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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1334 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1334

     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.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             June 24, 2009

   Mrs. Gillibrand (for herself, Mr. Schumer, Mr. Menendez, and Mr. 
  Lautenberg) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

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

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``James Zadroga 9/11 
Health and Compensation Act of 2009''.
    (b) Table of Contents.--The table of contents for 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 XXXI--WORLD TRADE CENTER HEALTH PROGRAM

     ``Subtitle A--Establishment of Program; Advisory and Steering 
                               Committees

        ``Sec. 3101. Establishment of World Trade Center Health Program 
                            within NIOSH.
        ``Sec. 3102. WTC Health Program Scientific/Technical Advisory 
                            Committee.
        ``Sec. 3103. WTC Health Program Steering Committees.
        ``Sec. 3104. Community education and outreach.
        ``Sec. 3105. Uniform data collection.
        ``Sec. 3106. Centers of excellence.
        ``Sec. 3107. Entitlement authorities.
        ``Sec. 3108. Definitions.
 ``Subtitle B--Program of Monitoring, Initial Health Evaluations, and 
                               Treatment

                      ``Part 1--For WTC Responders

        ``Sec. 3111. Identification of eligible WTC responders and 
                            provision of WTC-related monitoring 
                            services.
        ``Sec. 3112. Treatment of certified eligible WTC responders for 
                            WTC-related health conditions.
                      ``Part 2--Community Program

        ``Sec. 3121. Identification and initial health evaluation of 
                            eligible WTC community members.
        ``Sec. 3122. Followup monitoring and treatment of certified 
                            eligible WTC community members for WTC-
                            related health conditions.
        ``Sec. 3123. 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. 3131. National arrangement for benefits for eligible 
                            individuals outside New York.
                 ``Subtitle C--Research Into Conditions

        ``Sec. 3141. 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. 3151. World Trade Center Health Registry.
        ``Sec. 3152. 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. 2. FINDINGS.

    Congress finds the following:
            (1) Thousands of rescue workers who responded to the areas 
        devastated by the terrorist attacks of September 11, 2001, 
        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 
        September 11, 2001, 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 September 
        11, 2001, 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.
            (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 threefold 
        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, 2001, 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 World Trade Center (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 in 
        this area 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 the Governmental 
        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 September 11, 2001.
            (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, 2001.
            (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, 2001, 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, 2001, 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 of less than $15,000 per 
        year. The report also found a need to continue and expand 
        mental health services.
            (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, 2001, 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, 2001.
            (24) The Federal response to medical and financial issues 
        arising from the September 11, 2001, 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 (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following new title:

            ``TITLE XXXI--WORLD TRADE CENTER HEALTH PROGRAM

     ``Subtitle A--Establishment of Program; Advisory and Steering 
                               Committees

