II 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘James Zadroga 9/11 Health and Compensation Act of 

6 2009’’. 

7 (b) TABLE OF CONTENTS.—The table of contents for 

8 this Act is as follows: 


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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. 


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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. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Thousands of rescue workers who responded 

4 to the areas devastated by the terrorist attacks of 

5 September 11, 2001, local residents, office and area 

6 workers, and school children continue to suffer sig7 nificant medical problems as a result of com8 promised air quality and the release of other toxins 

9 from the attack sites. 

10 (2) In a September 2006 peer-reviewed study 

11 conducted by the World Trade Center Medical Moni12 toring Program, of 9,500 World Trade Center re13 sponders, almost 70 percent of World Trade Center 

14 responders had a new or worsened respiratory symp15 tom that developed during or after their time work16 ing at the World Trade Center; among the respond17 ers who were asymptomatic before September 11, 

18 2001, 61 percent developed respiratory symptoms 

19 while working at the World Trade Center; close to 

20 60 percent still had a new or worsened respiratory 

21 symptom at the time of their examination; one-third 

22 had abnormal pulmonary function tests; and severe 


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1 respiratory conditions including pneumonia were sig2 nificantly more common in the 6 months after Sep3 tember 11, 2001, than in the prior 6 months. 

4 (3) An April 2006 study documented that, on 

5 average, a New York City firefighter who responded 

6 to the World Trade Center has experienced a loss of 

7 12 years of lung capacity. 

8 (4) A peer-reviewed study of residents who lived 

9 near the World Trade Center titled ‘‘The World 

10 Trade Center Residents’ Respiratory Health Study: 

11 New Onset Respiratory Symptoms and Pulmonary 

12 Function’’, found that data demonstrated a threefold 

13 increase in new-onset, persistent lower respiratory 

14 symptoms in residents near the former World Trade 

15 Center as compared to a control population. 

16 (5) Previous research on the health impacts of 

17 the devastation caused by the September 11, 2001, 

18 terrorist attacks has shown relationships between 

19 the air quality from Ground Zero and a host of 

20 health impacts, including lower pregnancy rates, 

21 higher rates of respiratory and lung disorders, and 

22 a variety of post-disaster mental health conditions 

23 (including posttraumatic stress disorder) in workers 

24 and residents near Ground Zero. 


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1 (6) A variety of tests conducted by independent 

2 scientists have concluded that significant World 

3 Trade Center (WTC) contamination settled in indoor 

4 environments surrounding the disaster site. The En5 vironmental Protection Agency’s (EPA) cleanup pro6 grams for indoor residential spaces, in 2003 and 

7 2005, though limited, are an acknowledgment that 

8 indoor contamination continued after the WTC at9 tacks. 

10 (7) At the request of the Department of En11 ergy, the Davis DELTA Group at the University of 

12 California conducted outdoor dust sampling in Octo13 ber 2001 at Varick and Houston Streets (approxi14 mately 1.2 miles north of Ground Zero) and found 

15 that the contamination from the World Trade Cen16 ter ‘‘outdid even the worst pollution from the Ku17 wait oil fields fires’’. Further, the United States Ge18 ological Survey (USGS) reported on November 27, 

19 2001, that dust samples collected from indoor sur20 faces in this area registered at levels that were ‘‘as 

21 caustic as liquid drain cleaners’’. 

22 (8) According to both the EPA’s own Inspector 

23 General’s (EPA IG) report of August 21, 2003, and 

24 the Governmental Accountability Offices’s (GAO) re25 port of September 2007, no comprehensive program 


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1 has ever been conducted in order to characterize the 

2 full extent of WTC contamination, and therefore the 

3 full impact of that contamination—geographic or 

4 otherwise—remains unknown. 

5 (9) Such reports found that there has never 

6 been a comprehensive program to remediate WTC 

7 toxins from indoor spaces. Thus, area residents, 

8 workers, and students may continue to be exposed to 

9 WTC contamination in their homes, workplaces, and 

10 schools. 

11 (10) Because of the failure to release federally 

12 appropriated funds for community care, a lack of 

13 sufficient outreach, the fact that many community 

14 members are receiving care from physicians outside 

15 the current City-funded World Trade Center Envi16 ronmental Health Center program and thus fall out17 side data collection efforts, and other factors, the 

18 number of community members being treated at the 

19 World Trade Center Environmental Health Center 

20 underrepresents the total number in the community 

21 that have been affected by exposure to Ground Zero 

22 toxins. 

23 (11) Research by Columbia University’s Center 

24 for Children’s Environmental Health has shown neg25 ative health effects on babies born to women living 


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1 within 2 miles of the World Trade Center in the 

2 month following September 11, 2001. 

3 (12) Federal funding allocated for the moni4 toring of rescue workers’ health is not sufficient to 

5 ensure the long-term study of health impacts of Sep6 tember 11, 2001. 

7 (13) A significant portion of those who have de8 veloped health problems as result of exposures to 

9 airborne toxins or other hazards resulting from the 

10 September 11, 2001, attacks on the World Trade 

11 Center have no health insurance, have lost their 

12 health insurance as a result of the attacks, or have 

13 inadequate health insurance. 

14 (14) The Federal program to provide medical 

15 treatments to those who responded to the September 

16 11, 2001, aftermath, and who continue to experience 

17 health problems as a result, was finally established 

18 more than five years after the attacks, but has no 

19 certain long-term funding. 

20 (15) Rescue workers and volunteers seeking 

21 workers’ compensation have reported that their ap22 plications have been denied, delayed for months, or 

23 redirected, instead of receiving assistance in a timely 

24 and supportive manner. 


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1 (16) A February 2007 report released by the 

2 City of New York estimated that approximately 

3 410,000 people were the most heavily exposed to the 

4 environmental hazards and trauma of the September 

5 11, 2001, terrorist attacks. More than 30 percent of 

6 the Fire Department of the City of New York first 

7 responders were still experiencing some respiratory 

8 symptoms more than five years after the attacks 

9 and, according to the report, 59 percent of those 

10 seen by the WTC Environmental Health Center at 

11 Bellevue Hospital (which serves community mem12 bers) are without insurance and 65 percent have in13 comes of less than $15,000 per year. The report also 

14 found a need to continue and expand mental health 

15 services. 

16 (17) Since the 5th anniversary of the attack 

17 (September 11, 2006), hundreds of workers a month 

18 have been signing up with the monitoring and treat19 ment programs. 

20 (18) In April 2008, the Department of Health 

21 and Human Services reported to Congress that in 

22 fiscal year 2007 11,359 patients received medical 

23 treatment in the existing WTC Responder Medical 

24 and Treatment program for WTC-related health 

25 problems, and that number of responders who need 


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1 treatment and the severity of health problems is ex2 pected to increase. 

3 (19) The September 11 Victim Compensation 

4 Fund of 2001 was established to provide compensa5 tion to individuals who were physically injured or 

6 killed as a result of the terrorist-related aircraft 

7 crashes of September 11, 2001. 

8 (20) The deadline for filing claims for com9 pensation under the Victim Compensation Fund was 

10 December 22, 2003. 

11 (21) Some individuals did not know they were 

12 eligible to file claims for compensation for injuries or 

13 did not know they had suffered physical harm as a 

14 result of the terrorist-related aircraft crashes until 

15 after the December 22, 2003, deadline. 

16 (22) Further research is needed to evaluate 

17 more comprehensively the extent of the health im18 pacts of September 11, 2001, including research for 

19 emerging health problems such as cancer, which 

20 have been predicted. 

21 (23) Research is needed regarding possible 

22 treatment for the illnesses and injuries of September 

23 11, 2001. 

24 (24) The Federal response to medical and fi25 nancial issues arising from the September 11, 2001, 


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1 response efforts needs a comprehensive, coordinated 

2 long-term response in order to meet the needs of all 

3 the individuals who were exposed to the toxins of 

4 Ground Zero and are suffering health problems from 

5 the disaster. 

6 (25) The failure to extend the appointment of 

7 Dr. John Howard as Director of the National Insti8 tute for Occupational Safety and Health in July 

9 2008 is not in the interests of the administration of 

10 such Institute nor the continued operation of the 

11 World Trade Center Medical Monitoring and Treat12 ment Program which he has headed, and the Sec13 retary of Health and Human Services should recon14 sider extending such appointment. 

15 TITLE I—WORLD TRADE CENTER 

16 HEALTH PROGRAM 

17 SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 

18 The Public Health Service Act (42 U.S.C. 201 et 

19 seq.) is amended by adding at the end the following new 

20 title: 


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1 ‘‘TITLE XXXI—WORLD TRADE 

2 CENTER HEALTH PROGRAM 

3 ‘‘Subtitle A—Establishment of Pro4 gram; Advisory and Steering 

5 Committees 

6 ‘‘SEC. 3101. ESTABLISHMENT OF WORLD TRADE CENTER 

7 HEALTH PROGRAM WITHIN NIOSH. 

8 ‘‘(a) IN GENERAL.—There is hereby established with9 in the National Institute for Occupational Safety and 

10 Health a program to be known as the ‘World Trade Center 

11 Health Program’ (in this title referred to as the ‘WTC 

12 program’) to provide— 

13 ‘‘(1) medical monitoring and treatment benefits 

14 to eligible emergency responders and recovery and 

15 clean-up workers (including those who are Federal 

16 employees) who responded to the September 11, 

17 2001, terrorist attacks on the World Trade Center; 

18 and 

19 ‘‘(2) initial health evaluation, monitoring, and 

20 treatment benefits to residents and other building 

21 occupants and area workers in New York City who 

22 were directly impacted and adversely affected by 

23 such attacks. 

24 ‘‘(b) COMPONENTS OF PROGRAM.—The WTC pro25 gram includes the following components: 


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1 ‘‘(1) MEDICAL MONITORING FOR RESPOND2 ERS.—Medical monitoring under section 3111, in3 cluding clinical examinations and long-term health 

4 monitoring and analysis for individuals who were 

5 likely to have been exposed to airborne toxins that 

6 were released, or to other hazards, as a result of the 

7 September 11, 2001, terrorist attacks on the World 

8 Trade Center. 

9 ‘‘(2) INITIAL HEALTH EVALUATION FOR COM10 MUNITY MEMBERS.—An initial health evaluation 

11 under section 3121, including an evaluation to deter12 mine eligibility for followup monitoring and treat13 ment. 

14 ‘‘(3) FOLLOW-UP MONITORING AND TREAT15 MENT FOR WTC-RELATED CONDITIONS FOR RE16 SPONDERS AND COMMUNITY MEMBERS.—Provision 

17 under sections 3112, 3122, and 3123 of follow-up 

18 monitoring and treatment and payment, subject to 

19 the provisions of subsection (d), for all medically 

20 necessary health and mental health care expenses 

21 (including necessary prescription drugs) of individ22 uals with a WTC-related health condition. 

23 ‘‘(4) OUTREACH.—Establishment under section 

24 3104 of an outreach program to potentially eligible 

25 individuals concerning the benefits under this title. 


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1 ‘‘(5) UNIFORM DATA COLLECTION.—Collection 

2 under section 3105 of health and mental health data 

3 on individuals receiving monitoring or treatment 

4 benefits, using a uniform system of data collection. 

5 ‘‘(6) RESEARCH ON WTC CONDITIONS.—Estab6 lishment under subtitle C of a research program on 

7 health conditions resulting from the September 11, 

8 2001, terrorist attacks on the World Trade Center. 

9 ‘‘(c) NO COST-SHARING.—Monitoring and treatment 

10 benefits and initial health evaluation benefits are provided 

11 under subtitle B without any deductibles, copayments, or 

12 other cost-sharing to an eligible WTC responder or any 

13 eligible WTC community member. 

14 ‘‘(d) PAYOR.— 

15 ‘‘(1) IN GENERAL.—Except as provided in para16 graphs (2) and (3), the cost of monitoring and treat17 ment benefits and initial health evaluation benefits 

18 provided under subtitle B shall be paid for by the 

19 WTC program. 

20 ‘‘(2) WORKERS’ COMPENSATION PAYMENT.— 

21 ‘‘(A) IN GENERAL.—Except as provided in 

22 subparagraph (B), payment for treatment 

23 under subtitle B of a WTC-related health condi24 tion in an individual that is work-related shall 

25 be reduced or recouped to the extent that the 


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1 Secretary determines that payment has been 

2 made, or can reasonably be expected to be 

3 made, under a workers’ compensation law or 

4 plan of the United States or a State, or other 

5 work-related injury or illness benefit plan of the 

6 employer of such individual, for such treatment. 

7 The provisions of clauses (iii), (iv), (v), and (vi) 

8 of paragraph (2)(B) of section 1862(b) of the 

9 Social Security Act (42 U.S.C. 1395y(b)(2)) 

10 and paragraph (3) of such section shall apply to 

11 the recoupment under this paragraph of a pay12 ment to the WTC program with respect to a 

13 workers’ compensation law or plan, or other 

14 work-related injury or illness plan of the em15 ployer involved, and such individual in the same 

16 manner as such provisions apply to the reim17 bursement of a payment under section 

18 1862(b)(2) of such Act to the Secretary, with 

19 respect to such a law or plan and an individual 

20 entitled to benefits under title XVIII of such 

21 Act. 

22 ‘‘(B) EXCEPTION.—If the WTC Program 

23 Administrator certifies that the City of New 

24 York has contributed the matching contribution 

25 required under section 3106(a)(3) for a 12- 


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1 month period (specified by the WTC Program 

2 Administrator), subparagraph (A) shall not 

3 apply for that 12-month period with respect to 

4 a workers’ compensation law or plan, including 

5 line of duty compensation, to which the City is 

6 obligated to make payments. 

7 ‘‘(3) HEALTH INSURANCE COVERAGE.— 

8 ‘‘(A) IN GENERAL.—In the case of an indi9 vidual who has a WTC-related health condition 

10 that is not work-related and has health cov11 erage for such condition through any public or 

12 private health plan, the provisions of section 

13 1862(b) of the Social Security Act (42 U.S.C. 

14 1395y(b)) shall apply to such a health plan and 

15 such individual in the same manner as they 

16 apply to a group health plan and an individual 

17 entitled to benefits under title XVIII of such 

18 Act pursuant to section 226(a). Any costs for 

19 items and services covered under such plan that 

20 are not reimbursed by such health plan, due to 

21 the application of deductibles, copayments, coin22 surance, other cost-sharing, or otherwise, are 

23 reimbursable under this title to the extent that 

24 they are covered under the WTC program. 


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1 ‘‘(B) RECOVERY BY INDIVIDUAL PRO2 VIDERS.—Nothing in subparagraph (A) shall be 

3 construed as requiring an entity providing mon4 itoring and treatment under this title to seek 

5 reimbursement under a health plan with which 

6 the entity has no contract for reimbursement. 

7 ‘‘(4) WORK-RELATED DESCRIBED.—For the 

8 purposes of this subsection, a WTC-related health 

9 condition shall be treated as a condition that is 

10 work-related if— 

11 ‘‘(A) the condition is diagnosed in an eligi12 ble WTC responder, or in an individual who 

13 qualifies as an eligible WTC community mem14 ber on the basis of being a rescue, recovery, or 

15 clean-up worker; or 

16 ‘‘(B) with respect to the condition the indi17 vidual has filed and had established a claim 

18 under a workers’ compensation law or plan of 

19 the United States or a State, or other work-re20 lated injury or illness benefit plan of the em21 ployer of such individual. 

