children’s Environmental 

Health has shown negative health effects on babies born to women living within 

2 miles of the World Trade Center in the month following 9/11. 

(12) Federal funding allocated for the monitoring of rescue workers’ health is 

not sufficient to ensure the long-term study of health impacts of September 11. 

(13) A significant portion of those who have developed health problems as result of exposures to airborne toxins or other hazards resulting from the September 11, 2001, attacks on the World Trade Center have no health insurance, 

have lost their health insurance as a result of the attacks, or have inadequate 

health insurance. 

(14) The Federal program to provide medical treatments to those who responded to the September 11 aftermath, and who continue to experience health 

problems as a result, was finally established more than five years after the attacks, but has no certain long-term funding. 

(15) Rescue workers and volunteers seeking workers’ compensation have reported that their applications have been denied, delayed for months, or redirected, instead of receiving assistance in a timely and supportive manner. 

(16) A February 2007 report released by the City of New York estimated that 

approximately 410,000 people were the most heavily exposed to the environmental hazards and trauma of the September 11 terrorist attacks. More than 

30 percent of the Fire Department of the City of New York first responders 

were still experiencing some respiratory symptoms more than five years after 

the attacks and according to the report, 59 percent of those seen by the WTC 

Environmental Health Center at Bellevue Hospital (which serves community 

members) are without insurance and 65 percent have incomes less than $15,000 

per year. The report also found a need to continue and expand mental health 

services. 


jbell on DSKDVH8Z91PROD with REPORTS
5 

(17) Since the 5th anniversary of the attack (September 11, 2006), hundreds 

of workers a month have been signing up with the monitoring and treatment 

programs. 

(18) In April 2008, the Department of Health and Human Services reported 

to Congress that in fiscal year 2007 11,359 patients received medical treatment 

in the existing WTC Responder Medical and Treatment program for WTC-related health problems, and that number of responders who need treatment and 

the severity of health problems is expected to increase. 

(19) The September 11 Victim Compensation Fund of 2001 was established 

to provide compensation to individuals who were physically injured or killed as 

a result of the terrorist-related aircraft crashes of September 11, 2001. 

(20) The deadline for filing claims for compensation under the Victim Compensation Fund was December 22, 2003. 

(21) Some individuals did not know they were eligible to file claims for compensation for injuries or did not know they had suffered physical harm as a result of the terrorist-related aircraft crashes until after the December 22, 2003, 

deadline. 

(22) Further research is needed to evaluate more comprehensively the extent 

of the health impacts of September 11, including research for emerging health 

problems such as cancer, which have been predicted. 

(23) Research is needed regarding possible treatment for the illnesses and injuries of September 11. 

(24) The Federal response to medical and financial issues arising from the 

September 11 response efforts needs a comprehensive, coordinated long-term response in order to meet the needs of all the individuals who were exposed to 

the toxins of Ground Zero and are suffering health problems from the disaster. 

(25) The failure to extend the appointment of Dr. John Howard as Director 

of the National Institute for Occupational Safety and Health in July 2008 is not 

in the interests of the administration of such Institute nor the continued operation of the World Trade Center Medical Monitoring and Treatment Program 

which he has headed, and the Secretary of Health and Human Services should 

reconsider extending such appointment. 

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 XXX—WORLD TRADE CENTER HEALTH 

PROGRAM 

‘‘Subtitle A—Establishment of Program; Advisory 

and Steering Committees 

‘‘SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM WITHIN NIOSH. 

‘‘(a) IN GENERAL.—There is hereby established within the National Institute for 

Occupational Safety and Health a program to be known as the ‘World Trade Center 

Health Program’ (in this title referred to as the ‘WTC program’) to provide— 

‘‘(1) medical monitoring and treatment benefits to eligible emergency responders and recovery and clean-up workers (including those who are Federal employees) who responded to the September 11, 2001, terrorist attacks on the 

World Trade Center; 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 3011, including clinical examinations and long-term health monitoring and 

analysis for individuals 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 on the World Trade Center. 


jbell on DSKDVH8Z91PROD with REPORTS
6 

‘‘(2) INITIAL HEALTH EVALUATION FOR COMMUNITY MEMBERS.—An initial health 

evaluation under section 3021, including an evaluation to determine eligibility 

for followup monitoring and treatment. 

‘‘(3) FOLLOW-UP MONITORING AND TREATMENT FOR WTC-RELATED CONDITIONS

FOR RESPONDERS AND COMMUNITY MEMBERS.—Provision under sections 3012, 

3022, and 3023 of follow-up monitoring and treatment and payment, subject to 

the provisions of subsection (d), for all medically necessary health and mental 

health care expenses (including necessary prescription drugs) of individuals 

with a WTC-related health condition. 

‘‘(4) OUTREACH.—Establishment under section 3004 of an outreach program 

to potentially eligible individuals concerning the benefits under this title. 

‘‘(5) UNIFORM DATA COLLECTION.—Collection under section 3005 of health and 

mental health data on individuals receiving monitoring or treatment benefits, 

using a uniform system of data collection. 

‘‘(6) RESEARCH ON WTC CONDITIONS.—Establishment under subtitle C of a research program on health conditions resulting from the September 11, 2001, 

terrorist attacks on the World Trade Center. 

‘‘(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 eligible WTC responder or any eligible WTC community member. 

‘‘(d) PAYOR.— 

‘‘(1) IN GENERAL.—Except as provided in paragraphs (2) and (3), the cost of 

monitoring and treatment benefits and initial health evaluation benefits provided under subtitle B shall be paid for by the WTC program. 

‘‘(2) WORKERS’ COMPENSATION PAYMENT.— 

‘‘(A) IN GENERAL.—Except as provided in subparagraph (B), payment for 

treatment under subtitle B of a WTC-related condition in an individual that 

is work-related shall be reduced or recouped to the extent that the Secretary 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 or a State, or other work-related injury or illness benefit plan 

of the employer of such individual, for such treatment. The provisions of 

clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) of section 1862(b) of the 

Social Security Act (42 U.S.C. 1395y(b)(2)) and paragraph (3) of such section shall apply to the recoupment under this paragraph 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. 

‘‘(B) EXCEPTION.—If the WTC Program Administrator certifies that the 

City of New York has contributed the matching contribution required under 

section 3006(a)(3) for a 12-month period (specified by the WTC Program Administrator), subparagraph (A) shall not apply for that 12-month period 

with respect to a workers’ compensation law or plan, including line of duty 

compensation, to which the City is obligated to make payments. 

‘‘(3) HEALTH INSURANCE COVERAGE.— 

‘‘(A) IN GENERAL.—In the case of an individual who has a WTC-related 

condition that is not work-related and has health coverage for such condition through any public or private health plan, the provisions of section 

1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) shall apply to such 

a health plan and such individual in the same manner as they apply to a 

group health plan and an individual entitled to benefits under title XVIII 

of such Act pursuant to section 226(a). 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. 

‘‘(B) RECOVERY BY INDIVIDUAL PROVIDERS.—Nothing in subparagraph (A) 

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. 

‘‘(4) WORK-RELATED DESCRIBED.—For the purposes of this subsection, a WTCrelated condition shall be treated as a condition that is work-related if— 

‘‘(A) the condition is diagnosed in an eligible WTC responder, or in an individual who qualifies as an eligible WTC community member on the basis 

of being a rescue, recovery, or clean-up worker; or 


jbell on DSKDVH8Z91PROD with REPORTS
7 

‘‘(B) 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. 

‘‘(e) QUALITY ASSURANCE AND MONITORING OF CLINICAL EXPENDITURES.— ‘‘(1) QUALITY ASSURANCE.—The WTC Program Administrator working with 

the Clinical Centers of Excellence shall develop and implement a quality assurance program for the medical monitoring and treatment delivered by such Centers of Excellence and any other participating health care providers. Such program shall include— 

‘‘(A) adherence to medical monitoring and treatment protocols; 

‘‘(B) appropriate diagnostic and treatment referrals for participants; 

‘‘(C) prompt communication of test results to participants; and 

‘‘(D) such other elements as the Administrator specifies in consultation 

with the Clinical Centers of Excellence. 

‘‘(2) FRAUD PREVENTION.—The WTC Program Administrator shall develop and 

implement a program to review the program’s health care expenditures to detect fraudulent or duplicate billing and payment for inappropriate services. 

Such program shall be similar to current methods used in connection with the 

Medicare program under title XVIII of the Social Security Act. This title is a 

Federal health care program (as defined in section 1128B(f) of such 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. 

‘‘(f) WTC PROGRAM ADMINISTRATION.—The WTC program shall be administered 

by the Director of the National Institute for Occupational Safety and Health, or a 

designee of such Director. 

‘‘(g) 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 OF REPORT.—Each annual report under paragraph (1) shall include 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 medical 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. 

‘‘(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 

conditions that have been paid for or reimbursed by workers’ compensation, by public or private health plans, or by the City of New York 

under section 3012(c)(4). 

‘‘(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 WTC center 

exposures, including the findings of research conducted under section 

3041(a). 

‘‘(F) ADVISORY COMMITTEE RECOMMENDATIONS.—A list of recommendations by the WTC Scientific/Technical Advisory Committee on additional 


jbell on DSKDVH8Z91PROD with REPORTS
8 

WTC program eligibility criteria and on additional WTC-related health conditions and the action of the WTC Program Administrator concerning each 

such recommendation. 

‘‘(3) SEPARATE CLINICAL PROGRAMS DESCRIBED.—In paragraph (2), each of the 

following shall be treated as a separate clinical program of the WTC program: 

‘‘(A) FDNY RESPONDERS.—The benefits provided for eligible WTC responders described in section 3006(b)(1)(A). 

‘‘(B) OTHER ELIGIBLE WTC RESPONDERS.—The benefits provided for eligible 

WTC responders not described in subparagraph (A). 

‘‘(C) ELIGIBLE WTC COMMUNITY MEMBERS.—The benefits provided for eligible WTC community members in section 3006(b)(1)(C). 

‘‘(h) NOTIFICATION TO CONGRESS WHEN REACH 80 PERCENT OF ELIGIBILITY NU- MERICAL LIMITS.—The WTC Program Administrator shall promptly notify the Congress— 

‘‘(1) when the number of certifications for eligible WTC responders subject to 

the limit established under section 3011(a)(5) has reached 80 percent of such 

limit; and 

‘‘(2) when the number of certifications for eligible WTC community members 

subject to the limit established under section 3021(a)(5) has reached 80 percent 

of such limit. 

‘‘(i) GAO REPORT.—Not later than 3 years after the date of the enactment of this 

Act, the Comptroller General of the United States shall submit to the Congress a 

report on the costs of the monitoring and treatment programs provided under this 

title. 

‘‘(j) NYC RECOMMENDATIONS.—The City of New York may make recommendations 

to the WTC Program Administrator on ways to improve the monitoring and treatment programs under this title for both eligible WTC responders and eligible WTC 

community members. 

‘‘SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY COMMITTEE. 

‘‘(a) ESTABLISHMENT.—The WTC Program Administrator shall establish an advisory committee to be known as the WTC Health Program Scientific/Technical Advisory Committee (in this section 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. 

‘‘(b) COMPOSITION.—The WTC Program Administrator shall appoint the members 

of the Advisory Committee and shall include at least— 

‘‘(1) 4 occupational physicians, at least two of whom have experience treating 

WTC rescue and recovery workers; 

‘‘(2) 1 physician with expertise in pulmonary medicine; 

‘‘(3) 2 environmental medicine or environmental health specialists; 

‘‘(4) 2 representatives of eligible WTC responders; 

‘‘(5) 2 representatives of WTC community members; 

‘‘(6) an industrial hygienist; 

‘‘(7) a toxicologist; 

‘‘(8) an epidemiologist; and 

‘‘(9) a mental health professional. 

‘‘(c) MEETINGS.—The Advisory Committee shall meet at such frequency as may be 

required to carry out its duties. 

‘‘(d) REPORTS.—The WTC Program Administrator shall provide for publication of 

recommendations of the Advisory Committee on the public website established for 

the WTC program. 

‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this 

section, there are authorized to be appropriated such sums as may be necessary, not 

to exceed $100,000, for each fiscal year beginning with fiscal year 2009. 

‘‘(f) 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. 

‘‘(g) APPLICATION OF FACA.—Except as otherwise specifically provided, the Advisory Committee shall be subject to the Federal Advisory Committee Act. 

‘‘SEC. 3003. WTC HEALTH PROGRAM STEERING COMMITTEES. 

‘‘(a) ESTABLISHMENT.—The WTC Program Administrator shall establish two steering committees (each in this section referred to as a ‘Steering Committee’) as follows: 

‘‘(1) WTC RESPONDERS STEERING COMMITTEE.—One steering committee, to be 

known as the WTC Responders Steering Committee, for the purpose of facilitating the coordination of medical monitoring and treatment programs for the 

eligible WTC responders under part 1 of subtitle B. 


jbell on DSKDVH8Z91PROD with REPORTS
9 

‘‘(2) WTC COMMUNITY PROGRAM STEERING COMMITTEE.—One steering committee, to be known as the WTC Community Program Steering Committee, for 

the purpose of facilitating the coordination of initial health evaluations, monitoring, and treatment programs for eligible WTC community members under 

part 2 of subtitle B. 

‘‘(b) MEMBERSHIP.— 

‘‘(1) INITIAL MEMBERSHIP OF WTC RESPONDERS STEERING COMMITTEE.—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). In addition, the 

committee membership shall include— 

‘‘(A) a representative of the Police Commissioner of the City of New York; 

‘‘(B) a representative of the Department of Health of the City of New 

York; 

‘‘(C) a representative of another agency of the City of New York, selected 

by the Mayor of New York City, which had a large number of non-uniformed City workers who responded to the WTC disaster; and 

‘‘(D) three representatives of eligible WTC responders; 

in order that eligible WTC responders constitute half the members of the Steering Committee. 

‘‘(2) INITIAL MEMBERSHIP OF WTC COMMUNITY PROGRAM STEERING COMMITTEE.— 

‘‘(A) IN GENERAL.—The WTC Community Program Steering Committee 

shall initially be composed of members of the WTC Environmental Health 

Center Community Advisory Committee (as in existence on the day before 

the date of the enactment of this title) and shall initially have, as voting 

members, the following: 

‘‘(i) 11 representatives of the affected populations of residents, students, area workers, and other community members. 

‘‘(ii) The Medical Director of the WTC Environmental Health Center. 

‘‘(iii) The Executive Director of the WTC Environmental Health Center. 

‘‘(iv) Three physicians, one each representing the three WTC Environmental Health Center treatment sites of Bellevue Hospital Center, 

Gouverneur Healthcare Services, and Elmhurst Hospital Center. 

‘‘(v) Five specialists with WTC related expertise or experience in 

treating non-responder WTC diseases, such as a pediatrician, an epidemiologist, a psychiatrist or psychologist, an environmental/occupational specialists or a social worker from a WTC Environmental Health 

Center treatment site, or other relevant specialists. 

‘‘(vi) A representative of the Department of Health and Mental Hygiene of the City of New York. 

‘‘(B) APPOINTMENTS.— 

‘‘(i) WTC EHC COMMUNITY ADVISORY COMMITTEE.—The WTC Environmental Health Center Community Advisory Committee as in existence 

on the date of the enactment of this title shall nominate members for 

positions described in subparagraph (A)(i). 

‘‘(ii) NYC HEALTH AND HOSPITALS CORPORATION.—The New York City 

Health and Hospitals Corporation shall nominate members for positions described in clauses (iv) and (v) of subparagraph (A). 

‘‘(iii) TIMING.—Nominations under clauses (i) and (ii) shall be recommended to the WTC Program Administrator not later than 60 days 

after the date of the enactment of this title. 

‘‘(iv) APPOINTMENT.—The WTC Program Administrator shall appoint 

members of the WTC Community Program Steering Committee not 

later than 90 days after the date of the enactment of this title. 

‘‘(v) GENERAL REPRESENTATIVES.—Of the members appointed under 

subparagraph (A)(i)— 

‘‘(I) the representation shall reflect the broad and diverse WTCaffected populations and constituencies and the diversity of impacted neighborhoods, including residents, hard-to-reach populations, students, area workers, school parents, community-based 

organizations, Community Boards, WTC Environmental Health 

Center patients, labor unions, and labor advocacy organizations; 

and 

‘‘(II) no one individual organization can have more than one representative. 


jbell on DSKDVH8Z91PROD with REPORTS
10 

‘‘(3) ADDITIONAL APPOINTMENTS.—Each Steering Committee may appoint, if 

approved by a majority of voting members of the Committee, additional members to the Committee. 

‘‘(4) VACANCIES.—A vacancy in a Steering Committee shall be filled by the 

Steering Committee, subject to the approval of the WTC Program Administrator, so long as— 

‘‘(A) in the case of the WTC Responders Steering Committee, the composition of the Committee includes representatives of eligible WTC responders 

and representatives of each Clinical Center of Excellence and each Coordinating Center of Excellence that serves eligible WTC responders and such 

composition has eligible WTC responders constituting half of the membership of the Steering Committee; or 

‘‘(B) in the case of the WTC Community Program Steering Committee, 

the composition of the Committee includes representatives of eligible WTC 

community members and representatives of each Clinical Center of Excellence and each Coordinating Center of Excellence that serves eligible WTC 

community members and the nominating process is consistent with paragraph (2)(B). 

‘‘(5) CO-CHAIRS OF WTC COMMUNITY PROGRAM STEERING COMMITTEE.—The 

WTC Community Program Steering Committee shall have two Co-Chairs as follows: 

‘‘(A) COMMUNITY/LABOR CO-CHAIR.—A Community/Labor Co-Chair who 

shall be chosen by the community and labor-based members of the Steering 

Committee. 

‘‘(B) ENVIRONMENTAL HEALTH CLINIC CO-CHAIR.—A WTC Environmental 

Health Clinic Co-Chair who shall be chosen by the WTC Environmental 

Health Center members on the Steering Committee. 

‘‘(c) RELATION TO FACA.—Each Steering Committee shall not be subject to the 

Federal Advisory Committee Act. 

‘‘(d) MEETINGS.—Each Steering Committee shall meet at such frequency necessary 

to carry out its duties, but not less than 4 times each calendar year and at least 

two such meetings each year shall be a joint meeting with the voting membership 

of the other Steering Committee for the purpose of exchanging information regarding the WTC program. 

‘‘(e) DURATION.—Notwithstanding any other provision of law, each Steering Committee shall continue in operation during the period in which the WTC program is 

in operation. 

‘‘SEC. 3004. COMMUNITY EDUCATION AND OUTREACH. 

‘‘(a) IN GENERAL.—The WTC Program Administrator shall institute a program 

that provides education and outreach on the existence and availability of services 

under the WTC program. The outreach and education program— 

‘‘(1) shall include— 

‘‘(A) the establishment of a public website 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. 

‘‘(b) PARTNERSHIPS.—To the greatest extent possible, in carrying out this section, 

the WTC Program Administrator shall enter into partnerships with local governments and organizations with experience performing outreach to the affected populations, including community and labor-based organizations. 

‘‘SEC. 3005. UNIFORM DATA COLLECTION. 

‘‘(a) IN GENERAL.—The WTC Program Administrator shall provide for the uniform 

collection of data (and analysis of data and regular reports to the Administrator) 

on the utilization of monitoring and treatment benefits provided to eligible WTC responders and eligible WTC community members, the prevalence of WTC-related 

health conditions, and the identification of new WTC-related medical 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. 

‘‘(b) COORDINATING THROUGH CENTERS OF EXCELLENCE.—Each Clinical Center of 

Excellence shall collect data described in subsection (a) and report such data to the 


jbell on DSKDVH8Z91PROD with REPORTS
11 

corresponding Coordinating Center of Excellence for analysis by such Coordinating 

Center of Excellence. 

‘‘(c) PRIVACY.—The data collection and analysis under this section shall be conducted in a manner that protects the confidentiality of individually identifiable 

health information consistent with applicable legal requirements. 

‘‘SEC. 3006. CENTERS OF EXCELLENCE. 

‘‘(a) IN GENERAL.— 

‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF EXCELLENCE.—The WTC Program 

Administrator shall enter into contracts with Clinical Centers of Excellence 

specified in subsection (b)(1)— 

‘‘(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 follow-up 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 as for program participants who are not English language proficient; and 

‘‘(F) for the collection and reporting of data in accordance with section 

3005. 

‘‘(2) CONTRACTS WITH COORDINATING CENTERS OF EXCELLENCE.—The WTC 

Program Administrator shall enter into contracts with Coordinating Centers of 

Excellence specified in subsection (b)(2)— 

‘‘(A) for receiving, analyzing, and reporting to the WTC Program Administrator on data, in accordance with section 3005, that has been collected and 

reported to such Coordinating Centers by the corresponding Clinical Centers of Excellence under subsection (d)(3); 

‘‘(B) for the development of medical monitoring, initial health evaluation, 

and treatment protocols, with respect to WTC-related health conditions; 

‘‘(C) for coordinating the outreach activities conducted under paragraph 

(1)(B) by each corresponding Clinical Center of Excellence; 

‘‘(D) for establishing criteria for the credentialing of medical providers 

participating in the nationwide network under section 3031; 

‘‘(E) for coordinating and administrating the activities of the WTC Health 

Program Steering Committees established under section 3003(a); and 

‘‘(F) for meeting periodically with the corresponding Clinical Centers of 

Excellence to obtain input on the analysis and reporting of data collected 

under subparagraph (A) and on the development of medical monitoring, initial health evaluation, and treatment protocols under subparagraph (B). 

The medical providers under subparagraph (D) shall be selected by the WTC 

Program Administrator on the basis of their experience treating or diagnosing 

the medical conditions included in the list of identified WTC-related conditions 

for responders and of identified WTC-related conditions for community members. 

‘‘(3) REQUIRED PARTICIPATION BY NEW YORK CITY IN MONITORING AND TREATMENT PROGRAM AND COSTS.— 

‘‘(A) IN GENERAL.—In order for New York City, any agency or Department 

thereof, or the New York City Health and Hospitals Corporation to qualify 

for a contract for the provision of monitoring and treatment benefits and 

other services under section 3006, New York City is required to contribute 

a matching amount of 10 percent of the amount of the covered monitoring 

and treatment payment (as defined in subparagraph (B)). 

‘‘(B) COVERED MONITORING AND TREATMENT PAYMENT DEFINED.—For the 

purposes of this paragraph, the term ‘covered monitoring and treatment 

payment’ means payment under paragraphs (1) and (2), including under 

such paragraph as applied under section 3021(b), 3022(a), and 3023, and reimbursement under 3006(c) for items and services furnished by a Clinical 

Center of Excellence or Coordinating Center of Excellence, and providers 


jbell on DSKDVH8Z91PROD with REPORTS
12 

designated by the WTC Program under section 3031, after the application 

of paragraphs (2) and (3) of section 3001 (d). 

‘‘(C) PAYMENT OF NEW YORK CITY SHARE OF MONITORING AND TREATMENT

COSTS.—The WTC Program Administrator shall— 

‘‘(i) bill the amount specified in subparagraph (A) directly to New 

York City; and 

‘‘(ii) certify periodically, for purposes of section 3001(d)(2), whether or 

not New York City has paid the amount so billed. 

