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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 847 Engrossed Amendment Senate (EAS)]

                  In the Senate of the United States,

                                                     December 22, 2010.
    Resolved, That the bill from the House of Representatives (H.R. 
847) entitled ``An Act to amend the Public Health Service Act to extend 
and improve protections and services to individuals directly impacted 
by the terrorist attack in New York City on September 11, 2001, and for 
other purposes.'', do pass with the following

                               AMENDMENT:

            Strike all after the enacting clause and insert the 
      following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

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

Sec. 1. Short title; table of contents.

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

Sec. 101. World Trade Center Health Program.

           ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM

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

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

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

                        ``PART 1--WTC Responders

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

                        ``PART 2--WTC Survivors

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

                       ``PART 3--Payor Provisions

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

                 ``Subtitle C--Research Into Conditions

        ``Sec. 3341. Research regarding certain health conditions 
                            related to September 11 terrorist attacks.
        ``Sec. 3342. World Trade Center Health Registry.

                         ``Subtitle D--Funding

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

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

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

                 TITLE III--REVENUE RELATED PROVISIONS

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

                      TITLE IV--BUDGETARY EFFECTS

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

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM.

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

           ``TITLE XXXIII--WORLD TRADE CENTER HEALTH PROGRAM

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

``SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM.

    ``(a) In General.--There is hereby established within the 
Department of Health and Human Services a program to be known as the 
World Trade Center Health Program, which shall be administered by the 
WTC Program Administrator, to provide beginning on July 1, 2011--
            ``(1) medical monitoring and treatment benefits to eligible 
        emergency responders and recovery and cleanup workers 
        (including those who are Federal employees) who responded to 
        the September 11, 2001, terrorist attacks; and
            ``(2) initial health evaluation, monitoring, and treatment 
        benefits to residents and other building occupants and area 
        workers in New York City who were directly impacted and 
        adversely affected by such attacks.
    ``(b) Components of Program.--The WTC Program includes the 
following components:
            ``(1) Medical monitoring for responders.--Medical 
        monitoring under section 3311, including clinical examinations 
        and long-term health monitoring and analysis for enrolled WTC 
        responders who were likely to have been exposed to airborne 
        toxins that were released, or to other hazards, as a result of 
        the September 11, 2001, terrorist attacks.
            ``(2) Initial health evaluation for survivors.--An initial 
        health evaluation under section 3321, including an evaluation 
        to determine eligibility for followup monitoring and treatment.
            ``(3) Followup monitoring and treatment for wtc-related 
        health conditions for responders and survivors.--Provision 
        under sections 3312, 3322, and 3323 of followup monitoring and 
        treatment and payment, subject to the provisions of subsection 
        (d), for all medically necessary health and mental health care 
        expenses of an individual with respect to a WTC-related health 
        condition (including necessary prescription drugs).
            ``(4) Outreach.--Establishment under section 3303 of an 
        education and outreach program to potentially eligible 
        individuals concerning the benefits under this title.
            ``(5) Clinical data collection and analysis.--Collection 
        and analysis under section 3304 of health and mental health 
        data relating to individuals receiving monitoring or treatment 
        benefits in a uniform manner in collaboration with the 
        collection of epidemiological data under section 3342.
            ``(6) Research on health conditions.--Establishment under 
        subtitle C of a research program on health conditions resulting 
        from the September 11, 2001, terrorist attacks.
    ``(c) No Cost Sharing.--Monitoring and treatment benefits and 
initial health evaluation benefits are provided under subtitle B 
without any deductibles, copayments, or other cost sharing to an 
enrolled WTC responder or certified-eligible WTC survivor. Initial 
health evaluation benefits are provided under subtitle B without any 
deductibles, copayments, or other cost sharing to a screening-eligible 
WTC survivor.
    ``(d) Preventing Fraud and Unreasonable Administrative Costs.--
            ``(1) Fraud.--The Inspector General of the Department of 
        Health and Human Services shall develop and implement a program 
        to review the WTC Program's health care expenditures to detect 
        fraudulent or duplicate billing and payment for inappropriate 
        services. This title is a Federal health care program (as 
        defined in section 1128B(f) of the Social Security Act) and is 
        a health plan (as defined in section 1128C(c) of such Act) for 
        purposes of applying sections 1128 through 1128E of such Act.
            ``(2) Unreasonable administrative costs.--The Inspector 
        General of the Department of Health and Human Services shall 
        develop and implement a program to review the WTC Program for 
        unreasonable administrative costs, including with respect to 