``SEC. 3101. 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 3111, 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.
            ``(2) Initial health evaluation for community members.--An 
        initial health evaluation under section 3121, 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 3112, 3122, and 3123 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 3104 of an 
        outreach program to potentially eligible individuals concerning 
        the benefits under this title.
            ``(5) Uniform data collection.--Collection under section 
        3105 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 health 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 3106(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 health 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 WTC-related health 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
                    ``(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 the 
                        individuals 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 health 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 3106(a)(3).
                    ``(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 exposures, 
                including the findings of research conducted under 
                section 3141(a).
                    ``(F) Advisory committee recommendations.--A list 
                of recommendations by the WTC Scientific/Technical 
                Advisory Committee on additional WTC program 
                eligibility criteria and on additional WTC-related 
                health conditions and the action of the WTC Program 
                Administrator concerning each such recommendation.
            ``(3) Separate clinical programs described.--In paragraph 
        (2), each of the following shall be treated as a separate 
        clinical program of the WTC program:
                    ``(A) FDNY responders.--The benefits provided for 
                eligible WTC responders described in section 
                3106(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 
                3106(b)(1)(C).
    ``(h) Notification to Congress When Reach 80 Percent of Eligibility 
Numerical 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 
        3111(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 3121(a)(5) has reached 80 percent of such limit.
    ``(i) GAO Report.--Not later than 3 years after the date of the 
enactment of the James Zadroga 9/11 Health and Compensation Act of 
2009, 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. 3102. 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. 3103. 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.
            ``(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 September 11, 2001, 
                terrorist attacks on the World Trade Center; 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 
                        specialist, 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 WTC-
                                affected populations and constituencies 
                                and the diversity of impacted 
                                neighborhoods, including residents, 
                                hard-to-reach populations, students, 
                                area workers, parents of school-aged 
                                students, community-based 
                                organizations, Community Boards, WTC 
                                Environmental Health Center patients, 
                                labor unions, and labor advocacy 
                                organizations; and
                                    ``(II) no one individual 
                                organization shall have more than one 
                                representative.
            ``(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--
                            ``(i) the composition of the Steering 
                        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
                            ``(ii) 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--
                            ``(i) 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
                            ``(ii) 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. 3104. 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 WTC 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. 3105. 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 health conditions. Such data 
shall be collected for all individuals provided monitoring or treatment 
benefits under subtitle B and regardless of their place of residence or 
Clinical Center of Excellence through which the benefits are provided.
    ``(b) Coordinating Through Centers of Excellence.--Each Clinical 
Center of Excellence shall collect data described in subsection (a) and 
report such data to the corresponding 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. 3106. 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 3105.
            ``(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 3105, 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 3131;
                    ``(E) for coordinating and administrating the 
                activities of the WTC Health Program Steering 
                Committees established under section 3103(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 health 
        conditions for responders and of identified WTC-related health 
        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 this section, New 
                York City is required to contribute a matching amount 
                of 20 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 
                each such paragraph as applied under sections 3121(b) 
                and 3122(a) for WTC community members, and section 3123 
                for other individuals with WTC-related health 
                conditions, and reimbursement under section 
                3106(c)(1)(C) for items and services furnished by a 
                Clinical Center of Excellence or Coordinating Center of 
                Excellence, after the application of paragraphs (2) and 
                (3) of section 3101(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 3101(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 $250,000,000 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 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 the 
                responders 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 the 
                members 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 health 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 3101(d), as follows:
            ``(1) Clinical centers of excellence.--For carrying out 
        subparagraphs (B) through (F) of subsection (a)(1)--
                    ``(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 for 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 
        Center 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, 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 3105;
            ``(4) the Center has in place safeguards against fraud that 
        are satisfactory to the Administrator;
            ``(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.
    ``(e) NYC Right of Inspection and Audit.--
            ``(1) In general.--The City of New York, for any program 
        under this title for which the City contributes a matching 
        amount pursuant to subsection (a)(3)(C), shall have the right 
        to, independently but in coordination with the WTC Program 
        Administrator--
                    ``(A) inspect or otherwise evaluate the quality, 
                appropriateness, and timeliness of services provided to 
                recipients of assistance under a contract under such 
                program; and
                    ``(B) audit and inspect any books and records of 
                any Clinical Center of Excellence or Coordinating 
                Center of Excellence that pertain to--
                            ``(i) the ability of the Center of 
                        Excellence to provide services to program 
                        recipients under the contract; or
                            ``(ii) expenditures made utilizing City 
                        funds.
            ``(2) Memorandum of understanding.--The WTC Program 
        Administrator shall enter into a memorandum of understanding 
        with the City of New York setting forth the terms and 
        conditions of how the inspections and audits conducted by the 
        City under paragraph (1) shall be carried out. The memorandum 
        of understanding shall include provisions requiring that any 
        audits conducted by the City of New York under paragraph (1) 
        will be done in a manner to protect the confidentiality of 
        program participants and in accordance with the Health 
        Insurance Portability and Accountability Act of 1996 and other 
        applicable Federal and State medical confidentiality 
        requirements.

``SEC. 3107. ENTITLEMENT AUTHORITIES.

    ``Subject to subsections (b)(4)(C) and (c)(4) of section 3112--
            ``(1) 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
            ``(2) section 3106(c) constitutes such budget authority and 
        represents the obligation of the Federal Government to provide 
        for the payment described in such section.