‘‘(D) LIMITATION ON REQUIRED AMOUNT.—In no case is New York City required under this paragraph to contribute more than a total of 

$500,000,000 over any 10-year period. 

‘‘(b) CENTERS OF EXCELLENCE DEFINED.— 

‘‘(1) CLINICAL CENTER OF EXCELLENCE.—In this title, the term ‘Clinical Center 

of Excellence’ means the following: 

‘‘(A) FOR FDNY RESPONDERS.—With respect to an eligible WTC responder 

who responded to the 9/11 attacks as an employee of the Fire Department 

of the City of New York and who— 

‘‘(i) is an active employee of such Department— 

‘‘(I) with respect to monitoring, such Fire Department; and 

‘‘(II) with respect to treatment, such Fire Department (or such 

entity as has entered into a contract with the Fire Department for 

treatment of such responders) or any other Clinical Center of Excellence described in subparagraph (B), (C), or (D); or 

‘‘(ii) is not an active employee of such Department, such Fire Department (or such entity as has entered into a contract with the Fire Department for monitoring or treatment of such responders) or any other 

or any other Clinical Center of Excellence described in subparagraph 

(B), (C), or (D). 

‘‘(B) OTHER ELIGIBLE WTC RESPONDERS.—With respect to other eligible 

WTC responders, whether or not they reside in the New York Metropolitan 

area, the Mt. Sinai coordinated consortium, Queens College, State University of New York at Stony Brook, University of Medicine and Dentistry of 

New Jersey, and Bellevue Hospital. 

‘‘(C) WTC COMMUNITY MEMBERS.—With respect to eligible WTC community members, whether or not they reside in the New York Metropolitan 

area, the World Trade Center Environmental Health Center at Bellevue 

Hospital and such hospitals or other facilities, including but not limited to 

those within the New York City Health and Hospitals Corporation, as are 

identified by the WTC Program Administrator. 

‘‘(D) ALL ELIGIBLE WTC RESPONDERS AND ELIGIBLE WTC COMMUNITY MEMBERS.—With respect to all eligible WTC responders and eligible WTC community members, such other hospitals or other facilities as are identified 

by the WTC Program Administrator. 

The WTC Program Administrator shall limit the number of additional Centers 

of Excellence identified under subparagraph (D) to ensure that the participating 

centers have adequate experience in the treatment and diagnosis of identified 

WTC-related medical conditions. 

‘‘(2) COORDINATING CENTER OF EXCELLENCE.—In this title, the term ‘Coordinating Center of Excellence’ means the following: 

‘‘(A) FOR FDNY RESPONDERS.—With respect to an eligible WTC responder 

who responded to the 9/11 attacks as an employee of the Fire Department 

of the City of New York, such Fire Department. 

‘‘(B) OTHER WTC RESPONDERS.—With respect to other eligible WTC responders, the Mt. Sinai coordinated consortium. 

‘‘(C) WTC COMMUNITY MEMBERS.—With respect to eligible WTC community members, the World Trade Center Environmental Health Center at 

Bellevue Hospital. 

‘‘(3) CORRESPONDING CENTERS.—In this title, a Clinical Center of Excellence 

and a Coordinating Center of Excellence shall be treated as ‘corresponding’ to 

the extent that such Clinical Center and Coordinating Center serve the same 

population group. 

‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, NON-MONITORING PROGRAM COSTS.—A 

Clinical or Coordinating Center of Excellence with a contract under this section 

shall be reimbursed for the costs of such Center in carrying out the activities described in subsection (a), other than those described in subsection (a)(1)(A), subject 

to the provisions of section 3001(d), as follows: 

‘‘(1) CLINICAL CENTERS OF EXCELLENCE.—For carrying out subparagraphs (B) 

through (F) of subsection (a)(1)— 


jbell on DSKDVH8Z91PROD with REPORTS
13 

‘‘(A) CLINICAL CENTER FOR FDNY RESPONDERS IN NEW YORK.—The Clinical 

Center of Excellence for FDNY Responders in New York specified in subsection (b)(1)(A) shall be reimbursed— 

‘‘(i) in the first year of the contract under this section, $600 per certified eligible WTC responder in the medical treatment program, and 

$300 per certified eligible WTC responder in the monitoring program; 

and 

‘‘(ii) in each subsequent contract year, subject to paragraph (3), at the 

rates specified in this subparagraph for the previous contract year adjusted by the WTC Program Administrator to reflect the rate of medical 

care inflation during the previous contract year. 

‘‘(B) CLINICAL CENTERS SERVING OTHER ELIGIBLE WTC RESPONDERS IN NEW

YORK.—A Clinical Center of Excellence for other WTC responders in New 

York specified in subsection (b)(1)(B) shall be reimbursed the amounts specified in subparagraph (A). 

‘‘(C) CLINICAL CENTERS SERVING WTC COMMUNITY MEMBERS.—A Clinical 

Center of Excellence for eligible WTC community members in New York 

specified in subsection (b)(1)(C) shall be reimbursed— 

‘‘(i) in the first year of the contract under this section, for each certified eligible WTC community member in a medical treatment program enrolled at a non-hospital-based facility, $600, and for each certified eligible WTC community member in a medical treatment program enrolled at a hospital-based facility, $300; and 

‘‘(ii) in each subsequent contract year, subject to paragraph (3), at the 

rates specified in this subparagraph for the previous contract year adjusted by the WTC Program Administrator to reflect the rate of medical 

care inflation during the previous contract year. 

‘‘(D) OTHER CLINICAL CENTERS.—A Clinical Center of Excellence or other 

providers not described in a previous subparagraph shall be reimbursed at 

a rate set by the WTC Program Administrator. 

‘‘(E) REIMBURSEMENT RULES.—The reimbursement provided under subparagraphs (A), (B) and (C) shall be made for each certified eligible WTC 

responder and for each WTC community member in the WTC program per 

year that the member receives such services, regardless of the volume or 

cost of services required. 

‘‘(2) COORDINATING CENTERS OF EXCELLENCE.—A Coordinating Centers of Excellence specified in section (a)(2) shall be reimbursed for the provision of services set forth in this section at such levels as are established by the WTC Program Administrator. 

‘‘(3) REVIEW OF RATES.— 

‘‘(A) INITIAL REVIEW.—Before the end of the third contract year of the 

WTC program, the WTC Program Administrator shall conduct a review to 

determine whether the reimbursement rates set forth in this subsection 

provide fair and appropriate reimbursement for such program services. 

Based on such review, the Administrator may, by rule beginning with the 

fourth contract year, may modify such rates, taking into account a reasonable and fair rate for the services being provided. 

‘‘(B) SUBSEQUENT REVIEWS.—After the fourth contract year, the WTC Program Administrator shall conduct periodic reviews to determine whether 

the reimbursement rates in effect under this subsection provide fair and appropriate reimbursement for such program services. Based upon such a review, the Administrator may by rule modify such rates, taking into account 

a reasonable and fair rate for the services being provided. 

‘‘(C) GAO REVIEW.—The Comptroller General of the United States shall 

review the WTC Program Administrator’s determinations regarding fair 

and appropriate reimbursement for program services under this paragraph. 

‘‘(d) REQUIREMENTS.—The WTC Program Administrator shall not enter into a contract with a Clinical Center of Excellence under subsection (a)(1) unless— 

‘‘(1) the Center establishes 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; 

‘‘(2) the Center provides for the coordination of monitoring and treatment benefits under subtitle B with routine medical care provided for the treatment of 

conditions other than WTC-related health conditions; 

‘‘(3) the Center collects and reports to the corresponding Coordinating Center 

of Excellence data in accordance with section 3005; 

‘‘(4) the Center has in place safeguards against fraud that are satisfactory to 

the Administrator; 


jbell on DSKDVH8Z91PROD with REPORTS
14 

‘‘(5) the Center agrees to treat or refer for treatment all individuals who are 

eligible WTC responders or eligible WTC community members with respect to 

such Center who present themselves for treatment of a WTC-related health condition; 

‘‘(6) the Center has in place safeguards 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; 

‘‘(7) the Center provides assurances that the amounts paid under subsection 

(c)(1) are used only for costs incurred in carrying out the activities described 

in subsection (a), other than those described in subsection (a)(1)(A); and 

‘‘(8) the Center agrees to meet all the other applicable requirements of this 

title, including regulations implementing such requirements. 

‘‘SEC. 3007. ENTITLEMENT AUTHORITIES. 

‘‘Subject to subsections (b)(4)(C) and (c)(5) of section 3012, subtitle B constitutes 

budget authority in advance of appropriations Acts and represents the obligation of 

the Federal Government to provide for the payment for monitoring, initial health 

evaluations, and treatment in accordance with such subtitle and section 3006(c) constitutes such budget authority and represents the obligation of the Federal Government to provide for the payment described in such section. 

‘‘SEC. 3008. 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 on the World Trade 

Center 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 terms ‘certified eligible WTC responder’ and ‘certified eligible WTC 

community member’ mean an individual who has been certified as an eligible 

WTC responder under section 3011(a)(4) or an eligible WTC community member 

under section 3021(a)(4), respectively. 

‘‘(3) The terms ‘Clinical Center of Excellence’ and ‘Coordinating Center of Excellence’ have the meanings given such terms in section 3006(b). 

‘‘(4) The term ‘current consortium arrangements’ means the arrangements as 

in effect on the date of the enactment of this title between the National Institute for Occupational Safety and Health and the Mt. Sinai-coordinated consortium and the Fire Department of the City of New York. 

‘‘(5) The terms ‘eligible WTC responder’ and ‘eligible WTC community member’ are defined in sections 3011(a) and 3021(a), respectively. 

‘‘(6) 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. 

‘‘(7) The term ‘list of identified WTC-related health conditions’ means— 

‘‘(A) for eligible WTC responders, the identified WTC-related health condition for eligible WTC responders under section 3012(a)(3) or 3012(a)(4); or 

‘‘(B) for eligible WTC community members, the identified WTC-related 

health condition for WTC community members under section 3022(b)(1) or 

3022(b)(2). 

‘‘(8) The term ‘Mt.-Sinai-coordinated consortium’ means the consortium coordinated by Mt. Sinai hospital in New York City that coordinates the monitoring 

and treatment under the current consortium arrangements for eligible WTC responders other than with respect to those covered under the arrangement with 

the Fire Department of the City of New York. 

‘‘(9) 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. 

‘‘(10) The term ‘New York metropolitan area’ means an area, specified by the 

WTC Program Administrator, within which eligible WTC responders and eligible WTC community members 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 Centers of Excellence described in subparagraphs (A), (B), or (C) of section 3006(b)(1). 


jbell on DSKDVH8Z91PROD with REPORTS
15 

‘‘(11) Any reference to ‘September 11, 2001’ shall be deemed a reference to the 

period on such date subsequent to the terrorist attacks on the World Trade Center on such date. 

‘‘(12) The term ‘September 11, 2001, terrorist attacks on the World Trade 

Center’ means the terrorist attacks that occurred on September 11, 2001, in 

New York City and includes the aftermath of such attacks. 

‘‘(13) The term ‘WTC Health Program Steering Committee’ means such a 

Steering Committee established under section 3003. 

‘‘(14) The term ‘WTC Program Administrator’ means the individual responsible under section 3001(f) for the administration of the WTC program. 

‘‘(15) The term ‘WTC-related health condition’ is defined in section 3012(a). 

‘‘(16) The term ‘WTC Scientific/Technical Advisory Committee’ means such 

Committee established under section 3002. 

‘‘Subtitle B—Program of Monitoring, Initial 

Health Evaluations, and Treatment 

‘‘PART 1—FOR WTC RESPONDERS 

‘‘SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPONDERS AND PROVISION OF WTC-RELATED MONITORING SERVICES. 

‘‘(a) ELIGIBLE WTC RESPONDER DEFINED.— 

‘‘(1) IN GENERAL.—For purposes of this title, the term ‘eligible WTC responder’ 

means any of the following individuals, subject to paragraph (5): 

‘‘(A) CURRENTLY IDENTIFIED RESPONDER.—An individual who has been 

identified as eligible for medical monitoring under the current consortium 

arrangements (as defined in section 3008(4)). 

‘‘(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 on the World Trade Center, 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 on the World Trade Center as the 

WTC Program Administrator, after consultation with the WTC Responders Steering Committee and 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 certifications for eligible responders 

has reached 80 percent of the limit described in paragraph (5) or on or after 

the date that the number of certifications for eligible community members 

has reached 80 percent of the limit described in section 3021(a)(5). 

‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria described in this 

paragraph for an individual is that the individual is described in either of the 

following categories: 

‘‘(A) FIRE FIGHTERS AND RELATED PERSONNEL.—The individual— 

‘‘(i) was a member of the Fire Department of the City of New York 

(whether fire or emergency personnel, active or retired) who participated at least one day in the rescue and recovery effort at any of the 

former World Trade sites (including Ground Zero, Staten Island land 

fill, and the NYC 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 the City of New York (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 mental health condition described in section 3012(a)(1)(B) on or before September 1, 2008. 

‘‘(B) LAW ENFORCEMENT OFFICERS AND WTC RESCUE, RECOVERY, AND

CLEAN-UP WORKERS.—The individual— 


jbell on DSKDVH8Z91PROD with REPORTS
16 

‘‘(i) worked or volunteered on-site 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 the City of New 

York (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 on-site in rescue, recovery, debris clean-up, 

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 on-site in rescue, recovery, debris clean-up, or related services in at Ground Zero, the Staten Island Landfill or the 

barge loading piers, for at least one day during the period beginning 

on September 11, 2001, and ending on July 31, 2002; 

‘‘(III) participated on-site in rescue, recovery, debris clean-up, or related services in lower Manhattan (south of Canal St.) for at least 24 

hours during the period beginning on September 11, 2001, and ending 

on September 30, 2001; or 

‘‘(IV) participated on-site in rescue, recovery, debris clean-up, 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 the City of New York 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 on the World Trade 

Center during a duration and period described in subparagraph (A). 

‘‘(3) APPLICATION PROCESS.—The WTC Program Administrator in consultation 

with the Coordinating Centers of Excellence shall establish a process for individuals, other than eligible WTC responders described in paragraph (1)(A), to 

apply to be determined to be eligible WTC responders. Under such process— 

‘‘(A) there shall be no fee charged to the applicant for making an application for such determination; 

‘‘(B) the Administrator shall make a determination on such an application 

not later than 60 days after the date of filing the application; and 

‘‘(C) an individual who is determined not to be an eligible WTC responder 

shall have an opportunity to appeal such determination before an administrative law judge in a manner established under such process. 

‘‘(4) CERTIFICATION.— 

‘‘(A) IN GENERAL.—In the case of an individual who is described in paragraph (1)(A) or who is determined under paragraph (3) (consistent with 

paragraph (5)) to be an eligible WTC responder, the WTC Program Administrator shall provide an appropriate certification of such fact and of eligibility for monitoring and treatment benefits under this part. The Administrator shall make determinations of eligibility relating to an applicant’s 

compliance with this title, including the verification of information submitted in support of the application, and shall not deny such a certification 

to an individual unless the Administrator determines that— 

‘‘(i) based on the application submitted, the individual does not meet 

the eligibility criteria; or 

‘‘(ii) the numerical limitation on eligible WTC responders set forth in 

paragraph (5) has been met. 

‘‘(B) TIMING.— 


jbell on DSKDVH8Z91PROD with REPORTS
17 

‘‘(i) CURRENTLY IDENTIFIED RESPONDERS.—In the case of an individual 

who is described in paragraph (1)(A), the WTC Program Administrator 

shall provide the certification under subparagraph (A) not later than 60 

days after the date of the enactment of this title. 

‘‘(ii) OTHER RESPONDERS.—In the case of another individual who is 

determined under paragraph (3) and consistent with paragraph (5) to 

be an eligible WTC responder, the WTC Program Administrator shall 

provide the certification under subparagraph (A) at the time of the determination. 

‘‘(5) NUMERICAL LIMITATION ON ELIGIBLE WTC RESPONDERS.— 

‘‘(A) IN GENERAL.—The total number of individuals not described in subparagraph (C) who may qualify as eligible WTC responders for purposes of 

this title, and be certified as eligible WTC responders under paragraph (4), 

shall not exceed 15,000, subject to adjustment under paragraph (6), of 

which no more than 2,500 may be individuals certified based on modified 

eligibility criteria established under paragraph (1)(C). In applying the previous sentence, any individual who at any time so qualifies as an eligible 

WTC responder shall be counted against such numerical limitation. 

‘‘(B) PROCESS.—In implementing subparagraph (A), the WTC Program 

Administrator shall— 

‘‘(i) limit the number of certifications provided under paragraph (4) 

in accordance with such subparagraph; and 

‘‘(ii) provide priority in such certifications in the order in which individuals apply for a determination under paragraph (3). 

‘‘(C) CURRENTLY IDENTIFIED RESPONDERS NOT COUNTED.—Individuals described in this subparagraph are individuals who are described in paragraph (1)(A). 

‘‘(6) POTENTIAL ADJUSTMENT IN NUMERICAL LIMITATIONS DEPENDENT UPON ACTUAL SPENDING RELATIVE TO ESTIMATED SPENDING.— 

‘‘(A) INITIAL CALCULATION FOR FISCAL YEARS 2009 THROUGH 2011.—If the 

WTC Program Administrator determines as of December 1, 2011, that the 

WTC expenditure-to-CBO-estimate percentage (as defined in subparagraph 

(D)(iii)) for fiscal years 2009 through 2011 does not exceed 90 percent, then, 

effective January 1, 2012, the WTC Program Administrator may increase 

the numerical limitation under paragraph (5)(A), the numerical limitation 

under section 3021(a)(5), or both, by a number of percentage points not to 

exceed the number of percentage points specified in subparagraph (C) for 

such period of fiscal years. 

‘‘(B) SUBSEQUENT CALCULATION FOR FISCAL YEARS 2009 THROUGH 2015.—If 

the Secretary determines as of December 1, 2015, that the WTC expenditure-to-CBO-estimate percentages for fiscal years 2009 through 2015 and 

for fiscal years 2012 through 2015 do not exceed 90 percent, then, effective 

January 1, 2015, the WTC Program Administrator may increase the numerical limitation under paragraph (5)(A), the numerical limitation under section 3021(a)(5), or both, as in effect after the application of subparagraph 

(A), by a number of percentage points not to exceed twice the lesser of— 

‘‘(i) the number of percentage points specified in subparagraph (C) for 

fiscal years 2009 through 2012, or 

‘‘(ii) the number of percentage points specified in subparagraph (C) 

for fiscal years 2012 through 2015. 

‘‘(C) MAXIMUM PERCENTAGE INCREASE IN NUMERICAL LIMITATIONS FOR PERIOD OF FISCAL YEARS.—The number of percentage points specified in this 

clause for a period of fiscal years is— 

‘‘(i) 100 percentage points, multiplied by 

‘‘(ii) one minus a fraction the numerator of which is the net Federal 

WTC spending for such period, and the denominator of which is the 

CBO WTC spending estimate under this title for such period. 

‘‘(D) DEFINITIONS.—For purposes of this paragraph: 

‘‘(i) NET FEDERAL SPENDING.—The term ‘net Federal WTC spending’ 

means, with respect to a period of fiscal years, the net Federal spending under this title for such fiscal years. 

‘‘(ii) CBO WTC SPENDING ESTIMATE UNDER THIS TITLE.—The term 

‘CBO WTC medical spending estimate under this title’ means, with respect to— 

‘‘(I) fiscal years 2009 through 2011, $900,000,000; 

‘‘(II) fiscal years 2012 through 2015, $1,890,000,000; and 

‘‘(III) fiscal years 2009 through 2015, the sum of the amounts 

specified in subclauses (I) and (II). 


jbell on DSKDVH8Z91PROD with REPORTS
18 

‘‘(iii) WTC EXPENDITURE-TO-CBO-ESTIMATE PERCENTAGE.—The term 

‘WTC expenditure-to-estimate percentage’ means, with respect to a period of fiscal years, the ratio (expressed as a percentage) of— 

‘‘(I) the net Federal WTC spending for such period, to 

‘‘(II) the CBO WTC spending estimate under this title for such 

period. 

‘‘(b) MONITORING BENEFITS.— ‘‘(1) IN GENERAL.—In the case of an eligible WTC responder under section 

3011(a)(4) (other than one described in subsection (a)(2)(A)(ii)), the WTC program shall provide for monitoring benefits that include medical 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 eligible WTC responder who is an active member of the Fire Department of the City of New York, 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 3031. 

‘‘SEC. 3012. TREATMENT OF CERTIFIED ELIGIBLE 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) 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 on the World Trade Center, based on an 

examination by a medical professional with experience in treating or diagnosing the medical conditions included in the applicable list of identified 

WTC-related 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 

‘‘(B) a mental health condition for which such attacks, based on an examination by a medical professional with experience in treating or diagnosing 

the medical conditions included in the applicable list of identified WTC-related conditions, is substantially likely be a significant factor in aggravating, contributing to, or causing the condition, as determined under paragraph (2). 

In the case of an eligible WTC responder described in section 3011(a)(2)(A)(ii), 

such term only includes the mental health condition described in subparagraph 

(B). 

‘‘(2) DETERMINATION.—The determination of whether the September 11, 2001, 

terrorist attacks on the World Trade Center 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 medical conditions included on the list 

of identified WTC-related 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 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 IDENTIFIED WTC-RELATED HEALTH CONDITIONS FOR CERTIFIED ELIGIBLE WTC RESPONDERS.—For purposes of this title, the term ‘identified WTCrelated health condition for eligible WTC responders’ means any of the following 

health conditions: 

‘‘(A) AERODIGESTIVE DISORDERS.— 

‘‘(i) Interstitial lung diseases. 

‘‘(ii) Chronic respiratory disorder-fumes/vapors. 


jbell on DSKDVH8Z91PROD with REPORTS
19 

‘‘(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) Gastro-esophageal reflux disorder (GERD). 

‘‘(xii) Sleep apnea exacerbated by or related to a condition described 

in a previous clause. 

‘‘(B) MENTAL HEALTH CONDITIONS.— ‘‘(i) Post traumatic stress disorder (PTSD). 

‘‘(ii) Major depressive disorder. 

‘‘(iii) Panic disorder. 

‘‘(iv) Generalized anxiety disorder. 

‘‘(v) Anxiety disorder (not otherwise specified). 

‘‘(vi) Depression (not otherwise specified). 

‘‘(vii) Acute stress disorder. 

‘‘(viii) Dysthymic disorder. 

‘‘(ix) Adjustment disorder. 

‘‘(x) Substance abuse. 

‘‘(xi) V codes (treatments not specifically related to psychiatric disorders, such as marital problems, parenting problems etc.), secondary 

to another identified WTC-related health condition for WTC eligible responders. 

‘‘(C) MUSCULOSKELETAL DISORDERS.— 

‘‘(i) Low back pain. 

‘‘(ii) Carpal tunnel syndrome (CTS). 

‘‘(iii) Other musculoskeletal disorders. 