        infrastructure, administration, and claims processing.
    ``(e) Quality Assurance.--The WTC Program Administrator working 
with the Clinical Centers of Excellence shall develop and implement a 
quality assurance program for the monitoring and treatment delivered by 
such Centers of Excellence and any other participating health care 
providers. Such program shall include--
            ``(1) adherence to monitoring and treatment protocols;
            ``(2) appropriate diagnostic and treatment referrals for 
        participants;
            ``(3) prompt communication of test results to participants; 
        and
            ``(4) such other elements as the Administrator specifies in 
        consultation with the Clinical Centers of Excellence.
    ``(f) Annual Program Report.--
            ``(1) In general.--Not later than 6 months after the end of 
        each fiscal year in which the WTC Program is in operation, the 
        WTC Program Administrator shall submit an annual report to the 
        Congress on the operations of this title for such fiscal year 
        and for the entire period of operation of the program.
            ``(2) Contents included in report.--Each annual report 
        under paragraph (1) shall include at least the following:
                    ``(A) Eligible individuals.--Information for each 
                clinical program described in paragraph (3)--
                            ``(i) on the number of individuals who 
                        applied for certification under subtitle B and 
                        the number of such individuals who were so 
                        certified;
                            ``(ii) of the individuals who were 
                        certified, on the number who received 
                        monitoring under the program and the number of 
                        such individuals who received medical treatment 
                        under the program;
                            ``(iii) with respect to individuals so 
                        certified who received such treatment, on the 
                        WTC-related health conditions for which they 
                        were treated; and
                            ``(iv) on the projected number of 
                        individuals who will be certified under 
                        subtitle B in the succeeding fiscal year and 
                        the succeeding 10-year period.
                    ``(B) Monitoring, initial health evaluation, and 
                treatment costs.--For each clinical program so 
                described--
                            ``(i) information on the costs of 
                        monitoring and initial health evaluation and 
                        the costs of treatment and on the estimated 
                        costs of such monitoring, evaluation, and 
                        treatment in the succeeding fiscal year; and
                            ``(ii) an estimate of the cost of medical 
                        treatment for WTC-related health conditions 
                        that have been paid for or reimbursed by 
                        workers' compensation, by public or private 
                        health plans, or by New York City under section 
                        3331.
                    ``(C) Administrative costs.--Information on the 
                cost of administering the program, including costs of 
                program support, data collection and analysis, and 
                research conducted under the program.
                    ``(D) Administrative experience.--Information on 
                the administrative performance of the program, 
                including--
                            ``(i) the performance of the program in 
                        providing timely evaluation of and treatment to 
                        eligible individuals; and
                            ``(ii) a list of the Clinical Centers of 
                        Excellence and other providers that are 
                        participating in the program.
                    ``(E) Scientific reports.--A summary of the 
                findings of any new scientific reports or studies on 
                the health effects associated with exposure described 
                in section 3306(1), including the findings of research 
                conducted under section 3341(a).
                    ``(F) Advisory committee recommendations.--A list 
                of recommendations by the WTC Scientific/Technical 
                Advisory Committee on additional WTC Program 
                eligibility criteria and on additional WTC-related 
                health conditions and the action of the WTC Program 
                Administrator concerning each such recommendation.
            ``(3) Separate clinical programs described.--In paragraph 
        (2), each of the following shall be treated as a separate 
        clinical program of the WTC Program:
                    ``(A) Firefighters and related personnel.--The 
                benefits provided for enrolled WTC responders described 
                in section 3311(a)(2)(A).
                    ``(B) Other wtc responders.--The benefits provided 
                for enrolled WTC responders not described in 
                subparagraph (A).
                    ``(C) WTC survivors.--The benefits provided for 
                screening-eligible WTC survivors and certified-eligible 
                WTC survivors in section 3321(a).
    ``(g) Notification to Congress Upon Reaching 80 Percent of 
Eligibility Numerical Limits.--The Secretary shall promptly notify the 
Congress of each of the following:
            ``(1) When the number of enrollments of WTC responders 
        subject to the limit established under section 3311(a)(4) has 
        reached 80 percent of such limit.
            ``(2) When the number of certifications for certified-
        eligible WTC survivors subject to the limit established under 
        section 3321(a)(3) has reached 80 percent of such limit.
    ``(h) Consultation.--The WTC Program Administrator shall engage in 
ongoing outreach and consultation with relevant stakeholders, including 
the WTC Health Program Steering Committees and the Advisory Committee 
under section 3302, regarding the implementation and improvement of 
programs under this title.

``SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY 
              COMMITTEE; WTC HEALTH PROGRAM STEERING COMMITTEES.

    ``(a) Advisory Committee.--
            ``(1) Establishment.--The WTC Program Administrator shall 
        establish an advisory committee to be known as the WTC Health 
        Program Scientific/Technical Advisory Committee (in this 
        subsection referred to as the `Advisory Committee') to review 
        scientific and medical evidence and to make recommendations to 
        the Administrator on additional WTC Program eligibility 
        criteria and on additional WTC-related health conditions.
            ``(2) Composition.--The WTC Program Administrator shall 
        appoint the members of the Advisory Committee and shall include 
        at least--
                    ``(A) 4 occupational physicians, at least 2 of whom 
                have experience treating WTC rescue and recovery 
                workers;
                    ``(B) 1 physician with expertise in pulmonary 
                medicine;
                    ``(C) 2 environmental medicine or environmental 
                health specialists;
                    ``(D) 2 representatives of WTC responders;
                    ``(E) 2 representatives of certified-eligible WTC 
                survivors;
                    ``(F) an industrial hygienist;
                    ``(G) a toxicologist;
                    ``(H) an epidemiologist; and
                    ``(I) a mental health professional.
            ``(3) Meetings.--The Advisory Committee shall meet at such 
        frequency as may be required to carry out its duties.
            ``(4) Reports.--The WTC Program Administrator shall provide 
        for publication of recommendations of the Advisory Committee on 
        the public Web site established for the WTC Program.
            ``(5) Duration.--Notwithstanding any other provision of 
        law, the Advisory Committee shall continue in operation during 
        the period in which the WTC Program is in operation.
            ``(6) Application of faca.--Except as otherwise 
        specifically provided, the Advisory Committee shall be subject 
        to the Federal Advisory Committee Act.
    ``(b) WTC Health Program Steering Committees.--
            ``(1) Consultation.--The WTC Program Administrator shall 
        consult with 2 steering committees (each in this section 
        referred to as a `Steering Committee') that are established as 
        follows:
                    ``(A) WTC responders steering committee.--One 
                Steering Committee, to be known as the WTC Responders 
                Steering Committee, for the purpose of receiving input 
                from affected stakeholders and facilitating the 
                coordination of monitoring and treatment programs for 
                the enrolled WTC responders under part 1 of subtitle B.
                    ``(B) WTC survivors steering committee.--One 
                Steering Committee, to be known as the WTC Survivors 
                Steering Committee, for the purpose of receiving input 
                from affected stakeholders and facilitating the 
                coordination of initial health evaluations, monitoring, 
                and treatment programs for screening-eligible and 
                certified-eligible WTC survivors under part 2 of 
                subtitle B.
            ``(2) Membership.--
                    ``(A) WTC responders steering committee.--
                            ``(i) Representation.--The WTC Responders 
                        Steering Committee shall include--
                                    ``(I) representatives of the 
                                Centers of Excellence providing 
                                services to WTC responders;
                                    ``(II) representatives of labor 
                                organizations representing 
                                firefighters, police, other New York 
                                City employees, and recovery and 
                                cleanup workers who responded to the 
                                September 11, 2001, terrorist attacks; 
                                and
                                    ``(III) 3 representatives of New 
                                York City, 1 of whom will be selected 
                                by the police commissioner of New York 
                                City, 1 by the health commissioner of 
                                New York City, and 1 by the mayor of 
                                New York City.
                            ``(ii) Initial membership.--The WTC 
                        Responders Steering Committee shall initially 
                        be composed of members of the WTC Monitoring 
                        and Treatment Program Steering Committee (as in 
                        existence on the day before the date of the 
                        enactment of this title).
                    ``(B) WTC survivors steering committee.--
                            ``(i) Representation.--The WTC Survivors 
                        Steering Committee shall include 
                        representatives of--
                                    ``(I) the Centers of Excellence 
                                providing services to screening-
                                eligible and certified-eligible WTC 
                                survivors;
                                    ``(II) the population of residents, 
                                students, and area and other workers 
                                affected by the September 11, 2001, 
                                terrorist attacks;
                                    ``(III) screening-eligible and 
                                certified-eligible survivors receiving 
                                initial health evaluations, monitoring, 
                                or treatment under part 2 of subtitle B 
                                and organizations advocating on their 
                                behalf; and
                                    ``(IV) New York City.
                            ``(ii) Initial membership.--The WTC 
                        Survivors Steering Committee shall initially be 
                        composed of members of the WTC Environmental 
                        Health Center Survivor Advisory Committee (as 
                        in existence on the day before the date of the 
                        enactment of this title).
                    ``(C) Additional appointments.--Each Steering 
                Committee may recommend, if approved by a majority of 
                voting members of the Committee, additional members to 
                the Committee.
                    ``(D) Vacancies.--A vacancy in a Steering Committee 
                shall be filled by an individual recommended by the 
                Steering Committee.

``SEC. 3303. EDUCATION AND OUTREACH.

    ``The WTC Program Administrator shall institute a program that 
provides education and outreach on the existence and availability of 
services under the WTC Program. The outreach and education program--
            ``(1) shall include--
                    ``(A) the establishment of a public Web site with 
                information about the WTC Program;
                    ``(B) meetings with potentially eligible 
                populations;
                    ``(C) development and dissemination of outreach 
                materials informing people about the program; and
                    ``(D) the establishment of phone information 
                services; and
            ``(2) shall be conducted in a manner intended--
                    ``(A) to reach all affected populations; and
                    ``(B) to include materials for culturally and 
                linguistically diverse populations.

``SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS.

    ``(a) In General.--The WTC Program Administrator shall provide for 
the uniform collection of data, including claims data (and analysis of 
data and regular reports to the Administrator) on the prevalence of 
WTC-related health conditions and the identification of new WTC-related 
health conditions. Such data shall be collected for all individuals 
provided monitoring or treatment benefits under subtitle B and 
regardless of their place of residence or Clinical Center of Excellence 
through which the benefits are provided. The WTC Program Administrator 
shall provide, through the Data Centers or otherwise, for the 
integration of such data into the monitoring and treatment program 
activities under this title.
    ``(b) Coordinating Through Centers of Excellence.--Each Clinical 
Center of Excellence shall collect data described in subsection (a) and 
report such data to the corresponding Data Center for analysis by such 
Data Center.
    ``(c) Collaboration With WTC Health Registry.--The WTC Program 
Administrator shall provide for collaboration between the Data Centers 
and the World Trade Center Health Registry described in section 3342.
    ``(d) Privacy.--The data collection and analysis under this section 
shall be conducted and maintained in a manner that protects the 
confidentiality of individually identifiable health information 
consistent with applicable statutes and regulations, including, as 
applicable, HIPAA privacy and security law (as defined in section 
3009(a)(2)) and section 552a of title 5, United States Code.

``SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA CENTERS.

    ``(a) In General.--
            ``(1) Contracts with clinical centers of excellence.--The 
        WTC Program Administrator shall, subject to subsection 
        (b)(1)(B), enter into contracts with Clinical Centers of 
        Excellence (as defined in subsection (b)(1)(A))--
                    ``(A) for the provision of monitoring and treatment 
                benefits and initial health evaluation benefits under 
                subtitle B;
                    ``(B) for the provision of outreach activities to 
                individuals eligible for such monitoring and treatment 
                benefits, for initial health evaluation benefits, and 
                for followup to individuals who are enrolled in the 
                monitoring program;
                    ``(C) for the provision of counseling for benefits 
                under subtitle B, with respect to WTC-related health 
                conditions, for individuals eligible for such benefits;
                    ``(D) for the provision of counseling for benefits 
                for WTC-related health conditions that may be available 
                under workers' compensation or other benefit programs 
                for work-related injuries or illnesses, health 
                insurance, disability insurance, or other insurance 
                plans or through public or private social service 
                agencies and assisting eligible individuals in applying 
                for such benefits;
                    ``(E) for the provision of translational and 
                interpretive services for program participants who are 
                not English language proficient; and
                    ``(F) for the collection and reporting of data, 
                including claims data, in accordance with section 3304.
            ``(2) Contracts with data centers.--
                    ``(A) In general.--The WTC Program Administrator 
                shall enter into contracts with one or more Data 
                Centers (as defined in subsection (b)(2))--
                            ``(i) for receiving, analyzing, and 
                        reporting to the WTC Program Administrator on 
                        data, in accordance with section 3304, that 
                        have been collected and reported to such Data 
                        Centers by the corresponding Clinical Centers 
                        of Excellence under subsection (b)(1)(B)(iii);
                            ``(ii) for the development of monitoring, 
                        initial health evaluation, and treatment 
                        protocols, with respect to WTC-related health 
                        conditions;
                            ``(iii) for coordinating the outreach 
                        activities conducted under paragraph (1)(B) by 
                        each corresponding Clinical Center of 
                        Excellence;
                            ``(iv) for establishing criteria for the 
                        credentialing of medical providers 
                        participating in the nationwide network under 
                        section 3313;
                            ``(v) for coordinating and administering 
                        the activities of the WTC Health Program 
                        Steering Committees established under section 
                        3002(b); and
                            ``(vi) for meeting periodically with the 
                        corresponding Clinical Centers of Excellence to 
                        obtain input on the analysis and reporting of 
                        data collected under clause (i) and on the 
                        development of monitoring, initial health 
                        evaluation, and treatment protocols under 
                        clause (ii).
                    ``(B) Medical provider selection.--The medical 
                providers under subparagraph (A)(iv) shall be selected 
                by the WTC Program Administrator on the basis of their 
                experience treating or diagnosing the health conditions 
                included in the list of WTC-related health conditions.
                    ``(C) Clinical discussions.--In carrying out 
                subparagraph (A)(ii), a Data Center shall engage in 
                clinical discussions across the WTC Program to guide 
                treatment approaches for individuals with a WTC-related 
                health condition.
                    ``(D) Transparency of data.--A contract entered 
                into under this subsection with a Data Center shall 
                require the Data Center to make any data collected and 
                reported to such Center under subsection (b)(1)(B)(iii) 
                available to health researchers and others as provided 
                in the CDC/ATSDR Policy on Releasing and Sharing Data.
            ``(3) Authority for contracts to be class specific.--A 
        contract entered into under this subsection with a Clinical 
        Center of Excellence or a Data Center may be with respect to 
        one or more class of enrolled WTC responders, screening-
        eligible WTC survivors, or certified-eligible WTC survivors.
            ``(4) Use of cooperative agreements.--Any contract under 
        this title between the WTC Program Administrator and a Data 
        Center or a Clinical Center of Excellence may be in the form of 
        a cooperative agreement.
            ``(5) Review on feasibility of consolidating data 
        centers.--Not later than July 1, 2011, the Comptroller General 
        of the United States shall submit to the Committee on Energy 
        and Commerce of the House of Representatives and the Committee 
        on Health, Education, Labor, and Pensions of the Senate a 
        report on the feasibility of consolidating Data Centers into a 
        single Data Center.
    ``(b) Centers of Excellence.--
            ``(1) Clinical centers of excellence.--
                    ``(A) Definition.--For purposes of this title, the 
                term `Clinical Center of Excellence' means a Center 
                that demonstrates to the satisfaction of the 
                Administrator that the Center--
                            ``(i) uses an integrated, centralized 
                        health care provider approach to create a 
                        comprehensive suite of health services under 
                        this title that are accessible to enrolled WTC 
                        responders, screening-eligible WTC survivors, 
                        or certified-eligible WTC survivors;
                            ``(ii) has experience in caring for WTC 
                        responders and screening-eligible WTC survivors 