22 ‘‘(e) QUALITY ASSURANCE AND MONITORING OF

23 CLINICAL EXPENDITURES.— 

24 ‘‘(1) QUALITY ASSURANCE.—The WTC Pro25 gram Administrator, working with the Clinical CenVerDate Nov 24 2008 04:19 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 ters of Excellence, shall develop and implement a 

2 quality assurance program for the medical moni3 toring and treatment delivered by such Centers of 

4 Excellence and any other participating health care 

5 providers. Such program shall include— 

6 ‘‘(A) adherence to medical monitoring and 

7 treatment protocols; 

8 ‘‘(B) appropriate diagnostic and treatment 

9 referrals for participants; 

10 ‘‘(C) prompt communication of test results 

11 to participants; and 

12 ‘‘(D) such other elements as the Adminis13 trator specifies in consultation with the Clinical 

14 Centers of Excellence. 

15 ‘‘(2) FRAUD PREVENTION.—The WTC Program 

16 Administrator shall develop and implement a pro17 gram to review the program’s health care expendi18 tures to detect fraudulent or duplicate billing and 

19 payment for inappropriate services. Such program 

20 shall be similar to current methods used in connec21 tion with the Medicare program under title XVIII of 

22 the Social Security Act. This title is a Federal 

23 health care program (as defined in section 1128B(f) 

24 of such Act) and is a health plan (as defined in secVerDate Nov 24 2008 04:19 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 tion 1128C(c) of such Act) for purposes of applying 

2 sections 1128 through 1128E of such Act. 

3 ‘‘(f) WTC PROGRAM ADMINISTRATION.—The WTC 

4 program shall be administered by the Director of the Na5 tional Institute for Occupational Safety and Health, or a 

6 designee of such Director. 

7 ‘‘(g) ANNUAL PROGRAM REPORT.— 

8 ‘‘(1) IN GENERAL.—Not later than 6 months 

9 after the end of each fiscal year in which the WTC 

10 program is in operation, the WTC Program Admin11 istrator shall submit an annual report to the Con12 gress on the operations of this title for such fiscal 

13 year and for the entire period of operation of the 

14 program. 

15 ‘‘(2) CONTENTS OF REPORT.—Each annual re16 port under paragraph (1) shall include the following: 

17 ‘‘(A) ELIGIBLE INDIVIDUALS.—Informa18 tion for each clinical program described in para19 graph (3)— 

20 ‘‘(i) on the number of individuals who 

21 applied for certification under subtitle B 

22 and the number of such individuals who 

23 were so certified; 

24 ‘‘(ii) of the individuals who were cer25 tified, on the number who received medical 


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1 monitoring under the program and the 

2 number of such individuals who received 

3 medical treatment under the program; 

4 ‘‘(iii) with respect to individuals so 

5 certified who received such treatment, on 

6 the WTC-related health conditions for 

7 which the individuals were treated; and 

8 ‘‘(iv) on the projected number of indi9 viduals who will be certified under subtitle 

10 B in the succeeding fiscal year. 

11 ‘‘(B) MONITORING, INITIAL HEALTH EVAL12 UATION, AND TREATMENT COSTS.—For each 

13 clinical program so described— 

14 ‘‘(i) information on the costs of moni15 toring and initial health evaluation and the 

16 costs of treatment and on the estimated 

17 costs of such monitoring, evaluation, and 

18 treatment in the succeeding fiscal year; 

19 and 

20 ‘‘(ii) an estimate of the cost of med21 ical treatment for WTC-related health con22 ditions that have been paid for or reim23 bursed by workers’ compensation, by public 

24 or private health plans, or by the City of 

25 New York under section 3106(a)(3). 


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1 ‘‘(C) ADMINISTRATIVE COSTS.—Informa2 tion on the cost of administering the program, 

3 including costs of program support, data collec4 tion and analysis, and research conducted under 

5 the program. 

6 ‘‘(D) ADMINISTRATIVE EXPERIENCE.—In7 formation on the administrative performance of 

8 the program, including— 

9 ‘‘(i) the performance of the program 

10 in providing timely evaluation of and treat11 ment to eligible individuals; and 

12 ‘‘(ii) a list of the Clinical Centers of 

13 Excellence and other providers that are 

14 participating in the program. 

15 ‘‘(E) SCIENTIFIC REPORTS.—A summary 

16 of the findings of any new scientific reports or 

17 studies on the health effects associated with 

18 WTC exposures, including the findings of re19 search conducted under section 3141(a). 

20 ‘‘(F) ADVISORY COMMITTEE REC21 OMMENDATIONS.—A list of recommendations by 

22 the WTC Scientific/Technical Advisory Com23 mittee on additional WTC program eligibility 

24 criteria and on additional WTC-related health 

25 conditions and the action of the WTC Program 


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1 Administrator concerning each such rec2 ommendation. 

3 ‘‘(3) SEPARATE CLINICAL PROGRAMS DE4 SCRIBED.—In paragraph (2), each of the following 

5 shall be treated as a separate clinical program of the 

6 WTC program: 

7 ‘‘(A) FDNY RESPONDERS.—The benefits 

8 provided for eligible WTC responders described 

9 in section 3106(b)(1)(A). 

10 ‘‘(B) OTHER ELIGIBLE WTC RESPOND11 ERS.—The benefits provided for eligible WTC 

12 responders not described in subparagraph (A). 

13 ‘‘(C) ELIGIBLE WTC COMMUNITY MEM14 BERS.—The benefits provided for eligible WTC 

15 community members in section 3106(b)(1)(C). 

16 ‘‘(h) NOTIFICATION TO CONGRESS WHEN REACH 80 

17 PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The 

18 WTC Program Administrator shall promptly notify the 

19 Congress— 

20 ‘‘(1) when the number of certifications for eligi21 ble WTC responders subject to the limit established 

22 under section 3111(a)(5) has reached 80 percent of 

23 such limit; and 

24 ‘‘(2) when the number of certifications for eligi25 ble WTC community members subject to the limit 


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1 established under section 3121(a)(5) has reached 80 

2 percent of such limit. 

3 ‘‘(i) GAO REPORT.—Not later than 3 years after the 

4 date of the enactment of the James Zadroga 9/11 Health 

5 and Compensation Act of 2009, the Comptroller General 

6 of the United States shall submit to the Congress a report 

7 on the costs of the monitoring and treatment programs 

8 provided under this title. 

9 ‘‘(j) NYC RECOMMENDATIONS.—The City of New 

10 York may make recommendations to the WTC Program 

11 Administrator on ways to improve the monitoring and 

12 treatment programs under this title for both eligible WTC 

13 responders and eligible WTC community members. 

14 ‘‘SEC. 3102. WTC HEALTH PROGRAM SCIENTIFIC/TECH15 NICAL ADVISORY COMMITTEE. 

16 ‘‘(a) ESTABLISHMENT.—The WTC Program Admin17 istrator shall establish an advisory committee to be known 

18 as the WTC Health Program Scientific/Technical Advisory 

19 Committee (in this section referred to as the ‘Advisory 

20 Committee’) to review scientific and medical evidence and 

21 to make recommendations to the Administrator on addi22 tional WTC program eligibility criteria and on additional 

23 WTC-related health conditions. 


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1 ‘‘(b) COMPOSITION.—The WTC Program Adminis2 trator shall appoint the members of the Advisory Com3 mittee and shall include at least— 

4 ‘‘(1) 4 occupational physicians, at least two of 

5 whom have experience treating WTC rescue and re6 covery workers; 

7 ‘‘(2) 1 physician with expertise in pulmonary 

8 medicine; 

9 ‘‘(3) 2 environmental medicine or environmental 

10 health specialists; 

11 ‘‘(4) 2 representatives of eligible WTC respond12 ers; 

13 ‘‘(5) 2 representatives of WTC community 

14 members; 

15 ‘‘(6) an industrial hygienist; 

16 ‘‘(7) a toxicologist; 

17 ‘‘(8) an epidemiologist; and 

18 ‘‘(9) a mental health professional. 

19 ‘‘(c) MEETINGS.—The Advisory Committee shall 

20 meet at such frequency as may be required to carry out 

21 its duties. 

22 ‘‘(d) REPORTS.—The WTC Program Administrator 

23 shall provide for publication of recommendations of the 

24 Advisory Committee on the public website established for 

25 the WTC program. 


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1 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 

2 purpose of carrying out this section, there are authorized 

3 to be appropriated such sums as may be necessary, not 

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

5 fiscal year 2009. 

6 ‘‘(f) DURATION.—Notwithstanding any other provi7 sion of law, the Advisory Committee shall continue in op8 eration during the period in which the WTC program is 

9 in operation. 

10 ‘‘(g) APPLICATION OF FACA.—Except as otherwise 

11 specifically provided, the Advisory Committee shall be sub12 ject to the Federal Advisory Committee Act. 

13 ‘‘SEC. 3103. WTC HEALTH PROGRAM STEERING COMMIT14 TEES. 

15 ‘‘(a) ESTABLISHMENT.—The WTC Program Admin16 istrator shall establish two steering committees (each in 

17 this section referred to as a ‘Steering Committee’) as fol18 lows: 

19 ‘‘(1) WTC RESPONDERS STEERING COM20 MITTEE.—One steering committee, to be known as 

21 the WTC Responders Steering Committee, for the 

22 purpose of facilitating the coordination of medical 

23 monitoring and treatment programs for the eligible 

24 WTC responders under part 1 of subtitle B. 


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1 ‘‘(2) WTC COMMUNITY PROGRAM STEERING

2 COMMITTEE.—One steering committee, to be known 

3 as the WTC Community Program Steering Com4 mittee, for the purpose of facilitating the coordina5 tion of initial health evaluations, monitoring, and 

6 treatment programs for eligible WTC community 

7 members under part 2 of subtitle B. 

8 ‘‘(b) MEMBERSHIP.— 

9 ‘‘(1) INITIAL MEMBERSHIP OF WTC RESPOND10 ERS STEERING COMMITTEE.—The WTC Responders 

11 Steering Committee shall initially be composed of 

12 members of the WTC Monitoring and Treatment 

13 Program Steering Committee (as in existence on the 

14 day before the date of the enactment of this title). 

15 In addition, the committee membership shall in16 clude— 

17 ‘‘(A) a representative of the Police Com18 missioner of the City of New York; 

19 ‘‘(B) a representative of the Department of 

20 Health of the City of New York; 

21 ‘‘(C) a representative of another agency of 

22 the City of New York, selected by the Mayor of 

23 New York City, which had a large number of 

24 non-uniformed City workers who responded to 


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1 the September 11, 2001, terrorist attacks on 

2 the World Trade Center; and 

3 ‘‘(D) three representatives of eligible WTC 

4 responders; 

5 in order that eligible WTC responders constitute half 

6 the members of the Steering Committee. 

7 ‘‘(2) INITIAL MEMBERSHIP OF WTC COMMUNITY

8 PROGRAM STEERING COMMITTEE.— 

9 ‘‘(A) IN GENERAL.—The WTC Community 

10 Program Steering Committee shall initially be 

11 composed of members of the WTC Environ12 mental Health Center Community Advisory 

13 Committee (as in existence on the day before 

14 the date of the enactment of this title) and shall 

15 initially have, as voting members, the following: 

16 ‘‘(i) 11 representatives of the affected 

17 populations of residents, students, area 

18 workers, and other community members. 

19 ‘‘(ii) The Medical Director of the 

20 WTC Environmental Health Center. 

21 ‘‘(iii) The Executive Director of the 

22 WTC Environmental Health Center. 

23 ‘‘(iv) Three physicians, one each rep24 resenting the three WTC Environmental 

25 Health Center treatment sites of Bellevue 


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1 Hospital Center, Gouverneur Healthcare 

2 Services, and Elmhurst Hospital Center. 

3 ‘‘(v) Five specialists with WTC re4 lated expertise or experience in treating 

5 non-responder WTC diseases, such as a pe6 diatrician, an epidemiologist, a psychiatrist 

7 or psychologist, an environmental/occupa8 tional specialist, or a social worker from a 

9 WTC Environmental Health Center treat10 ment site, or other relevant specialists. 

11 ‘‘(vi) A representative of the Depart12 ment of Health and Mental Hygiene of the 

13 City of New York. 

14 ‘‘(B) APPOINTMENTS.— 

15 ‘‘(i) WTC EHC COMMUNITY ADVISORY

16 COMMITTEE.—The WTC Environmental 

17 Health Center Community Advisory Com18 mittee as in existence on the date of the 

19 enactment of this title shall nominate 

20 members for positions described in sub21 paragraph (A)(i). 

22 ‘‘(ii) NYC HEALTH AND HOSPITALS

23 CORPORATION.—The New York City 

24 Health and Hospitals Corporation shall 

25 nominate members for positions described 


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1 in clauses (iv) and (v) of subparagraph 

2 (A). 

3 ‘‘(iii) TIMING.—Nominations under 

4 clauses (i) and (ii) shall be recommended 

5 to the WTC Program Administrator not 

6 later than 60 days after the date of the en7 actment of this title. 

8 ‘‘(iv) APPOINTMENT.—The WTC Pro9 gram Administrator shall appoint members 

10 of the WTC Community Program Steering 

11 Committee not later than 90 days after the 

12 date of the enactment of this title. 

13 ‘‘(v) GENERAL REPRESENTATIVES.— 

14 Of the members appointed under subpara15 graph (A)(i)— 

16 ‘‘(I) the representation shall re17 flect the broad and diverse WTC-af18 fected populations and constituencies 

19 and the diversity of impacted neigh20 borhoods, including residents, hard-to21 reach populations, students, area 

22 workers, parents of school-aged stu23 dents, community-based organizations, 

24 Community Boards, WTC Environ25 mental Health Center patients, labor 


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1 unions, and labor advocacy organiza2 tions; and 

3 ‘‘(II) no one individual organiza4 tion shall have more than one rep5 resentative. 

6 ‘‘(3) ADDITIONAL APPOINTMENTS.—Each 

7 Steering Committee may appoint, if approved by a 

8 majority of voting members of the Committee, addi9 tional members to the Committee. 

10 ‘‘(4) VACANCIES.—A vacancy in a Steering 

11 Committee shall be filled by the Steering Committee, 

12 subject to the approval of the WTC Program Ad13 ministrator, so long as— 

14 ‘‘(A) in the case of the WTC Responders 

15 Steering Committee— 

16 ‘‘(i) the composition of the Steering 

17 Committee includes representatives of eligi18 ble WTC responders and representatives of 

19 each Clinical Center of Excellence and 

20 each Coordinating Center of Excellence 

21 that serves eligible WTC responders; and 

22 ‘‘(ii) such composition has eligible 

23 WTC responders constituting half of the 

24 membership of the Steering Committee; or 


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1 ‘‘(B) in the case of the WTC Community 

2 Program Steering Committee— 

3 ‘‘(i) the composition of the Committee 

4 includes representatives of eligible WTC 

5 community members and representatives of 

6 each Clinical Center of Excellence and 

7 each Coordinating Center of Excellence 

8 that serves eligible WTC community mem9 bers; and 

10 ‘‘(ii) the nominating process is con11 sistent with paragraph (2)(B). 

12 ‘‘(5) CO-CHAIRS OF WTC COMMUNITY PROGRAM

13 STEERING COMMITTEE.—The WTC Community Pro14 gram Steering Committee shall have two Co-Chairs 

15 as follows: 

16 ‘‘(A) COMMUNITY/LABOR CO-CHAIR.—A 

17 Community/Labor Co-Chair who shall be chosen 

18 by the community and labor-based members of 

19 the Steering Committee. 

20 ‘‘(B) ENVIRONMENTAL HEALTH CLINIC

21 CO-CHAIR.—A WTC Environmental Health 

22 Clinic Co-Chair who shall be chosen by the 

23 WTC Environmental Health Center members 

24 on the Steering Committee. 


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1 ‘‘(c) RELATION TO FACA.—Each Steering Com2 mittee shall not be subject to the Federal Advisory Com3 mittee Act. 