``SEC. 3108. 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 3111(a)(4) or an eligible WTC community member under 
        section 3121(a)(4), respectively.
            ``(3) The terms `Clinical Center of Excellence' and 
        `Coordinating Center of Excellence' have the meanings given 
        such terms in section 3106(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 3111(a) and 3121(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 conditions for eligible WTC 
                responders under paragraph (3) or (4) of section 
                3112(a); or
                    ``(B) for eligible WTC community members, the 
                identified WTC-related health conditions for WTC 
                community members under paragraph (1) or (2) of section 
                3122(b).
            ``(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 Center of Excellence 
        described in subparagraph (A), (B), or (C) of section 
        3106(b)(1).
            ``(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 3103.
            ``(14) The term `WTC Program Administrator' means the 
        individual responsible under section 3101(f) for the 
        administration of the WTC program.
            ``(15) The term `WTC-related health condition' is defined 
        in section 3112(a).
            ``(16) The term `WTC Scientific/Technical Advisory 
        Committee' means the WTC Health Program Scientific/Technical 
        Advisory Committee established under section 3102.

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

                      ``PART 1--FOR WTC RESPONDERS

``SEC. 3111. 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 3108(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 
                3121(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 Center sites (including Ground Zero, 
                        Staten Island Landfill, 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 3112(a)(1)(B) on or before September 1, 
                        2008.
                    ``(B) Law enforcement officers and wtc rescue, 
                recovery, and clean-up workers.--The individual--
                            ``(i) worked or volunteered on-site in 
                        rescue, recovery, debris-cleanup, or related 
                        support services in lower Manhattan (south of 
                        Canal Street), the Staten Island Landfill, or 
                        the barge loading piers, for--
                                    ``(I) at least 4 hours during the 
                                period beginning on September 11, 2001, 
                                and ending on September 14, 2001;
                                    ``(II) at least 24 hours during the 
                                period beginning on September 11, 2001, 
                                and ending on September 30, 2001; or
                                    ``(III) 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 support services in 
                        lower Manhattan (south of Canal Street), 
                        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 
                        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 September 11, 2001, 
                        terrorist attacks on the World Trade Center, 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, or 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.--
                            ``(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 
                3121(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 3121(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 wtc 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 medical 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).
                            ``(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 medical spending 
                                estimate under this title for such 
                                period.
    ``(b) Monitoring Benefits.--
            ``(1) In general.--In the case of an eligible WTC responder 
        under section 3111(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 
        3131.

``SEC. 3112. 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 health conditions, is 
                substantially likely to be a significant factor in 
                aggravating, contributing to, or causing the illness or 
                health condition, as determined under paragraph (2); or
                    ``(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 health 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 
        3111(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 health 
                        conditions.
                    ``(B) The type of symptoms and temporal sequence of 
                symptoms. Such symptoms shall be--
                            ``(i) assessed through the use of a 
                        standardized, population appropriate medical 
                        questionnaire approved by 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 
        eligible wtc responders.--For purposes of this title, the term 
        `identified WTC-related 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.
                            ``(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 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 
                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 3111 for a certified eligible 
                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 September, 11, 2001, 
                terrorist attacks on the World Trade Center 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 September 11, 
                        2001, terrorist attacks on the World Trade 
                        Center 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 a 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-related 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 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 treatment.--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 paragraphs (1) through (3) 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 (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 health conditions 
                        through one or more contracts with outside 
                        vendors.
                            ``(ii) Competitive bidding.--Under such 
                        program the Administrator shall--
                                    ``(I) select one or more 
                                appropriate vendors through a Federal 
                                competitive bid process; and
                                    ``(II) select the lowest bidder (or 
                                bidders) meeting the requirements for 
                                providing pharmaceutical benefits for 
                                participants in the WTC program.
                            ``(iii) Treatment of fdny participants.--
                        Under such program the Administrator may select 
                        a separate vendor to provide pharmaceutical 
                        benefits to certified eligible WTC responders 
                        for whom the Clinical Center of Excellence is 
                        described in section 3106(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. 3121. 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 after 
                consultation with the WTC Community Program Steering 
                Committee, the Coordinating Centers of Excellence 
                described in section 3106(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 WTC 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 
        WTC responders has reached 80 percent of the limit described in 
        section 3111(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.
                    ``(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) A 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 members. 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--
                            ``(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 Monitoring 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. 3122. 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 3111 and 3112 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 3106(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 members.--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.
                            ``(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 3112(a) shall apply with respect to an addition to the 
        list of identified WTC-related health 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 health conditions for eligible WTC responders under 
        section 3112(a)(3).