‘‘(4) ADDITION OF IDENTIFIED WTC-RELATED HEALTH CONDITIONS FOR ELIGIBLE

WTC RESPONDERS.— 

‘‘(A) IN GENERAL.—The WTC Program Administrator may promulgate 

regulations to add an illness or health condition not described in paragraph 

(3) to be added to the list of identified WTC-related conditions for eligible 

WTC responders. In promulgating such regulations, the Secretary shall provide for notice and opportunity for a public hearing and at least 90 days 

of public comment. In promulgating such regulations, the WTC Program 

Administrator shall take into account the findings and recommendations of 

Clinical Centers of Excellence published in peer reviewed journals in the 

determination of whether an additional illness or health condition, such as 

cancer, should be added to the list of identified WTC-related health conditions for eligible WTC responders. 

‘‘(B) PETITIONS.—Any person (including the WTC Health Program Scientific/Technical Advisory Committee) may petition the WTC Program Administrator to propose regulations described in subparagraph (A). Unless 

clearly frivolous, or initiated by such Committee, any such petition shall be 

referred to such Committee for its recommendations. Following— 

‘‘(i) receipt of any recommendation of the Committee; or 

‘‘(ii) 180 days after the date of the referral to the Committee, 

whichever occurs first, the WTC Program Administrator shall conduct a 

rulemaking proceeding on the matters proposed in the petition or publish 

in the Federal Register a statement of reasons for not conducting such proceeding. 

‘‘(C) EFFECTIVENESS.—Any addition under subparagraph (A) of an illness 

or health condition shall apply only with respect to applications for benefits 

under this title which are filed after the effective date of such regulation. 

‘‘(D) ROLE OF ADVISORY COMMITTEE.—Except with respect to a regulation 

recommended by the WTC Health Program Scientific/Technical Advisory 

Committee), the WTC Program Administrator may not propose a regulation 

under this paragraph, unless the Administrator has first provided to the 

Committee a copy of the proposed regulation, requested recommendations 

and comments by the Committee, and afforded the Committee at least 90 

days to make such recommendations. 

‘‘(b) COVERAGE OF TREATMENT FOR WTC-RELATED HEALTH CONDITIONS.— 

‘‘(1) DETERMINATION BASED ON AN IDENTIFIED WTC-RELATED HEALTH CONDITION FOR CERTIFIED ELIGIBLE WTC RESPONDERS.— 

‘‘(A) IN GENERAL.—If a physician at a Clinical Center of Excellence that 

is providing monitoring benefits under section 3011 for a certified eligible 


jbell on DSKDVH8Z91PROD with REPORTS
20 

WTC responder determines that the responder has an identified WTC-related health condition, and the physician makes a clinical determination 

that exposure to airborne toxins, other hazards, or adverse conditions resulting from the 9/11 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) of a WTC-related health condition. 

‘‘(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 an identified WTC-related health 

condition or that exposure to airborne toxins, other hazards, or adverse 

conditions resulting from the 9/11 terrorist attacks is not substantially 

likely to be a significant factor in significantly aggravating, contributing to, or causing the condition. 

‘‘(iii) APPEAL PROCESS.—The Administrator shall provide a process for 

the appeal of determinations under clause (ii) before an administrative 

law judge. 

‘‘(2) DETERMINATION BASED ON OTHER WTC-RELATED HEALTH CONDITION.— 

‘‘(A) IN GENERAL.—If a physician at a Clinical Center of Excellence determines pursuant to subsection (a) that the certified eligible WTC responder 

has a WTC-related health condition that is not an identified WTC-related 

health condition for eligible WTC responders— 

‘‘(i) the physician shall promptly transmit such determination to the 

WTC Program Administrator and provide the Administrator with the 

facts supporting such determination; and 

‘‘(ii) the Administrator shall make a determination under subparagraph (B) with respect to such physician’s determination. 

‘‘(B) REVIEW; CERTIFICATION.— 

‘‘(i) USE OF PHYSICIAN PANEL.—With respect to each determination 

relating to a WTC-related health condition transmitted under subparagraph (A)(i), the WTC Program Administrator shall provide for the review of the condition to be made by a physician panel with appropriate 

expertise appointed by the WTC Program Administrator. Such a panel 

shall make recommendations to the Administrator on the evidence supporting such determination. 

‘‘(ii) REVIEW OF RECOMMENDATIONS OF PANEL; CERTIFICATION.—The 

Administrator, based on such recommendations shall determine, within 

60 days after the date of the transmittal under subparagraph (A)(i), 

whether or not the condition is a WTC-related health condition and, if 

it is, provide for a certification under paragraph (1)(B)(ii) of coverage 

of such condition. The Administrator shall provide a process for the appeal of determinations that the responder’s condition is not a WTC-related health condition before an administrative law judge. 

‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 

‘‘(A) IN GENERAL.—In providing treatment for a WTC-health condition, a 

physician shall provide treatment that is medically necessary and in accordance with medical protocols established under subsection (d). 

‘‘(B) MEDICALLY NECESSARY STANDARD.—For the purpose of this title, 

health care services shall be treated as medically necessary for an individual if a physician, exercising prudent clinical judgment, would consider 

the services to be medically necessary for the individual for the purpose of 

evaluating, diagnosing, or treating an illness, injury, disease or its symptoms, and that are— 

‘‘(i) in accordance with the generally accepted standards of medical 

practice; 

‘‘(ii) clinically appropriate, in terms of type, frequency, extent, site, 

and duration, and considered effective for the individual’s illness, injury, or disease; and 

‘‘(iii) not primarily for the convenience of the patient or physician, or 

another physician, and not more costly than an alternative service or 


jbell on DSKDVH8Z91PROD with REPORTS
21 

sequence of services at least as likely to produce equivalent therapeutic 

or diagnostic results as to the diagnosis or treatment of the individual’s 

illness, injury, or disease. 

‘‘(C) DETERMINATION OF MEDICAL NECESSITY.— ‘‘(i) REVIEW OF MEDICAL NECESSITY.—As part of the reimbursement 

payment process under subsection (c), the WTC Program Administrator 

shall review claims for reimbursement for the provision of medical 

treatment to determine if such treatment is medically necessary. 

‘‘(ii) WITHHOLDING OF PAYMENT FOR MEDICALLY UNNECESSARY TREAT- MENT.—The Administrator may withhold such payment for treatment 

that the Administrator determines is not medically necessary. 

‘‘(iii) REVIEW OF DETERMINATIONS OF MEDICAL NECESSITY.—The Administrator shall provide a process for providers to appeal a determination under clause (ii) that medical treatment is not medically necessary. Such appeals shall be reviewed through the use of a physician 

panel with appropriate expertise. 

‘‘(4) SCOPE OF TREATMENT COVERED.— ‘‘(A) IN GENERAL.—The scope of treatment covered under such paragraphs 

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.—To the extent provided in advance in 

appropriations Acts, the WTC Program Administrator may provide for necessary and reasonable transportation and expenses incident to the securing 

of medically necessary treatment 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.—In the case of a certified eligible WTC responder who has been determined by an examining physician under subsection (b)(1) to have an identified WTC-related health condition, 

but for whom a certification of the determination has not yet been made by the 

WTC Program Administrator, medical treatment may be provided under this 

subsection, subject to paragraph (6), until the Administrator makes a decision 

on such certification. Medical treatment provided under this paragraph shall be 

considered to be medical treatment for which payment may be made under subsection (c). 

‘‘(6) PRIOR APPROVAL PROCESS FOR NON-CERTIFIED NON-EMERGENCY INPATIENT

HOSPITAL SERVICES.—Non-emergency inpatient hospital services for a WTC-related health condition identified by an examining physician under paragraph 

(b)(1) that is not certified under paragraph (1)(B)(ii) is not covered unless the 

services have been determined to be medically necessary and approved through 

a process established by the WTC Program Administrator. Such process shall 

provide for a decision on a request for such services within 15 days of the date 

of receipt of the request. The WTC Administrator shall provide a process for the 

appeal of a decision that the services are not medically necessary. 

‘‘(c) PAYMENT FOR INITIAL HEALTH EVALUATION, MEDICAL MONITORING, AND

TREATMENT OF WTC-RELATED HEALTH CONDITIONS.— 

‘‘(1) MEDICAL TREATMENT.— 

‘‘(A) USE OF FECA PAYMENT RATES.—Subject to subparagraph (B), 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. 

‘‘(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 conditions 

through one or more contracts with outside vendors. 

‘‘(ii) COMPETITIVE BIDDING.—Under such program the Administrator 

shall— 


jbell on DSKDVH8Z91PROD with REPORTS
22 

‘‘(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 select a separate vendor to provide pharmaceutical benefits to certified eligible WTC responders for whom the 

Clinical Center of Excellence is described in section 3006(b)(1)(A) if 

such an arrangement is deemed necessary and beneficial to the program by the WTC Program Administrator. 

‘‘(C) OTHER TREATMENT.—For treatment not covered under a preceding 

subparagraph, the WTC Program Administrator shall designate a reimbursement rate for each such service. 

‘‘(2) MEDICAL MONITORING AND INITIAL HEALTH EVALUATION.—The WTC Program Administrator shall reimburse the costs of medical monitoring and the 

costs of an initial health evaluation provided under this title at a rate set by 

the Administrator. 

‘‘(3) 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 this section. 

‘‘(4) CLAIMS PROCESSING SUBJECT TO APPROPRIATIONS.—The payment by the 

WTC Program Administrator for the processing of claims under this title is limited to the amounts provided in advance in appropriations Acts. 

‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

‘‘(1) DEVELOPMENT.—The Coordinating Centers of Excellence shall develop 

medical treatment protocols for the treatment of certified eligible WTC responders and certified eligible WTC community members for identified WTC-related 

health conditions. 

‘‘(2) APPROVAL.—The WTC Program Administrator shall approve the medical 

treatment protocols, in consultation with the WTC Health Program Steering 

Committees. 

‘‘PART 2—COMMUNITY PROGRAM 

‘‘SEC. 3021. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF ELIGIBLE WTC COMMUNITY MEMBERS. 

‘‘(a) ELIGIBLE WTC COMMUNITY MEMBER DEFINED.— 

‘‘(1) IN GENERAL.—In this title, the term ‘eligible WTC community member’ 

means, subject to paragraphs (3) and (5), an individual who claims symptoms 

of a WTC-related health condition and is described in any of the following subparagraphs: 

‘‘(A) CURRENTLY IDENTIFIED COMMUNITY MEMBER.—An individual, including an eligible WTC responder, who has been identified as eligible for medical treatment or monitoring by the WTC Environmental Health Center as 

of the date of enactment of this title. 

‘‘(B) COMMUNITY MEMBER WHO MEETS CURRENT ELIGIBILITY CRITERIA.—An 

individual who is not an eligible WTC responder and meets any of the current eligibility criteria described in a subparagraph of paragraph (2). 

‘‘(C) COMMUNITY MEMBER WHO MEETS MODIFIED ELIGIBILITY CRITERIA.— 

An individual who is not an eligible WTC responder and meets such eligibility criteria relating to exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, terrorist attacks on 

the World Trade Center as the WTC Administrator determines eligible, 

after consultation with the WTC Community Program Steering Committee, 

Coordinating Centers of Excellence described in section 3006(b)(1)(C), and 

the WTC Scientific/Technical Advisory Committee. 

The Administrator shall not modify such criteria under subparagraph (C) on or 

after the date that the number of certifications for eligible community members 

has reached 80 percent of the limit described in paragraph (5) or on or after 

the date that the number of certifications for eligible responders has reached 

80 percent of the limit described in section 3021(a)(5). 

‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria described in this 

paragraph for an individual are that the individual is described in any of the 

following subparagraphs: 

‘‘(A) A person who was present in the New York City disaster area in the 

dust or dust cloud on September 11, 2001. 


jbell on DSKDVH8Z91PROD with REPORTS
23 

‘‘(B) A person who worked, resided or attended school, child care or adult 

day care in the New York City disaster area for— 

‘‘(i) at least four 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. 

‘‘(C) Any person who worked as a clean-up 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. 

‘‘(D) 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. 

‘‘(E) 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 on the World Trade Center. 

‘‘(3) APPLICATION PROCESS.—The WTC Program Administrator in consultation 

with the Coordinating Centers of Excellence shall establish a process for individuals, other than individuals described in paragraph (1)(A), to be determined 

eligible WTC community member. Under such process— 

‘‘(A) there shall be no fee charged to the applicant for making an application for such determination; 

‘‘(B) the Administrator shall make a determination on such an application 

not later than 60 days after the date of filing the application; and 

‘‘(C) an individual who is determined not to be an eligible WTC community member shall have an opportunity to appeal such determination before 

an administrative law judge in a manner established under such process. 

‘‘(4) CERTIFICATION.— 

‘‘(A) IN GENERAL.—In the case of an individual who is described in paragraph (1)(A) or who is determined under paragraph (3) (consistent with 

paragraph (5)) to be an eligible WTC community member, the WTC Program Administrator shall provide an appropriate certification of such fact 

and of eligibility for followup monitoring and treatment benefits under this 

part. The Administrator shall make determinations of eligibility relating to 

an applicant’s compliance with this title, including the verification of information submitted in support of the application and shall not deny such a 

certification to an individual unless the Administrator determines that— 

‘‘(i) based on the application submitted, the individual does not meet 

the eligibility criteria; or 

‘‘(ii) the numerical limitation on certification of eligible WTC community members set forth in paragraph (5) has been met. 

‘‘(B) TIMING.— 

‘‘(i) CURRENTLY IDENTIFIED COMMUNITY MEMBERS.—In the case of an 

individual who is described in paragraph (1)(A), the WTC Program Administrator shall provide the certification under subparagraph (A) not 

later than 60 days after the date of the enactment of this title. 

‘‘(ii) OTHER MEMBERS.—In the case of another individual who is determined under paragraph (3) and consistent with paragraph (5) to be 

an eligible WTC community member, the WTC Program Administrator 

shall provide the certification under subparagraph (A) at the time of 

such determination. 

‘‘(5) NUMERICAL LIMITATION ON CERTIFICATION OF ELIGIBLE WTC COMMUNITY

MEMBERS.— 

‘‘(A) IN GENERAL.—The total number of individuals not described in subparagraph (C) who may be certified as eligible WTC community members 

under paragraph (4) shall not exceed 15,000. In applying the previous sentence, any individual who at any time so qualifies as an eligible WTC community member shall be counted against such numerical limitation. 

‘‘(B) PROCESS.—In implementing subparagraph (A), the WTC Program 

Administrator shall— 


jbell on DSKDVH8Z91PROD with REPORTS
24 

‘‘(i) limit the number of certifications provided under paragraph (4) 

in accordance with such subparagraph; and 

‘‘(ii) provide priority in such certifications in the order in which individuals apply for a determination under paragraph (4). 

‘‘(C) INDIVIDUALS CURRENTLY RECEIVING TREATMENT NOT COUNTED.—Individuals described in this subparagraph are individuals who— 

‘‘(i) are described in paragraph (1)(A); or 

‘‘(ii) before the date of the enactment of this title, have received monitoring or treatment at the World Trade Center Environmental Health 

Center at Bellevue Hospital Center, Gouverneur Health Care Services, 

or Elmhurst Hospital Center. 

The New York City Health and Hospitals Corporation shall, not later than 

6 months after the date of enactment of this title, enter into arrangements 

with the Mt. Sinai Data and Clinical Coordination Center for the reporting 

of medical data concerning eligible WTC responders described in paragraph 

(1)(A), as determined by the WTC Program Administrator and consistent 

with applicable Federal and State laws and regulations relating to confidentiality of individually identifiable health information. 

‘‘(D) REPORT TO CONGRESS IF NUMERICAL LIMITATION TO BE REACHED.—If 

the WTC Program Administrator determines that the number of individuals 

subject to the numerical limitation of subparagraph (A) is likely to exceed 

such numerical limitation, the Administrator shall submit to Congress a report on such determination. Such report shall include an estimate of the 

number of such individuals in excess of such numerical limitation and of 

the additional expenditures that would result under this title if such numerical limitation were removed. 

‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE ELIGIBILITY FOR FOLLOWUP MON- ITORING OR TREATMENT.— ‘‘(1) IN GENERAL.—In the case of a certified eligible WTC community member, 

the WTC program shall provide for an initial health evaluation to determine if 

the member has a WTC-related health condition and is eligible for followup 

monitoring and treatment benefits under the WTC program. Initial health evaluation protocols shall be approved by the WTC Program Administrator, in consultation with the World Trade Center Environmental Health Center at Bellevue Hospital and the WTC Community Program Steering Committee. 

‘‘(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 initial health evaluation under this part for an eligible WTC community member 

shall consist only of a single medical initial health evaluation consistent with 

initial health evaluation protocols described in paragraph (1). Nothing in this 

paragraph shall be construed as preventing such an individual from seeking additional medical initial health evaluations at the expense of the individual. 

‘‘SEC. 3022. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED ELIGIBLE WTC COMMUNITY MEMBERS FOR WTC-RELATED HEALTH CONDITIONS. 

‘‘(a) IN GENERAL.—Subject to subsection (b), the provisions of sections 3011 and 

3012 shall apply to followup monitoring and treatment of WTC-related health conditions for certified eligible WTC community members in the same manner as such 

provisions apply to the monitoring and treatment of identified WTC-related health 

conditions for certified eligible WTC responders, except that such monitoring shall 

only be available to those certified as eligible for treatment under this title. Under 

section 3006(a)(3), the City of New York is required to contribute a share of the 

costs of such treatment. 

‘‘(b) LIST OF IDENTIFIED WTC-RELATED HEALTH CONDITIONS FOR WTC COMMUNITY

MEMBERS.— ‘‘(1) IDENTIFIED WTC-RELATED HEALTH CONDITIONS FOR WTC COMMUNITY MEM- BERS.—For purposes of this title, the term ‘identified WTC-related health conditions for WTC community members’ means any of the following health conditions: 

‘‘(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. 


jbell on DSKDVH8Z91PROD with REPORTS
25 

‘‘(ix) Chronic nasopharyngitis. 

‘‘(x) Chronic laryngitis. 

‘‘(xi) Gastro-esophageal reflux disorder (GERD). 

‘‘(xii) Sleep apnea exacerbated by or related to a condition described 

in a previous clause. 

‘‘(B) MENTAL HEALTH CONDITIONS.— 

‘‘(i) Post traumatic stress disorder (PTSD). 

‘‘(ii) Major depressive disorder. 

‘‘(iii) Panic disorder. 

‘‘(iv) Generalized anxiety disorder. 

‘‘(v) Anxiety disorder (not otherwise specified). 

‘‘(vi) Depression (not otherwise specified). 

‘‘(vii) Acute stress disorder. 

‘‘(viii) Dysthymic disorder. 

‘‘(ix) Adjustment disorder. 

‘‘(x) Substance abuse. 

‘‘(xi) V codes (treatments not specifically related to psychiatric disorders, such as marital problems, parenting problems etc.), secondary 

to another identified WTC-related health condition for WTC community 

members. 

‘‘(2) ADDITIONS TO IDENTIFIED WTC-RELATED HEALTH CONDITIONS FOR WTC

COMMUNITY MEMBERS.—The provisions of paragraph (4) of section 3012(a) shall 

apply with respect to an addition to the list of identified WTC-related conditions 

for eligible WTC community members under paragraph (1) in the same manner 

as such provisions apply to an addition to the list of identified WTC-related conditions for eligible WTC responders under section 3012(a)(3). 

‘‘SEC. 3023. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS WITH WTCRELATED HEALTH CONDITIONS. 

‘‘(a) IN GENERAL.—Subject to subsection (c), the provisions of section 3022 shall 

apply to the followup monitoring and treatment of WTC-related health conditions 

for eligible WTC community members 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 WTC community members. 

Under section 3006(a)(3), the City of New York is required to contribute a share of 

the costs of such monitoring and treatment. 

‘‘(b) INDIVIDUALS DESCRIBED.—An individual described in this subsection is an individual who, regardless of location of residence— 

‘‘(1) is not a eligible WTC responder or an eligible WTC community member; 

and 

‘‘(2) is diagnosed at a Clinical Center of Excellence (with respect to an eligible 

WTC community member) with an identified WTC-related health condition for 

WTC community members. 

‘‘(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) fiscal year 2009 is $20,000,000; or 

‘‘(B) 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—NATIONAL ARRANGEMENT FOR BENEFITS 

FOR ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK 

‘‘SEC. 3031. 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 eligible WTC responders or eligible WTC community 

members 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 


jbell on DSKDVH8Z91PROD with REPORTS
26 

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 Coordinating Centers of 

Excellence; 

‘‘(2) follow the monitoring, initial health evaluation, and treatment protocols 

developed under section 3006(a)(2)(B); 

‘‘(3) collect and report data in accordance with section 3005; and 

‘‘(4) meet such fraud, quality assurance, and other requirements as the WTC 

Program Administrator establishes. 

‘‘Subtitle C—Research Into Conditions 

‘‘SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO SEPTEMBER 

11 TERRORIST ATTACKS IN NEW YORK CITY. 

‘‘(a) IN GENERAL.—With respect to individuals, including eligible WTC responders 

and eligible WTC community members, 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 3051), 

through a Clinical Center of Excellence, or through a Coordinating Center of Excellence. 

‘‘(b) TYPES OF RESEARCH.—The research under subsection (a)(1) shall include epidemiologic and other research studies on WTC-related conditions or emerging conditions— 

‘‘(1) among WTC responders and community members under treatment; and 

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

populations. 

‘‘(c) CONSULTATION.—The WTC Program Administrator shall carry out this section 

in consultation with the WTC Health Program Steering Committees and 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 otherwise conducted 

by the National Institutes of Health. 

‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the purpose of carrying out this 

section, there are authorized to be appropriated $15,000,000 for each fiscal year, in 

addition to any other authorizations of appropriations that are available for such 

purpose. 

‘‘Subtitle D—Programs of the New York City 

Department of Health and Mental Hygiene 

‘‘SEC. 3051. WORLD TRADE CENTER HEALTH REGISTRY. 

‘‘(a) PROGRAM EXTENSION.—For the purpose of ensuring on-going data collection 

for victims of the September 11, 2001, terrorist attacks on the World Trade Center, 

the WTC Program Administrator, shall extend and expand the arrangements in effect as of January 1, 2008, with the New York City Department of Health and Mental Hygiene that provide for the World Trade Center Health Registry. 

‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated $7,000,000 for each fiscal year to carry out this section. 

‘‘SEC. 3052. MENTAL HEALTH SERVICES. 

‘‘(a) IN GENERAL.—The WTC Program Administrator may make grants to the New 

York City Department of Health and Mental Hygiene to provide mental health servVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00026 Fmt 6659 Sfmt 6621 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
27 

ices to address mental health needs relating to the September 11, 2001, terrorist 

attacks on the World Trade Center. 

‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There are authorized to be appropriated $8,500,000 for each fiscal year to carry out this section.’’. 

TITLE II—SEPTEMBER 11TH VICTIM 

COMPENSATION FUND OF 2001 

SEC. 201. DEFINITIONS. 