4 ‘‘(d) MEETINGS.—Each Steering Committee shall 

5 meet at such frequency necessary to carry out its duties, 

6 but not less than 4 times each calendar year and at least 

7 two such meetings each year shall be a joint meeting with 

8 the voting membership of the other Steering Committee 

9 for the purpose of exchanging information regarding the 

10 WTC program. 

11 ‘‘(e) DURATION.—Notwithstanding any other provi12 sion of law, each Steering Committee shall continue in op13 eration during the period in which the WTC program is 

14 in operation. 

15 ‘‘SEC. 3104. COMMUNITY EDUCATION AND OUTREACH. 

16 ‘‘(a) IN GENERAL.—The WTC Program Adminis17 trator shall institute a program that provides education 

18 and outreach on the existence and availability of services 

19 under the WTC program. The outreach and education 

20 program— 

21 ‘‘(1) shall include— 

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

23 with information about the WTC program; 

24 ‘‘(B) meetings with potentially eligible pop25 ulations; 


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1 ‘‘(C) development and dissemination of 

2 outreach materials informing people about the 

3 WTC program; and 

4 ‘‘(D) the establishment of phone informa5 tion services; and 

6 ‘‘(2) shall be conducted in a manner intended— 

7 ‘‘(A) to reach all affected populations; and 

8 ‘‘(B) to include materials for culturally and 

9 linguistically diverse populations. 

10 ‘‘(b) PARTNERSHIPS.—To the greatest extent pos11 sible, in carrying out this section, the WTC Program Ad12 ministrator shall enter into partnerships with local govern13 ments and organizations with experience performing out14 reach to the affected populations, including community 

15 and labor-based organizations. 

16 ‘‘SEC. 3105. UNIFORM DATA COLLECTION. 

17 ‘‘(a) IN GENERAL.—The WTC Program Adminis18 trator shall provide for the uniform collection of data (and 

19 analysis of data and regular reports to the Administrator) 

20 on the utilization of monitoring and treatment benefits 

21 provided to eligible WTC responders and eligible WTC 

22 community members, the prevalence of WTC-related 

23 health conditions, and the identification of new WTC-re24 lated health conditions. Such data shall be collected for 

25 all individuals provided monitoring or treatment benefits 


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1 under subtitle B and regardless of their place of residence 

2 or Clinical Center of Excellence through which the benefits 

3 are provided. 

4 ‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL5 LENCE.—Each Clinical Center of Excellence shall collect 

6 data described in subsection (a) and report such data to 

7 the corresponding Coordinating Center of Excellence for 

8 analysis by such Coordinating Center of Excellence. 

9 ‘‘(c) PRIVACY.—The data collection and analysis 

10 under this section shall be conducted in a manner that 

11 protects the confidentiality of individually identifiable 

12 health information consistent with applicable legal require13 ments. 

14 ‘‘SEC. 3106. CENTERS OF EXCELLENCE. 

15 ‘‘(a) IN GENERAL.— 

16 ‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF

17 EXCELLENCE.—The WTC Program Administrator 

18 shall enter into contracts with Clinical Centers of 

19 Excellence specified in subsection (b)(1)— 

20 ‘‘(A) for the provision of monitoring and 

21 treatment benefits and initial health evaluation 

22 benefits under subtitle B; 

23 ‘‘(B) for the provision of outreach activities 

24 to individuals eligible for such monitoring and 

25 treatment benefits, for initial health evaluation 


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1 benefits, and for follow-up to individuals who 

2 are enrolled in the monitoring program; 

3 ‘‘(C) for the provision of counseling for 

4 benefits under subtitle B, with respect to WTC5 related health conditions, for individuals eligible 

6 for such benefits; 

7 ‘‘(D) for the provision of counseling for 

8 benefits for WTC-related health conditions that 

9 may be available under workers’ compensation 

10 or other benefit programs for work-related inju11 ries or illnesses, health insurance, disability in12 surance, or other insurance plans or through 

13 public or private social service agencies and as14 sisting eligible individuals in applying for such 

15 benefits; 

16 ‘‘(E) for the provision of translational and 

17 interpretive services as for program participants 

18 who are not English language proficient; and 

19 ‘‘(F) for the collection and reporting of 

20 data in accordance with section 3105. 

21 ‘‘(2) CONTRACTS WITH COORDINATING CEN22 TERS OF EXCELLENCE.—The WTC Program Ad23 ministrator shall enter into contracts with Coordi24 nating Centers of Excellence specified in subsection 

25 (b)(2)— 


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1 ‘‘(A) for receiving, analyzing, and report2 ing to the WTC Program Administrator on 

3 data, in accordance with section 3105, that has 

4 been collected and reported to such Coordi5 nating Centers by the corresponding Clinical 

6 Centers of Excellence under subsection (d)(3); 

7 ‘‘(B) for the development of medical moni8 toring, initial health evaluation, and treatment 

9 protocols, with respect to WTC-related health 

10 conditions; 

11 ‘‘(C) for coordinating the outreach activi12 ties conducted under paragraph (1)(B) by each 

13 corresponding Clinical Center of Excellence; 

14 ‘‘(D) for establishing criteria for the 

15 credentialing of medical providers participating 

16 in the nationwide network under section 3131; 

17 ‘‘(E) for coordinating and administrating 

18 the activities of the WTC Health Program 

19 Steering Committees established under section 

20 3103(a); and 

21 ‘‘(F) for meeting periodically with the cor22 responding Clinical Centers of Excellence to ob23 tain input on the analysis and reporting of data 

24 collected under subparagraph (A) and on the 

25 development of medical monitoring, initial 


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1 health evaluation, and treatment protocols 

2 under subparagraph (B). 

3 The medical providers under subparagraph (D) shall 

4 be selected by the WTC Program Administrator on 

5 the basis of their experience treating or diagnosing 

6 the medical conditions included in the list of identi7 fied WTC-related health conditions for responders 

8 and of identified WTC-related health conditions for 

9 community members. 

10 ‘‘(3) REQUIRED PARTICIPATION BY NEW YORK

11 CITY IN MONITORING AND TREATMENT PROGRAM

12 AND COSTS.— 

13 ‘‘(A) IN GENERAL.—In order for New 

14 York City, any agency or Department thereof, 

15 or the New York City Health and Hospitals 

16 Corporation to qualify for a contract for the 

17 provision of monitoring and treatment benefits 

18 and other services under this section, New York 

19 City is required to contribute a matching 

20 amount of 20 percent of the amount of the cov21 ered monitoring and treatment payment (as de22 fined in subparagraph (B)). 

23 ‘‘(B) COVERED MONITORING AND TREAT24 MENT PAYMENT DEFINED.—For the purposes 

25 of this paragraph, the term ‘covered monitoring 


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1 and treatment payment’ means payment under 

2 paragraphs (1) and (2) including under each 

3 such paragraph as applied under sections 

4 3121(b) and 3122(a) for WTC community 

5 members, and section 3123 for other individ6 uals with WTC-related health conditions, and 

7 reimbursement under section 3106(c)(1)(C) for 

8 items and services furnished by a Clinical Cen9 ter of Excellence or Coordinating Center of Ex10 cellence, after the application of paragraphs (2) 

11 and (3) of section 3101(d). 

12 ‘‘(C) PAYMENT OF NEW YORK CITY SHARE

13 OF MONITORING AND TREATMENT COSTS.—The 

14 WTC Program Administrator shall— 

15 ‘‘(i) bill the amount specified in sub16 paragraph (A) directly to New York City; 

17 and 

18 ‘‘(ii) certify periodically, for purposes 

19 of section 3101(d)(2), whether or not New 

20 York City has paid the amount so billed. 

21 ‘‘(D) LIMITATION ON REQUIRED

22 AMOUNT.—In no case is New York City re23 quired under this paragraph to contribute more 

24 than a total of $250,000,000 over any 10-year 

25 period. 


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1 ‘‘(b) CENTERS OF EXCELLENCE DEFINED.— 

2 ‘‘(1) CLINICAL CENTER OF EXCELLENCE.—In 

3 this title, the term ‘Clinical Center of Excellence’ 

4 means the following: 

5 ‘‘(A) FOR FDNY RESPONDERS.—With re6 spect to an eligible WTC responder who re7 sponded to the 9/11 attacks as an employee of 

8 the Fire Department of the City of New York 

9 and who— 

10 ‘‘(i) is an active employee of such De11 partment— 

12 ‘‘(I) with respect to monitoring, 

13 such Fire Department; and 

14 ‘‘(II) with respect to treatment, 

15 such Fire Department (or such entity 

16 as has entered into a contract with 

17 the Fire Department for treatment of 

18 such responders) or any other Clinical 

19 Center of Excellence described in sub20 paragraph (B), (C), or (D); or 

21 ‘‘(ii) is not an active employee of such 

22 Department, such Fire Department (or 

23 such entity as has entered into a contract 

24 with the Fire Department for monitoring 

25 or treatment of such responders) or any 


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•S 1334 IS

1 other Clinical Center of Excellence de2 scribed in subparagraph (B), (C), or (D). 

3 ‘‘(B) OTHER ELIGIBLE WTC RESPOND4 ERS.—With respect to other eligible WTC re5 sponders, whether or not the responders reside 

6 in the New York Metropolitan area, the Mt. 

7 Sinai-coordinated consortium, Queens College, 

8 State University of New York at Stony Brook, 

9 University of Medicine and Dentistry of New 

10 Jersey, and Bellevue Hospital. 

11 ‘‘(C) WTC COMMUNITY MEMBERS.—With 

12 respect to eligible WTC community members, 

13 whether or not the members reside in the New 

14 York Metropolitan area, the World Trade Cen15 ter Environmental Health Center at Bellevue 

16 Hospital and such hospitals or other facilities, 

17 including but not limited to those within the 

18 New York City Health and Hospitals Corpora19 tion, as are identified by the WTC Program Ad20 ministrator. 

21 ‘‘(D) ALL ELIGIBLE WTC RESPONDERS

22 AND ELIGIBLE WTC COMMUNITY MEMBERS.— 

23 With respect to all eligible WTC responders and 

24 eligible WTC community members, such other 


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1 hospitals or other facilities as are identified by 

2 the WTC Program Administrator. 

3 The WTC Program Administrator shall limit the 

4 number of additional Centers of Excellence identified 

5 under subparagraph (D) to ensure that the partici6 pating centers have adequate experience in the treat7 ment and diagnosis of identified WTC-related health 

8 conditions. 

9 ‘‘(2) COORDINATING CENTER OF EXCEL10 LENCE.—In this title, the term ‘Coordinating Center 

11 of Excellence’ means the following: 

12 ‘‘(A) FOR FDNY RESPONDERS.—With re13 spect to an eligible WTC responder who re14 sponded to the 9/11 attacks as an employee of 

15 the Fire Department of the City of New York, 

16 such Fire Department. 

17 ‘‘(B) OTHER WTC RESPONDERS.—With re18 spect to other eligible WTC responders, the Mt. 

19 Sinai-coordinated consortium. 

20 ‘‘(C) WTC COMMUNITY MEMBERS.—With 

21 respect to eligible WTC community members, 

22 the World Trade Center Environmental Health 

23 Center at Bellevue Hospital. 

24 ‘‘(3) CORRESPONDING CENTERS.—In this title, 

25 a Clinical Center of Excellence and a Coordinating 


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1 Center of Excellence shall be treated as ‘cor2 responding’ to the extent that such Clinical Center 

3 and Coordinating Center serve the same population 

4 group. 

5 ‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, NON6 MONITORING PROGRAM COSTS.—A Clinical or Coordi7 nating Center of Excellence with a contract under this sec8 tion shall be reimbursed for the costs of such Center in 

9 carrying out the activities described in subsection (a), 

10 other than those described in subsection (a)(1)(A), subject 

11 to the provisions of section 3101(d), as follows: 

12 ‘‘(1) CLINICAL CENTERS OF EXCELLENCE.— 

13 For carrying out subparagraphs (B) through (F) of 

14 subsection (a)(1)— 

15 ‘‘(A) CLINICAL CENTER FOR FDNY RE16 SPONDERS IN NEW YORK.—The Clinical Center 

17 of Excellence for FDNY responders in New 

18 York specified in subsection (b)(1)(A) shall be 

19 reimbursed— 

20 ‘‘(i) in the first year of the contract 

21 under this section, $600 per certified eligi22 ble WTC responder in the medical treat23 ment program, and $300 per certified eli24 gible WTC responder in the monitoring 

25 program; and 


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1 ‘‘(ii) in each subsequent contract year, 

2 subject to paragraph (3), at the rates spec3 ified in this subparagraph for the previous 

4 contract year adjusted by the WTC Pro5 gram Administrator to reflect the rate of 

6 medical care inflation during the previous 

7 contract year. 

8 ‘‘(B) CLINICAL CENTERS SERVING OTHER

9 ELIGIBLE WTC RESPONDERS IN NEW YORK.—A 

10 Clinical Center of Excellence for other WTC re11 sponders in New York specified in subsection 

12 (b)(1)(B) shall be reimbursed the amounts 

13 specified in subparagraph (A). 

14 ‘‘(C) CLINICAL CENTERS SERVING WTC

15 COMMUNITY MEMBERS.—A Clinical Center of 

16 Excellence for eligible WTC community mem17 bers in New York specified in subsection 

18 (b)(1)(C) shall be reimbursed— 

19 ‘‘(i) in the first year of the contract 

20 under this section, for each certified eligi21 ble WTC community member in a medical 

22 treatment program enrolled at a non-hos23 pital-based facility, $600, and for each cer24 tified eligible WTC community member in 


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•S 1334 IS

1 a medical treatment program enrolled at a 

2 hospital-based facility, $300; and 

3 ‘‘(ii) in each subsequent contract year, 

4 subject to paragraph (3), at the rates spec5 ified in this subparagraph for the previous 

6 contract year adjusted by the WTC Pro7 gram Administrator to reflect the rate of 

8 medical care inflation during the previous 

9 contract year. 

10 ‘‘(D) OTHER CLINICAL CENTERS.—A Clin11 ical Center of Excellence for other providers not 

12 described in a previous subparagraph shall be 

13 reimbursed at a rate set by the WTC Program 

14 Administrator. 

15 ‘‘(E) REIMBURSEMENT RULES.—The reim16 bursement provided under subparagraphs (A), 

17 (B), and (C) shall be made for each certified el18 igible WTC responder and for each WTC com19 munity member in the WTC program per year 

20 that the member receives such services, regard21 less of the volume or cost of services required. 

22 ‘‘(2) COORDINATING CENTERS OF EXCEL23 LENCE.—A Coordinating Center of Excellence speci24 fied in section (a)(2) shall be reimbursed for the 

25 provision of services set forth in this section at such 


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•S 1334 IS

1 levels as are established by the WTC Program Ad2 ministrator. 

3 ‘‘(3) REVIEW OF RATES.— 

4 ‘‘(A) INITIAL REVIEW.—Before the end of 

5 the third contract year of the WTC program, 

6 the WTC Program Administrator shall conduct 

7 a review to determine whether the reimburse8 ment rates set forth in this subsection provide 

9 fair and appropriate reimbursement for such 

10 program services. Based on such review, the 

11 Administrator may, by rule beginning with the 

12 fourth contract year, modify such rates, taking 

13 into account a reasonable and fair rate for the 

14 services being provided. 

15 ‘‘(B) SUBSEQUENT REVIEWS.—After the 

16 fourth contract year, the WTC Program Ad17 ministrator shall conduct periodic reviews to de18 termine whether the reimbursement rates in ef19 fect under this subsection provide fair and ap20 propriate reimbursement for such program serv21 ices. Based upon such a review, the Adminis22 trator may by rule modify such rates, taking 

23 into account a reasonable and fair rate for the 

24 services being provided. 