``SEC. 3123. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS 
              WITH WTC-RELATED HEALTH CONDITIONS.

    ``(a) In General.--Subject to subsection (c), the provisions of 
section 3122 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 
3106(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 an 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. 3131. 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 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 3106(a)(2)(B);
            ``(3) collect and report data in accordance with section 
        3105; and
            ``(4) meet such fraud, quality assurance, and other 
        requirements as the WTC Program Administrator establishes.

                 ``Subtitle C--Research Into Conditions

``SEC. 3141. 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 on the World Trade Center;
            ``(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 3151), 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 
health 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. 3151. 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. 3152. 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 services 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 3101 of the Public Health Service 
        Act,'' after ``September 11, 2001'';
            (2) by inserting after paragraph (6) the following new 
        paragraphs and redesignating subsequent paragraphs accordingly:
            ``(7) Contractor and subcontractor.--The term `contractor 
        and subcontractor' means any contractor or subcontractor (at 
        any tier of a subcontracting relationship), including any 
        general contractor, construction manager, prime contractor, 
        consultant, or any parent, subsidiary, associated or allied 
        company, affiliated company, corporation, firm, organization, 
        or joint venture thereof that participated in debris removal at 
        any 9/11 crash site. Such term shall not include any entity, 
        including the Port Authority of New York and New Jersey, with a 
        property interest in the World Trade Center, on September 11, 
        2001, whether fee simple, leasehold or easement, direct or 
        indirect.
            ``(8) Debris removal.--The term `debris removal' means 
        rescue and recovery efforts, removal of debris, cleanup, 
        remediation, and response during the immediate aftermath of the 
        terrorist-related aircraft crashes of September 11, 2001, with 
        respect to a 9/11 crash site.'';
            (3) by inserting after paragraph (10), as so redesignated, 
        the following new paragraph and redesignating the subsequent 
        paragraphs accordingly:
            ``(11) Immediate aftermath.--The term `immediate aftermath' 
        means any period beginning with the terrorist-related aircraft 
        crashes of September 11, 2001, and ending on August 30, 
        2002.''; and
            (4) by adding at the end the following new paragraph:
            ``(14) 9/11 crash site.--The term `9/11 crash site' means--
                    ``(A) the World Trade Center site, Pentagon site, 
                and Shanksville, Pennsylvania site;
                    ``(B) the buildings or portions of buildings that 
                were destroyed as a result of the terrorist-related 
                aircraft crashes of September 11, 2001;
                    ``(C) any area contiguous to a site of such crashes 
                that the Special Master determines was sufficiently 
                close to the site that there was a demonstrable risk of 
                physical harm resulting from the impact of the aircraft 
                or any subsequent fire, explosions, or building 
                collapses (including the immediate area in which the 
                impact occurred, fire occurred, portions of buildings 
                fell, or debris fell upon and injured individuals); and
                    ``(D) any area related to, or along, routes of 
                debris removal, such as barges and Fresh Kills.''.

SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.