Section 402 of the Air Transportation Safety and System Stabilization Act (49 

U.S.C. 40101 note) is amended— 

(1) in paragraph (6) by inserting ‘‘, or debris removal, including under the 

World Trade Center Health Program established under section 3001 of the Public Health Service Act’’ after ‘‘September 11, 2001’’; 

(2) by inserting after paragraph (6) the following new paragraphs and redesignating subsequent paragraphs accordingly: 

‘‘(7) CONTRACTOR AND SUBCONTRACTOR.—The term ‘contractor and subcontractor’ means any contractor or subcontractor (at any tier of a subcontracting 

relationship), including any general contractor, construction manager, prime 

contractor, consultant, or any parent, subsidiary, associated or allied company, 

affiliated company, corporation, firm, organization, or joint venture thereof that 

participated in debris removal at any 9/11 crash site. Such term shall not include any entity, including the Port Authority of New York and New Jersey, 

with a property interest in the World Trade Center, on September 11, 2001, 

whether fee simple, leasehold or easement, direct or indirect. 

‘‘(8) DEBRIS REMOVAL.—The term ‘debris removal’ means rescue and recovery 

efforts, removal of debris, cleanup, remediation, and response during the immediate aftermath of the terrorist-related aircraft crashes of September 11, 2001, 

with respect to a 9/11 crash site.’’; 

(3) by inserting after paragraph (10), as so redesignated, the following new 

paragraph and redesignating the subsequent paragraphs accordingly: 

‘‘(11) IMMEDIATE AFTERMATH.—The term ‘immediate aftermath’ means any period beginning with the terrorist-related aircraft crashes of September 11, 2001, 

and ending on August 30, 2002.’’; and 

(4) by adding at the end the following new paragraph: 

‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash site’ means— 

‘‘(A) the World Trade Center site, Pentagon site, and Shanksville, Pennsylvania site; 

‘‘(B) the buildings or portions of buildings that were destroyed as a result 

of the terrorist-related aircraft crashes of September 11, 2001; 

‘‘(C) any area contiguous to a site of such crashes that the Special Master 

determines was sufficiently close to the site that there was a demonstrable 

risk of physical harm resulting from the impact of the aircraft or any subsequent fire, explosions, or building collapses (including the immediate area 

in which the impact occurred, fire occurred, portions of buildings fell, or debris fell upon and injured individuals); and 

‘‘(D) any area related to, or along, routes of debris removal, such as 

barges and Fresh Kills.’’. 

SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION. 

(a) INFORMATION ON LOSSES RESULTING FROM DEBRIS REMOVAL INCLUDED IN

CONTENTS OF CLAIM FORM.—Section 405(a)(2)(B) of the Air Transportation Safety 

and System Stabilization Act (49 U.S.C. 40101 note) is amended— 

(1) in clause (i), by inserting ‘‘, or debris removal during the immediate aftermath’’ after ‘‘September 11, 2001’’; 

(2) in clause (ii), by inserting ‘‘or debris removal during the immediate aftermath’’ after ‘‘crashes’’; and 

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

(b) EXTENSION OF DEADLINE FOR CLAIMS UNDER SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001.—Section 405(a)(3) of such Act is amended to read as follows: 

‘‘(3) LIMITATION.— 

‘‘(A) IN GENERAL.—Except as provided by subparagraph (B), no claim may 

be filed under paragraph (1) after the date that is 2 years after the date 

on which regulations are promulgated under section 407(a). 


jbell on DSKDVH8Z91PROD with REPORTS
28 

‘‘(B) EXCEPTION.—A claim may be filed under paragraph (1), in accordance with subsection (c)(3)(A)(i), by an individual (or by a personal representative on behalf of a deceased individual) during the period beginning 

on the date on which the regulations are updated under section 407(b) and 

ending on December 22, 2031.’’. 

(c) REQUIREMENTS FOR FILING CLAIMS DURING EXTENDED FILING PERIOD.—Section 405(c)(3) of such Act is amended— 

(1) by redesignating subparagraphs (A) and (B) as subparagraphs (B) and (C), 

respectively; and 

(2) by inserting before subparagraph (B), as so redesignated, the following 

new subparagraph: 

‘‘(A) REQUIREMENTS FOR FILING CLAIMS DURING EXTENDED FILING PE- RIOD.— 

‘‘(i) TIMING REQUIREMENTS FOR FILING CLAIMS.—An individual (or a 

personal representative on behalf of a deceased individual) may file a 

claim during the period described in subsection (a)(3)(B) as follows: 

‘‘(I) In the case that the Special Master determines the individual 

knew (or reasonably should have known) before the date specified 

in clause (iii) that the individual suffered a physical harm at a 9/ 

11 crash site as a result of the terrorist-related aircraft crashes of 

September 11, 2001, or as a result of debris removal, and that the 

individual knew (or should have known) before such specified date 

that the individual was eligible to file a claim under this title, the 

individual may file a claim not later than the date that is 2 years 

after such specified date. 

‘‘(II) In the case that the Special Master determines the individual first knew (or reasonably should have known) on or after the 

date specified in clause (iii) that the individual suffered such a 

physical harm or that the individual first knew (or should have 

known) on or after such specified date that the individual was eligible to file a claim under this title, the individual may file a claim 

not later than the last day of the 2-year period beginning on the 

date the Special Master determines the individual first knew (or 

should have known) that the individual both suffered from such 

harm and was eligible to file a claim under this title. 

‘‘(ii) OTHER ELIGIBILITY REQUIREMENTS FOR FILING CLAIMS.—An individual may file a claim during the period described in subsection 

(a)(3)(B) only if— 

‘‘(I) the individual was treated by a medical professional for suffering from a physical harm described in clause (i)(I) within a reasonable time from the date of discovering such harm; and 

‘‘(II) the individual’s physical harm is verified by contemporaneous medical records created by or at the direction of the medical 

professional who provided the medical care. 

‘‘(iii) DATE SPECIFIED.—The date specified in this clause is the date 

on which the regulations are updated under section 407(a).’’. 

(d) CLARIFYING APPLICABILITY TO ALL 9/11 CRASH SITES.—Section 405(c)(2)(A)(i) 

of such Act is amended by striking ‘‘or the site of the aircraft crash at Shanksville, 

Pennsylvania’’ and inserting ‘‘the site of the aircraft crash at Shanksville, Pennsylvania, or any other 9/11 crash site’’. 

(e) INCLUSION OF PHYSICAL HARM RESULTING FROM DEBRIS REMOVAL.—Section 

405(c) of such Act is amended in paragraph (2)(A)(ii), by inserting ‘‘or debris removal’’ after ‘‘air crash’’. 

(f) LIMITATIONS ON CIVIL ACTIONS.— 

(1) APPLICATION TO DAMAGES RELATED TO DEBRIS REMOVAL.—Clause (i) of section 405(c)(3)(C) of such Act, as redesignated by subsection (c), is amended by 

inserting ‘‘, or for damages arising from or related to debris removal’’ after ‘‘September 11, 2001’’. 

(2) PENDING ACTIONS.—Clause (ii) of such section, as so redesignated, is 

amended to read as follows: 

‘‘(ii) PENDING ACTIONS.—In the case of an individual who is a party 

to a civil action described in clause (i), such individual may not submit 

a claim under this title— 

‘‘(I) during the period described in subsection (a)(3)(A) unless 

such individual withdraws from such action by the date that is 90 

days after the date on which regulations are promulgated under 

section 407(a); and 

‘‘(II) during the period described in subsection (a)(3)(B) unless 

such individual withdraws from such action by the date that is 90 


jbell on DSKDVH8Z91PROD with REPORTS
29 

days after the date on which the regulations are updated under 

section 407(b).’’. 

(3) AUTHORITY TO REINSTITUTE CERTAIN LAWSUITS.—Such section, as so redesignated, is further amended by adding at the end the following new clause: 

‘‘(iii) AUTHORITY TO REINSTITUTE CERTAIN LAWSUITS.—In the case of 

a claimant who was a party to a civil action described in clause (i), who 

withdrew from such action pursuant to clause (ii), and who is subsequently determined to not be an eligible individual for purposes of this 

subsection, such claimant may reinstitute such action without prejudice 

during the 90-day period beginning after the date of such ineligibility 

determination.’’. 

SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

Section 407 of the Air Transportation Safety and System Stabilization Act (49 

U.S.C. 40101 note) is amended— 

(1) by striking ‘‘Not later than’’ and inserting ‘‘(a) IN GENERAL.—Not later 

than’’; and 

(2) by adding at the end the following new subsection: 

‘‘(b) UPDATED REGULATIONS.—Not later than 90 days after the date of the enactment of the James Zadroga 9/11 Health and Compensation Act of 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 

through December 22, 2031) for compensatory damages, contribution or indemnity, or any other form or type of relief, arising from or related to debris removal, against 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 

clauses (i) and (ii) shall not be included. 

‘‘(D) As it relates to the limitation of liability of any entity, including the 

Port Authority of New York and New Jersey, with a property interest in 

the World Trade Center on September 11, 2001 (whether fee simple, leasehold or easement, or direct or indirect), the amount of all available liability 

insurance coverage maintained by any such entity. 

‘‘(E) As it relates to the limitation of liability of any individual contractor 

or subcontractor, the amount of all available liability insurance coverage 

maintained by such contractor or subcontractor on September 11, 2001. 

‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Payments to plaintiffs who obtain a settlement or judgment with respect to a claim or action to which paragraph (4)(A) 

applies, shall be paid solely from the following funds in the following order, as 

may be applicable: 

‘‘(A) The funds described in clause (i) or (ii) of paragraph (4)(A). 

‘‘(B) If there are no funds available as described in clause (i) or (ii) of 

paragraph (4)(A), the funds described in clause (iii) of such paragraph. 

‘‘(C) If there are no funds available as described in clause (i), (ii), or (iii) 

of paragraph (4)(A), the funds described in clause (iv) of such paragraph. 

‘‘(D) If there are no funds available as described in clause (i), (ii), (iii), 

or (iv) of paragraph (4)(A), the funds described in clause (v) of such paragraph. 

‘‘(6) DECLARATORY JUDGMENT ACTIONS AND DIRECT ACTION.—Any party to a 

claim or action to which paragraph (4)(A) applies may, with respect to such 

claim or action, either file an action for a declaratory judgment for insurance 

coverage or bring a direct action against the insurance company involved.’’. 


jbell on DSKDVH8Z91PROD with REPORTS
30 

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 

subsection (d), not later than’’; 

(2) in subsection (b), by striking ‘‘This title’’ and inserting ‘‘Subject to subsection (d), this title’’; and 

(3) by adding at the end the following new subsections: 

‘‘(d) LIMITATION.—The total payment of amounts 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 $8,400,000,000. 

‘‘(e) ATTORNEY FEES.— 

‘‘(1) IN GENERAL.—Notwithstanding any contract, and except as provided in 

paragraph (2), 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) EXCEPTION.—With respect to a claim made on behalf of an individual for 

whom a lawsuit was filed in the Southern District of New York prior to January 

1, 2009, in the event that the representative believes in good faith that the fee 

limit set by paragraph (1) will not provide adequate compensation for services 

rendered in connection with such claim because of the substantial amount of 

legal work provided on behalf of the claimant (including work performed before 

the enactment of this legislation), application for greater compensation may be 

made to the Special Master. Upon such application, the Special Master may, in 

his or her discretion, award as reasonable compensation for services rendered 

an amount greater than that allowed for in paragraph (1). Such fee award will 

be final, binding, and non-appealable.’’. 

PURPOSE AND SUMMARY

H.R. 847 establishes the World Trade Center Health Program to 

provide medical monitoring and treatment benefits to emergency 

responders, recovery and cleanup workers, area residents, and others who were directly impacted by the attacks of September 11, 

2001. The bill also reopens the September 11 Victim Compensation 

Fund of 2001 to provide compensation to anyone who was injured 

in the aftermath of the attacks, including persons who were injured 

during debris removal at the September 11 crash sites. The bill extends the deadline for making claims under the fund, and it provides certain liability protections for the City of New York and 

other entities that engaged in recovery efforts and debris removal 

following the September 11 attacks. 

BACKGROUND AND NEED FOR THE LEGISLATION

SEPTEMBER 11, 2001 AND ITS AFTERMATH

On September 11, 2001, terrorists flew two hijacked commercial 

jets into the World Trade Center towers in New York City. Almost 

3,000 people were killed in the collapse of the towers, including 

hundreds of first responders, police officers, and firefighters. Beyond this immediate loss of life, thousands of other persons are 

now suffering debilitating and even deadly illnesses due to their 

proximity to the World Trade Center site in the aftermath of the 

attacks. 

It is now well documented that the collapse of the World Trade 

Center towers and the adjacent buildings released numerous hazardous substances into the environment. These substances included 

hundreds of tons of asbestos, nearly half a million pounds of lead, 

and large amounts of glass fibers, various heavy metals, dioxin, 

benzene, polychlorinated biphenyls (PCBs) and other potentially 


jbell on DSKDVH8Z91PROD with REPORTS
31 

1See ‘‘World Trade Center USGS Bulk Chemistry Results,’’ U.S. Geological Survey, Open-File 

Report 01-0429, available at: pubs.usgs.gov/of/2001/ofr-01-0429/chem1/index.html; ‘‘Characterization of the Dust/Smoke Aerosol that Settled East of the World Trade Center (WTC) in Lower 

Manhattan after the Collapse of the WTC 11 September 2001,’’ 110 Environmental Health Perspectives 7 (July 2002), available at: www.ehponline.org/members/2002/110p703-714lioy/lioyfull.html; Office of Inspector General, Environmental Protection Agency, EPA’s Response to the 

World Trade Center Collapse: Challenges, Successes, and Areas for Improvement, Rpt. No. 2003- 

P-00012, at 65 (Aug. 21, 2003). 2See Id.; Megan Nordgre ́n, Eric Goldstein, and Mark Izeman, The Environmental Impacts of 

the World Trade Center Attacks, Natural Resources Defense Council, at 3 (2002); Office of the 

Inspector General, Federal Emergency Management Agency, FEMA’s Delivery of Individual Assistance Program, at 25 (Dec. 18, 2002). 3Levin, S.M., Physical Health Status of World Trade Center Rescue and Recovery Workers 

and Volunteers—New York City, July 2002—August 2004, Centers for Disease Control and Prevention (Sept. 10, 2004); Mt. Sinai WTC Medical Monitoring Program, The World Trade Center 

Disaster and the Health of Workers: Five-Year Assessment of a Unique Medical Screening Program (Sept. 6, 2006). 4See, e.g., Cancer may be ‘‘third wave’’ of WTC illnesses, Associated Press (May 31, 2007), 

available at: http://www.msnbc.msn.com/id/18969197/; Gabriel Izbicki, M.D., et al., World Trade 

Center ‘‘Sarcoid-Like’’ Granulomatous Pulmonary Disease in New York City Fire Department Rescue Workers, Chest Journal (Jan. 26, 2007), abstract available at: 

http://www.chestjournal.org/content/131/5/1414.abstract; Jonathan M. Samet, M.D., et al., The 

Legacy of World Trade Center Dust, The New England Journal of Medicine (May 31, 2007), 

available at: http://content.nejm.org/cgi/content/full/356/22/2233. 

deadly chemicals and materials.1 These substances formed a large 

cloud of toxic dust and smoke, which blanketed parts of New York 

City and New Jersey and spread into many of the surrounding office buildings, schools, and residences. All together, the collapse of 

the towers dispersed about one million tons of dust on the area 

around Lower Manhattan. 

Many of those who worked and lived in this area are now experiencing serious and life-threatening illnesses due to their exposure 

to ‘‘World Trade Center dust.’’ Evidence accumulated since the collapse of the World Trade Center buildings indicates that the air in 

Lower Manhattan was hazardous, notwithstanding safety assurances from the Environmental Protection Agency (EPA), and that 

exposure to World Trade Center dust has caused adverse health effects in thousands of responders, recovery workers, and others at 

or near Ground Zero in the immediate aftermath of the September 

11 attacks.2 Such effects include pulmonary fibrosis, sarcoidosis, interstitial lung disease, chronic sinusitis, severe asthma and other 

conditions resulting in significant loss of lung function.3 There is 

also growing evidence that exposure to World Trade Center dust is 

resulting in other serious diseases, including respiratory tract cancer, lymphoma, and a range of blood cell cancers.4 Medical monitoring has been put in place for thousands of workers at the World 

Trade Center site to track cancer rates among this population into 

the future. 

Such illnesses have caused major financial strains on those who, 

exposed to the toxins during the aftermath of the September 11 attacks, are no longer able to work, and face the high price of health 

care without assistance. While some of the above diseases can improve with medical treatment, the ultimate medical outcome for 

people currently being treated or who will become ill in the future 

is uncertain. In many cases, individuals suffer from progressive 

loss of pulmonary capacity, resulting in incapacitation, and an inability to perform job duties or everyday activities. Many others 

suffer from recurrent episodes of lung infections leading to frequent 

hospitalizations. 


jbell on DSKDVH8Z91PROD with REPORTS
32 

THE SEPTEMBER 11 VICTIM COMPENSATION FUND OF 2001

In the immediate aftermath of the September 11 terrorist attacks, Congress created the September 11 Victim Compensation 

Fund (VCF), a unique program designed to compensate people for 

losses sustained as a result of the attacks on the World Trade Center and other 9/11 crash sites. The VCF provided aid to the families 

of September 11 victims and to individuals who suffered personal 

injury. In return for accepting VCF funds, recipients relinquished 

their right to sue the airlines, whose liability was limited to the 

value of their insurance. Victims or their personal representatives 

were offered the choice to seek no-fault compensation through the 

VCF or to bring a civil tort action against an airline or other parties. For those who chose to enter the fund, the VCF required that 

applications be filed before December 22, 2003. 

The special master of the VCF, Kenneth Feinberg, was given 

wide latitude to determine eligibility and the amount of compensation to be paid individuals on a case-by-case basis. Over a 33- 

month period, the VCF distributed over $7 billion to the surviving 

family members of 2,880 of those who were killed on September 11 

and to 2,680 of those who were injured in the attacks or the immediate rescue efforts. Families of the deceased were paid in amounts 

ranging from $800,000 to $6.5 million. People who had sustained 

physical injuries were paid amounts ranging from $500 for a broken finger to $7.1 million for severe burns over 85% of the victim’s 

body. Awards were reduced to offset other forms of compensation 

such as workers compensation, pension awards and life insurance. 

The VCF provided an attractive alternative to the uncertainty 

and delay of litigation, and the program was widely considered to 

be a success. Most families of deceased victims chose to participate 

in the VCF, and 97% of those who submitted claims received compensation through the program. 

While the VCF did an excellent job in handling claims involving 

people who died or had an immediate and easily diagnosable ailment (such as a broken leg), the fund was not as suitable for dealing with other kinds of injuries. The Fund’s regulations, for example, limited compensation to workers who were injured in the ‘‘immediate aftermath’’ of the attacks, which was defined as the 96- 

hour time period immediately following the attacks. This timeframe was sufficient to deal with workers who suffered immediate 

injuries. However, it left no recourse for individuals with late-onset 

injuries or for those who arrived after September 15, 2001 to assist 

in recovery and cleanup efforts and are now suffering injuries as 

a result of those efforts. 

Additionally, some injured persons either did not know they were 

eligible to file claims or were unaware of ailments that had yet to 

manifest prior to expiration of the deadline. Such persons include 

thousands of first responders, construction workers, local residents 

and other individuals who are now developing a range of diseases 

because of their exposure to World Trade Center toxins. Many of 

these individuals are now developing career-ending injuries, such 

as pulmonary and respiratory ailments, but are not eligible to receive assistance because their symptoms developed after the VCF 

filing deadline had passed. 


jbell on DSKDVH8Z91PROD with REPORTS
33 

THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010

The James Zadroga 9/11 Health and Compensation Act of 2010 

addresses the above concerns by establishing a program to provide 

health care to those injured during recovery and cleanup efforts at 

September 11 crash sites and by reopening the September 11 Victim Compensation Fund to provide compensation for such injured 

individuals. 

Specifically, title I of the bill amends the Public Health Service 

Act to establish the World Trade Center Health Program within 

the National Institute for Occupational Safety and Health. This 

program will provide medical monitoring and treatment benefits to 

eligible emergency responders and recovery and cleanup workers 

who worked at the World Trade Center crash site. It will also provide initial health evaluation, monitoring, and treatment benefits 

to residents and other building occupants and area workers who 

were directly impacted and adversely affected by the September 11 

attacks. The program will ensure that every person at risk of illness from exposure to World Trade Center toxins can obtain medical monitoring and that all those who are injured or sick as a result of such exposure can obtain treatment. 

Title II of the bill reopens the VCF to provide compensation for 

economic damages and losses to persons injured during recovery efforts and debris removal, including workers and area residents injured by toxins released during the collapse of the World Trade 

Center towers. To this end, the bill redefines a number of terms in 

the original VCF legislation so as to expand coverage to persons exposed to World Trade Center toxins. The bill expands coverage to 

all injuries occurring during recovery efforts and debris removal, 

including injuries occurring near the World Trade Center site and 

along the routes used to remove debris from that site. The bill defines ‘‘debris removal’’ comprehensively, so as to include the wide 

range of activities performed at the World Trade Center site and 

debris-removal routes, including, but not limited to, the assessment 

of damaged structures and the debris pile, the development of temporary stabilization procedures and mechanisms, demolition of unsafe structures, and removal of the debris pile. The bill also defines 

the term ‘‘immediate aftermath’’ as any period beginning with the 

terrorist-related aircraft crashes of September 11, 2001 and ending 

on August 30, 2002. 

The bill reopens the VCF until December 22, 2031, allowing individuals who did not previously file a claim, or who became ill after 

the original December 22, 2003 deadline, to be compensated for 

economic damages and losses stemming from their injuries. The 

purpose behind reopening the fund for over 20 years is to protect 

to the greatest extent possible those persons who were exposed to 

World Trade Center toxins during recovery and cleanup efforts but 

whose resulting injuries are latent and will manifest over the next 

two decades. 

While extending protection to injured individuals, the bill also 

provides protection from liability to certain entities that participated in recovery efforts and debris removal. The bill provides that 

their liability for all claims and actions arising from, or related to, 

recovery efforts and debris removal (including claims and actions 

previously resolved, currently pending, or filed through December 


jbell on DSKDVH8Z91PROD with REPORTS
34 

22, 2031) is limited to the amount of funds held by the World 

Trade Center Captive Insurance Company, the amount of available 

insurance coverage identified by the Captive Insurance Company, 

and the amount of insurance coverage held by certain other entities. 

The bill provides that the liability of the City of New York is lim- ited to the City’s insurance coverage or $350,000,000, whichever is 

greater. It further provides that the liability of the Port Authority 

of New York and New Jersey, and any other entity with a property 

interest in the World Trade Center on September 11, 2001, is limited to the amount of all available insurance coverage maintained 

by any such entity. The bill also limits liability of any individual 

contractor or subcontractor that participated in recovery efforts and 

debris removal to the amount of available liability insurance maintained by such contractor or subcontractor. 

The bill establishes a priority of funds from which plaintiffs may 

satisfy judgments or settlements obtained in civil claims or actions 

related to recovery and cleanup efforts. The priority requires exhaustion of amounts held by the Captive Insurance Company and 

identified insurance policies, followed by exhaustion of the amount 

for which the City of New York is liable, followed by exhaustion of 

the available insurance coverage maintained by the Port Authority 

and other entities with a property interest in the World Trade Center on September 11, 2001, followed by exhaustion of the available 

insurance coverage maintained by individual contractors and subcontractors. 