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1 ‘‘(C) GAO REVIEW.—The Comptroller 

2 General of the United States shall review the 

3 WTC Program Administrator’s determinations 

4 regarding fair and appropriate reimbursement 

5 for program services under this paragraph. 

6 ‘‘(d) REQUIREMENTS.—The WTC Program Adminis7 trator shall not enter into a contract with a Clinical Center 

8 of Excellence under subsection (a)(1) unless— 

9 ‘‘(1) the Center establishes a formal mechanism 

10 for consulting with and receiving input from rep11 resentatives of eligible populations receiving moni12 toring and treatment benefits under subtitle B from 

13 such Center; 

14 ‘‘(2) the Center provides for the coordination of 

15 monitoring and treatment benefits under subtitle B 

16 with routine medical care provided for the treatment 

17 of conditions other than WTC-related health condi18 tions; 

19 ‘‘(3) the Center collects and reports to the cor20 responding Coordinating Center of Excellence data 

21 in accordance with section 3105; 

22 ‘‘(4) the Center has in place safeguards against 

23 fraud that are satisfactory to the Administrator; 

24 ‘‘(5) the Center agrees to treat or refer for 

25 treatment all individuals who are eligible WTC reVerDate Nov 24 2008 04:19 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00045 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 sponders or eligible WTC community members with 

2 respect to such Center who present themselves for 

3 treatment of a WTC-related health condition; 

4 ‘‘(6) the Center has in place safeguards to en5 sure the confidentiality of an individual’s individ6 ually identifiable health information, including re7 quiring that such information not be disclosed to the 

8 individual’s employer without the authorization of 

9 the individual; 

10 ‘‘(7) the Center provides assurances that the 

11 amounts paid under subsection (c)(1) are used only 

12 for costs incurred in carrying out the activities de13 scribed in subsection (a), other than those described 

14 in subsection (a)(1)(A); and 

15 ‘‘(8) the Center agrees to meet all the other ap16 plicable requirements of this title, including regula17 tions implementing such requirements. 

18 ‘‘(e) NYC RIGHT OF INSPECTION AND AUDIT.— 

19 ‘‘(1) IN GENERAL.—The City of New York, for 

20 any program under this title for which the City con21 tributes a matching amount pursuant to subsection 

22 (a)(3)(C), shall have the right to, independently but 

23 in coordination with the WTC Program Adminis24 trator— 


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1 ‘‘(A) inspect or otherwise evaluate the 

2 quality, appropriateness, and timeliness of serv3 ices provided to recipients of assistance under a 

4 contract under such program; and 

5 ‘‘(B) audit and inspect any books and 

6 records of any Clinical Center of Excellence or 

7 Coordinating Center of Excellence that pertain 

8 to— 

9 ‘‘(i) the ability of the Center of Excel10 lence to provide services to program recipi11 ents under the contract; or 

12 ‘‘(ii) expenditures made utilizing City 

13 funds. 

14 ‘‘(2) MEMORANDUM OF UNDERSTANDING.—The 

15 WTC Program Administrator shall enter into a 

16 memorandum of understanding with the City of New 

17 York setting forth the terms and conditions of how 

18 the inspections and audits conducted by the City 

19 under paragraph (1) shall be carried out. The 

20 memorandum of understanding shall include provi21 sions requiring that any audits conducted by the 

22 City of New York under paragraph (1) will be done 

23 in a manner to protect the confidentiality of pro24 gram participants and in accordance with the Health 

25 Insurance Portability and Accountability Act of 


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1 1996 and other applicable Federal and State med2 ical confidentiality requirements. 

3 ‘‘SEC. 3107. ENTITLEMENT AUTHORITIES. 

4 ‘‘Subject to subsections (b)(4)(C) and (c)(4) of sec5 tion 3112— 

6 ‘‘(1) subtitle B constitutes budget authority in 

7 advance of appropriations Acts and represents the 

8 obligation of the Federal Government to provide for 

9 the payment for monitoring, initial health evalua10 tions, and treatment in accordance with such sub11 title; and 

12 ‘‘(2) section 3106(c) constitutes such budget 

13 authority and represents the obligation of the Fed14 eral Government to provide for the payment de15 scribed in such section. 

16 ‘‘SEC. 3108. DEFINITIONS. 

17 ‘‘In this title: 

18 ‘‘(1) The term ‘aggravating’ means, with re19 spect to a health condition, a health condition that 

20 existed on September 11, 2001, and that, as a result 

21 of exposure to airborne toxins, any other hazard, or 

22 any other adverse condition resulting from the Sep23 tember 11, 2001, terrorist attacks on the World 

24 Trade Center, requires medical treatment that is (or 

25 will be) in addition to, more frequent than, or of 


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1 longer duration than the medical treatment that 

2 would have been required for such condition in the 

3 absence of such exposure. 

4 ‘‘(2) The terms ‘certified eligible WTC re5 sponder’ and ‘certified eligible WTC community 

6 member’ mean an individual who has been certified 

7 as an eligible WTC responder under section 

8 3111(a)(4) or an eligible WTC community member 

9 under section 3121(a)(4), respectively. 

10 ‘‘(3) The terms ‘Clinical Center of Excellence’ 

11 and ‘Coordinating Center of Excellence’ have the 

12 meanings given such terms in section 3106(b). 

13 ‘‘(4) The term ‘current consortium arrange14 ments’ means the arrangements as in effect on the 

15 date of the enactment of this title between the Na16 tional Institute for Occupational Safety and Health 

17 and the Mt. Sinai-coordinated consortium and the 

18 Fire Department of the City of New York. 

19 ‘‘(5) The terms ‘eligible WTC responder’ and 

20 ‘eligible WTC community member’ are defined in 

21 sections 3111(a) and 3121(a), respectively. 

22 ‘‘(6) The term ‘initial health evaluation’ in23 cludes, with respect to an individual, a medical and 

24 exposure history, a physical examination, and addi25 tional medical testing as needed to evaluate whether 


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1 the individual has a WTC-related health condition 

2 and is eligible for treatment under the WTC pro3 gram. 

4 ‘‘(7) The term ‘list of identified WTC-related 

5 health conditions’ means— 

6 ‘‘(A) for eligible WTC responders, the 

7 identified WTC-related health conditions for eli8 gible WTC responders under paragraph (3) or 

9 (4) of section 3112(a); or 

10 ‘‘(B) for eligible WTC community mem11 bers, the identified WTC-related health condi12 tions for WTC community members under 

13 paragraph (1) or (2) of section 3122(b). 

14 ‘‘(8) The term ‘Mt.-Sinai-coordinated consor15 tium’ means the consortium coordinated by Mt. 

16 Sinai hospital in New York City that coordinates the 

17 monitoring and treatment under the current consor18 tium arrangements for eligible WTC responders 

19 other than with respect to those covered under the 

20 arrangement with the Fire Department of the City 

21 of New York. 

22 ‘‘(9) The term ‘New York City disaster area’ 

23 means the area within New York City that is— 

24 ‘‘(A) the area of Manhattan that is south 

25 of Houston Street; and 


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•S 1334 IS

1 ‘‘(B) any block in Brooklyn that is wholly 

2 or partially contained within a 1.5-mile radius 

3 of the former World Trade Center site. 

4 ‘‘(10) The term ‘New York metropolitan area’ 

5 means an area, specified by the WTC Program Ad6 ministrator, within which eligible WTC responders 

7 and eligible WTC community members who reside in 

8 such area are reasonably able to access monitoring 

9 and treatment benefits and initial health evaluation 

10 benefits under this title through a Clinical Center of 

11 Excellence described in subparagraph (A), (B), or 

12 (C) of section 3106(b)(1). 

13 ‘‘(11) Any reference to ‘September 11, 2001’, 

14 shall be deemed a reference to the period on such 

15 date subsequent to the terrorist attacks on the 

16 World Trade Center on such date. 

17 ‘‘(12) The term ‘September 11, 2001, terrorist 

18 attacks on the World Trade Center’ means the ter19 rorist attacks that occurred on September 11, 2001, 

20 in New York City and includes the aftermath of 

21 such attacks. 

22 ‘‘(13) The term ‘WTC Health Program Steer23 ing Committee’ means such a Steering Committee 

24 established under section 3103. 


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1 ‘‘(14) The term ‘WTC Program Administrator’ 

2 means the individual responsible under section 

3 3101(f) for the administration of the WTC program. 

4 ‘‘(15) The term ‘WTC-related health condition’ 

5 is defined in section 3112(a). 

6 ‘‘(16) The term ‘WTC Scientific/Technical Ad7 visory Committee’ means the WTC Health Program 

8 Scientific/Technical Advisory Committee established 

9 under section 3102. 

10 ‘‘Subtitle B—Program of Moni11 toring, Initial Health Evalua12 tions, and Treatment 

13 ‘‘PART 1—FOR WTC RESPONDERS 

14 ‘‘SEC. 3111. IDENTIFICATION OF ELIGIBLE WTC RESPOND15 ERS AND PROVISION OF WTC-RELATED MONI16 TORING SERVICES. 

17 ‘‘(a) ELIGIBLE WTC RESPONDER DEFINED.— 

18 ‘‘(1) IN GENERAL.—For purposes of this title, 

19 the term ‘eligible WTC responder’ means any of the 

20 following individuals, subject to paragraph (5): 

21 ‘‘(A) CURRENTLY IDENTIFIED RE22 SPONDER.—An individual who has been identi23 fied as eligible for medical monitoring under the 

24 current consortium arrangements (as defined in 

25 section 3108(4)). 


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1 ‘‘(B) RESPONDER WHO MEETS CURRENT

2 ELIGIBILITY CRITERIA.—An individual who 

3 meets the current eligibility criteria described in 

4 paragraph (2). 

5 ‘‘(C) RESPONDER WHO MEETS MODIFIED

6 ELIGIBILITY CRITERIA.—An individual who— 

7 ‘‘(i) performed rescue, recovery, demo8 lition, debris cleanup, or other related serv9 ices in the New York City disaster area in 

10 response to the September 11, 2001, ter11 rorist attacks on the World Trade Center, 

12 regardless of whether such services were 

13 performed by a State or Federal employee 

14 or member of the National Guard or other15 wise; and 

16 ‘‘(ii) meets such eligibility criteria re17 lating to exposure to airborne toxins, other 

18 hazards, or adverse conditions resulting 

19 from the September 11, 2001, terrorist at20 tacks on the World Trade Center as the 

21 WTC Program Administrator, after con22 sultation with the WTC Responders Steer23 ing Committee and the WTC Scientific/ 

24 Technical Advisory Committee, determines 

25 appropriate. 


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1 The WTC Program Administrator shall not 

2 modify such eligibility criteria on or after the 

3 date that the number of certifications for eligi4 ble responders has reached 80 percent of the 

5 limit described in paragraph (5) or on or after 

6 the date that the number of certifications for el7 igible community members has reached 80 per8 cent of the limit described in section 

9 3121(a)(5). 

10 ‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The 

11 eligibility criteria described in this paragraph for an 

12 individual is that the individual is described in either 

13 of the following categories: 

14 ‘‘(A) FIRE FIGHTERS AND RELATED PER15 SONNEL.—The individual— 

16 ‘‘(i) was a member of the Fire De17 partment of the City of New York (wheth18 er fire or emergency personnel, active or 

19 retired) who participated at least one day 

20 in the rescue and recovery effort at any of 

21 the former World Trade Center sites (in22 cluding Ground Zero, Staten Island Land23 fill, and the NYC Chief Medical Exam24 iner’s office) for any time during the peVerDate Nov 24 2008 23:14 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00054 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 riod beginning on September 11, 2001, 

2 and ending on July 31, 2002; or 

3 ‘‘(ii)(I) is a surviving immediate fam4 ily member of an individual who was a 

5 member of the Fire Department of the 

6 City of New York (whether fire or emer7 gency personnel, active or retired) and was 

8 killed at the World Trade site on Sep9 tember 11, 2001; and 

10 ‘‘(II) received any treatment for a 

11 WTC-related mental health condition de12 scribed in section 3112(a)(1)(B) on or be13 fore September 1, 2008. 

14 ‘‘(B) LAW ENFORCEMENT OFFICERS AND

15 WTC RESCUE, RECOVERY, AND CLEAN-UP

16 WORKERS.—The individual— 

17 ‘‘(i) worked or volunteered on-site in 

18 rescue, recovery, debris-cleanup, or related 

19 support services in lower Manhattan (south 

20 of Canal Street), the Staten Island Land21 fill, or the barge loading piers, for— 

22 ‘‘(I) at least 4 hours during the 

23 period beginning on September 11, 

24 2001, and ending on September 14, 

25 2001; 


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1 ‘‘(II) at least 24 hours during 

2 the period beginning on September 

3 11, 2001, and ending on September 

4 30, 2001; or 

5 ‘‘(III) at least 80 hours during 

6 the period beginning on September 

7 11, 2001, and ending on July 31, 

8 2002; 

9 ‘‘(ii)(I) was a member of the Police 

10 Department of the City of New York 

11 (whether active or retired) or a member of 

12 the Port Authority Police of the Port Au13 thority of New York and New Jersey 

14 (whether active or retired) who partici15 pated on-site in rescue, recovery, debris 

16 clean-up, or related support services in 

17 lower Manhattan (south of Canal Street), 

18 including Ground Zero, the Staten Island 

19 Landfill, or the barge loading piers, for at 

20 least 4 hours during the period beginning 

21 September 11, 2001, and ending on Sep22 tember 14, 2001; 

23 ‘‘(II) participated on-site in rescue, 

24 recovery, debris clean-up, or related serv25 ices at Ground Zero, the Staten Island 


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1 Landfill or the barge loading piers, for at 

2 least one day during the period beginning 

3 on September 11, 2001, and ending on 

4 July 31, 2002; 

5 ‘‘(III) participated on-site in rescue, 

6 recovery, debris clean-up, or related serv7 ices in lower Manhattan (south of Canal 

8 St.) for at least 24 hours during the period 

9 beginning on September 11, 2001, and 

10 ending on September 30, 2001; or 

11 ‘‘(IV) participated on-site in rescue, 

12 recovery, debris clean-up, or related serv13 ices in lower Manhattan (south of Canal 

14 St.) for at least 80 hours during the period 

15 beginning on September 11, 2001, and 

16 ending on July 31, 2002; 

17 ‘‘(iii) was an employee of the Office of 

18 the Chief Medical Examiner of the City of 

19 New York involved in the examination and 

20 handling of human remains from the Sep21 tember 11, 2001, terrorist attacks on the 

22 World Trade Center, or other morgue 

23 worker who performed similar post-Sep24 tember 11 functions for such Office staff, 


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1 during the period beginning on September 

2 11, 2001, and ending on July 31, 2002; 

3 ‘‘(iv) was a worker in the Port Au4 thority Trans-Hudson Corporation tunnel 

5 for at least 24 hours during the period be6 ginning on February 1, 2002, and ending 

7 on July 1, 2002; or 

8 ‘‘(v) was a vehicle-maintenance worker 

9 who was exposed to debris from the former 

10 World Trade Center while retrieving, driv11 ing, cleaning, repairing, or maintaining ve12 hicles contaminated by airborne toxins 

13 from the September 11, 2001, terrorist at14 tacks on the World Trade Center during a 

15 duration and period described in subpara16 graph (A). 