                        or includes health care providers who have been 
                        trained pursuant to section 3313(c);
                            ``(iii) employs health care provider staff 
                        with expertise that includes, at a minimum, 
                        occupational medicine, environmental medicine, 
                        trauma-related psychiatry and psychology, and 
                        social services counseling; and
                            ``(iv) meets such other requirements as 
                        specified by the Administrator.
                    ``(B) Contract requirements.--The WTC Program 
                Administrator shall not enter into a contract with a 
                Clinical Center of Excellence under subsection (a)(1) 
                unless the Center agrees to do each of the following:
                            ``(i) Establish a formal mechanism for 
                        consulting with and receiving input from 
                        representatives of eligible populations 
                        receiving monitoring and treatment benefits 
                        under subtitle B from such Center.
                            ``(ii) Coordinate monitoring and treatment 
                        benefits under subtitle B with routine medical 
                        care provided for the treatment of conditions 
                        other than WTC-related health conditions.
                            ``(iii) Collect and report to the 
                        corresponding Data Center data, including 
                        claims data, in accordance with section 
                        3304(b).
                            ``(iv) Have in place safeguards against 
                        fraud that are satisfactory to the 
                        Administrator, in consultation with the 
                        Inspector General of the Department of Health 
                        and Human Services.
                            ``(v) Treat or refer for treatment all 
                        individuals who are enrolled WTC responders or 
                        certified-eligible WTC survivors with respect 
                        to such Center who present themselves for 
                        treatment of a WTC-related health condition.
                            ``(vi) Have in place safeguards, consistent 
                        with section 3304(c), to ensure the 
                        confidentiality of an individual's individually 
                        identifiable health information, including 
                        requiring that such information not be 
                        disclosed to the individual's employer without 
                        the authorization of the individual.
                            ``(vii) Use amounts paid under subsection 
                        (c)(1) only for costs incurred in carrying out 
                        the activities described in subsection (a), 
                        other than those described in subsection 
                        (a)(1)(A).
                            ``(viii) Utilize health care providers with 
                        occupational and environmental medicine 
                        expertise to conduct physical and mental health 
                        assessments, in accordance with protocols 
                        developed under subsection (a)(2)(A)(ii).
                            ``(ix) Communicate with WTC responders and 
                        screening-eligible and certified-eligible WTC 
                        survivors in appropriate languages and conduct 
                        outreach activities with relevant stakeholder 
                        worker or community associations.
                            ``(x) Meet all the other applicable 
                        requirements of this title, including 
                        regulations implementing such requirements.
                    ``(C) Transition rule to ensure continuity of 
                care.--The WTC Program Administrator shall to the 
                maximum extent feasible ensure continuity of care in 
                any period of transition from monitoring and treatment 
                of an enrolled WTC responder or certified-eligible WTC 
                survivor by a provider to a Clinical Center of 
                Excellence or a health care provider participating in 
                the nationwide network under section 3313.
            ``(2) Data centers.--For purposes of this title, the term 
        `Data Center' means a Center that the WTC Program Administrator 
        determines has the capacity to carry out the responsibilities 
        for a Data Center under subsection (a)(2).
            ``(3) Corresponding centers.--For purposes of this title, a 
        Clinical Center of Excellence and a Data Center shall be 
        treated as `corresponding' to the extent that such Clinical 
        Center and Data Center serve the same population group.
    ``(c) Payment for Infrastructure Costs.--
            ``(1) In general.--The WTC Program Administrator shall 
        reimburse a Clinical Center of Excellence for the fixed 
        infrastructure costs of such Center in carrying out the 
        activities described in subtitle B at a rate negotiated by the 
        Administrator and such Centers. Such negotiated rate shall be 
        fair and appropriate and take into account the number of 
        enrolled WTC responders receiving services from such Center 
        under this title.
            ``(2) Fixed infrastructure costs.--For purposes of 
        paragraph (1), the term `fixed infrastructure costs' means, 
        with respect to a Clinical Center of Excellence, the costs 
        incurred by such Center that are not otherwise reimbursable by 
        the WTC Program Administrator under section 3312(c) for patient 
        evaluation, monitoring, or treatment but which are needed to 
        operate the WTC program such as the costs involved in outreach 
        to participants or recruiting participants, data collection and 
        analysis, social services for counseling patients on other 
        available assistance outside the WTC program, and the 
        development of treatment protocols. Such term does not include 
        costs for new construction or other capital costs.
    ``(d) GAO Analysis.--Not later than July 1, 2011, the Comptroller 
General shall submit to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on Health, Education, Labor, 
and Pensions of the Senate an analysis on whether Clinical Centers of 
Excellence with which the WTC Program Administrator enters into a 
contract under this section have financial systems that will allow for 
the timely submission of claims data for purposes of section 3304 and 
subsections (a)(1)(F) and (b)(1)(B)(iii).

``SEC. 3306. DEFINITIONS.