As amended in Committee, the bill caps the total amount of new compensation that could be awarded by the VCF to $8.4 billion. 

The bill also caps the amount of such compensation that could be 

used to pay attorney’s fees at 10 percent, except that the Special 

Master is given the discretion to raise this percentage for certain 

cases filed in the Southern District of New York prior to January 

1, 2009. This discretion is provided to the Special Master to address cases where the 10 percent cap on attorney’s fees may not 

provide adequate compensation for services rendered in connection 

with a claim because of the substantial amount of legal work expended on that claim during the period after which the initial period for filing claims under the VCF expired. 

The bill also requires the Special Master to update regulations 

consistent with revisions to the Victim Compensation Fund under 

this bill. 

HEARINGS

The Committee’s Subcommittee on Immigration, Citizenship, 

Refugees, Border Security, and International Law and Subcommittee on the Constitution, Civil Rights, and Civil Liberties 

held a joint hearing on H.R. 847 on March 31, 2009. Testimony was 

received from Kenneth R. Feinberg, former Special Master, Victim 

Compensation Fund; Barbara Burnette, former Detective, New 

York City Police Department; James Melius, MD., Administrator, 

New York State Laborers’ Health and Safety Trust Fund; Christine 

LaSala, Chief Executive Officer, World Trade Center Captive Insurance Fund; Michael A. Cardozo, Corporation Counsel, City of 

New York; Theodore H. Frank, American Enterprise Institute; and 

Richard Wood, President, Plaza Construction Corporation. AddiVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00034 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
35 

tional materials were submitted by the Associated Builders and 

Contractors (ABC) and Christine C. Quinn, Speaker, New York 

City Council. 

COMMITTEE CONSIDERATION

On July 29, 2009, the Committee met in open session and ordered the bill H.R. 847 favorably reported with an amendment, by 

a rollcall vote of 22 to 9, a quorum being present. 

COMMITTEE VOTES

In compliance with clause 3(b) of rule XIII of the Rules of the 

House of Representatives, the Committee advises that the following 

rollcall vote occurred during the Committee’s consideration of H.R. 

847: 

1. An amendment by Mr. Smith to: (a) reduce the life of the Victim Compensation Fund from 22 to 5 years; (b) reduce the cap on 

the Fund from $8.4 billion to $5.5 billion; and (c) strike several provisions intended to expand eligibility under the VCF to first responders, recovery workers, and others injured as a result of exposure to World Trade Center toxins during recovery efforts and debris removal. Defeated 9 to 21. 

ROLLCALL NO. 1 

Ayes Nays Present 

Mr. Conyers, Jr., Chairman ............................................................................... X 

Mr. Berman .......................................................................................................

Mr. Boucher .......................................................................................................

Mr. Nadler ......................................................................................................... X 

Mr. Scott ........................................................................................................... X 

Mr. Watt ............................................................................................................ X 

Ms. Lofgren ....................................................................................................... X 

Ms. Jackson Lee ................................................................................................ X 

Ms. Waters ........................................................................................................

Mr. Delahunt .....................................................................................................

Mr. Wexler ......................................................................................................... X 

Mr. Cohen .......................................................................................................... X 

Mr. Johnson ....................................................................................................... X 

Mr. Pierluisi ....................................................................................................... X 

Mr. Quigley ........................................................................................................ X 

Mr. Gutierrez .....................................................................................................

Mr. Sherman ..................................................................................................... X 

Ms. Baldwin ...................................................................................................... X 

Mr. Gonzalez ...................................................................................................... X 

Mr. Weiner ......................................................................................................... X 

Mr. Schiff .......................................................................................................... X 

Ms. Sa ́nchez ...................................................................................................... X 

Ms. Wasserman Schultz ....................................................................................

Mr. Maffei ......................................................................................................... X 

Mr. Smith, Ranking Member ............................................................................. X 

Mr. Sensenbrenner, Jr. ...................................................................................... X 

Mr. Coble ........................................................................................................... X 

Mr. Gallegly .......................................................................................................

Mr. Goodlatte ....................................................................................................

Mr. Lungren ....................................................................................................... X 

Mr. Issa ............................................................................................................. X 

Mr. Forbes ......................................................................................................... X 

Mr. King ............................................................................................................ X 

Mr. Franks ......................................................................................................... X 

Mr. Gohmert ...................................................................................................... X 

Mr. Jordan ......................................................................................................... X 

Mr. Poe .............................................................................................................. X 


jbell on DSKDVH8Z91PROD with REPORTS
36 

ROLLCALL NO. 1—Continued 

Ayes Nays Present 

Mr. Chaffetz ......................................................................................................

Mr. Rooney ........................................................................................................ X 

Mr. Harper .........................................................................................................

Total ................................................................................................ 9 21 

2. Motion to order the bill favorably reported as amended. Approved 22–9. 

ROLLCALL NO. 2 

Ayes Nays Present 

Mr. Conyers, Jr., Chairman ............................................................................... X 

Mr. Berman .......................................................................................................

Mr. Boucher .......................................................................................................

Mr. Nadler ......................................................................................................... X 

Mr. Scott ........................................................................................................... X 

Mr. Watt ............................................................................................................ X 

Ms. Lofgren ....................................................................................................... X 

Ms. Jackson Lee ................................................................................................ X 

Ms. Waters ........................................................................................................

Mr. Delahunt .....................................................................................................

Mr. Wexler ......................................................................................................... X 

Mr. Cohen .......................................................................................................... X 

Mr. Johnson ....................................................................................................... X 

Mr. Pierluisi ....................................................................................................... X 

Mr. Quigley ........................................................................................................ X 

Mr. Gutierrez .....................................................................................................

Mr. Sherman ..................................................................................................... X 

Ms. Baldwin ...................................................................................................... X 

Mr. Gonzalez ...................................................................................................... X 

Mr. Weiner ......................................................................................................... X 

Mr. Schiff .......................................................................................................... X 

Ms. Sa ́nchez ...................................................................................................... X 

Ms. Wasserman Schultz .................................................................................... X 

Mr. Maffei ......................................................................................................... X 

Mr. Smith, Ranking Member ............................................................................. X 

Mr. Sensenbrenner, Jr. ...................................................................................... X 

Mr. Coble ........................................................................................................... X 

Mr. Gallegly .......................................................................................................

Mr. Goodlatte ....................................................................................................

Mr. Lungren ....................................................................................................... X 

Mr. Issa ............................................................................................................. X 

Mr. Forbes ......................................................................................................... X 

Mr. King ............................................................................................................ X 

Mr. Franks ......................................................................................................... X 

Mr. Gohmert ......................................................................................................

Mr. Jordan ......................................................................................................... X 

Mr. Poe .............................................................................................................. X 

Mr. Chaffetz ...................................................................................................... X 

Mr. Rooney ........................................................................................................ X 

Mr. Harper .........................................................................................................

Total ................................................................................................ 22 9 

COMMITTEE OVERSIGHT FINDINGS

In compliance with clause 3(c)(1) of rule XIII of the Rules of the 

House of Representatives, the Committee advises that the findings 

and recommendations of the Committee, based on oversight activities under clause 2(b)(1) of rule X of the Rules of the House of RepVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00036 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
37 

resentatives, are incorporated in the descriptive portions of this report. 

NEW BUDGET AUTHORITY AND TAX EXPENDITURES

In compliance with clause 3(c)(2) of rule XIII of the House of 

Representatives, the Committee adopts the estimate prepared by 

the Director of the Congressional Budget Office printed below. 

CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

In compliance with clause 3(c)(3) of rule XIII of the House of 

Representatives, the Committee sets forth, with respect to the bill, 

H.R. 847, the following estimate and comparison prepared by the 

Director of the Congressional Budget Office under section 402 of 

the Congressional Budget Act of 1974: 

U.S. CONGRESS, CONGRESSIONAL BUDGET OFFICE, Washington, DC, June 25, 2010. 

Hon. JOHN CONYERS, Jr., Chairman, 

Committee on the Judiciary, 

House of Representatives, Washington, DC. 

DEAR MR. CHAIRMAN: The Congressional Budget Office has prepared the enclosed cost estimate for H.R. 847, the ‘‘James Zadroga 

9/11 Health and Compensation Act of 2010.’’ As you requested, 

CBO has completed an estimate that reflects Title I of the bill as 

ordered reported by the Committee on Energy and Commerce and 

Title II as ordered reported by the Committee on the Judiciary. 

If you wish further details on this estimate, we will be pleased 

to provide them. The CBO staff contacts are Stephanie Cameron 

(Title I), who can be reached at 226–9010, and Leigh Angres (Title 

II), who can be reached at 226–2700. 

Sincerely, 

DOUGLAS W. ELMENDORF, DIRECTOR. 

Enclosure 

cc: Honorable Lamar S. Smith. 

Ranking Member 

Identical letter sent to the Honorable Henry A. Waxman. 

H.R. 847—James Zadroga 9/11 Health and Compensation Act of 

2010. 

Title I as ordered reported by the House Committee on Energy 

and Commerce on May 25, 2010, and 

Title II as ordered reported by the House Committee on the Judiciary on July 29, 2009. 

SUMMARY

H.R. 847 would establish the World Trade Center (WTC) Health 

Program and extend and expand eligibility for compensation under 


jbell on DSKDVH8Z91PROD with REPORTS
38 

the September 11th Victim Compensation Fund (VCF) of 2001. 

Specifically, H.R. 847 would provide: 

• Health care benefits for eligible emergency personnel who responded to the September 11, 2001, terrorist attacks (the 

terrorist attacks) in New York City, the Pentagon, and 

Shanksville, Pennsylvania, and for workers who participated 

in recovery and cleanup following the attacks (collectively referred to as responders in this estimate); 

• Health care benefits for eligible residents and others present 

in the area of New York City near the World Trade Center 

(defined as survivors under the bill); and 

• Monetary compensation to individuals eligible under the bill 

to submit claims for death and physical injury claims resulting from the attacks. 

CBO estimates that enacting H.R. 847 would increase direct 

spending by $7.2 billion over the 2011–2015 period and $10.5 billion over the 2011–2020 period. Pay-as-you-go procedures apply because enacting the legislation would affect direct spending. 

In addition, we estimate that, subject to appropriation of the necessary amounts, administering the VCF awards process would cost 

$514 million over the next 10 years. However, assuming appropriation actions consistent with title I of the bill, CBO estimates a $688 

million reduction in discretionary outlays over the 2011–2020 period because some spending that is currently funded by annual appropriations would become direct spending under the bill. On balance, CBO estimates that discretionary spending would decrease by 

$174 million over 10 years. 

H.R. 847 contains no intergovernmental mandates as defined in 

the Unfunded Mandates Reform Act (UMRA). 

H.R. 847 would impose a private-sector mandate as defined in 

UMRA. The bill would impose a mandate on individuals seeking 

compensatory damages or other relief arising from or related to debris removal from sites of the terrorist attacks by limiting the liability of entities from which individuals might win compensation. 

CBO cannot determine whether the aggregate cost of complying 

with that mandate would exceed the threshold established by 

UMRA for private-sector mandates in 2011 ($141 million in 2010, 

adjusted annually for inflation). 

ESTIMATED COST TO THE FEDERAL GOVERNMENT

The estimated budgetary impact of H.R. 847 is shown in the following table. The costs of this legislation fall within budget functions 550 (health), 570 (Medicare), and 750 (administration of justice). 

BASIS OF ESTIMATE

For this estimate, CBO assumes that H.R. 847 will be enacted 

by the end of fiscal year 2010. H.R. 847 would provide health benefits and compensation to those who qualify based on a combination 

of factors, including where they were exposed to hazardous conditions following the terrorist attacks, and their current and expected 

future health conditions. CBO’s estimate is based on an analysis of 

the size of the potentially affected populations, the prevalence of 


jbell on DSKDVH8Z91PROD with REPORTS
39 

certain health conditions in those populations, the propensity to 

seek health services or compensation from the program, and the 

monetary damages previously awarded by the VCF through 2004. 

Under H.R. 847, spending for the WTC Health Program and VCF 

awards would increase direct spending, while the administrative 

costs associated with the VCF would be subject to future appropriations. Expenditures related to the WTC Health Program would be 

subject to annual spending caps totaling about $4.6 billion through 

2020, when the program would sunset. Award payments under the 

VCF would be subject to a lifetime spending cap of $8.4 billion 

through 2032, when the program would cease operation. 

On June 10, 2010, a Federal district court judge approved a settlement between firefighters, police, contractors, and others who 


jbell on DSKDVH8Z91PROD with REPORTSHR847A-1.eps
40 

worked at the World Trade Center site, and New York City and its 

contractors for claims of injuries associated with their rescue and 

cleanup work. To become final, the settlement requires the participation of 95 percent of the plaintiffs, who have yet to agree to the 

terms. Should that settlement become final, CBO expects that the 

number and value of compensation awards provided through the 

VCF would be lower than presented in this cost estimate for H.R. 

847. 

Eligible Population 

CBO’s analysis focused on two populations—responders and survivors. The responder population includes those who were involved 

in the rescue, recovery, and cleanup efforts following the terrorist 

attacks in 2001. Survivors include commuters, residents, ‘‘passersby,’’ and students who were in the New York City (NYC) disaster 

area around the time of the attacks and in the months following. 

Under H.R. 847, CBO estimates that roughly 650,000 individuals 

from the NYC disaster area—approximately 75,000 responders and 

575,000 survivors—would meet the exposure requirements specified in the legislation, along with potentially another 10,000 responders from the Pentagon and Shanksville, Pennsylvania, sites. 

Although many of those individuals may have or develop health 

conditions related to the terrorist attacks, CBO estimates that only 

a portion would participate in the WTC Health Program and apply 

for an award under the VCF. Overall, CBO expects that of the total 

population that meets the exposure requirements, slightly less than 

15 percent would enroll in the WTC Health Program by 2020 and 

slightly more than 5 percent would receive awards from the VCF. 

Those estimated participation rates reflect people’s willingness to 

enroll in government programs as well as additional requirements 

that would have to be met to receive a VCF award. 

Geographic and Time-Period Requirements. Title I specifies 

that individuals must have been present in the following locations 

following the terrorist attacks to be eligible for the new health program: NYC disaster area, the Pentagon site, and the Shanksville, 

Pennsylvania, site. Title II would give discretion to the VCF Special Master (appointed by the U.S. Attorney General to administer 

the fund) to define the geographic area for awards from that fund; 

for this estimate, CBO assumes that the geographic areas of exposure specified in title I would also be used as the criteria for compensation payments under title II. Title I defines the NYC disaster 

area as the part of Manhattan that is south of Houston Street and 

any block in Brooklyn that is wholly or partially contained within 

a 1.5-mile radius of the former World Trade Center site. H.R. 847 

would also base eligibility on the amount of time an individual 

spent in the specified region. Based on those requirements, CBO 

estimates that about 75,000 responders and 575,000 survivors from 

the NYC disaster area would meet the geographic-eligibility and 

time-period requirements specified in H.R. 847, as well as potentially another 10,000 responders from the Pentagon and Shanksville, Pensylvania, sites. 

Those estimates are based on information collected by certain 

hospitals (known as the Centers of Excellence) in the NYC area 

that are treating responders, New York City’s Department of 

Health and Mental Hygiene, the U.S. Department of Health and 


jbell on DSKDVH8Z91PROD with REPORTS
41 

Human Services, Research Triangle International, and New York 

State Laborers’ Tri-Fund. In particular, CBO’s analysis relies heavily on the WTC Health Registry which was developed by New York 

City’s Department of Health and Mental Hygiene and the U.S. Department of Health and Human Services (HHS) to document and 

evaluate the short- and long-term physical and mental health 

issues associated with the terrorist attacks and recovery efforts. 

The Registry established eligibility criteria that considered an individual’s residence, location at the time of attacks, and intensity and 

duration of exposure to hazardous conditions. About 71,000 individuals enrolled voluntarily in this Registry before it closed in November 2004. 

Diseases. The bill would require a determination that the terrorist attacks were substantially likely to be a significant factor in 

aggravating, contributing to, or causing the condition or illness 

prior to receiving treatment through the WTC Health Program. 

Title I would specify certain physical and mental health conditions 

deemed WTC-related for both responders and survivors. Title II 

would give discretion to the Special Master to determine what 

physical conditions would be eligible for an award; for this estimate, CBO assumes that the diseases specified in title I would also 

be used as criteria for compensation payments. 

In general, individuals whose health conditions developed or 

were aggravated as a result of the terrorist attacks cannot easily 

be distinguished from individuals whose conditions would have developed or worsened in the absence of those attacks. Therefore, 

CBO considered the entire population that may develop and seek 

treatment for eligible physical and mental health conditions that 

might be associated with the aftermath of the terrorist attacks. The 

existence of a causal relationship between the attacks and specific 

diseases generally would be difficult to establish or disprove. 

CBO analyzed more than a dozen studies on the incidence and 

prevalence of the WTC-related health conditions in both responders 

and survivors. We also analyzed data collected in the Morbidity 

and Mortality Weekly Report (MMWR) and population level data 

collected by the Medical Expenditure Panel Survey (MEPS). The 

MEPS collects annual data pertaining to the use of health care 

services, sources of payment for those services, and health insurance coverage. Based on those analyses, CBO estimates that about 

280,000 of the individuals (about 40 percent) who meet the exposure criteria defined in the legislation have or will develop a health 

condition that meets the criteria set in the bill. 

Responders who meet the geographic-eligibility criteria and survivors who both meet the geographic-eligibility criteria and develop 

a qualifying physical or mental health condition, as defined in the 

bill, would be eligible to enroll in the WTC Health Program. CBO 

estimates that about 50,000 responders and 230,000 survivors 

would develop at least one qualifying physical or mental health 

condition. That estimate reflects the prevalence of the eligible conditions among the general population as well as the increase in 

prevalence attributable to the attacks themselves. 

Eligibility for an award under the VCF would differ from that for 

the WTC Health Program. The VCF would only compensate individuals with physical health conditions who have received treatVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00041 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
42 

ment. CBO estimates that about 100,000 responders and survivors 

would meet those criteria. 

Direct Spending 

CBO estimates that enacting H.R. 847 would increase direct 

spending by $10.5 billion over the 2011–2020 period. About $4.2 

billion of that amount would result from spending for health care 

benefits provided under title I. The remaining $6.3 billion would be 

spent on compensation payments provided under title II. 

Title I: Health Care Benefits. Under current law, the National 

Institute of Occupational Safety and Health (NIOSH) provides 

funding to several programs that offer medical monitoring and 

treatment to responders and survivors with conditions associated 

with the September 11, 2001, terrorist attacks under the umbrella 

of the WTC Medical Monitoring and Treatment Program. Those 

programs treat or have enrolled approximately 60,000 individuals: 

about 40,000 in the Mt. Sinai Coordinated Consortium Responder 

Heath Program and the National Responder Program; about 16,000 

in the Fire Department City of New York Responder Health Program; and about 4,600 survivors in the WTC Environmental 

Health Center Program. Funding for those programs is subject to 

annual appropriation. For 2010, $70 million was appropriated to 

NIOSH through the Centers for Disease Control and Prevention 

(CDC) to support those programs. 

H.R. 847 would establish the WTC Health Program within HHS 

to replace and expand the NIOSH programs. The WTC Health Program would provide monitoring and treatment benefits for qualifying health conditions to individuals who were engaged in emergency response, recovery, and cleanup operations related to the terrorist attacks. It also would provide monitoring and treatment benefits to certain residents and others with a qualifying health condition who were working, visiting, or residing near the WTC during 

the year following the attacks. H.R 847 would replace annual appropriations for the NIOSH programs with mandatory funding for 

the WTC Health Program. (An estimated reduction in authorized 

discretionary spending is discussed below under ‘‘Spending Subject 

to Appropriation.’’) 

CBO estimates that, if unconstrained, the WTC Health Program 

would cost between $5 billion and $6 billion over the 2011–2020 period. In contrast, the cap on Federal spending specified in H.R. 847 

is about $4.6 billion over that same period. Taking that spending 

cap into consideration, CBO estimates that gross spending would 

total $4.4 billion over the 2011–2020 period. The WTC Health Program also would result in some savings for Medicare and Medicaid, 

yielding a net increase in direct spending of $4.2 billion over the 

2011–2020 period, as shown in the table on page 3. CBO also estimates that New York City would contribute $0.5 billion to the 

WTC Health Program over the 2011–2020 period. 

Program Participation. The WTC Health Program would cover 

individuals enrolled in the existing programs as of the date of enactment and would allow up to an additional 25,000 responders 

and 25,000 survivors to enroll in the program. H.R. 847 defines exposure and health criteria for an eligible WTC responder and an 

eligible WTC survivor. The program’s administrator would be alVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00042 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
43 

lowed to expand those eligibility criteria until 80 percent of the numerical limitation is reached. 

CBO estimates that about 65,000 of the approximately 85,000 responders at the various sites who would meet the exposure criteria 

would enroll in the WTC Health Program and that about 20 percent of those enrollees would receive treatment through the program in a given year. We estimate that about 250,000 individuals, 

or roughly 40 percent of the approximately 575,000 survivors who 

would meet those criteria, would also meet the health condition criteria specified in title I of H.R. 847. CBO expects that less than 10 

percent of those individuals would enroll in the WTC Health Program by 2020. In part, this estimate reflects the expectation that 

most individuals will continue to receive care from providers who 

are not affiliated with a Center of Excellence or the WTC Health 

Program. CBO further expects that, in a given year, slightly less 

than half of the enrolled survivors would receive treatment through 

the WTC Health Program. 

Survivor and Responder Health Benefits. H.R. 847 would 

provide for health benefits, including monitoring and medically necessary follow-up treatment for enrolled responders. Survivors 

would receive an initial health evaluation to determine program 

eligibility. Once eligibility is determined, H.R. 847 would provide 

for monitoring and medically necessary follow-up treatment for survivors. Monitoring, initial health evaluations, and medically necessary follow-up would only be covered when provided by Centers 

of Excellence or by providers who participate in the nationwide network established by the WTC program administrator. The WTC 

Health Program would also provide funding for coordination and 

administrative expenses for the Centers of Excellence. CBO estimates that the cost of the health benefits program (including initial 

health evaluations, monitoring, treatment, and administration) 

would total up to $4.5 billion over the 2011–2020 period. That 

amount comprises about $4.2 billion for monitoring and medically 

necessary treatment and $0.3 billion for administrative costs. 

The WTC Health Program would pay for the monitoring and 

medically necessary treatment costs associated with a qualifying 

health condition that are not covered by a patient’s primary insurer, including deductibles, copayments, coinsurance, and other 

cost-sharing requirements. (As a practical matter, the WTC Health 

Program would be the primary insurer for individuals covered by 

Medicare.) H.R. 847 specifies a series of WTC-related health conditions; however, H.R. 847 would authorize the administrator to approve conditions and illnesses not specified in the legislation but 

deemed to be a WTC-related health condition for treatment. The 

administrator could also add illnesses and conditions to the list of 

WTC-related health conditions through the rulemaking process, 

which might include requesting a recommendation of the Advisory 

Panel. In addition, for an individual, a condition not on the list 

would be deemed to be WTC-related if a physician determines that 

it was likely to have been caused or aggravated by exposure to the 

terrorist attacks. 