17 ‘‘(3) APPLICATION PROCESS.—The WTC Pro18 gram Administrator in consultation with the Coordi19 nating Centers of Excellence shall establish a proc20 ess for individuals, other than eligible WTC respond21 ers described in paragraph (1)(A), to apply to be de22 termined to be eligible WTC responders. Under such 

23 process— 


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1 ‘‘(A) there shall be no fee charged to the 

2 applicant for making an application for such 

3 determination; 

4 ‘‘(B) the Administrator shall make a deter5 mination on such an application not later than 

6 60 days after the date of filing the application; 

7 and 

8 ‘‘(C) an individual who is determined not 

9 to be an eligible WTC responder shall have an 

10 opportunity to appeal such determination before 

11 an administrative law judge in a manner estab12 lished under such process. 

13 ‘‘(4) CERTIFICATION.— 

14 ‘‘(A) IN GENERAL.—In the case of an indi15 vidual who is described in paragraph (1)(A) or 

16 who is determined under paragraph (3) (con17 sistent with paragraph (5)) to be an eligible 

18 WTC responder, the WTC Program Adminis19 trator shall provide an appropriate certification 

20 of such fact and of eligibility for monitoring 

21 and treatment benefits under this part. The Ad22 ministrator shall make determinations of eligi23 bility relating to an applicant’s compliance with 

24 this title, including the verification of informa25 tion submitted in support of the application, 


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1 and shall not deny such a certification to an in2 dividual unless the Administrator determines 

3 that— 

4 ‘‘(i) based on the application sub5 mitted, the individual does not meet the 

6 eligibility criteria; or 

7 ‘‘(ii) the numerical limitation on eligi8 ble WTC responders set forth in paragraph 

9 (5) has been met. 

10 ‘‘(B) TIMING.— 

11 ‘‘(i) CURRENTLY IDENTIFIED RE12 SPONDERS.—In the case of an individual 

13 who is described in paragraph (1)(A), the 

14 WTC Program Administrator shall provide 

15 the certification under subparagraph (A) 

16 not later than 60 days after the date of the 

17 enactment of this title. 

18 ‘‘(ii) OTHER RESPONDERS.—In the 

19 case of another individual who is deter20 mined under paragraph (3) and consistent 

21 with paragraph (5) to be an eligible WTC 

22 responder, the WTC Program Adminis23 trator shall provide the certification under 

24 subparagraph (A) at the time of the deter25 mination. 


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1 ‘‘(5) NUMERICAL LIMITATION ON ELIGIBLE

2 WTC RESPONDERS.— 

3 ‘‘(A) IN GENERAL.—The total number of 

4 individuals not described in subparagraph (C) 

5 who may qualify as eligible WTC responders for 

6 purposes of this title, and be certified as eligible 

7 WTC responders under paragraph (4), shall not 

8 exceed 15,000, subject to adjustment under 

9 paragraph (6), of which no more than 2,500 

10 may be individuals certified based on modified 

11 eligibility criteria established under paragraph 

12 (1)(C). In applying the previous sentence, any 

13 individual who at any time so qualifies as an el14 igible WTC responder shall be counted against 

15 such numerical limitation. 

16 ‘‘(B) PROCESS.—In implementing subpara17 graph (A), the WTC Program Administrator 

18 shall— 

19 ‘‘(i) limit the number of certifications 

20 provided under paragraph (4) in accord21 ance with such subparagraph; and 

22 ‘‘(ii) provide priority in such certifi23 cations in the order in which individuals 

24 apply for a determination under paragraph 

25 (3). 


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1 ‘‘(C) CURRENTLY IDENTIFIED RESPOND2 ERS NOT COUNTED.—Individuals described in 

3 this subparagraph are individuals who are de4 scribed in paragraph (1)(A). 

5 ‘‘(6) POTENTIAL ADJUSTMENT IN NUMERICAL

6 LIMITATIONS DEPENDENT UPON ACTUAL SPENDING

7 RELATIVE TO ESTIMATED SPENDING.— 

8 ‘‘(A) INITIAL CALCULATION FOR FISCAL

9 YEARS 2009 THROUGH 2011.—If the WTC Pro10 gram Administrator determines as of December 

11 1, 2011, that the WTC expenditure-to-CBO-es12 timate percentage (as defined in subparagraph 

13 (D)(iii)) for fiscal years 2009 through 2011 

14 does not exceed 90 percent, then, effective Jan15 uary 1, 2012, the WTC Program Administrator 

16 may increase the numerical limitation under 

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

18 under section 3121(a)(5), or both, by a number 

19 of percentage points not to exceed the number 

20 of percentage points specified in subparagraph 

21 (C) for such period of fiscal years. 

22 ‘‘(B) SUBSEQUENT CALCULATION FOR FIS23 CAL YEARS 2009 THROUGH 2015.—If the Sec24 retary determines as of December 1, 2015, that 

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1 ages for fiscal years 2009 through 2015 and for 

2 fiscal years 2012 through 2015 do not exceed 

3 90 percent, then, effective January 1, 2015, the 

4 WTC Program Administrator may increase the 

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

6 the numerical limitation under section 

7 3121(a)(5), or both, as in effect after the appli8 cation of subparagraph (A), by a number of 

9 percentage points not to exceed twice the lesser 

10 of— 

11 ‘‘(i) the number of percentage points 

12 specified in subparagraph (C) for fiscal 

13 years 2009 through 2012, or 

14 ‘‘(ii) the number of percentage points 

15 specified in subparagraph (C) for fiscal 

16 years 2012 through 2015. 

17 ‘‘(C) MAXIMUM PERCENTAGE INCREASE IN

18 NUMERICAL LIMITATIONS FOR PERIOD OF FIS19 CAL YEARS.—The number of percentage points 

20 specified in this clause for a period of fiscal 

21 years is— 

22 ‘‘(i) 100 percentage points, multiplied 

23 by 

24 ‘‘(ii) one minus a fraction the numer25 ator of which is the net Federal WTC 


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•S 1334 IS

1 spending for such period, and the denomi2 nator of which is the CBO WTC spending 

3 estimate under this title for such period. 

4 ‘‘(D) DEFINITIONS.—For purposes of this 

5 paragraph: 

6 ‘‘(i) NET FEDERAL WTC SPENDING.— 

7 The term ‘net Federal WTC spending’ 

8 means, with respect to a period of fiscal 

9 years, the net Federal spending under this 

10 title for such fiscal years. 

11 ‘‘(ii) CBO WTC MEDICAL SPENDING

12 ESTIMATE UNDER THIS TITLE.—The term 

13 ‘CBO WTC medical spending estimate 

14 under this title’ means, with respect to— 

15 ‘‘(I) fiscal years 2009 through 

16 2011, $900,000,000; 

17 ‘‘(II) fiscal years 2012 through 

18 2015, $1,890,000,000; and 

19 ‘‘(III) fiscal years 2009 through 

20 2015, the sum of the amounts speci21 fied in subclauses (I) and (II). 

22 ‘‘(iii) WTC EXPENDITURE-TO-CBO-ES23 TIMATE PERCENTAGE.—The term ‘WTC 

24 expenditure-to-estimate percentage’ means, 


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•S 1334 IS

1 with respect to a period of fiscal years, the 

2 ratio (expressed as a percentage) of— 

3 ‘‘(I) the net Federal WTC spend4 ing for such period, to 

5 ‘‘(II) the CBO WTC medical 

6 spending estimate under this title for 

7 such period. 

8 ‘‘(b) MONITORING BENEFITS.— 

9 ‘‘(1) IN GENERAL.—In the case of an eligible 

10 WTC responder under section 3111(a)(4) (other 

11 than one described in subsection (a)(2)(A)(ii)), the 

12 WTC program shall provide for monitoring benefits 

13 that include medical monitoring consistent with pro14 tocols approved by the WTC Program Administrator 

15 and including clinical examinations and long-term 

16 health monitoring and analysis. In the case of an eli17 gible WTC responder who is an active member of 

18 the Fire Department of the City of New York, the 

19 responder shall receive such benefits as part of the 

20 individual’s periodic company medical exams. 

21 ‘‘(2) PROVISION OF MONITORING BENEFITS.— 

22 The monitoring benefits under paragraph (1) shall 

23 be provided through the Clinical Center of Excel24 lence for the type of individual involved or, in the 

25 case of an individual residing outside the New York 


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•S 1334 IS

1 metropolitan area, under an arrangement under sec2 tion 3131. 

3 ‘‘SEC. 3112. TREATMENT OF CERTIFIED ELIGIBLE WTC RE4 SPONDERS FOR WTC-RELATED HEALTH CON5 DITIONS. 

6 ‘‘(a) WTC-RELATED HEALTH CONDITION DE7 FINED.— 

8 ‘‘(1) IN GENERAL.—For purposes of this title, 

9 the term ‘WTC-related health condition’ means— 

10 ‘‘(A) an illness or health condition for 

11 which exposure to airborne toxins, any other 

12 hazard, or any other adverse condition resulting 

13 from the September 11, 2001, terrorist attacks 

14 on the World Trade Center, based on an exam15 ination by a medical professional with experi16 ence in treating or diagnosing the medical con17 ditions included in the applicable list of identi18 fied WTC-related health conditions, is substan19 tially likely to be a significant factor in aggra20 vating, contributing to, or causing the illness or 

21 health condition, as determined under para22 graph (2); or 

23 ‘‘(B) a mental health condition for which 

24 such attacks, based on an examination by a 

25 medical professional with experience in treating 


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•S 1334 IS

1 or diagnosing the medical conditions included in 

2 the applicable list of identified WTC-related 

3 health conditions, is substantially likely be a 

4 significant factor in aggravating, contributing 

5 to, or causing the condition, as determined 

6 under paragraph (2). 

7 In the case of an eligible WTC responder described 

8 in section 3111(a)(2)(A)(ii), such term only includes 

9 the mental health condition described in subpara10 graph (B). 

11 ‘‘(2) DETERMINATION.—The determination of 

12 whether the September 11, 2001, terrorist attacks 

13 on the World Trade Center were substantially likely 

14 to be a significant factor in aggravating, contrib15 uting to, or causing an individual’s illness or health 

16 condition shall be made based on an assessment of 

17 the following: 

18 ‘‘(A) The individual’s exposure to airborne 

19 toxins, any other hazard, or any other adverse 

20 condition resulting from the terrorist attacks. 

21 Such exposure shall be— 

22 ‘‘(i) evaluated and characterized 

23 through the use of a standardized, popu24 lation appropriate questionnaire approved 


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•S 1334 IS

1 by the Director of the National Institute 

2 for Occupational Safety and Health; and 

3 ‘‘(ii) assessed and documented by a 

4 medical professional with experience in 

5 treating or diagnosing medical conditions 

6 included on the list of identified WTC-re7 lated health conditions. 

8 ‘‘(B) The type of symptoms and temporal 

9 sequence of symptoms. Such symptoms shall 

10 be— 

11 ‘‘(i) assessed through the use of a 

12 standardized, population appropriate med13 ical questionnaire approved by Director of 

14 the National Institute for Occupational 

15 Safety and Health and a medical examina16 tion; and 

17 ‘‘(ii) diagnosed and documented by a 

18 medical professional described in subpara19 graph (A)(ii). 

20 ‘‘(3) LIST OF IDENTIFIED WTC-RELATED

21 HEALTH CONDITIONS FOR ELIGIBLE WTC RESPOND22 ERS.—For purposes of this title, the term ‘identified 

23 WTC-related health condition for eligible WTC re24 sponders’ means any of the following health condi25 tions: 


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1 ‘‘(A) AERODIGESTIVE DISORDERS.— 

2 ‘‘(i) Interstitial lung diseases. 

3 ‘‘(ii) Chronic respiratory disorder4 fumes/vapors. 

5 ‘‘(iii) Asthma. 

6 ‘‘(iv) Reactive airways dysfunction 

7 syndrome (RADS). 

8 ‘‘(v) WTC-exacerbated chronic ob9 structive pulmonary disease (COPD). 

10 ‘‘(vi) Chronic cough syndrome. 

11 ‘‘(vii) Upper airway hyperreactivity. 

12 ‘‘(viii) Chronic rhinosinusitis. 

13 ‘‘(ix) Chronic nasopharyngitis. 

14 ‘‘(x) Chronic laryngitis. 

15 ‘‘(xi) Gastro-esophageal reflux dis16 order (GERD). 

17 ‘‘(xii) Sleep apnea exacerbated by or 

18 related to a condition described in a pre19 vious clause. 

20 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

21 ‘‘(i) Post traumatic stress disorder 

22 (PTSD). 

23 ‘‘(ii) Major depressive disorder. 

24 ‘‘(iii) Panic disorder. 

25 ‘‘(iv) Generalized anxiety disorder. 


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1 ‘‘(v) Anxiety disorder (not otherwise 

2 specified). 

3 ‘‘(vi) Depression (not otherwise speci4 fied). 

5 ‘‘(vii) Acute stress disorder. 

6 ‘‘(viii) Dysthymic disorder. 

7 ‘‘(ix) Adjustment disorder. 

8 ‘‘(x) Substance abuse. 

9 ‘‘(xi) V codes (treatments not specifi10 cally related to psychiatric disorders, such 

11 as marital problems, parenting problems, 

12 etc.), secondary to another identified 

13 WTC-related health condition for WTC eli14 gible responders. 

15 ‘‘(C) MUSCULOSKELETAL DISORDERS.— 

16 ‘‘(i) Low back pain. 

17 ‘‘(ii) Carpal tunnel syndrome (CTS). 

18 ‘‘(iii) Other musculoskeletal disorders. 

19 ‘‘(4) ADDITION OF IDENTIFIED WTC-RELATED

20 HEALTH CONDITIONS FOR ELIGIBLE WTC RESPOND21 ERS.— 

22 ‘‘(A) IN GENERAL.—The WTC Program 

23 Administrator may promulgate regulations to 

24 add an illness or health condition not described 

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1 related conditions for eligible WTC responders. 

2 In promulgating such regulations, the Secretary 

3 shall provide for notice and opportunity for a 

4 public hearing and at least 90 days of public 

5 comment. In promulgating such regulations, the 

6 WTC Program Administrator shall take into 

7 account the findings and recommendations of 

8 Clinical Centers of Excellence published in peer 

9 reviewed journals in the determination of 

10 whether an additional illness or health condi11 tion, such as cancer, should be added to the list 

12 of identified WTC-related health conditions for 

13 eligible WTC responders. 

14 ‘‘(B) PETITIONS.—Any person (including 

15 the WTC Health Program Scientific/Technical 

16 Advisory Committee) may petition the WTC 

17 Program Administrator to propose regulations 

18 described in subparagraph (A). Unless clearly 

19 frivolous, or initiated by such Committee, any 

20 such petition shall be referred to such Com21 mittee for its recommendations. Following— 

22 ‘‘(i) receipt of any recommendation of 

23 the Committee; or 

24 ‘‘(ii) 180 days after the date of the re25 ferral to the Committee, 


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1 whichever occurs first, the WTC Program Ad2 ministrator shall conduct a rulemaking pro3 ceeding on the matters proposed in the petition 

4 or publish in the Federal Register a statement 

5 of reasons for not conducting such proceeding. 

6 ‘‘(C) EFFECTIVENESS.—Any addition 

7 under subparagraph (A) of an illness or health 

8 condition shall apply only with respect to appli9 cations for benefits under this title which are 

10 filed after the effective date of such regulation. 

11 ‘‘(D) ROLE OF ADVISORY COMMITTEE.— 

12 Except with respect to a regulation rec13 ommended by the WTC Scientific/Technical Ad14 visory Committee, the WTC Program Adminis15 trator may not propose a regulation under this 

16 paragraph, unless the Administrator has first 

17 provided to the Committee a copy of the pro18 posed regulation, requested recommendations 

19 and comments by the Committee, and afforded 

20 the Committee at least 90 days to make such 

21 recommendations. 