    ``In this title:
            ``(1) The term `aggravating' means, with respect to a 
        health condition, a health condition that existed on September 
        11, 2001, and that, as a result of exposure to airborne toxins, 
        any other hazard, or any other adverse condition resulting from 
        the September 11, 2001, terrorist attacks, requires medical 
        treatment that is (or will be) in addition to, more frequent 
        than, or of longer duration than the medical treatment that 
        would have been required for such condition in the absence of 
        such exposure.
            ``(2) The term `certified-eligible WTC survivor' has the 
        meaning given such term in section 3321(a)(2).
            ``(3) The terms `Clinical Center of Excellence' and `Data 
        Center' have the meanings given such terms in section 3305.
            ``(4) The term `enrolled WTC responder' means a WTC 
        responder enrolled under section 3311(a)(3).
            ``(5) The term `initial health evaluation' includes, with 
        respect to an individual, a medical and exposure history, a 
        physical examination, and additional medical testing as needed 
        to evaluate whether the individual has a WTC-related health 
        condition and is eligible for treatment under the WTC Program.
            ``(6) The term `list of WTC-related health conditions' 
        means--
                    ``(A) for WTC responders, the health conditions 
                listed in section 3312(a)(3); and
                    ``(B) for screening-eligible and certified-eligible 
                WTC survivors, the health conditions listed in section 
                3322(b).
            ``(7) The term `New York City disaster area' means the area 
        within New York City that is--
                    ``(A) the area of Manhattan that is south of 
                Houston Street; and
                    ``(B) any block in Brooklyn that is wholly or 
                partially contained within a 1.5-mile radius of the 
                former World Trade Center site.
            ``(8) The term `New York metropolitan area' means an area, 
        specified by the WTC Program Administrator, within which WTC 
        responders and eligible WTC screening-eligible survivors who 
        reside in such area are reasonably able to access monitoring 
        and treatment benefits and initial health evaluation benefits 
        under this title through a Clinical Center of Excellence 
        described in subparagraphs (A), (B), or (C) of section 
        3305(b)(1).
            ``(9) The term `screening-eligible WTC survivor' has the 
        meaning given such term in section 3321(a)(1).
            ``(10) Any reference to `September 11, 2001' shall be 
        deemed a reference to the period on such date subsequent to the 
        terrorist attacks at the World Trade Center, Shanksville, 
        Pennsylvania, or the Pentagon, as applicable, on such date.
            ``(11) The term `September 11, 2001, terrorist attacks' 
        means the terrorist attacks that occurred on September 11, 
        2001, in New York City, in Shanksville, Pennsylvania, and at 
        the Pentagon, and includes the aftermath of such attacks.
            ``(12) The term `WTC Health Program Steering Committee' 
        means such a Steering Committee established under section 
        3302(b).
            ``(13) The term `WTC Program' means the Word Trade Center 
        Health Program established under section 3301(a).
            ``(14)(A) The term `WTC Program Administrator' means--
                    ``(i) subject to subparagraph (B), with respect to 
                paragraphs (3) and (4) of section 3311(a) (relating to 
                enrollment of WTC responders), section 3312(c) and the 
                corresponding provisions of section 3322 (relating to 
                payment for initial health evaluation, monitoring, and 
                treatment, paragraphs (1)(C), (2)(B), and (3) of 
                section 3321(a) (relating to determination or 
                certification of screening-eligible or certified-
                eligible WTC responders), and part 3 of subtitle B 
                (relating to payor provisions), an official in the 
                Department of Health and Human Services, to be 
                designated by the Secretary; and
                    ``(ii) with respect to any other provision of this 
                title, the Director of the National Institute for 
                Occupational Safety and Health, or a designee of such 
                Director.
            ``(B) In no case may the Secretary designate under 
        subparagraph (A)(i) the Director of the National Institute for 
        Occupational Safety and Health or a designee of such Director 
        with respect to section 3322 (relating to payment for initial 
        health evaluation, monitoring, and treatment).
            ``(15) The term `WTC-related health condition' is defined 
        in section 3312(a).
            ``(16) The term `WTC responder' is defined in section 
        3311(a).
            ``(17) The term `WTC Scientific/Technical Advisory 
        Committee' means such Committee established under section 
        3302(a).

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

                        ``PART 1--WTC RESPONDERS

``SEC. 3311. IDENTIFICATION OF WTC RESPONDERS AND PROVISION OF WTC-
              RELATED MONITORING SERVICES.