CBO estimated the cost of treatment for WTC-related health conditions using data from MEPS, Medicare, and the Federal Employees Compensation Act (FECA) program. CBO analyzed MEPS data 

to estimate the national average cost of treating qualifying condiVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00043 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
44 

1For responders employed by New York City, all WTC-related conditions would be considered 

work-related. The legislation would relieve the city’s worker’s compensation program or other 

work-related injury or illness benefit plan of the obligation to pay for those conditions in return 

for the city’s participation in the financing of the WTC Health Program. 

tions. Those costs were then adjusted to reflect the relative costs 

in New York City—spending per Medicare enrollee is about 20 percent higher in New York City than the national average—and to 

account for differences between payment rates in the FECA program and those underlying our estimate of national average cost. 

Those costs were then projected based on CBO’s estimates of 

growth in per capita health spending. The administrator would be 

required to establish a program for necessary outpatient prescription pharmaceuticals prescribed under this title through contracts 

with one or more vendors. Separately, CBO estimated the cost of 

outpatient prescription drugs and assumed that those payment 

amounts would be comparable to prices paid in the private market. 

The WTC Health Program would be the secondary payer for survivors with private insurance or Medicaid coverage and for responders receiving benefits from a non-NYC worker’s compensation 

or other work-related injury or illness benefit plan. For those individuals, the program would pay the difference between FECA payment rates and the amounts paid by the primary insurer; the individual would have no out-of-pocket obligation.1 CBO estimates that 

primary insurers would cover about 60 percent of the cost of treating WTC-related health conditions for those individuals, with the 

WTC Health Program paying the rest. 

CBO estimates that Federal spending for Medicaid would be re- duced by about $30 million over the 2011–2020 period. Those savings would occur largely because, in some cases, providers would 

bill the WTC Health Program instead of Medicaid to avoid the administrative cost of dealing with two payers. 

The WTC Health Program would reduce Medicare spending because it would replace Medicare as the primary payer for individuals enrolled in Medicare. CBO estimates that Medicare savings 

would total about $155 million over the 2011–2020 period. 

CBO estimates that costs incurred to administer health evaluations, monitor, and provide treatment would total up to $0.3 billion 

over the 2011–2020 period. H.R. 847 would direct the administrator to enter into contracts with Clinical Centers of Excellence to 

provide monitoring and treatment benefits and initial health evaluations, counseling, outreach, translational and interpretive services, and to collect and report on utilization, incidence, and prevalence data. 

Other Health Benefits and Program Funding. H.R. 847 would 

provide funding for: 

• Mental health benefits for surviving family members of responders who died at the WTC site on September 11, 2001; 

• Creation of a scientific committee and technical advisory 

committee; 

• Education and outreach; 

• Uniform data collection; 

• Research pertaining to conditions related to the September 

11, 2001, terrorist attacks; and 


jbell on DSKDVH8Z91PROD with REPORTS
45 

• Maintaining ongoing data collection through the WTC health 

registry. 

The bill specifies a maximum amount for each of those activities. 

CBO estimates that the costs of those activities would total up to 

$0.5 billion over the 2011–2020 period. In addition, H.R. 847 would 

provide funding for training and technical assistance, transportation expenses, and claims processing. CBO estimates that the 

costs of those activities would total an additional $0.2 billion over 

the 2011–2020 period. Thus, the total cost of other activities would 

total up to $0.7 billion over the 2011–2020 period. 

World Trade Center Health Program Fund. H.R. 847 would establish the WTC Health Program Fund to pay for the benefits included under title I. New York City and the Federal Government 

would contribute to the fund based on percentages and amounts 

provided in the legislation. 

The legislation would authorize implementation of the WTC 

Health Program only if New York City enters into a contract with 

the WTC program administrator in which the city agrees to pay 10 

percent of program costs. This estimate assumes that the city 

would enter into that contract and that the city would reimburse 

the WTC Health Program within six to nine months. (Alternatively, if the city would not enter into a contract with the administrator, CBO expects that no payments would be made from the 

WTC Health Program Fund, resulting in no increase in direct 

spending over the 2011–2020 period.) 

The Federal Government would be required to contribute the 

lesser of 90 percent of the program expenditures or an annual 

amount specified in the legislation. That cap on Federal spending 

would rise from $71 million in 2011 to $743 million in 2020 and 

would total about $4.6 billion over the 2011–2020 period. 

In the absence of a cap, CBO estimates that the Federal share 

of annual expenditures for the WTC Health Program would probably be about 1 percent to 5 percent higher than the annual caps. 

However, CBO’s cost estimate targets the midpoint of a distribution of likely spending outcomes. Establishing a cap on annual 

spending truncates that distribution of likely outcomes by eliminating the potential for spending above the cap. Therefore, the 

middle of the truncated range of likely spending outcomes would be 

slightly below the cap. As a result, CBO estimates that Federal 

spending would total about $4.4 billion over the 2011–2020 period. 

H.R. 847 would require New York City to cover 10 percent of the 

expenditures for carrying out title I. If the city pays its share, the 

WTC Health Program would assume responsibility for treatment 

costs for responders that would under current law be the responsibility of the city’s worker’s compensation or other work-related injury or illness benefit plan. Late payments from the city would accrue interest on the unpaid amount. For the purpose of our estimate, we assume that New York City would make payments on 

time. If the city fails to pay pursuant to its contract with the administrator and interest accrues on the unpaid amount, the Federal expenditures would reach the cap more quickly. 

CBO estimates that the city of New York would contribute about 

$0.5 billion over the 2011–2020 period. 


jbell on DSKDVH8Z91PROD with REPORTS
46 

Title II: Compensation Payments. Title II would reopen the 

September 11, 2001, Victim Compensation Fund, which provided 

compensation to any individual (or relatives of a deceased individual) who was physically injured or killed as a result of the terrorist attacks. The VCF, which terminated operations in 2004, was 

established by the Air Transportation Safety and System Stabilization Act (Public Law 107–42) as an administrative alternative to 

litigation. That act created a Special Master, who determined the 

compensation levels based on specified eligibility criteria and subsequent regulations. Through 2004, the VCF made 2,880 death and 

2,680 injury awards, totaling more than $7 billion (about $6 billion 

was for death awards). Public Law 107–42 did not cap the number 

or amount of awards that could be issued by the Special Master. 

H.R. 847 would establish broader eligibility rules for compensation than those established for the VCF under Public Law 107–42. 

Under the bill, total payments would be capped at $8.4 billion 

through 2032. CBO estimates that compensation payments would 

total $6.3 billion over the 2011–2020 period, with about 90 percent 

($5.7 billion) of those payments made in the first five years following enactment. Most of the awards would be for physical injuries associated with the attacks or with debris removal and response activities following the attacks. CBO estimates that the 

VCF would make additional payments totalling about $300 million 

after 2020. 

CBO’s estimate of those payments is based on a number of assumptions and projections regarding eligibility, average award 

amounts, and attorneys’ fees. 

Changes in Eligibility. Title II would make many more individuals who were involved in the rescue, recovery, and cleanup efforts 

potentially eligible for compensation. Based on information provided by the previous Special Master of the VCF, CBO assumes 

that the VCF would be administered in the same manner as it was 

previously but would reflect new regulations written after the bill’s 

enactment. Those regulations would reflect the following changes 

made by the bill: 

• Time Present at Site: Eligibility would be determined in part 

based on the time an individual was present or near the 

sites of the terrorist attacks. Specifically, the bill would require that an eligible individual must have been at those 

sites some time during the period beginning on September 

11, 2001, and ending on August 30, 2002. Prior to the sunset 

of the original VCF, the implementing regulations required 

that an individual had to have been present at those sites 

during the 12 hours immediately following the attacks, or for 

responders, 96 hours after the attacks. 

• Geographical Expansion: Based on regulations promulgated 

under Public Law 107–42, the Special Master originally defined the crash site as a zone bounded by specific streets 

very close to the WTC area. H.R. 847 would expand the definition of the crash site to include routes related to debris removal (such as barges and landfills). Although the bill does 

not specify other changes to the site definition, the Special 

Master would have discretion to expand the site if it is determined that there was demonstrable risk of physical harm in 


jbell on DSKDVH8Z91PROD with REPORTS
47 

adjacent areas. For this estimate, CBO assumes that the 

new regulations would extend the boundaries to be the same 

as those defined for eligibility for the health care benefits authorized in title I of the bill. 

• Extended Claims Filing Deadlines: Generally, the filing 

deadline under the bill would depend primarily on when the 

Special Master determines that a claimant realizes that he 

or she suffered some form of physical harm resulting from 

the terrorist attacks or associated debris removal. If the Special Master determines that a claimant was aware (or should 

have been aware) of such an injury by the time the regulations are promulgated, the claimant would have two years to 

file from that time (roughly by the end of December 2012). 

For all others, if a claimant realizes such an injury after the 

new regulations are finalized, the claimant would have two 

years from when the Special Master determines that the 

claimant should have been aware of such injury. All claims 

would have to be filed by December 22, 2031. 

Awards and Average Award Amount. CBO expects that the bill’s 

expanded eligibility criteria would significantly increase the number of individuals who could seek compensation from the VCF. 

CBO expects that most of the awards would be for injuries associated with the attacks, and therefore our analysis focused on those 

claims. Further, the bill would not provide compensation for mental 

health conditions although it would provide treatment for mental 

illnesses under title I. Over the next 10 years, CBO estimates that 

about 35,000 awards would be made, with an average award 

amount of about $180,000. 

• Number of Awards: CBO expects that the number awards 

would depend largely on the estimated number of responders 

and survivors who have or will have health conditions or 

symptoms associated with the terrorist attacks and recovery 

efforts, and are being treated for such conditions. Under H.R. 

847, the VCF would require that all claimants prove they 

were treated by medical professionals and provide contemporaneous medical records to verify that treatment. CBO estimates that about 100,000 individuals—nearly 25,000 responders and more than 75,000 survivors—would meet that 

additional eligibility requirement. 

CBO estimated the proportion of those individuals who 

would file a claim by reviewing studies on the propensity of 

individuals to seek legal remedy for injuries. Although CBO 

estimates that the overall claim rate would be a bit under 

50 percent, we expect that responders would have a much 

higher filing rate than survivors because of their involvement in the existing treatment programs at the Centers of 

Excellence and because of the efforts by certain union organizations to publicize the possible health issues associated 

with the cleanup efforts. 

Taking into account the VCF’s previous approval rate and 

the approval rates of other compensation programs, CBO estimates that about 35,000 awards would be made, including 

payments to nearly 20,000 responders and 15,000 survivors. 

CBO expects that the number of death claims would be very 


jbell on DSKDVH8Z91PROD with REPORTS
48 

small because there is little evidence that many individuals 

have died from injuries caused by the 2001 terrorist attacks 

after compensation benefits were first awarded. 

• Average Award Amount: Under the bill, award amounts 

would be determined in the same way as they were before 

the sunset of the original VCF. Awards would comprise two 

parts—economic and noneconomic loss—adjusted for collateral offsets such as pensions. For injury victims, economic 

loss would reflect the actual lost income or expenses incurred 

as a direct result of the injury and future lost income and 

costs due to those injuries. Noneconomic loss would reflect 

compensation for pain and suffering due to injuries associated with the attacks. Awards, which would be provided in 

one payment, would be determined within 120 days of filing 

the claim and paid within 20 days of such determination. 

Based on information provided by administrators of the 

previous VCF program, CBO estimates that the average injury award would be about $180,000. (For death claims, the 

average award would be about $2 million, the same amount 

provided under the original VCF.) CBO estimated the average injury award by considering the characteristics of the 

current population enrolled in WTC Medical Monitoring and 

Treatment Programs, including average age, extent of disability, estimated income, and employer-provided benefits 

such as pensions and health insurance. CBO estimates that 

the average award would be higher for responders—about 

$240,000 per claim—because we expect that a greater proportion of responders have more serious injuries. In contrast, 

we estimate that awards for survivors would average about 

$100,000. The award estimates also were adjusted to account for certain health care benefits provided under title I. 

Attorneys’ Fees. This estimate does not include any significant 

additional costs for attorneys’ compensation that the Special Master could award under the bill. The bill would give the Special Master discretion to provide compensation to attorneys for services rendered on cases filed in district court for injuries associated with the 

terrorist attacks, but CBO expects that this authority would be 

used sparingly, based on the historical experience of the VCF. Previously, attorneys provided free legal assistance to claimants. 

Spending Subject to Appropriation 

CBO estimates that implementing H.R. 847 would decrease discretionary spending by $174 million over the 2011–2020 period. 

Administering VCF Awards. Under H.R. 847, additional funding would be required to administer the VCF. The original compensation program was administered by the Department of Justice’s (DOJ’s) Civil Division. About $87 million was spent to process 

about 7,400 claims, and the average administrative cost per claim 

was about $11,500. Under the bill, CBO assumes that DOJ would 

again administer and oversee the program. 

Based on information provided by DOJ, CBO estimates that the 

average cost to process a claim under H.R. 847 would be about 

$10,000. CBO expects that the average cost would be lower than 

under the original program because the administrative infrastrucVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00048 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
49 

ture already exists and because we assume that certain efficiencies 

would be achieved with a larger number of claims. In total, CBO 

estimates that, assuming appropriation of the necessary amounts, 

administrative costs for the program would total $483 million over 

2011–2015 period and $514 million over the 2011–2020 period to 

process an estimated 50,000 claims, including many from individuals who would not qualify for an award. Most of that amount 

would be for salaries of hundreds of individuals to process millions 

of documents, operate a claims management system, and manage 

20 to 30 claims-assistance sites around the country. Compensation 

also would be provided for DOJ attorneys, administrative law 

judges, and support staff. 

NOISH World Trade Center Health Program. As discussed 

above, the enactment of H.R. 847 would replace annual appropriations with mandatory funding for NIOSH through CDC. Under the 

current-law baseline, CBO projects that discretionary appropriations will continue at the current level of funding adjusted annually for anticipated inflation. Assuming appropriation actions consistent with the bill, CBO estimates that appropriations for NIOSH 

would be reduced by $71 million in 2011 and increasing amounts 

in subsequent years because that baseline spending would be replaced by new direct spending under H.R. 847. We estimate that 

the reduction in appropriations would total $764 million over the 

2011–2020 period, resulting in a corresponding reduction in outlays 

of $688 million over the same period. 

PAY-AS-YOU-GO CONSIDERATIONS

The Statutory Pay-As-You-Go Act of 2010 establishes budget reporting and enforcement procedures for legislation affecting direct 

spending or revenues. The net changes in outlays that are subject 

to those pay-as-you-go procedures are shown in the following table. 

ESTIMATED IMPACT ON STATE, LOCAL, AND TRIBAL GOVERNMENTS

H.R. 847 contains no intergovernmental mandates as defined in 

UMRA. The bill would place conditions on the city of New York for 

participating in the health program authorized by the bill, but 

those conditions would not be intergovernmental mandates as defined in UMRA. 


jbell on DSKDVH8Z91PROD with REPORTSHR847A-2.eps
50 

ESTIMATED IMPACT ON THE PRIVATE SECTOR

H.R. 847 would impose a private-sector mandate as defined in 

UMRA by limiting the liability of New York City, any entity with 

a property interest in the World Trade Center on September 11, 

2001, and any contractors and subcontractors thereof. Liability 

would be limited to the total amount of available insurance coverage of those entities for compensatory damages or other relief 

arising from or related to debris removal from sites of the terrorist 

attacks. By limiting the liability of those entities, the bill would impose a mandate on individuals seeking compensatory damages or 

other relief. Because of uncertainty about the potential amount of 

the awards and the ability of the city of New York and other entities whose liability would be limited to pay for any awards in excess of the liability limit, CBO cannot determine the costs the mandate would impose on the affected individuals. 

ESTIMATE PREPARED BY: 

Federal Costs: Stephanie Cameron, Leigh Angres, and Chapin 

White 

Impact on State, Local, and Tribal Governments: Lisa RamirezBranum 

Impact on the Private Sector: Sarah Axeen 

ESTIMATE APPROVED BY: 

Holly Harvey, Deputy Assistant Director for Budget Analysis 

PERFORMANCE GOALS AND OBJECTIVES

The Committee states that pursuant to clause 3(c)(4) of rule XIII 

of the Rules of the House of Representatives, H.R. 847 will establish a program to provide health care monitoring and treatment to 

persons injured during recovery efforts and debris removal at September 11, 2001 crash sites, and it will reopen the September 11 

Victim Compensation Fund to provide compensation for such injured individuals. 

CONSTITUTIONAL AUTHORITY STATEMENT

Pursuant to clause 3(d)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee finds the authority for this legislation in article I, section 8, clause 3 of the Constitution. 

ADVISORY ON EARMARKS

In accordance with clause 9 of rule XXI of the Rules of the House 

of Representatives, H.R. 847 does not contain any congressional 

earmarks, limited tax benefits, or limited tariff benefits as defined 

in clause 9(d), 9(e), or 9(f) of Rule XXI. 

SECTION-BY-SECTION ANALYSIS

The following discussion describes the bill as reported by the 

Committee. 

Sec. 1. Short Title; Table of Contents. Section 1 sets forth the 

short title of the bill as the ‘‘James Zadroga 9/11 Health and ComVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00050 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
51 

pensation Act of 2010.’’ The section also sets forth the table of contents of the bill. 

Sec. 2. Findings. Section 2 sets forth several findings of Congress. 

Sec. 101. World Trade Center Health Program. Section 101 

amends the Public Health Service Act to establish the World Trade 

Center Health Program (WTC program) within the National Institute for Occupational Safety and Health to provide medical monitoring and treatment benefits to emergency responders, recovery 

and cleanup workers, area residents and others who were directly 

impacted and adversely affected by the attacks of September 11, 

2001. 

Sec. 201. Definitions. Section 201 amends the original Victim 

Compensation Fund provisions within the Air Transportation Safety and System Stabilization Act as follows: 

• amends the definition of ‘‘collateral source’’ by including payments related to debris removal; 

• defines ‘‘contractor and subcontractor’’ to mean any entity 

that participated in debris removal at any September 11 

crash site, except for any such entity with a property interest 

in the World Trade Center on September 11, 2001; 

• defines ‘‘debris removal’’ to mean rescue and recovery efforts, 

removal of debris, cleanup, remediation, and response during 

the immediate aftermath of the September 11 attacks; 

• defines ‘‘immediate aftermath’’ to mean any period beginning 

with the terrorist-related aircraft crashes of September 11, 

2001, and ending on August 30, 2002; and 

• defines ‘‘9/11 crash site’’ to mean: (1) the World Trade Center, Pentagon, and Shanksville, Pennsylvania crash sites; (2) 

the buildings or portions of buildings destroyed as a result 

of the September 11 aircraft crashes; (3) any areas contiguous to the site of such crashes that the Special Master determines are sufficiently close to the site so that there was 

a demonstrable risk of physical harm resulting from the impact of the aircraft or any subsequent fire, explosions, or 

building collapses; and (4) any area related to, or along, 

routes of debris removal, such as barges and Fresh Kills. 

Sec. 202. Extended and Expanded Eligibility for Compensation. 

Section 202 amends the Air Transportation Safety and System Stabilization Act to generally extend and expand eligibility for compensation under the Victim Compensation Fund. 

Subsection (a) requires that the eligibility claim form for compensation benefits be amended to also request information concerning physical harm or death resulting from debris removal related to the September 11 attacks. 

Subsection (b) provides new deadlines for claims related to physical harm or death from debris removal at the crash sites that 

would extend to December 22, 2031. 

Subsection (c) establishes timing and proof requirements for 

claims filed during the extended filing period. 

Subsection (d) makes a technical correction to the original Victims Compensation Fund to clarify that claimants may include individuals who were present at other September 11 aircraft crash 


jbell on DSKDVH8Z91PROD with REPORTS
52 

sites at the time of, or in the immediate aftermath of, the aircraft 

crashes. 

Subsection (e) amends the eligibility requirements for claimants 

to include individuals who suffered physical harm resulting from 

debris removal. 

Subsection (f) requires an individual filing a claim for compensation related to debris removal to waive his or her right to file a civil 

action or be party to such action in any Federal or state court for 

damages sustained as the result of the September 11 terrorist attacks. Any individual who was a party to such action, withdrew 

from such action in order to submit a claim for compensation, and 

was found ineligible for compensation, is permitted to reinstitute 

the civil action without prejudice during the 90-day period after ineligibility is determined. 

Sec. 203. Requirement to Update Regulations. Section 203 

amends the Air Transportation Safety and System Stabilization 

Act to require the Special Master to update, within 90 days of enactment, VCF regulations to reflect the changes made by this Act. 

Sec. 204. Limited Liability for Certain Claims. Section 204 

amends the Air Transportation Safety and System Stabilization 

Act to limit the liability of certain entities for civil claims and actions arising from or related to debris removal, including claims or 

actions previously resolved, currently pending, and that may be 

filed through December 22, 2031. Liability for such claims or actions is limited to the amount of funds held by the World Trade 

Center Captive Insurance Company, the amount of available insurance coverage identified in schedule 2 of the Captive Insurance 

Company insurance policy, and the amount of insurance coverage 

held by the City of New York, by entities with a property interest 

in the World Trade Center on September 11, 2001, and by contractors and subcontractors that participated in debris removal. 

Section 204 specifically provides that the individual liability of 

the City of New York is limited to the City’s insurance coverage or 

$350,000,000, whichever is greater. The liability of the Port Authority of New York and New Jersey and any other entity with a 

property interest in the World Trade Center on September 11, 2001 

is limited to the amount of all available insurance coverage maintained by any such entity. The liability of any contractor or subcontractor that participated in debris removal is limited to the amount 

of available liability insurance maintained by such contractor or 

subcontractor. 

Section 204 also establishes a priority of funds from which plaintiffs may satisfy judgments or settlements obtained for civil claims 

or actions related to debris removal. The priority requires exhaustion of amounts held by the Captive Insurance Company and identified insurance policies, followed by exhaustion of the amount for 

which the City of New York is liable, followed by exhaustion of the 

available insurance coverage maintained by the Port Authority and 

other entities with a property interest in the World Trade Center 

on September 11, 2001, followed by exhaustion of the available insurance coverage maintained by contractors and subcontractors. In 

addition, section 204 specifies that any party to a claim or action 

can file an action for a declaratory judgment for insurance coverage 

or bring a direct action against the insurance company involved. 


jbell on DSKDVH8Z91PROD with REPORTS
53 

Sec. 205. Funding; Attorney Fees. Section 205 amends the Air 

Transportation Safety and System Stabilization Act to cap the total 

payment of amounts for compensation from the VCF to $8.4 billion 

with respect to claims filed on or after the Special Master updates 

the Fund’s regulations. Section 205 would also cap at 10 percent 

the percentage of compensation that attorneys could receive in fees, 

except that the Special Master is given the discretion to raise this 

percentage for certain cases filed in the Southern District of New 

York prior to January 1, 2009. This discretion is provided to the 

Special Master to address cases where the 10 percent cap on attorneys’ fees may not provide adequate compensation for services rendered in connection with a claim because of the substantial amount 

of legal work expended on that claim during the period after which 

the initial period for filing claims under the VCF expired. 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

The bill was referred to this committee for consideration of such 

provisions of the bill as fall within the jurisdiction of this committee pursuant to clause 2 of rule XII of the Rules of the House 

of Representatives. In compliance with clause 3(e) of rule XIII of 

the Rules of the House of Representatives, changes in existing law 

made by the bill, as reported, are shown as follows (existing law 

proposed to be omitted is enclosed in black brackets, new matter 

is printed in italics, existing law in which no change is proposed 

is shown in roman): 

AIR TRANSPORTATION SAFETY AND SYSTEM 

STABILIZATION ACT 

TITLE IV—VICTIM COMPENSATION 

* * * * * * * 

SEC. 402. DEFINITIONS. 