22 ‘‘(b) COVERAGE OF TREATMENT FOR WTC-RELATED

23 HEALTH CONDITIONS.— 


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1 ‘‘(1) DETERMINATION BASED ON AN IDENTI2 FIED WTC-RELATED HEALTH CONDITION FOR CER3 TIFIED ELIGIBLE WTC RESPONDERS.— 

4 ‘‘(A) IN GENERAL.—If a physician at a 

5 Clinical Center of Excellence that is providing 

6 monitoring benefits under section 3111 for a 

7 certified eligible WTC responder determines 

8 that the responder has an identified WTC-re9 lated health condition, and the physician makes 

10 a clinical determination that exposure to air11 borne toxins, other hazards, or adverse condi12 tions resulting from the September, 11, 2001, 

13 terrorist attacks on the World Trade Center is 

14 substantially likely to be a significant factor in 

15 aggravating, contributing to, or causing the 

16 condition— 

17 ‘‘(i) the physician shall promptly 

18 transmit such determination to the WTC 

19 Program Administrator and provide the 

20 Administrator with the medical facts sup21 porting such determination; and 

22 ‘‘(ii) on and after the date of such 

23 transmittal and subject to subparagraph 

24 (B), the WTC program shall provide for 


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•S 1334 IS

1 payment under subsection (c) for medically 

2 necessary treatment for such condition. 

3 ‘‘(B) REVIEW; CERTIFICATION; AP4 PEALS.— 

5 ‘‘(i) REVIEW.—A Federal employee 

6 designated by the WTC Program Adminis7 trator shall review determinations made 

8 under subparagraph (A) of a WTC-related 

9 health condition. 

10 ‘‘(ii) CERTIFICATION.—The Adminis11 trator shall provide a certification of such 

12 condition based upon reviews conducted 

13 under clause (i). Such a certification shall 

14 be provided unless the Administrator de15 termines that the responder’s condition is 

16 not an identified WTC-related health con17 dition or that exposure to airborne toxins, 

18 other hazards, or adverse conditions result19 ing from the September 11, 2001, terrorist 

20 attacks on the World Trade Center is not 

21 substantially likely to be a significant fac22 tor in significantly aggravating, contrib23 uting to, or causing the condition. 

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1 peal of determinations under clause (ii) be2 fore an administrative law judge. 

3 ‘‘(2) DETERMINATION BASED ON OTHER WTC4 RELATED HEALTH CONDITION.— 

5 ‘‘(A) IN GENERAL.—If a physician at a 

6 Clinical Center of Excellence determines pursu7 ant to subsection (a) that a certified eligible 

8 WTC responder has a WTC-related health con9 dition that is not an identified WTC-related 

10 health condition for eligible WTC responders— 

11 ‘‘(i) the physician shall promptly 

12 transmit such determination to the WTC 

13 Program Administrator and provide the 

14 Administrator with the facts supporting 

15 such determination; and 

16 ‘‘(ii) the Administrator shall make a 

17 determination under subparagraph (B) 

18 with respect to such physician’s determina19 tion. 

20 ‘‘(B) REVIEW; CERTIFICATION.— 

21 ‘‘(i) USE OF PHYSICIAN PANEL.— 

22 With respect to each determination relat23 ing to a WTC-related health condition 

24 transmitted under subparagraph (A)(i), 

25 the WTC Program Administrator shall 


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1 provide for the review of the condition to 

2 be made by a physician panel with appro3 priate expertise appointed by the WTC 

4 Program Administrator. Such a panel shall 

5 make recommendations to the Adminis6 trator on the evidence supporting such de7 termination. 

8 ‘‘(ii) REVIEW OF RECOMMENDATIONS

9 OF PANEL; CERTIFICATION.—The Adminis10 trator, based on such recommendations 

11 shall determine, within 60 days after the 

12 date of the transmittal under subpara13 graph (A)(i), whether or not the condition 

14 is a WTC-related health condition and, if 

15 it is, provide for a certification under para16 graph (1)(B)(ii) of coverage of such condi17 tion. The Administrator shall provide a 

18 process for the appeal of determinations 

19 that the responder’s condition is not a 

20 WTC-related health condition before an 

21 administrative law judge. 

22 ‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 

23 ‘‘(A) IN GENERAL.—In providing treat24 ment for a WTC-related health condition, a 

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1 cally necessary and in accordance with medical 

2 protocols established under subsection (d). 

3 ‘‘(B) MEDICALLY NECESSARY STAND4 ARD.—For the purpose of this title, health care 

5 services shall be treated as medically necessary 

6 for an individual if a physician, exercising pru7 dent clinical judgment, would consider the serv8 ices to be medically necessary for the individual 

9 for the purpose of evaluating, diagnosing, or 

10 treating an illness, injury, disease or its symp11 toms, and that are— 

12 ‘‘(i) in accordance with the generally 

13 accepted standards of medical practice; 

14 ‘‘(ii) clinically appropriate, in terms of 

15 type, frequency, extent, site, and duration, 

16 and considered effective for the individual’s 

17 illness, injury, or disease; and 

18 ‘‘(iii) not primarily for the conven19 ience of the patient or physician, or an20 other physician, and not more costly than 

21 an alternative service or sequence of serv22 ices at least as likely to produce equivalent 

23 therapeutic or diagnostic results as to the 

24 diagnosis or treatment of the individual’s 

25 illness, injury, or disease. 


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1 ‘‘(C) DETERMINATION OF MEDICAL NE2 CESSITY.— 

3 ‘‘(i) REVIEW OF MEDICAL NECES4 SITY.—As part of the reimbursement pay5 ment process under subsection (c), the 

6 WTC Program Administrator shall review 

7 claims for reimbursement for the provision 

8 of medical treatment to determine if such 

9 treatment is medically necessary. 

10 ‘‘(ii) WITHHOLDING OF PAYMENT FOR

11 MEDICALLY UNNECESSARY TREATMENT.— 

12 The Administrator may withhold such pay13 ment for treatment that the Administrator 

14 determines is not medically necessary. 

15 ‘‘(iii) REVIEW OF DETERMINATIONS

16 OF MEDICAL NECESSITY.—The Adminis17 trator shall provide a process for providers 

18 to appeal a determination under clause (ii) 

19 that medical treatment is not medically 

20 necessary. Such appeals shall be reviewed 

21 through the use of a physician panel with 

22 appropriate expertise. 

23 ‘‘(4) SCOPE OF TREATMENT COVERED.— 

24 ‘‘(A) IN GENERAL.—The scope of treat25 ment covered under paragraphs (1) through (3) 


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1 includes services of physicians and other health 

2 care providers, diagnostic and laboratory tests, 

3 prescription drugs, inpatient and outpatient 

4 hospital services, and other medically necessary 

5 treatment. 

6 ‘‘(B) PHARMACEUTICAL COVERAGE.—With 

7 respect to ensuring coverage of medically nec8 essary outpatient prescription drugs, such drugs 

9 shall be provided, under arrangements made by 

10 the WTC Program Administrator, directly 

11 through participating Clinical Centers of Excel12 lence or through one or more outside vendors. 

13 ‘‘(C) TRANSPORTATION EXPENSES.—To 

14 the extent provided in advance in appropria15 tions Acts, the WTC Program Administrator 

16 may provide for necessary and reasonable 

17 transportation and expenses incident to the se18 curing of medically necessary treatment involv19 ing travel of more than 250 miles and for which 

20 payment is made under this section in the same 

21 manner in which individuals may be furnished 

22 necessary and reasonable transportation and ex23 penses incident to services involving travel of 

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1 ees Occupational Illness Compensation Program 

2 Act of 2000 (title XXXVI of Public Law 106– 

3 398; 42 U.S.C. 7384t(c)). 

4 ‘‘(5) PROVISION OF TREATMENT PENDING CER5 TIFICATION.—In the case of a certified eligible WTC 

6 responder who has been determined by an examining 

7 physician under subsection (b)(1) to have an identi8 fied WTC-related health condition, but for whom a 

9 certification of the determination has not yet been 

10 made by the WTC Program Administrator, medical 

11 treatment may be provided under this subsection, 

12 subject to paragraph (6), until the Administrator 

13 makes a decision on such certification. Medical 

14 treatment provided under this paragraph shall be 

15 considered to be medical treatment for which pay16 ment may be made under subsection (c). 

17 ‘‘(6) PRIOR APPROVAL PROCESS FOR NON-CER18 TIFIED NON-EMERGENCY INPATIENT HOSPITAL

19 SERVICES.—Non-emergency inpatient hospital serv20 ices for a WTC-related health condition identified by 

21 an examining physician under paragraph (1) that is 

22 not certified under paragraph (1)(B)(ii) is not cov23 ered unless the services have been determined to be 

24 medically necessary and approved through a process 

25 established by the WTC Program Administrator. 


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1 Such process shall provide for a decision on a re2 quest for such services within 15 days of the date 

3 of receipt of the request. The WTC Administrator 

4 shall provide a process for the appeal of a decision 

5 that the services are not medically necessary. 

6 ‘‘(c) PAYMENT FOR INITIAL HEALTH EVALUATION, 

7 MEDICAL MONITORING, AND TREATMENT OF WTC-RE8 LATED HEALTH CONDITIONS.— 

9 ‘‘(1) MEDICAL TREATMENT.— 

10 ‘‘(A) USE OF FECA PAYMENT RATES.— 

11 Subject to subparagraph (B), the WTC Pro12 gram Administrator shall reimburse costs for 

13 medically necessary treatment under this title 

14 for WTC-related health conditions according to 

15 the payment rates that would apply to the pro16 vision of such treatment and services by the fa17 cility under the Federal Employees Compensa18 tion Act. 

19 ‘‘(B) PHARMACEUTICALS.— 

20 ‘‘(i) IN GENERAL.—The WTC Pro21 gram Administrator shall establish a pro22 gram for paying for the medically nec23 essary outpatient prescription pharma24 ceuticals prescribed under this title for 


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1 WTC-related health conditions through one 

2 or more contracts with outside vendors. 

3 ‘‘(ii) COMPETITIVE BIDDING.—Under 

4 such program the Administrator shall— 

5 ‘‘(I) select one or more appro6 priate vendors through a Federal com7 petitive bid process; and 

8 ‘‘(II) select the lowest bidder (or 

9 bidders) meeting the requirements for 

10 providing pharmaceutical benefits for 

11 participants in the WTC program. 

12 ‘‘(iii) TREATMENT OF FDNY PARTICI13 PANTS.—Under such program the Admin14 istrator may select a separate vendor to 

15 provide pharmaceutical benefits to certified 

16 eligible WTC responders for whom the 

17 Clinical Center of Excellence is described 

18 in section 3106(b)(1)(A) if such an ar19 rangement is deemed necessary and bene20 ficial to the program by the WTC Program 

21 Administrator. 

22 ‘‘(C) OTHER TREATMENT.—For treatment 

23 not covered under a preceding subparagraph, 

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1 ignate a reimbursement rate for each such serv2 ice. 

3 ‘‘(2) MEDICAL MONITORING AND INITIAL

4 HEALTH EVALUATION.—The WTC Program Admin5 istrator shall reimburse the costs of medical moni6 toring and the costs of an initial health evaluation 

7 provided under this title at a rate set by the Admin8 istrator. 

9 ‘‘(3) ADMINISTRATIVE ARRANGEMENT AUTHOR10 ITY.—The WTC Program Administrator may enter 

11 into arrangements with other government agencies, 

12 insurance companies, or other third-party adminis13 trators to provide for timely and accurate processing 

14 of claims under this section. 

15 ‘‘(4) CLAIMS PROCESSING SUBJECT TO APPRO16 PRIATIONS.—The payment by the WTC Program 

17 Administrator for the processing of claims under 

18 this title is limited to the amounts provided in ad19 vance in appropriations Acts. 

20 ‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

21 ‘‘(1) DEVELOPMENT.—The Coordinating Cen22 ters of Excellence shall develop medical treatment 

23 protocols for the treatment of certified eligible WTC 

24 responders and certified eligible WTC community 


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1 members for identified WTC-related health condi2 tions. 

3 ‘‘(2) APPROVAL.—The WTC Program Adminis4 trator shall approve the medical treatment protocols, 

5 in consultation with the WTC Health Program 

6 Steering Committees. 

7 ‘‘PART 2—COMMUNITY PROGRAM 

8 ‘‘SEC. 3121. IDENTIFICATION AND INITIAL HEALTH EVALUA9 TION OF ELIGIBLE WTC COMMUNITY MEM10 BERS. 

11 ‘‘(a) ELIGIBLE WTC COMMUNITY MEMBER DE12 FINED.— 

13 ‘‘(1) IN GENERAL.—In this title, the term ‘eligi14 ble WTC community member’ means, subject to 

15 paragraphs (3) and (5), an individual who claims 

16 symptoms of a WTC-related health condition and is 

17 described in any of the following subparagraphs: 

18 ‘‘(A) CURRENTLY IDENTIFIED COMMUNITY

19 MEMBER.—An individual, including an eligible 

20 WTC responder, who has been identified as eli21 gible for medical treatment or monitoring by 

22 the WTC Environmental Health Center as of 

23 the date of enactment of this title. 

24 ‘‘(B) COMMUNITY MEMBER WHO MEETS

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1 vidual who is not an eligible WTC responder 

2 and meets any of the current eligibility criteria 

3 described in a subparagraph of paragraph (2). 

4 ‘‘(C) COMMUNITY MEMBER WHO MEETS

5 MODIFIED ELIGIBILITY CRITERIA.—An indi6 vidual who is not an eligible WTC responder 

7 and meets such eligibility criteria relating to ex8 posure to airborne toxins, other hazards, or ad9 verse conditions resulting from the September 

10 11, 2001, terrorist attacks on the World Trade 

11 Center as the WTC Administrator determines 

12 after consultation with the WTC Community 

13 Program Steering Committee, the Coordinating 

14 Centers of Excellence described in section 

15 3106(b)(1)(C), and the WTC Scientific/Tech16 nical Advisory Committee. 

17 The Administrator shall not modify such criteria 

18 under subparagraph (C) on or after the date that 

19 the number of certifications for eligible WTC com20 munity members has reached 80 percent of the limit 

21 described in paragraph (5) or on or after the date 

22 that the number of certifications for eligible WTC 

23 responders has reached 80 percent of the limit de24 scribed in section 3111(a)(5). 


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1 ‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The 

2 eligibility criteria described in this paragraph for an 

3 individual are that the individual is described in any 

4 of the following subparagraphs: 

5 ‘‘(A) A person who was present in the New 

6 York City disaster area in the dust or dust 

7 cloud on September 11, 2001. 

8 ‘‘(B) A person who worked, resided, or at9 tended school, child care or adult day care in 

10 the New York City disaster area for— 

11 ‘‘(i) at least four days during the 4- 

12 month period beginning on September 11, 

13 2001, and ending on January 10, 2002; or 

14 ‘‘(ii) at least 30 days during the pe15 riod beginning on September 11, 2001, 

16 and ending on July 31, 2002. 

17 ‘‘(C) A person who worked as a clean-up 

18 worker or performed maintenance work in the 

19 New York City disaster area during the 4- 

20 month period described in subparagraph (B)(i) 

21 and had extensive exposure to WTC dust as a 

22 result of such work. 

23 ‘‘(D) A person who was deemed eligible to 

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1 gram, who possessed a lease for a residence or 

2 purchased a residence in the New York City 

3 disaster area, and who resided in such residence 

4 during the period beginning on September 11, 

5 2001, and ending on May 31, 2003. 