    ``(a) WTC Responder Defined.--
            ``(1) In general.--For purposes of this title, the term 
        `WTC responder' means any of the following individuals, subject 
        to paragraph (4):
                    ``(A) Currently identified responder.--An 
                individual who has been identified as eligible for 
                monitoring under the arrangements as in effect on the 
                date of the enactment of this title between the 
                National Institute for Occupational Safety and Health 
                and--
                            ``(i) the consortium coordinated by Mt. 
                        Sinai Hospital in New York City that 
                        coordinates the monitoring and treatment for 
                        enrolled WTC responders other than with respect 
                        to those covered under the arrangement with the 
                        Fire Department of New York City; or
                            ``(ii) the Fire Department of New York 
                        City.
                    ``(B) Responder who meets current eligibility 
                criteria.--An individual who meets the current 
                eligibility criteria described in paragraph (2).
                    ``(C) Responder who meets modified eligibility 
                criteria.--An individual who--
                            ``(i) performed rescue, recovery, 
                        demolition, debris cleanup, or other related 
                        services in the New York City disaster area in 
                        response to the September 11, 2001, terrorist 
                        attacks, regardless of whether such services 
                        were performed by a State or Federal employee 
                        or member of the National Guard or otherwise; 
                        and
                            ``(ii) meets such eligibility criteria 
                        relating to exposure to airborne toxins, other 
                        hazards, or adverse conditions resulting from 
                        the September 11, 2001, terrorist attacks as 
                        the WTC Program Administrator, after 
                        consultation with the WTC Scientific/Technical 
                        Advisory Committee, determines appropriate.
                The WTC Program Administrator shall not modify such 
                eligibility criteria on or after the date that the 
                number of enrollments of WTC responders has reached 80 
                percent of the limit described in paragraph (4) or on 
                or after the date that the number of certifications for 
                certified-eligible WTC survivors under section 
                3321(a)(2)(B) has reached 80 percent of the limit 
                described in section 3321(a)(3).
            ``(2) Current eligibility criteria.--The eligibility 
        criteria described in this paragraph for an individual is that 
        the individual is described in any of the following categories:
                    ``(A) Firefighters and related personnel.--The 
                individual--
                            ``(i) was a member of the Fire Department 
                        of New York City (whether fire or emergency 
                        personnel, active or retired) who participated 
                        at least one day in the rescue and recovery 
                        effort at any of the former World Trade Center 
                        sites (including Ground Zero, Staten Island 
                        Landfill, and the New York City Chief Medical 
                        Examiner's Office) for any time during the 
                        period beginning on September 11, 2001, and 
                        ending on July 31, 2002; or
                            ``(ii)(I) is a surviving immediate family 
                        member of an individual who was a member of the 
                        Fire Department of New York City (whether fire 
                        or emergency personnel, active or retired) and 
                        was killed at the World Trade site on September 
                        11, 2001; and
                            ``(II) received any treatment for a WTC-
                        related health condition described in section 
                        3312(a)(1)(A)(ii) (relating to mental health 
                        conditions) on or before September 1, 2008.
                    ``(B) Law enforcement officers and wtc rescue, 
                recovery, and cleanup workers.--The individual--
                            ``(i) worked or volunteered onsite in 
                        rescue, recovery, debris cleanup, or related 
                        support services in lower Manhattan (south of 
                        Canal St.), the Staten Island Landfill, or the 
                        barge loading piers, for at least 4 hours 
                        during the period beginning on September 11, 
                        2001, and ending on September 14, 2001, for at 
                        least 24 hours during the period beginning on 
                        September 11, 2001, and ending on September 30, 
                        2001, or for at least 80 hours during the 
                        period beginning on September 11, 2001, and 
                        ending on July 31, 2002;
                            ``(ii)(I) was a member of the Police 
                        Department of New York City (whether active or 
                        retired) or a member of the Port Authority 
                        Police of the Port Authority of New York and 
                        New Jersey (whether active or retired) who 
                        participated onsite in rescue, recovery, debris 
                        cleanup, or related services in lower Manhattan 
                        (south of Canal St.), including Ground Zero, 
                        the Staten Island Landfill, or the barge 
                        loading piers, for at least 4 hours during the 
                        period beginning September 11, 2001, and ending 
                        on September 14, 2001;
                            ``(II) participated onsite in rescue, 
                        recovery, debris cleanup, or related services 
                        at Ground Zero, the Staten Island Landfill, or 
                        the barge loading piers, for at least one day 
                        during the period beginning on September 11, 
                        2001, and ending on July 31, 2002;
                            ``(III) participated onsite in rescue, 
                        recovery, debris cleanup, or related services 
                        in lower Manhattan (south of Canal St.) for at 
                        least 24 hours during the period beginning on 
                        September 11, 2001, and ending on September 30, 
                        2001; or
                            ``(IV) participated onsite in rescue, 
                        recovery, debris cleanup, or related services 
                        in lower Manhattan (south of Canal St.) for at 
                        least 80 hours during the period beginning on 
                        September 11, 2001, and ending on July 31, 
                        2002;
                            ``(iii) was an employee of the Office of 
                        the Chief Medical Examiner of New York City 
                        involved in the examination and handling of 
                        human remains from the World Trade Center 
                        attacks, or other morgue worker who performed 
                        similar post-September 11 functions for such 
                        Office staff, during the period beginning on 
                        September 11, 2001, and ending on July 31, 
                        2002;
                            ``(iv) was a worker in the Port Authority 
                        Trans-Hudson Corporation Tunnel for at least 24 
                        hours during the period beginning on February 