In this title, the following definitions apply: 

(1) * * * 

* * * * * * * 

(6) COLLATERAL SOURCE.—The term ‘‘collateral source’’ 

means all collateral sources, including life insurance, pension 

funds, death benefit programs, and payments by Federal, 

State, or local governments related to the terrorist-related aircraft crashes of September 11, 2001, or debris removal, including under the World Trade Center Health Program established 

under section 3001 of the Public Health Service Act. 

(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 


jbell on DSKDVH8Z91PROD with REPORTS
54 

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. 

ø(7)¿ (9) ECONOMIC LOSS.—The term ‘‘economic loss’’ means 

any pecuniary loss resulting from harm (including the loss of 

earnings or other benefits related to employment, medical expense loss, replacement services loss, loss due to death, burial 

costs, and loss of business or employment opportunities) to the 

extent recovery for such loss is allowed under applicable State 

law. 

ø(8)¿ (10) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible individual’’ means an individual determined to be eligible for compensation under section 405(c). 

(11) IMMEDIATE AFTERMATH.—The term ‘‘immediate aftermath’’ means any period beginning with the terrorist-related 

aircraft crashes of September 11, 2001, and ending on August 

30, 2002. 

ø(9)¿ (12) NONECONOMIC LOSSES.—The term ‘‘noneconomic 

losses’’ means losses for physical and emotional pain, suffering, 

inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium (other than loss of domestic service), 

hedonic damages, injury to reputation, and all other nonpecuniary losses of any kind or nature. 

ø(10)¿ (13) SPECIAL MASTER.—The term ‘‘Special Master’’ 

means the Special Master appointed under section 404(a). 

(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. 405. DETERMINATION OF ELIGIBILITY FOR COMPENSATION. 

(a) FILING OF CLAIM.— 

(1) * * * 

(2) CLAIM FORM.— 

(A) * * * 


jbell on DSKDVH8Z91PROD with REPORTS
55 

(B) CONTENTS.—The form developed under subparagraph (A) shall request— 

(i) information from the claimant concerning the 

physical harm that the claimant suffered, or in the 

case of a claim filed on behalf of a decedent information confirming the decedent’s death, as a result of the 

terrorist-related aircraft crashes of September 11, 

2001, or debris removal during the immediate aftermath; 

(ii) information from the claimant concerning any 

possible economic and noneconomic losses that the 

claimant suffered as a result of such crashes or debris 

removal during the immediate aftermath; and 

(iii) information regarding collateral sources of compensation the claimant has received or is entitled to 

receive as a result of such crashes or debris removal 

during the immediate aftermath. ø(3) LIMITATION.—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.¿ 

(3) LIMITATION.— 

(A) IN GENERAL.—Except as provided by subparagraph 

(B), no claim may be filed under paragraph (1) after the 

date that is 2 years after the date on which regulations are 

promulgated under section 407(a). 

(B) EXCEPTION.—A claim may be filed under paragraph 

(1), in accordance with subsection (c)(3)(A)(i), by an individual (or by a personal representative on behalf of a deceased individual) during the period beginning on the date 

on which the regulations are updated under section 407(b) 

and ending on December 22, 2031. 

* * * * * * * 

(c) ELIGIBILITY.— 

(1) * * * 

(2) INDIVIDUALS.—A claimant is an individual described in 

this paragraph if the claimant is— 

(A) an individual who— 

(i) was present at the World Trade Center, (New 

York, New York), the Pentagon (Arlington, Virginia), 

øor the site of the aircraft crash at Shanksville, Pennsylvania¿ the site of the aircraft crash at Shanksville, 

Pennsylvania, or any other 9/11 crash site at the time, 

or in the immediate aftermath, of the terrorist-related 

aircraft crashes of September 11, 2001; and 

(ii) suffered physical harm or death as a result of 

such an air crash or debris removal; 

* * * * * * * 

(3) REQUIREMENTS.— 

(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: 


jbell on DSKDVH8Z91PROD with REPORTS
56 

(I) In the case that the Special Master determines the individual knew (or reasonably should 

have known) before the date specified in clause (iii) 

that the individual suffered a physical harm at a 

9/11 crash site as a result of the terrorist-related 

aircraft crashes of September 11, 2001, or as a result of debris removal, and that the individual 

knew (or should have known) before such specified 

date that the individual was eligible to file a claim 

under this title, the individual may file a claim 

not later than the date that is 2 years after such 

specified date. 

(II) In the case that the Special Master determines the individual first knew (or reasonably 

should have known) on or after the date specified 

in clause (iii) that the individual suffered such a 

physical harm or that the individual first knew (or 

should have known) on or after such specified date 

that the individual was eligible to file a claim 

under this title, the individual may file a claim 

not later than the last day of the 2-year period beginning on the date the Special Master determines 

the individual first knew (or should have known) 

that the individual both suffered from such harm 

and was eligible to file a claim under this title. 

(ii) OTHER ELIGIBILITY REQUIREMENTS FOR FILING

CLAIMS.—An individual may file a claim during the 

period described in subsection (a)(3)(B) only if— 

(I) the individual was treated by a medical professional for suffering from a physical harm described in clause (i)(I) within a reasonable time 

from the date of discovering such harm; and 

(II) the individual’s physical harm is verified by 

contemporaneous medical records created by or at 

the direction of the medical professional who provided the medical care. 

(iii) DATE SPECIFIED.—The date specified in this 

clause is the date on which the regulations are updated 

under section 407(a). 

ø(A)¿ (B) SINGLE CLAIM.—Not more than one claim may 

be submitted under this title by an individual or on behalf 

of a deceased individual. 

ø(B)¿ (C) LIMITATION ON CIVIL ACTION.— 

(i) IN GENERAL.—Upon the submission of a claim 

under this title, the claimant waives the right to file 

a civil action (or to be a party to an action) in any Federal or State court for damages sustained as a result 

of the terrorist-related aircraft crashes of September 

11, 2001, or for damages arising from or related to debris removal. The preceding sentence does not apply to 

a civil action to recover collateral source obligations, or 

to a civil action against any person who is a knowing 

participant in any conspiracy to hijack any aircraft or 

commit any terrorist act. 


jbell on DSKDVH8Z91PROD with REPORTS
57 

ø(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 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.¿ 

(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). 

(iii) AUTHORITY TO REINSTITUTE CERTAIN LAWSUITS.—In the case of a claimant who was a party to 

a civil action described in clause (i), who withdrew 

from such action pursuant to clause (ii), and who is 

subsequently determined to not be an eligible individual for purposes of this subsection, such claimant 

may reinstitute such action without prejudice during 

the 90-day period beginning after the date of such ineligibility determination. 

SEC. 406. PAYMENTS TO ELIGIBLE INDIVIDUALS. 

(a) IN GENERAL.—øNot later than¿ Subject to subsection (d), not 

later than 20 days after the date on which a determination is made 

by the Special Master regarding the amount of compensation due 

a claimant under this title, the Special Master shall authorize payment to such claimant of the amount determined with respect to 

the claimant. 

(b) PAYMENT AUTHORITY.—øThis title¿ Subject to subsection (d), 

this title constitutes budget authority in advance of appropriations 

Acts and represents the obligation of the Federal Government to 

provide for the payment of amounts for compensation under this 

title. 

* * * * * * * 

(d) LIMITATION.—The total payment of amounts 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 $8,400,000,000. 

(e) ATTORNEY FEES.— 

(1) IN GENERAL.—Notwithstanding any contract, and except 

as provided in paragraph (2), 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. 


jbell on DSKDVH8Z91PROD with REPORTS
58 

(2) EXCEPTION.—With respect to a claim made on behalf of an 

individual for whom a lawsuit was filed in the Southern District of New York prior to January 1, 2009, in the event that 

the representative believes in good faith that the fee limit set by 

paragraph (1) will not provide adequate compensation for services rendered in connection with such claim because of the substantial amount of legal work provided on behalf of the claimant (including work performed before the enactment of this legislation), application for greater compensation may be made to 

the Special Master. Upon such application, the Special Master 

may, in his or her discretion, award as reasonable compensation for services rendered an amount greater than that allowed 

for in paragraph (1). Such fee award will be final, binding, and 

non-appealable. 

SEC. 407. REGULATIONS. 

øNot later than¿ (a) IN GENERAL.—Not later than 90 days after 

the date of enactment of this Act, the Attorney General, in consultation with the Special Master, shall promulgate regulations to 

carry out this title, including regulations with respect to— 

(1) * * * 

* * * * * * * 

(b) UPDATED REGULATIONS.—Not later than 90 days after the 

date of the enactment of the James Zadroga 9/11 Health and Compensation Act of 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. 408. LIMITATION ON LIABILITY. 

(a) IN GENERAL.— 

(1) * * * 

* * * * * * * 

(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 through December 22, 2031) for compensatory damages, contribution or indemnity, or any other form or type of relief, arising from or related to debris removal, against 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 purVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00058 Fmt 6659 Sfmt 6603 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
59 

poses of the previous sentence, any amount described in 

clauses (i) and (ii) shall not be included. 

(D) As it relates to the limitation of liability of any entity, 

including the Port Authority of New York and New Jersey, 

with a property interest in the World Trade Center on September 11, 2001 (whether fee simple, leasehold or easement, 

or direct or indirect), the amount of all available liability 

insurance coverage maintained by any such entity. 

(E) As it relates to the limitation of liability of any individual contractor or subcontractor, the amount of all available liability insurance coverage maintained by such contractor or subcontractor on September 11, 2001. 

(5) PRIORITY OF CLAIMS PAYMENTS.—Payments to plaintiffs 

who obtain a settlement or judgment with respect to a claim or 

action to which paragraph (4)(A) applies, shall be paid solely 

from the following funds in the following order, as may be applicable: 

(A) The funds described in clause (i) or (ii) of paragraph 

(4)(A). 

(B) If there are no funds available as described in clause 

(i) or (ii) of paragraph (4)(A), the funds described in clause 

(iii) of such paragraph. 

(C) If there are no funds available as described in clause 

(i), (ii), or (iii) of paragraph (4)(A), the funds described in 

clause (iv) of such paragraph. 

(D) If there are no funds available as described in clause 

(i), (ii), (iii), or (iv) of paragraph (4)(A), the funds described 

in clause (v) of such paragraph. 

(6) DECLARATORY JUDGMENT ACTIONS AND DIRECT ACTION.— Any party to a claim or action to which paragraph (4)(A) applies may, with respect to such claim or action, either file an 

action for a declaratory judgment for insurance coverage or 

bring a direct action against the insurance company involved. 

* * * * * * * 

DISSENTING VIEWS

Despite its success, the fund has not set a precedent. Congress has not authorized similar compensation for the thousands of victims of Hurricane Katrina, for those injured by 

other natural disasters or for the families of those killed in 

such tragedies. Nor has Congress exhibited such generosity 

toward U.S. soldiers wounded, or the families of those 

killed, in Iraq and Afghanistan. 

The same is true of victims of terrorist attacks that took 

place before Sept. 11, 2001. The Navy personnel who died 

in the suicide attack on the USS Cole and the victims of 

the Oklahoma City bombing received no such public compensation. Even the victims of the first terrorist attack on 

the World Trade Center, in 1993, were denied. Cold though 

it may sound, this is as it should be. 

Bad things happen to good people every day; Congress 

does not come to their financial rescue with generous, taxfree checks. In our free society, based on notions of limited 

government and equal protection of the laws, we simply do 


jbell on DSKDVH8Z91PROD with REPORTS
60 

1Kenneth R. Feinberg, 9/11 Fund: Once Was Enough, Wash. Post, September 11, 2008, at 

A17. Kenneth R. Feinberg was the Special Master of the September 11th Victim Compensation 

Fund. 2Pub. L. No. 107–42 (2001), 115 Stat. 230 (2001) (codified at 49 U.S.C. § 40101 note). 

3 H.R. 847, the ‘‘James Zadroga 9/11 Health and Compensation Act of 2009’’: Joint Hearing 

Before the Subcomm. on the Constitution and the Subcomm. on Immigration of the House Comm. 

on the Judiciary, 111th Cong. (2009) (statement of Kenneth R. Feinberg). 4 H.R. 847, the ‘‘James Zadroga 9/11 Health and Compensation Act of 2009’’: Joint Hearing 

Before the Subcomm. on the Constitution and the Subcomm. on Immigration of the House Comm. 

on the Judiciary, 111th Cong. (2009) (statement of Theodore H. Frank) (‘‘Frank testimony’’) . 

not expect the government to step in whenever misfortune 

strikes. This is not out of concern about bankrupting the 

Treasury. It is because our heritage teaches that we all 

must take our chances in life. 

—Kenneth R. Feinberg 1

INTRODUCTION

Eight years ago, just 11 days after the terrorist attacks of September 11th, Congress passed the Air Transportation Safety and 

System Stability Act,2 which created the September 11th Victim 

Compensation Fund, and President Bush quickly signed it into law. 

This bipartisan bill was one-of-a-kind legislation, providing generous public compensation to the physically injured and to the families of the dead. The original 9/11 Fund successfully served its purpose by effectively and efficiently providing a short-term, administrative, no-fault alternative to tort litigation to compensate the victims. The Fund paid out over $7 billion in taxpayer dollars to 5,560 

eligible claimants. 

The original fund reflected national solidarity towards the victims and expressed a national sense of compassion not only to the 

victims, but to the rest of the world. It was ‘‘an expression of the 

best in the American character.’’ 3 The question H.R. 847 raises is 

whether Congress should pass a new 9/11 Fund, with different 

terms than the original fund, or whether the original fund should 

be considered a unique, singular response to an unprecedented 

tragedy. The answer to that question—at least with regard to H.R. 

847 in its current form—is that a new 9/11 Fund should not be enacted. 

The approach H.R. 847 takes ‘‘does not have the advantages that 

made the [original 9/11 Fund] successful, and magnifies the disadvantages and fairness problems of the [original 9/11 Fund].’’ 4

Three of the main problems with H.R. 847 are that (1) it leaves the 

fund open for 22 years, well beyond what is needed to take care 

of any latent claims; (2) gives the Special Master virtually 

unbounded authority, that will not work for a long-term (22 years) 

compensation program involving a substantially larger set of potential claimants than the original 9/11 Fund with injuries of more 

ambiguous causation; and (3) the nature of the fund will make it 

highly susceptible to waste, fraud, and abuse. 

In short, while there is a sympathetic and potentially deserving 

class of claimants and while there is good reason to give the construction contractors that aided after 9/11 in the recovery and 

cleanup efforts liability protection, the fund that will be created by 

H.R. 847 is not narrowly and appropriately tailored towards those 


jbell on DSKDVH8Z91PROD with REPORTS
61 

5Lloyd Dixon and Rachel Kaganoff Stern, ‘‘Compensation for Losses from the 9/11 Attacks’’ 

(The Rand Institute for Civil Justice: 2004) at 121. 6See 67 Fed. Reg. 11,239 (Mar. 13, 2002). 7Pub. L. No. 107–42 (2001), 115 Stat. 230 (2001) (codified at 49 U.S.C. § 40101 note). 

ends. Accordingly, Congress should not create the new 9/11 Fund 

contained in H.R. 847. 

BACKGROUND

Title II of H.R. 847 will create a new September 11th Victim 

Compensation Fund (‘‘VCF’’), which will be open until December 

22, 2031, to provide compensation for individuals who did not file 

before, or became ill after, the December 22, 2003 filing deadline 

for the original fund. In addition, Title II will limit the liability of 

defendants—including the contractors and subcontractors that 

aided in the rescue, recovery, and cleanup efforts—for lawsuits previously resolved, currently pending, or filed through December 22, 

2031, related to the rescue, recovery, and cleanup efforts at the 

World Trade Center site. 

A. Original Victim Compensation Fund 

Eleven days after the terrorist attacks on September 11, 2001, 

Congress passed the Air Transportation Safety and Stabilization 

Act to protect air carriers from tort lawsuits that threatened to 

cripple air travel in the United States. The Act capped damages 

against the airlines at their pre-existing liability insurance limits 

and limited jurisdiction for tort claims to the U.S. District Court 

for the Southern District of New York. Moreover, the Act established the 9/11 Victim Compensation Fund, through which victims 

of the attacks could opt to waive all federal and state tort claims 

and receive administrative relief through a predetermined formula, 

under the discretion of the Fund’s Special Master. 

The VCF limited recovery to a discrete class of victims, determined by time and place. To be eligible for recovery under the 

Fund, victims had to have been on the flights or at the World 

Trade Center or Pentagon sites ‘‘within 12 hours of the attacks, 

suffered a physical injury, and been treated by a medical professional within 24 hours of the injury, within 24 hours of rescue, or 

within 72 hours of injury or rescue for those victims who were unable to realize immediately the extent of their injuries or for whom 

treatment by a medical professional was not available on September 11.’’ 5 Those who died in the attacks and rescue workers 

who were at the site within 96 hours of the attacks were eligible. 

The VCF thus had a clearly defined class of victims whose death 

or injuries did not present complex questions of causation. 

The VCF granted awards for economic loss based on the victim’s 

annual income prior to the attack. Awards for non-economic losses 

for death cases were set at $250,000 per victim and $100,000 for 

a spouse and each dependent child; those who did not believe that 

these levels provided adequate compensation for non-economic 

damages could petition for a hearing.6 The VCF deducted from 

awards all collateral-source benefits, including ‘‘life insurance, pension funds, death benefit programs, and payments by Federal, 

State, or local governments related to the terrorist-related aircraft 

crashes of September 11, 2001.’’ 7


jbell on DSKDVH8Z91PROD with REPORTS
62 

B. Current Situation 

Immediately after the terrorist attacks on 9/11, large private contracting firms were asked by the City of New York to immediately 

begin cleanup efforts at Ground Zero. They did so heroically and 

in strained circumstances, even though they were unable to secure 

the liability insurance they would normally obtain before starting 

a project. They were unable to obtain such insurance because the 

unprecedented nature of the disaster site (containing some 20 stories of debris) caused insurance markets to be incapable of pricing 

such an insurance product. 

Since then, many people who worked and lived in and around the 

cleanup site have developed medical problems alleged to have been 

caused by the toxic particulates in the air around the site and by 

the alleged negligence of the cleanup companies to ensure that 

their workers and those in the area were not exposed to such contaminants. The alleged victims of this alleged negligence have filed 

lawsuits (over 10,000 claimants so far) which now proceed for huge 

demands of damages. The contractors claim that the vast majority 

of claimants are not contractor employees, but New York City employees such as firemen. These lawsuits place the solvency of these 

firms in jeopardy. 

Other major entities affected by the 9/11 attacks, including the 

airlines, the owner of the World Trade Center, and the Port Authority of New York and New Jersey, were protected from excessive 

liability exposure following the attacks by federal legislation. Unfortunately, the cleanup firms, whose liability issues did not arise 

until many months after the attacks, were not. While approximately a billion dollars have been appropriated to help pay for the 

medical expenses of those affects by the contaminants in the areas 

around the World Trade Center site, the administrative compensation program created to help the immediate victims of 9/11 (the 

VCF) did not cover those exposed to subsequent site contaminants, 

and the liability protections passed after 9/11 do not cover the 

cleanup and recovery firms. 

DISCUSSION

Title II of H.R. 847 creates a new September 11th Victim Compensation Fund to provide compensation to those who were injured 

by air contaminants as a result of rescue, recovery, and cleanup efforts following 9/11 but were ineligible for compensation under the 

VCF because their injuries did not manifest themselves by the 

fund’s December 22, 2003 filing deadline. However, the structure of 

the original 9/11 Fund, which H.R. 847 incorporates, intended for 

compensating a limited set of claimants in time and place with relatively uncontroversial claims in a non-adversarial setting, will not 

work for the significantly longer-term fund created by H.R. 847 involving a substantially larger set of claimants with injuries of more 

ambiguous causation. 

Under the original 9/11 Fund, there was, in general, no ambiguity with regard to causation. Someone who was on one of the 

planes or was killed in the World Trade Center or at the Pentagon 

clearly was entitled to compensation from the Fund. Accordingly, 

determining who was eligible for compensation was for the most 

part a ministerial function, which did not require adjudication. 


jbell on DSKDVH8Z91PROD with REPORTS
63 

8Frank testimony at 3. 

9Paying With Their Lives: The Status of Compensation for 9/11 Health Effects: Joint Hearing 

Before the Subcomm. on the Constitution and the Subcomm. on Immigration of the House Comm. 

on the Judiciary, 110th Cong. (2008) (statement of Kenneth R. Feinberg). 

Moreover, as the number of potential claimants to the original fund 

was limited to several thousand, the Fund was able to be administered effectively and efficiently with a structure that was relatively 

thin for a government bureaucracy. However, ‘‘[a] longer-term and 

larger compensation fund could not possibly vest that much discretionary authority in a single individual, and would need to craft 

‘rigidly standardized rules’ that the current statutory structure of 

the Fund would not permit.’’ 8 Yet, H.R. 847 makes no changes to 

the original Fund’s structure to account for the long-term nature 

and increased size and complexity of the new Fund. 

Thus, while enacting a new 9/11 Fund is in some ways an attractive proposition, the Fund that will be created by H.R. 847 is highly problematic. 

A. H.R. 847 extends the 9/11 Compensation Fund over 30 years beyond September 11, 2001. 

Under H.R. 847, a claim may be filed at any time during the period that begins on the date the Special Master updates the VCF 

regulations and ends on December 22, 2031. The Special Master is 

required to update the regulations within 90 days of enactment of 

H.R. 847. Thus, under this bill, the Fund will be open from at least 

2010 to 2031—a period of over 21 years and over 30 years beyond 

September 11, 2001. 

The sponsors of the legislation want to leave the VCF open for 

such a long period of time to address potential latent claims. However, according to Kenneth Feinberg, Special Master of the original 

VCF, ‘‘no latent claims need such an extended date.’’ As the original 9/11 Fund paid over $1 billion to 2,680 eligible physical injury 

claimants the majority of whom were suffering from respiratory ailments, former Special Master Feinberg has firsthand knowledge of 

the types of claims that can be expected for the new Fund. 