6 ‘‘(E) A person whose place of employ7 ment— 

8 ‘‘(i) at any time during the period be9 ginning on September 11, 2001, and end10 ing on May 31, 2003, was in the New 

11 York City disaster area; and 

12 ‘‘(ii) was deemed eligible to receive a 

13 grant from the Lower Manhattan Develop14 ment Corporation WTC Small Firms At15 traction and Retention Act program or 

16 other government incentive program de17 signed to revitalize the Lower Manhattan 

18 economy after the September 11, 2001, 

19 terrorist attacks on the World Trade Cen20 ter. 

21 ‘‘(3) APPLICATION PROCESS.—The WTC Pro22 gram Administrator in consultation with the Coordi23 nating Centers of Excellence shall establish a proc24 ess for individuals, other than individuals described 


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1 in paragraph (1)(A), to be determined eligible WTC 

2 community members. Under such process— 

3 ‘‘(A) there shall be no fee charged to the 

4 applicant for making an application for such 

5 determination; 

6 ‘‘(B) the Administrator shall make a deter7 mination on such an application not later than 

8 60 days after the date of filing the application; 

9 and 

10 ‘‘(C) an individual who is determined not 

11 to be an eligible WTC community member shall 

12 have an opportunity to appeal such determina13 tion before an administrative law judge in a 

14 manner established under such process. 

15 ‘‘(4) CERTIFICATION.— 

16 ‘‘(A) IN GENERAL.—In the case of an indi17 vidual who is described in paragraph (1)(A) or 

18 who is determined under paragraph (3) (con19 sistent with paragraph (5)) to be an eligible 

20 WTC community member, the WTC Program 

21 Administrator shall provide an appropriate cer22 tification of such fact and of eligibility for fol23 lowup monitoring and treatment benefits under 

24 this part. The Administrator shall make deter25 minations of eligibility relating to an applicant’s 


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1 compliance with this title, including the 

2 verification of information submitted in support 

3 of the application and shall not deny such a 

4 certification to an individual unless the Admin5 istrator determines that— 

6 ‘‘(i) based on the application sub7 mitted, the individual does not meet the 

8 eligibility criteria; or 

9 ‘‘(ii) the numerical limitation on cer10 tification of eligible WTC community mem11 bers set forth in paragraph (5) has been 

12 met. 

13 ‘‘(B) TIMING.— 

14 ‘‘(i) CURRENTLY IDENTIFIED COMMU15 NITY MEMBERS.—In the case of an indi16 vidual who is described in paragraph 

17 (1)(A), the WTC Program Administrator 

18 shall provide the certification under sub19 paragraph (A) not later than 60 days after 

20 the date of the enactment of this title. 

21 ‘‘(ii) OTHER MEMBERS.—In the case 

22 of another individual who is determined 

23 under paragraph (3) and consistent with 

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1 ministrator shall provide the certification 

2 under subparagraph (A) at the time of 

3 such determination. 

4 ‘‘(5) NUMERICAL LIMITATION ON CERTIFI5 CATION OF ELIGIBLE WTC COMMUNITY MEMBERS.— 

6 ‘‘(A) IN GENERAL.—The total number of 

7 individuals not described in subparagraph (C) 

8 who may be certified as eligible WTC commu9 nity members under paragraph (4) shall not ex10 ceed 15,000. In applying the previous sentence, 

11 any individual who at any time so qualifies as 

12 an eligible WTC community member shall be 

13 counted against such numerical limitation. 

14 ‘‘(B) PROCESS.—In implementing subpara15 graph (A), the WTC Program Administrator 

16 shall— 

17 ‘‘(i) limit the number of certifications 

18 provided under paragraph (4) in accord19 ance with such subparagraph; and 

20 ‘‘(ii) provide priority in such certifi21 cations in the order in which individuals 

22 apply for a determination under paragraph 

23 (4). 

24 ‘‘(C) INDIVIDUALS CURRENTLY RECEIVING

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1 scribed in this subparagraph are individuals 

2 who— 

3 ‘‘(i) are described in paragraph 

4 (1)(A); or 

5 ‘‘(ii) before the date of the enactment 

6 of this title, have received monitoring or 

7 treatment at the World Trade Center En8 vironmental Health Center at Bellevue 

9 Hospital Center, Gouverneur Health Care 

10 Services, or Elmhurst Hospital Center. 

11 The New York City Health and Hospitals Cor12 poration shall, not later than 6 months after 

13 the date of enactment of this title, enter into 

14 arrangements with the Mt. Sinai Data and 

15 Clinical Coordination Center for the reporting 

16 of medical data concerning eligible WTC re17 sponders described in paragraph (1)(A), as de18 termined by the WTC Program Administrator 

19 and consistent with applicable Federal and 

20 State laws and regulations relating to confiden21 tiality of individually identifiable health infor22 mation. 

23 ‘‘(D) REPORT TO CONGRESS IF NUMER24 ICAL LIMITATION TO BE REACHED.—If the 

25 WTC Program Administrator determines that 


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1 the number of individuals subject to the numer2 ical limitation of subparagraph (A) is likely to 

3 exceed such numerical limitation, the Adminis4 trator shall submit to Congress a report on 

5 such determination. Such report shall include 

6 an estimate of the number of such individuals 

7 in excess of such numerical limitation and of 

8 the additional expenditures that would result 

9 under this title if such numerical limitation 

10 were removed. 

11 ‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE

12 ELIGIBILITY FOR FOLLOWUP MONITORING OR TREAT13 MENT.— 

14 ‘‘(1) IN GENERAL.—In the case of a certified el15 igible WTC community member, the WTC program 

16 shall provide for an initial health evaluation to deter17 mine if the member has a WTC-related health condi18 tion and is eligible for followup monitoring and 

19 treatment benefits under the WTC program. Initial 

20 health evaluation protocols shall be approved by the 

21 WTC Program Administrator, in consultation with 

22 the World Trade Center Environmental Health Cen23 ter at Bellevue Hospital and the WTC Community 

24 Program Steering Committee. 


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1 ‘‘(2) INITIAL HEALTH EVALUATION PRO2 VIDERS.—The initial health evaluation described in 

3 paragraph (1) shall be provided through a Clinical 

4 Center of Excellence with respect to the individual 

5 involved. 

6 ‘‘(3) LIMITATION ON INITIAL HEALTH EVALUA7 TION BENEFITS.—Benefits for initial health evalua8 tion under this part for an eligible WTC community 

9 member shall consist only of a single medical initial 

10 health evaluation consistent with initial health eval11 uation protocols described in paragraph (1). Nothing 

12 in this paragraph shall be construed as preventing 

13 such an individual from seeking additional medical 

14 initial health evaluations at the expense of the indi15 vidual. 

16 ‘‘SEC. 3122. FOLLOWUP MONITORING AND TREATMENT OF 

17 CERTIFIED ELIGIBLE WTC COMMUNITY MEM18 BERS FOR WTC-RELATED HEALTH CONDI19 TIONS. 

20 ‘‘(a) IN GENERAL.—Subject to subsection (b), the 

21 provisions of sections 3111 and 3112 shall apply to fol22 lowup monitoring and treatment of WTC-related health 

23 conditions for certified eligible WTC community members 

24 in the same manner as such provisions apply to the moni25 toring and treatment of identified WTC-related health 


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1 conditions for certified eligible WTC responders, except 

2 that such monitoring shall only be available to those cer3 tified as eligible for treatment under this title. Under sec4 tion 3106(a)(3), the City of New York is required to con5 tribute a share of the costs of such treatment. 

6 ‘‘(b) LIST OF IDENTIFIED WTC-RELATED HEALTH

7 CONDITIONS FOR WTC COMMUNITY MEMBERS.— 

8 ‘‘(1) IDENTIFIED WTC-RELATED HEALTH CON9 DITIONS FOR WTC COMMUNITY MEMBERS.—For pur10 poses of this title, the term ‘identified WTC-related 

11 health conditions for WTC community members’ 

12 means any of the following health conditions: 

13 ‘‘(A) AERODIGESTIVE DISORDERS.— 

14 ‘‘(i) Interstitial lung diseases. 

15 ‘‘(ii) Chronic respiratory disorder— 

16 fumes/vapors. 

17 ‘‘(iii) Asthma. 

18 ‘‘(iv) Reactive airways dysfunction 

19 syndrome (RADS). 

20 ‘‘(v) WTC-exacerbated chronic ob21 structive pulmonary disease (COPD). 

22 ‘‘(vi) Chronic cough syndrome. 

23 ‘‘(vii) Upper airway hyperreactivity. 

24 ‘‘(viii) Chronic rhinosinusitis. 

25 ‘‘(ix) Chronic nasopharyngitis. 


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1 ‘‘(x) Chronic laryngitis. 

2 ‘‘(xi) Gastro-esophageal reflux dis3 order (GERD). 

4 ‘‘(xii) Sleep apnea exacerbated by or 

5 related to a condition described in a pre6 vious clause. 

7 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

8 ‘‘(i) Post traumatic stress disorder 

9 (PTSD). 

10 ‘‘(ii) Major depressive disorder. 

11 ‘‘(iii) Panic disorder. 

12 ‘‘(iv) Generalized anxiety disorder. 

13 ‘‘(v) Anxiety disorder (not otherwise 

14 specified). 

15 ‘‘(vi) Depression (not otherwise speci16 fied). 

17 ‘‘(vii) Acute stress disorder. 

18 ‘‘(viii) Dysthymic disorder. 

19 ‘‘(ix) Adjustment disorder. 

20 ‘‘(x) Substance abuse. 

21 ‘‘(xi) V codes (treatments not specifi22 cally related to psychiatric disorders, such 

23 as marital problems, parenting problems, 

24 etc.), secondary to another identified 


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1 WTC-related health condition for WTC 

2 community members. 

3 ‘‘(2) ADDITIONS TO IDENTIFIED WTC-RELATED

4 HEALTH CONDITIONS FOR WTC COMMUNITY MEM5 BERS.—The provisions of paragraph (4) of section 

6 3112(a) shall apply with respect to an addition to 

7 the list of identified WTC-related health conditions 

8 for eligible WTC community members under para9 graph (1) in the same manner as such provisions 

10 apply to an addition to the list of identified WTC11 related health conditions for eligible WTC respond12 ers under section 3112(a)(3). 

13 ‘‘SEC. 3123. FOLLOWUP MONITORING AND TREATMENT OF 

14 OTHER INDIVIDUALS WITH WTC-RELATED 

15 HEALTH CONDITIONS. 

16 ‘‘(a) IN GENERAL.—Subject to subsection (c), the 

17 provisions of section 3122 shall apply to the followup mon18 itoring and treatment of WTC-related health conditions 

19 for eligible WTC community members in the case of indi20 viduals described in subsection (b) in the same manner 

21 as such provisions apply to the followup monitoring and 

22 treatment of WTC-related health conditions for WTC 

23 community members. Under section 3106(a)(3), the City 

24 of New York is required to contribute a share of the costs 

25 of such monitoring and treatment. 


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1 ‘‘(b) INDIVIDUALS DESCRIBED.—An individual de2 scribed in this subsection is an individual who, regardless 

3 of location of residence— 

4 ‘‘(1) is not an eligible WTC responder or an eli5 gible WTC community member; and 

6 ‘‘(2) is diagnosed at a Clinical Center of Excel7 lence (with respect to an eligible WTC community 

8 member) with an identified WTC-related health con9 dition for WTC community members. 

10 ‘‘(c) LIMITATION.— 

11 ‘‘(1) IN GENERAL.—The WTC Program Admin12 istrator shall limit benefits for any fiscal year under 

13 subsection (a) in a manner so that payments under 

14 this section for such fiscal year do not exceed the 

15 amount specified in paragraph (2) for such fiscal 

16 year. 

17 ‘‘(2) LIMITATION.—The amount specified in 

18 this paragraph for— 

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

20 ‘‘(B) a succeeding fiscal year is the 

21 amount specified in this paragraph for the pre22 vious fiscal year increased by the annual per23 centage increase in the medical care component 

24 of the Consumer Price Index for All Urban 

25 Consumers. 


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1 ‘‘PART 3—NATIONAL ARRANGEMENT FOR BENE2 FITS FOR ELIGIBLE INDIVIDUALS OUTSIDE 

3 NEW YORK 

4 ‘‘SEC. 3131. NATIONAL ARRANGEMENT FOR BENEFITS FOR 

5 ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 

6 ‘‘(a) IN GENERAL.—In order to ensure reasonable ac7 cess to benefits under this subtitle for individuals who are 

8 eligible WTC responders or eligible WTC community 

9 members and who reside in any State, as defined in sec10 tion 2(f), outside the New York metropolitan area, the 

11 WTC Program Administrator shall establish a nationwide 

12 network of health care providers to provide monitoring 

13 and treatment benefits and initial health evaluations near 

14 such individuals’ areas of residence in such States. Noth15 ing in this subsection shall be construed as preventing 

16 such individuals from being provided such monitoring and 

17 treatment benefits or initial health evaluation through any 

18 Clinical Center of Excellence. 

19 ‘‘(b) NETWORK REQUIREMENTS.—Any health care 

20 provider participating in the network under subsection (a) 

21 shall— 

22 ‘‘(1) meet criteria for credentialing established 

23 by the Coordinating Centers of Excellence; 

24 ‘‘(2) follow the monitoring, initial health evalua25 tion, and treatment protocols developed under sec26 tion 3106(a)(2)(B); 


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1 ‘‘(3) collect and report data in accordance with 

2 section 3105; and 

3 ‘‘(4) meet such fraud, quality assurance, and 

4 other requirements as the WTC Program Adminis5 trator establishes. 

6 ‘‘Subtitle C—Research Into 

7 Conditions 

8 ‘‘SEC. 3141. RESEARCH REGARDING CERTAIN HEALTH CON9 DITIONS RELATED TO SEPTEMBER 11 TER10 RORIST ATTACKS IN NEW YORK CITY. 

11 ‘‘(a) IN GENERAL.—With respect to individuals, in12 cluding eligible WTC responders and eligible WTC com13 munity members, receiving monitoring or treatment under 

14 subtitle B, the WTC Program Administrator shall conduct 

15 or support— 

16 ‘‘(1) research on physical and mental health 

17 conditions that may be related to the September 11, 

18 2001, terrorist attacks on the World Trade Center; 

19 ‘‘(2) research on diagnosing WTC-related 

20 health conditions of such individuals, in the case of 

21 conditions for which there has been diagnostic un22 certainty; and 

23 ‘‘(3) research on treating WTC-related health 

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1 tions for which there has been treatment uncer2 tainty. 

3 The Administrator may provide such support through con4 tinuation and expansion of research that was initiated be5 fore the date of the enactment of this title and through 

6 the World Trade Center Health Registry (referred to in 

7 section 3151), through a Clinical Center of Excellence, or 

8 through a Coordinating Center of Excellence. 

9 ‘‘(b) TYPES OF RESEARCH.—The research under 

10 subsection (a)(1) shall include epidemiologic and other re11 search studies on WTC-related health conditions or 

12 emerging conditions— 

13 ‘‘(1) among WTC responders and community 

14 members under treatment; and 

15 ‘‘(2) in sampled populations outside the New 

16 York City disaster area in Manhattan as far north 

17 as 14th Street and in Brooklyn, along with control 

18 populations, to identify potential for long-term ad19 verse health effects in less exposed populations. 

20 ‘‘(c) CONSULTATION.—The WTC Program Adminis21 trator shall carry out this section in consultation with the 

22 WTC Health Program Steering Committees and the WTC 

23 Scientific/Technical Advisory Committee. 

24 ‘‘(d) APPLICATION OF PRIVACY AND HUMAN SUB25 JECT PROTECTIONS.—The privacy and human subject 


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1 protections applicable to research conducted under this 

2 section shall not be less than such protections applicable 

3 to research otherwise conducted by the National Institutes 

4 of Health. 