    (a) Information on Losses Resulting From Debris Removal Included in 
Contents of Claim Form.--Section 405(a)(2)(B) of the Air Transportation 
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) in clause (i), by inserting ``, or debris removal 
        during the immediate aftermath'' after ``September 11, 2001'';
            (2) in clause (ii), by inserting ``or debris removal during 
        the immediate aftermath'' after ``crashes''; and
            (3) in clause (iii), by inserting ``or debris removal 
        during the immediate aftermath'' after ``crashes''.
    (b) Extension of Deadline for Claims Under September 11th Victim 
Compensation Fund of 2001.--Section 405(a)(3) of such Act is amended to 
read as follows:
            ``(3) Limitation.--
                    ``(A) In general.--Except as provided by 
                subparagraph (B), no claim may be filed under paragraph 
                (1) after the date that is 2 years after the date on 
                which regulations are promulgated under section 407(a).
                    ``(B) Exception.--A claim may be filed under 
                paragraph (1), in accordance with subsection 
                (c)(3)(A)(i), by an individual (or by a personal 
                representative on behalf of a deceased individual) 
                during the period beginning on the date on which the 
                regulations are updated under section 407(b) and ending 
                on December 22, 2031.''.
    (c) Requirements for Filing Claims During Extended Filing Period.--
Section 405(c)(3) of such Act is amended--
            (1) by redesignating subparagraphs (A) and (B) as 
        subparagraphs (B) and (C), respectively; and
            (2) by inserting before subparagraph (B), as so 
        redesignated, the following new subparagraph:
                    ``(A) Requirements for filing claims during 
                extended filing period.--
                            ``(i) Timing requirements for filing 
                        claims.--An individual (or a personal 
                        representative on behalf of a deceased 
                        individual) may file a claim during the period 
                        described in subsection (a)(3)(B) as follows:
                                    ``(I) In the case that the Special 
                                Master determines the individual knew 
                                (or reasonably should have known) 
                                before the date specified in clause 
                                (iii) that the individual suffered a 
                                physical harm at a 9/11 crash site as a 
                                result of the terrorist-related 
                                aircraft crashes of September 11, 2001, 
                                or as a result of debris removal, and 
                                that the individual knew (or should 
                                have known) before such specified date 
                                that the individual was eligible to 
                                file a claim under this title, the 
                                individual may file a claim not later 
                                than the date that is 2 years after 
                                such specified date.
                                    ``(II) In the case that the Special 
                                Master determines the individual first 
                                knew (or reasonably should have known) 
                                on or after the date specified in 
                                clause (iii) that the individual 
                                suffered such a physical harm or that 
                                the individual first knew (or should 
                                have known) on or after such specified 
                                date that the individual was eligible 
                                to file a claim under this title, the 
                                individual may file a claim not later 
                                than the last day of the 2-year period 
                                beginning on the date the Special 
                                Master determines the individual first 
                                knew (or should have known) that the 
                                individual both suffered from such harm 
                                and was eligible to file a claim under 
                                this title.
                            ``(ii) Other eligibility requirements for 
                        filing claims.--An individual may file a claim 
                        during the period described in subsection 
                        (a)(3)(B) only if--
                                    ``(I) the individual was treated by 
                                a medical professional for suffering 
                                from a physical harm described in 
                                clause (i)(I) within a reasonable time 
                                from the date of discovering such harm; 
                                and
                                    ``(II) the individual's physical 
                                harm is verified by contemporaneous 
                                medical records created by or at the 
                                direction of the medical professional 
                                who provided the medical care.
                            ``(iii) Date specified.--The date specified 
                        in this clause is the date on which the 
                        regulations are updated under section 
                        407(a).''.
    (d) Clarifying Applicability to All 9/11 Crash Sites.--Section 
405(c)(2)(A)(i) of such Act is amended by striking ``or the site of the 
aircraft crash at Shanksville, Pennsylvania'' and inserting ``the site 
of the aircraft crash at Shanksville, Pennsylvania, or any other 9/11 
crash site''.
    (e) Inclusion of Physical Harm Resulting From Debris Removal.--
Section 405(c) of such Act is amended in paragraph (2)(A)(ii), by 
inserting ``or debris removal'' after ``air crash''.
    (f) Limitations on Civil Actions.--
            (1) Application to damages related to debris removal.--
        Clause (i) of section 405(c)(3)(C) of such Act, as redesignated 
        by subsection (c), is amended by inserting ``, or for damages 
        arising from or related to debris removal'' after ``September 
        11, 2001''.
            (2) Pending actions.--Clause (ii) of such section, as so 
        redesignated, is amended to read as follows:
                            ``(ii) Pending actions.--In the case of an 
                        individual who is a party to a civil action 
                        described in clause (i), such individual may 
                        not submit a claim under this title--
                                    ``(I) during the period described 
                                in subsection (a)(3)(A) unless such 
                                individual withdraws from such action 
                                by the date that is 90 days after the 
                                date on which regulations are 
                                promulgated under section 407(a); and
                                    ``(II) during the period described 
                                in subsection (a)(3)(B) unless such 
                                individual withdraws from such action 
                                by the date that is 90 days after the 
                                date on which the regulations are 
                                updated under section 407(b).''.
            (3) Authority to reinstitute certain lawsuits.--Such 
        section, as so redesignated, is further amended by adding at 
        the end the following new clause:
                            ``(iii) Authority to reinstitute certain 
                        lawsuits.--In the case of a claimant who was a 
                        party to a civil action described in clause 
                        (i), who withdrew from such action pursuant to 
                        clause (ii), and who is subsequently determined 
                        to not be an eligible individual for purposes 
                        of this subsection, such claimant may 
                        reinstitute such action without prejudice 
                        during the 90-day period beginning after the 
                        date of such ineligibility determination.''.

SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.

    Section 407 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) by striking ``Not later than'' and inserting ``(a) In 
        General.--Not later than''; and
            (2) by adding at the end the following new subsection:
    ``(b) Updated Regulations.--Not later than 90 days after the date 
of the enactment of the James Zadroga 9/11 Health and Compensation Act 
of 2009, the Special Master shall update the regulations promulgated 
under subsection (a) to the extent necessary to comply with the 
provisions of title II of such Act.''.

SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.

    Section 408(a) of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended by adding at the 
end the following new paragraphs:
            ``(4) Liability for certain claims.--
                    ``(A) In general.--Notwithstanding any other 
                provision of law, subject to subparagraph (B), 
                liability for all claims and actions (including claims 
                or actions that have been previously resolved, that are 
                currently pending, and that may be filed through 
                December 22, 2031) for compensatory damages, 
                contribution or indemnity, or any other form or type of 
                relief, arising from or related to debris removal, 
                against 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 thereof, shall not be in an amount 
                that exceeds the sum of the following:
                            ``(i) The amount of funds of the WTC 
                        Captive Insurance Company, including the 
                        cumulative interest.
                            ``(ii) The amount of all available 
                        insurance identified in schedule 2 of the WTC 
                        Captive Insurance Company insurance policy.
                            ``(iii) The amount that is the greater of 
                        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.
                            ``(iv) The amount of all available 
                        liability insurance coverage maintained by any 
                        entity, including the Port Authority of New 
                        York and New Jersey, with a property interest 
                        in the World Trade Center, on September 11, 
                        2001, whether fee simple, leasehold or 
                        easement, or direct or indirect.
                            ``(v) The amount of all available liability 
                        insurance coverage maintained by contractors 
                        and subcontractors.
                    ``(B) Exception.--Subparagraph (A) shall not apply 
                to claims or actions based upon conduct held to be 
                intentionally tortious in nature or to acts of gross 
                negligence or other such acts to the extent to which 
                punitive damages are awarded as a result of such 
                conduct or acts.
            ``(5) Priority of claims payments.--Payments to plaintiffs 
        who obtain a settlement or judgment with respect to a claim or 
        action to which paragraph (4)(A) applies, shall be paid solely 
        from the following funds in the following order:
                    ``(A) The funds described in clause (i) or (ii) of 
                paragraph (4)(A).
                    ``(B) If there are no funds available as described 
                in clause (i) or (ii) of paragraph (4)(A), the funds 
                described in clause (iii) of such paragraph.
                    ``(C) If there are no funds available as described 
                in clause (i), (ii), or (iii) of paragraph (4)(A), the 
                funds described in clause (iv) of such paragraph.
                    ``(D) If there are no funds available as described 
                in clause (i), (ii), (iii), or (iv) of paragraph 
                (4)(A), the funds described in clause (v) of such 
                paragraph.
            ``(6) Declaratory judgment actions and direct action.--Any 
        party to a claim or action to which paragraph (4)(A) applies 
        may, with respect to such claim or action, either file an 
        action for a declaratory judgment for insurance coverage or 
        bring a direct action against the insurance company 
        involved.''.
                                 <all>
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