Based on his experience, Mr. Feinberg has suggested that ‘‘Congress could simply reopen the 9/11 Fund to encompass all such 

claims during a ‘window’ of 5 years during which time all September 11 related respiratory physical injuries could be evaluated 

and processed.’’ 9 Moreover, if latent claims present a problem at a 

later date, victims can sue the contractors and the city assuming 

the liability cap has not been reached. Or, if a shorter period (e.g., 

5 years) does not end up being long enough, Congress could once 

again consider the issue and reenact the fund. This is an obvious 

solution as that is exactly the situation that is occurring here: according to the bill’s sponsors the original fund was not open long 

enough so this legislation would reenact it. 

What is more, the bill extends the time period for when an individual’s injuries had to have been sustained from the 96 hours 

after the 9/11 attacks contained in the original fund to almost a full 

year after September 11, 2001. That is to say, claimants will be eligible for the Fund if they were present in a covered area between 

September 11, 2001 and August 30, 2002. Inexplicably, however, 

the last three months of this nearly additional year of coverage fall 

after the cleanup of Ground Zero ended on May 30, 2002. Why 


jbell on DSKDVH8Z91PROD with REPORTS
64 

10Frank testimony at 4. 

should taxpayers be providing compensation for injuries that were 

sustained up to three months after the cleanup ended? 

B. H.R. 847 gives the Special Master unchecked and unreviewable 

discretionary power that is inappropriate for the compensation 

fund it creates. 

The compensation fund that will be created by H.R. 847, like the 

original 9/11 Fund, vests tremendous unchecked and unreviewable 

discretionary power in the Fund’s special master. This may have 

been acceptable for the original 9/11 Fund, with its limited set of 

claimants in time and place with relatively uncontroversial claims. 

But it is inappropriate for the longer-term compensation program 

created by H.R. 847 involving a substantially larger set of potential 

claimants with injuries of more ambiguous causation. 

The country was tremendously lucky that Special Master 

Feinberg exercised the discretion he was given under the original 

fund so ably. The compensation fund that will be created by H.R. 

847, however, is greater in scope and is of a significantly longer duration than the original fund. Thus it is highly problematic that 

H.R. 847 contains very few, if any, constraints on the new Special 

Master’s discretion to disburse compensation to the tens of thousands of potential claimants. This is especially true with regard to 

medical causation and non-economic damages. 

In terms of medical causation, if the Fund is to be anymore than 

a giveaway of taxpayer money to anyone who is suffering a respiratory problem and was in the appropriate geographic area, the 

cooperative non-adversarial structure of the original 9/11 Fund will 

necessarily have to change. This cooperative non-adversarial structure was advantageous in the original fund as there was no dispute 

as to causation and there were a relatively limited number of 

claimants. This structure, which H.R. 847 leaves unaltered, however, is not appropriate for the type or scope of claims that will be 

covered by the new fund or the larger number of claims that can 

be expected. 

With regard to non-economic damages, the discretion given to the 

Special Master under H.R. 847 is also problematic. Non-economic 

damages are highly subjective. The original 9/11 Fund had a regulatory limitation on presumed non-economic damages, but the Special Master could exceed that limitation in exceptional cases and 

‘‘[a] different Special Master could undo those regulatory limitations, and open the Treasury to arbitrary non-economic damages 

awards to thousands of claimants.’’ 10

In other words, H.R. 847 simply puts too much discretion in the 

hands of what will likely be several Special Masters over the duration of the 22-year fund. Although Mr. Feinberg did an exceptional 

job with the original fund, Congress should not leave to chance that 

there will be as able a set of Special Masters over the course of the 

fund created by H.R. 847. Nor should Congress treat this larger, 

more complex and longer-lasting fund as though it is simply a carbon copy of the original Fund. 


jbell on DSKDVH8Z91PROD with REPORTS
65 

11Kenneth R. Feinberg, 1 Final Report of the Special Master of the September 11th Victim 

Compensation Fund 7 (2004). 12Frank testimony at 5. 13Frank testimony at 5–6. 14 Bill Hutchinson, Coroner Says Hero James Zadroga Didn’t Die From WTC Dust, N.Y. Daily 

News (Oct. 19, 2007). 

C. Fund will be susceptible to fraud, waste, error, and abuse 

The original 9/11 Fund was designed for a select group of claimants who, for the most part, were unquestionably the intended recipients and eligible for benefits. In general, this narrow focus allowed for a non-adversarial process, involving a limited number of 

claimants, without dispute over causation. Indeed, as Special Master Feinberg has noted, ‘‘Claimants did not need to present detailed 

computations or analyses. Instead, they only needed to supply the 

fund easily obtained data.’’ 11

However, the structure of the original fund, ‘‘left unchanged in 

H.R. 847, is inappropriate for either the broader scope of the new 

Fund or the larger volume of claims the Fund can anticipate.’’ 12 In 

order to avoid waste, fraud, and abuse of taxpayer dollars, Ted 

Frank of the American Enterprise Institute, a witness at the Committee’s hearing on this legislation, explained in his written testimony that: 

If the Fund is to be aimed at a specific set of victims of terrorist attack, rather than simply a giveaway of taxpayer money 

to a geographic area and to trial lawyers, Section 405 will need 

to be amended to both require the Fund to establish neutral 

medical criteria for demonstrating causation, and to have a 

more realistic timeframe for adjudication of potentially controversial claims for compensation. Congress should require 

the Fund to establish appropriate burdens of proof and permit 

for independent medical review to ensure that, if taxpayers are 

to be responsible for compensation for injuries caused in the 

aftermath of the September 11 attacks, they are responsible for 

that amount and no more.13

For an example of the potential for fraud, waste, and abuse, one 

need look no further than the namesake of H.R. 847, James 

Zadroga. Detective Zadroga died from pulmonary disease and respiratory failure allegedly caused by exposure to dust at Ground 

Zero. The chief New York City medical examiner, however, concluded that, ‘‘[i]t is our unequivocal opinion, with certainty beyond 

doubt, that the foreign material in [Detective Zadroga’s] lungs did 

not get there as the result of inhaling dust at the World Trade 

Center or elsewhere.’’ 14 Although Zadroga’s family disputes the 

medical examiner’s finding, the simple fact that this controversy 

exists demonstrates that the non-adversarial structure of the original fund cannot be retained without opening the new Fund up to 

fraud, waste, and abuse. 

As Ted Frank further explained in his written testimony, 

The danger here is not simply the occasional false positive 

of unmerited compensation, but the creation of a compensation 

structure that will be subject to pervasive fraud. History has 

shown in the asbestos and silicosis mass tort litigations that 

claims of lung ailments are especially susceptible to 

fraud. . . . 


jbell on DSKDVH8Z91PROD with REPORTS
66 

15Frank testimony at 7 (citations omitted). 16 Id. at 8 (citing Richard A. Nagareda, Mass Torts in a World of Settlement 143 (2007). 17 Id. at 8. 18 Id. 19 Id. at 9. 

The only hurdle the bill creates is Section 405(c)(3)(A)(ii)— 

proof that one contemporaneously sought medical treatment. 

This may succeed in winnowing out especially meritless claims 

that have already been brought, but the bar is quite low for future claimants. 

Even legitimate medical facilities have a danger of suffering 

from confirmation bias and exaggerating the scope of pulmonary injuries, given the millions of dollars of federal money 

at stake. Many of the most sensational reports, including congressional testimony, have come from the Irving J. Selikoff 

Center for Occupational and Environmental Medicine. . . . But critics have complained that ‘‘doctors at the clinic, which 

has strong historical ties to labor unions, have allowed their 

advocacy for workers to trump their science by making statements that go beyond what their studies have confirmed’’; and 

they have presented findings in ‘‘scientifically questionable 

ways.’’ 15

Moreover, as Mr. Frank explains, a fund like the one created in 

H.R. 847 will invariably suffer from the Field of Dreams problem: 

‘‘if you build it they will come.’’ 16 In other words, ‘‘[i]f Congress creates a compensation system where geographic proximity and a diagnosis are the only prerequisites for a large government check 

and an attorney’s contingent fee, attorneys will have every incentive to manufacture such diagnoses, and have done so in the past, 

often with the cooperation of unions.’’ 17 In the case of a new 9/11 

Fund, this concern is more than hypothetical. ‘‘Thousands of lawsuits in the September 11 litigation in [federal] court alleging pulmonary injury have been filed by Napoli, Kaiser & Bern LLP, 

which was responsible for massive fraud in the fen-phen litigation.’’ 18

What will stop this same type of fraud from seeping into the new 

9/11 Fund that is to be created by H.R. 847? As Mr. Frank points 

out, it likely will not be the structure of the Fund as it currently 

stands: 

Given the likely volume of claims and the complexity of the underlying causation and timeliness issues, it will be extraordinarily unlikely that the next Special Master will be able to 

adequately review claims for merit. Without firm medical criteria and the opportunity of scrutiny of claims on the front end 

and the promise of criminal penalties for fraud on the back 

end, the reopening of the VCF will be subject to substantial 

fraud and abuse.19

D. The manager’s amendment’s $8.4 billion cap is an invitation to spend $8.4 billion 

Through the manager’s amendment that was adopted in Com- mittee, expenditures from the fund will be capped at $8.4 billion. 

There are several problems with this cap. First, at base, a cap of 

$8.4 billion is nothing more than an invitation for the Fund’s Special Master to spend $8.4 billion. Second, it is unclear where this 


jbell on DSKDVH8Z91PROD with REPORTS
67 

20The Congressional Budget Office only calculated the cost of an uncapped fund for the first 

10 years the Fund would be opened. However, CBO determined that claims for compensation 

from the Fund would decrease over time. According to CBO’s cost estimate, in year 10 annual 

payouts from the fund would only be $100 million. Thus, even assuming $100 million in payouts 

per year for the remaining 12 years the Fund will be open, the overall cost only gets to $7.6 

billion. It is likely though that this number would be lower than $7.6 billion as it does not account for a further annual drop in payouts over the remaining 12 years. 21See, e.g., Feinberg testimony at 8–10. 22Lloyd Dixon and Rachel Kaganoff Stern, ‘‘Compensation for Losses from the 9/11 Attacks’’ 

(The Rand Institute for Civil Justice: 2004) at 143. 23Government Accountability Office, ‘‘Federal Compensation Programs: Perspectives on Four 

Programs (November 2005) at 4–5 (analyzing the Black Lung Program, the Vaccine Injury Compensation Program, the Radiation Exposure Compensation Program, and the Energy Employees 

Occupational Illness Compensation Program). 

$8.4 billion figure came from. The Congressional Budget Office 

(CBO) scored the first 10 years of the new Fund at $6.4 billion, but 

extrapolating CBO’s 10-year numbers out for a 22-year long fund 

comes to no more than $7.6 billion.20 Additionally, Special Master 

Feinberg, who probably has as good a grasp on the scope of these 

claims as anyone, has indicated that all existing claims could be 

settled for $1.5 billion.21 If $1.5 billion is anywhere close to being 

correct, why then is the cap set at $8.4 billion? It should not be. 

Third, an $8.4 billion cap in H.R. 847 does nothing to prevent a future Congress from increasing the cap. For instance, if the Special 

Master pays out $8.4 billion in the first 10 years of the Fund, is 

a future Congress not going to be at least tempted to authorize an 

increase in the cap? Of course it will. If a future Congress can increase the cap, why then not limit the initial cap to the $1.5 billion 

figure suggested for Mr. Feinberg? The bill’s sponsors do not explain why they have not chosen that route. 

In other words, the $8.4 billion cap has little real effect. Had the 

proponents of H.R. 847 really wanted to put safeguards in the legislation to protect taxpayer money, they would have eliminated or 

capped the amount of highly subjective non-economic damages that 

could be awarded; limited the duration of the fund; and put in 

place some concrete rules on medical causation. Simply put, the 

$8.4 billion cap will do little, if anything, to protect taxpayers. 

While the victims and the parties that are being sued in federal 

court are worthy of protection, so too are taxpayers. 

E. A new Fund may reduce Congress’ ability to provide funding for 

future disasters or terrorist attacks. 

As the nonpartisan Rand Institute for Civil Justice pointed out 

in 2004, in its report on the original VCF, ‘‘precommitments by government programs . . . reduce the ability of government, and society more generally, to allocate resources to meet the most pressing 

needs after an attack.’’ 22 And the Government Accountability Office, in 2005, also cautioned, in a study of four federal compensation programs, that ‘‘the federal role in all four programs has expanded significantly over time . . . As might be expected, as the 

federal role for those four programs has grown, so have their costs 

. . . [B]ecause these programs may expand significantly beyond the 

initial cost estimates, policymakers must carefully consider the cost 

and precedent-setting implications of establishing any new federal 

compensation programs, particularly in light of the current federal 

deficit.’’ 23


jbell on DSKDVH8Z91PROD with REPORTS
68 

24Letter from Leo V. Boyle, President, Association of Trial Lawyers of America, to Congressional Leaders reprinted in 147 Cong. Rec. H5914 (daily ed. Sept. 21, 2001) (statement of Rep. 

Delahunt); 147 Cong. Rec. S9599 (daily ed. Sept. 21, 2001) (statement of Mr. Reid). 

F. H.R. 847 allows attorneys to collect taxpayer funded fees for 

work not directly related to recovery from the Victim Compensation Fund. 

Because the 9/11 Fund is a no-fault, administrative scheme that 

does not involve the kind of risks and expense that would justify 

significant contingency fees, attorneys’ fees should be limited. The 

entire purpose of the compensation fund is to provide victims with 

compensation without requiring them to prove complex legal concepts such as negligence, products liability, or other tort theories. 

Indeed, when Congress was considering the original VCF, the Association of Trial Lawyers of America sent a letter to Congress stating that ‘‘ATLA believes that 100% of the compensation from the 

fund should go directly to these families.’’ 24

Through the manager’s amendment, the bill will include a cap on 

attorneys’ fees; however, the cap is poorly crafted if it is truly intended to maximize victims’ recoveries by limiting attorneys to reasonable fees. What is more, the fee cap has an exception that will 

swallow the rule by allowing attorneys to receive fees for work that 

is not directly related to a victim’s recovery under the VCF. A true 

fee cap would have given the Special Master the discretion to 

award less than 10 percent attorneys’ fees depending on the facts 

of the claim and the amount of work the attorney truly put in on 

that particular claim. Indeed, under the first 9/11 Fund, the Special Master had a non-binding guideline of 5 percent attorneys’ fees 

and many attorneys worked pro bono. It is truly ironic that not giving the Special Master the discretion to award less than 10 percent 

attorneys’ fees is the one area that H.R. 847 puts limits on the Special Master’s discretion. Surely, taxpayers who are providing the 

money for the new Fund would appreciate more meaningful limits 

on the Special Master’s nearly unbounded discretion. 

Second, the attorneys’ fee cap has an exception that provides that 

attorneys who have worked on civil litigation for a claimant prior 

to January 1, 2009, arising out of the cleanup efforts at the Ground 

Zero, will not be bound by the manager’s amendment’s 10 percent 

attorneys’ fee cap. Essentially, this means that some attorneys will 

be compensated for work that is not directly related to filing a 

claim under the new 9/11 Fund. In other words, attorneys will be, 

for instance, compensated with taxpayer dollars for having filed 

motions in federal district court that are wholly unrelated to the 

no-fault, administrative compensation being provided for under the 

Fund. Why should taxpayers be paying attorneys for work that is 

not directly related to a claim under the Fund? The vast majority 

of the money from the Fund should go to the victims, not to attorneys that they may have hired. When these attorneys took on the 

civil litigation the manager’s amendment intends to compensate 

them for, they did so at the risk (as is the case with all contingent 

fee litigation) that they would receive nothing for their work. Why 

now should Congress offset that risk? 

Simply put, the attorneys’ fee cap in the manager’s amendment 

to H.R. 847 is really not much of a cap at all. Attorneys representing World Trade Center cleanup-related victims should reVerDate Mar 15 2010 01:12 Jul 23, 2010 Jkt 057563 PO 00000 Frm 00068 Fmt 6659 Sfmt 6601 E:\HR\OC\HR560P2.XXX HR560P2

jbell on DSKDVH8Z91PROD with REPORTS
69 

25Feinberg testimony at 7. 26Peter Schuck, Special Dispensation, Am. Lawyer, June 2004. 

member the sentiments of the ATLA right after the attacks and not 

seek fees, or anything more than minimal fees, for their representations of victims before the 9/11 Fund. And Congress should not 

step in with this so-called attorneys’ fees cap and invite attorneys 

to take money from the victims for work they did in civil litigation. 

G. Other disaster victims do not receive this type of federal compensation. 

There is also the question of why Congress should reopen the 9/ 

11 Fund, providing billions in additional federal compensation to 

the physical injury victims of the 9/11 attacks, while no such fund 

exists for the victims of the Oklahoma City bombing, the victims 

of the U.S. embassy bombings, the victims of the first World Trade 

Center Attack in 1993, or the victims of the unprecedented disaster 

associated with Hurricane Katrina. If this entitlement is approved, 

how does Congress say ‘‘no’’ to the victims of future tragedies, 

whether as a result of natural disasters or terrorist attacks? Congress must stop and think of the precedent this bill sets for future 

disasters. As former Special Master Feinberg has written, 

Why should Congress, which has already enacted legislation 

authorizing over $7 billion in public compensation to the families of those who died on September 11, or who were physically 

injured as a result of the attacks, now authorize additional millions or even billions in compensation for the remaining September 11 victims, while failing to do anything similar to the 

other victims of life’s misfortunes? It is a fundamental question 

posed to our elected officials in a free democratic society. Why 

some victims but not others? On what basis should such distinctions be made? Are some victims more ‘‘worthy’’ than others? 25

Moreover, it is not just that the VCF compensates the victims of 

one set of terrorist attacks but not victims of other terrorist attacks 

on American and foreign soil. It is also that the VCF ‘‘compensates 

the 9/11 victims while most other innocent victims of crime, intentional wrongdoing, or negligence must suffer without remedy unless they are ‘lucky’ enough to have been injured by someone who 

can be held liable under the tort system’s peculiar, often arbitrary 

rules and who is also sufficiently insured or secure financially to 

pay the judgment.’’ 26

H. H.R. 847 contains a partially self-defeating provision that allows 

for the reinstatement of lawsuits if a claimant is ineligible under 

the VCF. 

Section 202, paragraph 3 of H.R. 847 provides that if a claimant 

is determined to be ineligible for the compensation fund, he may 

reinstitute his lawsuit. One of the arguments, however, for reenacting the Fund is to bring a close to litigation against the City 

and its contractors. If ineligible claimants can reinstitute their lawsuits, this legislation is providing an avenue for lawsuits to move 

forward even after the Special Master has determined that they do 

not have an eligible claim. Moreover, the bill’s limitation of liability 

provisions may not serve to discourage litigation. Those that seek 


jbell on DSKDVH8Z91PROD with REPORTS
70 

27Feinberg testimony at 6. 28Feinberg testimony at 5. 

compensation in the fund but are denied compensation not only 

will be able to reinstitute their tort cases in federal court; the liability caps actually may serve to create an approximately $2 billion incentive to sue in federal court rather than go through the 

fund. In other words, creation of the Fund may not have the anticipated impact on ending the litigation. 

REPUBLICAN AMENDMENTS

Republican Members offered two amendments to Title II of H.R. 

847 at the Committee markup. Neither of the Republican amendments was adopted: 

• Smith Amendment. Ranking Member Smith offered an 

amendment, based on the recommendation of former Special 

Master Feinberg, to limit reopening of the fund to 5 years on 

the Fund’s original terms. As Special Master Feinberg wrote 

in his written testimony at a Judiciary Committee hearing 

on reenacting the 9/11 Fund, ‘‘any attempt to reenact and extend the 9/11 Fund should be initiated with the understanding that there would be no changes in the rules and 

regulations governing the original Fund, that the new law 

would simply be a ‘one line’ extension of reaffirmation of the 

law which established the original 9/11 Fund.’’ 27 According 

to Special Master Feinberg, ‘‘Congress could simply reopen 

the 9/11 Fund to encompass all such claims during a ‘window’ of 5 years during which time all September 11 related 

respiratory injuries could be evaluated and processed.’’ 28

Ranking Member Smith’s amendment would have accomplished Special Master Feinberg’s recommendation of a ‘‘oneline,’’ 5-year extension of the original 9/11 Fund. This 

amendment would have, in a very simple manner, addressed 

many of the concerns expressed above with regards to the 

new Fund that will be created by H.R. 847. Unfortunately, 

Ranking Member Smith’s amendment was not adopted. 

• King Amendment. Mr. King offered an amendment to remove the exception in the attorneys’ fee cap for attorneys 

who had filed a lawsuit on behalf of a victim in federal court 

prior to January 1, 2009. This exception swallows the rule. 

Had Mr. King’s amendment been adopted it would have ensured that more of the compensation under the Fund would 

have gone to the victims and not to any attorneys they may 

have hired. Given that the VCF is a no-fault, administrative 

scheme, there is no justification for high attorneys’ fees. Nor 

is there any reason to provide attorneys with compensation 

under the VCF for work they performed for litigation in federal court—the VCF is wholly a separate system from that 

litigation. When attorneys took on that representation in 

that litigation they did so at the risk that they would receive 

no compensation at all if the plaintiff lost—such is the nature of a contingency fee. Mr. King’s amendment was not 

adopted. 


jbell on DSKDVH8Z91PROD with REPORTS
71 

CONCLUSION

Consideration of creating the new Victim Compensation Fund 

contained in Title II of H.R. 847 raises two questions. First, why 

should Congress reenact and expand the 9/11 Fund, providing millions in additional public compensation to the physical injury victims of the September 11 attacks, while no such Fund exists at all 

for the victims of the Oklahoma City bombing, the victims of the 

African Embassy bombing, the victims of the first World Trade 

Center attack in 1993 or, for that matter, the victims of the unprecedented disaster associated with Hurricane Katrina? Underlying 

this question is the issue of whether the federal government, i.e., 

the taxpayers of the United States, are to become in perpetuity the 

guarantors of last resort for all the tragedies that beset people over 

their lives. Members will have to make their own philosophical decision as to this first question. 

The second question is whether the 9/11 Fund that will be created by H.R. 847 is written in such a manner that it will safeguard 

valuable taxpayer dollars while appropriately compensating only 

the actual victims of the aftermath of the 9/11 attacks. The answer 

to the second question is much more clear—the Fund that will be 

created by H.R. 847 is open for much longer than is necessary (at 

least 21 years); gives far too much discretion to the Special Master 

considering the long-term nature of the Fund, which will have a 

larger set of claimants with claims of much more ambiguous causation than under the original Fund; and the size and unstructured 

nature of the Fund will make it highly susceptible to waste, fraud, 

and abuse. Simply put, the structure of the original 9/11 Fund will 

not work for the Fund that will be created by H.R. 847. 

There may be a deserving class of claimants who are suffering 

respiratory and other physical ailments as a result of their work 

at Ground Zero. And it may be that the original 9/11 Fund should 

be reopened for a limited period of time in order to compensate 

those individuals. But the Fund created in H.R. 847 is not the 

original 9/11 Fund, nor is it being re-opened for a brief window. We 

are unable to support enactment of this legislation. 

LAMAR SMITH. 

F. JAMES SENSENBRENNER, JR. 

BOB GOODLATTE. 

GREGG HARPER. 

Æ 


jbell on DSKDVH8Z91PROD with REPORTS