5 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 

6 purpose of carrying out this section, there are authorized 

7 to be appropriated $15,000,000 for each fiscal year, in 

8 addition to any other authorizations of appropriations that 

9 are available for such purpose. 

10 ‘‘Subtitle D—Programs of the New 

11 York City Department of Health 

12 and Mental Hygiene 

13 ‘‘SEC. 3151. WORLD TRADE CENTER HEALTH REGISTRY. 

14 ‘‘(a) PROGRAM EXTENSION.—For the purpose of en15 suring on-going data collection for victims of the Sep16 tember 11, 2001, terrorist attacks on the World Trade 

17 Center, the WTC Program Administrator, shall extend 

18 and expand the arrangements in effect as of January 1, 

19 2008, with the New York City Department of Health and 

20 Mental Hygiene that provide for the World Trade Center 

21 Health Registry. 

22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

23 are authorized to be appropriated $7,000,000 for each fis24 cal year to carry out this section. 


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1 ‘‘SEC. 3152. MENTAL HEALTH SERVICES. 

2 ‘‘(a) IN GENERAL.—The WTC Program Adminis3 trator may make grants to the New York City Department 

4 of Health and Mental Hygiene to provide mental health 

5 services to address mental health needs relating to the 

6 September 11, 2001, terrorist attacks on the World Trade 

7 Center. 

8 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 

9 are authorized to be appropriated $8,500,000 for each fis10 cal year to carry out this section.’’. 

11 TITLE II—SEPTEMBER 11TH VIC12 TIM COMPENSATION FUND OF 

13 2001 

14 SEC. 201. DEFINITIONS. 

15 Section 402 of the Air Transportation Safety and 

16 System Stabilization Act (49 U.S.C. 40101 note) is 

17 amended— 

18 (1) in paragraph (6) by inserting ‘‘, or debris 

19 removal, including under the World Trade Center 

20 Health Program established under section 3101 of 

21 the Public Health Service Act,’’ after ‘‘September 

22 11, 2001’’; 

23 (2) by inserting after paragraph (6) the fol24 lowing new paragraphs and redesignating subse25 quent paragraphs accordingly: 


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1 ‘‘(7) CONTRACTOR AND SUBCONTRACTOR.—The 

2 term ‘contractor and subcontractor’ means any con3 tractor or subcontractor (at any tier of a subcon4 tracting relationship), including any general con5 tractor, construction manager, prime contractor, 

6 consultant, or any parent, subsidiary, associated or 

7 allied company, affiliated company, corporation, 

8 firm, organization, or joint venture thereof that par9 ticipated in debris removal at any 9/11 crash site. 

10 Such term shall not include any entity, including the 

11 Port Authority of New York and New Jersey, with 

12 a property interest in the World Trade Center, on 

13 September 11, 2001, whether fee simple, leasehold 

14 or easement, direct or indirect. 

15 ‘‘(8) DEBRIS REMOVAL.—The term ‘debris re16 moval’ means rescue and recovery efforts, removal of 

17 debris, cleanup, remediation, and response during 

18 the immediate aftermath of the terrorist-related air19 craft crashes of September 11, 2001, with respect to 

20 a 9/11 crash site.’’; 

21 (3) by inserting after paragraph (10), as so re22 designated, the following new paragraph and redes23 ignating the subsequent paragraphs accordingly: 

24 ‘‘(11) IMMEDIATE AFTERMATH.—The term ‘im25 mediate aftermath’ means any period beginning with 


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1 the terrorist-related aircraft crashes of September 

2 11, 2001, and ending on August 30, 2002.’’; and 

3 (4) by adding at the end the following new 

4 paragraph: 

5 ‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash 

6 site’ means— 

7 ‘‘(A) the World Trade Center site, Pen8 tagon site, and Shanksville, Pennsylvania site; 

9 ‘‘(B) the buildings or portions of buildings 

10 that were destroyed as a result of the terrorist11 related aircraft crashes of September 11, 2001; 

12 ‘‘(C) any area contiguous to a site of such 

13 crashes that the Special Master determines was 

14 sufficiently close to the site that there was a de15 monstrable risk of physical harm resulting from 

16 the impact of the aircraft or any subsequent 

17 fire, explosions, or building collapses (including 

18 the immediate area in which the impact oc19 curred, fire occurred, portions of buildings fell, 

20 or debris fell upon and injured individuals); and 

21 ‘‘(D) any area related to, or along, routes 

22 of debris removal, such as barges and Fresh 

23 Kills.’’. 


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1 SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 

2 COMPENSATION. 

3 (a) INFORMATION ON LOSSES RESULTING FROM DE4 BRIS REMOVAL INCLUDED IN CONTENTS OF CLAIM

5 FORM.—Section 405(a)(2)(B) of the Air Transportation 

6 Safety and System Stabilization Act (49 U.S.C. 40101 

7 note) is amended— 

8 (1) in clause (i), by inserting ‘‘, or debris re9 moval during the immediate aftermath’’ after ‘‘Sep10 tember 11, 2001’’; 

11 (2) in clause (ii), by inserting ‘‘or debris re12 moval during the immediate aftermath’’ after 

13 ‘‘crashes’’; and 

14 (3) in clause (iii), by inserting ‘‘or debris re15 moval during the immediate aftermath’’ after 

16 ‘‘crashes’’. 

17 (b) EXTENSION OF DEADLINE FOR CLAIMS UNDER

18 SEPTEMBER 11TH VICTIM COMPENSATION FUND OF

19 2001.—Section 405(a)(3) of such Act is amended to read 

20 as follows: 

21 ‘‘(3) LIMITATION.— 

22 ‘‘(A) IN GENERAL.—Except as provided by 

23 subparagraph (B), no claim may be filed under 

24 paragraph (1) after the date that is 2 years 

25 after the date on which regulations are promul26 gated under section 407(a). 


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1 ‘‘(B) EXCEPTION.—A claim may be filed 

2 under paragraph (1), in accordance with sub3 section (c)(3)(A)(i), by an individual (or by a 

4 personal representative on behalf of a deceased 

5 individual) during the period beginning on the 

6 date on which the regulations are updated 

7 under section 407(b) and ending on December 

8 22, 2031.’’. 

9 (c) REQUIREMENTS FOR FILING CLAIMS DURING

10 EXTENDED FILING PERIOD.—Section 405(c)(3) of such 

11 Act is amended— 

12 (1) by redesignating subparagraphs (A) and 

13 (B) as subparagraphs (B) and (C), respectively; and 

14 (2) by inserting before subparagraph (B), as so 

15 redesignated, the following new subparagraph: 

16 ‘‘(A) REQUIREMENTS FOR FILING CLAIMS

17 DURING EXTENDED FILING PERIOD.— 

18 ‘‘(i) TIMING REQUIREMENTS FOR FIL19 ING CLAIMS.—An individual (or a personal 

20 representative on behalf of a deceased indi21 vidual) may file a claim during the period 

22 described in subsection (a)(3)(B) as fol23 lows: 

24 ‘‘(I) In the case that the Special 

25 Master determines the individual 


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1 knew (or reasonably should have 

2 known) before the date specified in 

3 clause (iii) that the individual suffered 

4 a physical harm at a 9/11 crash site 

5 as a result of the terrorist-related air6 craft crashes of September 11, 2001, 

7 or as a result of debris removal, and 

8 that the individual knew (or should 

9 have known) before such specified 

10 date that the individual was eligible to 

11 file a claim under this title, the indi12 vidual may file a claim not later than 

13 the date that is 2 years after such 

14 specified date. 

15 ‘‘(II) In the case that the Special 

16 Master determines the individual first 

17 knew (or reasonably should have 

18 known) on or after the date specified 

19 in clause (iii) that the individual suf20 fered such a physical harm or that the 

21 individual first knew (or should have 

22 known) on or after such specified date 

23 that the individual was eligible to file 

24 a claim under this title, the individual 

25 may file a claim not later than the 


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1 last day of the 2-year period begin2 ning on the date the Special Master 

3 determines the individual first knew 

4 (or should have known) that the indi5 vidual both suffered from such harm 

6 and was eligible to file a claim under 

7 this title. 

8 ‘‘(ii) OTHER ELIGIBILITY REQUIRE9 MENTS FOR FILING CLAIMS.—An indi10 vidual may file a claim during the period 

11 described in subsection (a)(3)(B) only if— 

12 ‘‘(I) the individual was treated by 

13 a medical professional for suffering 

14 from a physical harm described in 

15 clause (i)(I) within a reasonable time 

16 from the date of discovering such 

17 harm; and 

18 ‘‘(II) the individual’s physical 

19 harm is verified by contemporaneous 

20 medical records created by or at the 

21 direction of the medical professional 

22 who provided the medical care. 

23 ‘‘(iii) DATE SPECIFIED.—The date 

24 specified in this clause is the date on which 


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1 the regulations are updated under section 

2 407(a).’’. 

3 (d) CLARIFYING APPLICABILITY TO ALL 9/11 CRASH

4 SITES.—Section 405(c)(2)(A)(i) of such Act is amended 

5 by striking ‘‘or the site of the aircraft crash at Shanksville, 

6 Pennsylvania’’ and inserting ‘‘the site of the aircraft crash 

7 at Shanksville, Pennsylvania, or any other 9/11 crash 

8 site’’. 

9 (e) INCLUSION OF PHYSICAL HARM RESULTING

10 FROM DEBRIS REMOVAL.—Section 405(c) of such Act is 

11 amended in paragraph (2)(A)(ii), by inserting ‘‘or debris 

12 removal’’ after ‘‘air crash’’. 

13 (f) LIMITATIONS ON CIVIL ACTIONS.— 

14 (1) APPLICATION TO DAMAGES RELATED TO

15 DEBRIS REMOVAL.—Clause (i) of section 

16 405(c)(3)(C) of such Act, as redesignated by sub17 section (c), is amended by inserting ‘‘, or for dam18 ages arising from or related to debris removal’’ after 

19 ‘‘September 11, 2001’’. 

20 (2) PENDING ACTIONS.—Clause (ii) of such sec21 tion, as so redesignated, is amended to read as fol22 lows: 

23 ‘‘(ii) PENDING ACTIONS.—In the case 

24 of an individual who is a party to a civil 

25 action described in clause (i), such indiVerDate Nov 24 2008 04:19 Jun 25, 2009 Jkt 079200 PO 00000 Frm 00109 Fmt 6652 Sfmt 6201 E:\BILLS\S1334.IS S1334

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1 vidual may not submit a claim under this 

2 title— 

3 ‘‘(I) during the period described 

4 in subsection (a)(3)(A) unless such in5 dividual withdraws from such action 

6 by the date that is 90 days after the 

7 date on which regulations are promul8 gated under section 407(a); and 

9 ‘‘(II) during the period described 

10 in subsection (a)(3)(B) unless such in11 dividual withdraws from such action 

12 by the date that is 90 days after the 

13 date on which the regulations are up14 dated under section 407(b).’’. 

15 (3) AUTHORITY TO REINSTITUTE CERTAIN

16 LAWSUITS.—Such section, as so redesignated, is fur17 ther amended by adding at the end the following 

18 new clause: 

19 ‘‘(iii) AUTHORITY TO REINSTITUTE

20 CERTAIN LAWSUITS.—In the case of a 

21 claimant who was a party to a civil action 

22 described in clause (i), who withdrew from 

23 such action pursuant to clause (ii), and 

24 who is subsequently determined to not be 

25 an eligible individual for purposes of this 


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1 subsection, such claimant may reinstitute 

2 such action without prejudice during the 

3 90-day period beginning after the date of 

4 such ineligibility determination.’’. 

5 SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

6 Section 407 of the Air Transportation Safety and 

7 System Stabilization Act (49 U.S.C. 40101 note) is 

8 amended— 

9 (1) by striking ‘‘Not later than’’ and inserting 

10 ‘‘(a) IN GENERAL.—Not later than’’; and 

11 (2) by adding at the end the following new sub12 section: 

13 ‘‘(b) UPDATED REGULATIONS.—Not later than 90 

14 days after the date of the enactment of the James Zadroga 

15 9/11 Health and Compensation Act of 2009, the Special 

16 Master shall update the regulations promulgated under 

17 subsection (a) to the extent necessary to comply with the 

18 provisions of title II of such Act.’’. 

19 SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 

20 Section 408(a) of the Air Transportation Safety and 

21 System Stabilization Act (49 U.S.C. 40101 note) is 

22 amended by adding at the end the following new para23 graphs: 

24 ‘‘(4) LIABILITY FOR CERTAIN CLAIMS.— 


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1 ‘‘(A) IN GENERAL.—Notwithstanding any 

2 other provision of law, subject to subparagraph 

3 (B), liability for all claims and actions (includ4 ing claims or actions that have been previously 

5 resolved, that are currently pending, and that 

6 may be filed through December 22, 2031) for 

7 compensatory damages, contribution or indem8 nity, or any other form or type of relief, arising 

9 from or related to debris removal, against the 

10 City of New York, any entity (including the 

11 Port Authority of New York and New Jersey) 

12 with a property interest in the World Trade 

13 Center on September 11, 2001 (whether fee 

14 simple, leasehold or easement, or direct or indi15 rect), and any contractors and subcontractors 

16 thereof, shall not be in an amount that exceeds 

17 the sum of the following: 

18 ‘‘(i) The amount of funds of the WTC 

19 Captive Insurance Company, including the 

20 cumulative interest. 

21 ‘‘(ii) The amount of all available in22 surance identified in schedule 2 of the 

23 WTC Captive Insurance Company insur24 ance policy. 


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1 ‘‘(iii) The amount that is the greater 

2 of the City of New York’s insurance cov3 erage or $350,000,000. In determining the 

4 amount of the City’s insurance coverage 

5 for purposes of the previous sentence, any 

6 amount described in clauses (i) and (ii) 

7 shall not be included. 

8 ‘‘(iv) The amount of all available li9 ability insurance coverage maintained by 

10 any entity, including the Port Authority of 

11 New York and New Jersey, with a prop12 erty interest in the World Trade Center, 

13 on September 11, 2001, whether fee sim14 ple, leasehold or easement, or direct or in15 direct. 

16 ‘‘(v) The amount of all available liabil17 ity insurance coverage maintained by con18 tractors and subcontractors. 

19 ‘‘(B) EXCEPTION.—Subparagraph (A) 

20 shall not apply to claims or actions based upon 

21 conduct held to be intentionally tortious in na22 ture or to acts of gross negligence or other such 

23 acts to the extent to which punitive damages 

24 are awarded as a result of such conduct or acts. 


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1 ‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Pay2 ments to plaintiffs who obtain a settlement or judg3 ment with respect to a claim or action to which 

4 paragraph (4)(A) applies, shall be paid solely from 

5 the following funds in the following order: 

6 ‘‘(A) The funds described in clause (i) or 

7 (ii) of paragraph (4)(A). 

8 ‘‘(B) If there are no funds available as de9 scribed in clause (i) or (ii) of paragraph (4)(A), 

10 the funds described in clause (iii) of such para11 graph. 

12 ‘‘(C) If there are no funds available as de13 scribed in clause (i), (ii), or (iii) of paragraph 

14 (4)(A), the funds described in clause (iv) of 

15 such paragraph. 

16 ‘‘(D) If there are no funds available as de17 scribed in clause (i), (ii), (iii), or (iv) of para18 graph (4)(A), the funds described in clause (v) 

19 of such paragraph. 

20 ‘‘(6) DECLARATORY JUDGMENT ACTIONS AND

21 DIRECT ACTION.—Any party to a claim or action to 

22 which paragraph (4)(A) applies may, with respect to 

23 such claim or action, either file an action for a de24 claratory judgment for insurance coverage or bring 


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1 a direct action against the insurance company in2 volved.’’. 

Æ 


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