                        1, 2002, and ending on July 1, 2002; or
                            ``(v) was a vehicle-maintenance worker who 
                        was exposed to debris from the former World 
                        Trade Center while retrieving, driving, 
                        cleaning, repairing, and maintaining vehicles 
                        contaminated by airborne toxins from the 
                        September 11, 2001, terrorist attacks during a 
                        duration and period described in subparagraph 
                        (A).
                    ``(C) Responders to the september 11 attacks at the 
                pentagon and shanksville, pennsylvania.--The 
                individual--
                            ``(i)(I) was a member of a fire or police 
                        department (whether fire or emergency 
                        personnel, active or retired), worked for a 
                        recovery or cleanup contractor, or was a 
                        volunteer; and performed rescue, recovery, 
                        demolition, debris cleanup, or other related 
                        services at the Pentagon site of the terrorist-
                        related aircraft crash of September 11, 2001, 
                        during the period beginning on September 11, 
                        2001, and ending on the date on which the 
                        cleanup of the site was concluded, as 
                        determined by the WTC Program Administrator; or
                            ``(II) was a member of a fire or police 
                        department (whether fire or emergency 
                        personnel, active or retired), worked for a 
                        recovery or cleanup contractor, or was a 
                        volunteer; and performed rescue, recovery, 
                        demolition, debris cleanup, or other related 
                        services at the Shanksville, Pennsylvania, site 
                        of the terrorist-related aircraft crash of 
                        September 11, 2001, during the period beginning 
                        on September 11, 2001, and ending on the date 
                        on which the cleanup of the site was concluded, 
                        as determined by the WTC Program Administrator; 
                        and
                            ``(ii) is determined by the WTC Program 
                        Administrator to be at an increased risk of 
                        developing a WTC-related health condition as a 
                        result of exposure to airborne toxins, other 
                        hazards, or adverse conditions resulting from 
                        the September 11, 2001, terrorist attacks, and 
                        meets such eligibility criteria related to such 
                        exposures, as the WTC Program Administrator 
                        determines are appropriate, after consultation 
                        with the WTC Scientific/Technical Advisory 
                        Committee.
            ``(3) Enrollment process.--
                    ``(A) In general.--The WTC Program Administrator 
                shall establish a process for enrolling WTC responders 
                in the WTC Program. Under such process--
                            ``(i) WTC responders described in paragraph 
                        (1)(A) shall be deemed to be enrolled in such 
                        Program;
                            ``(ii) subject to clause (iii), the 
                        Administrator shall enroll in such program 
                        individuals who are determined to be WTC 
                        responders;
                            ``(iii) the Administrator shall deny such 
                        enrollment to an individual if the 
                        Administrator determines that the numerical 
                        limitation in paragraph (4) on enrollment of 
                        WTC responders has been met;
                            ``(iv) there shall be no fee charged to the 
                        applicant for making an application for such 
                        enrollment;
                            ``(v) the Administrator shall make a 
                        determination on such an application not later 
                        than 60 days after the date of filing the 
                        application; and
                            ``(vi) an individual who is denied 
                        enrollment in such Program shall have an 
                        opportunity to appeal such determination in a 
                        manner established under such process.
                    ``(B) Timing.--
                            ``(i) Currently identified responders.--In 
                        accordance with subparagraph (A)(i), the WTC 
                        Program Administrator shall enroll an 
                        individual described in paragraph (1)(A) in the 
                        WTC Program not later than July 1, 2011.
                            ``(ii) Other responders.--In accordance 
                        with subparagraph (A)(ii) and consistent with 
                        paragraph (4), the WTC Program Administrator 
                        shall enroll any other individual who is 
                        determined to be a WTC responder in the WTC 
                        Program at the time of such determination.
            ``(4) Numerical limitation on eligible wtc responders.--
                    ``(A) In general.--The total number of individuals 
                not described in paragraph (1)(A) or (2)(A)(ii) who may 
                be enrolled under paragraph (3)(A)(ii) shall not exceed 
                25,000 at any time, of which no more than 2,500 may be 
                individuals enrolled based on modified eligibility 
                criteria established under paragraph (1)(C).
                    ``(B) Process.--In implementing subparagraph (A), 
                the WTC Program Administrator shall--
                            ``(i) limit the number of enrollments made 
                        under paragraph (3)--
                                    ``(I) in accordance with such 
                                subparagraph; and
                                    ``(II) to such number, as 
                                determined by the Administrator based 
                                on the best available information and 
                                subject to amounts available under 
                                section 3351, that will ensure 
                                sufficient funds will be available to 
                                provide treatment and monitoring 
                                benefits under this title, with respect 
                                to all individuals who are enrolled 
                                through the end of fiscal year 2020; 
                                and
                            ``(ii) provide priority (subject to 
                        paragraph (3)(A)(i)) in such enrollments in the 
                        order in which individuals apply for enrollment 
                        under paragraph (3).
            ``(5) Disqualification of individuals on terrorist watch 
        list.--No individual who is on the terrorist watch list 
        maintained by the Department of Homeland Security shall qualify 
        as an eligible WTC responder. Before enrolling any individual 
        as a WTC responder in the WTC Program under paragraph (3), the 
        Administrator, in consultation with the Secretary of Homeland 
        Security, shall determine whether the individual is on such 
        list.
    ``(b) Monitoring Benefits.--
            ``(1) In general.--In the case of an enrolled WTC responder 
        (other than one described in subsection (a)(2)(A)(ii)), the WTC 
        Program shall provide for monitoring benefits that include 
        monitoring consistent with protocols approved by the WTC 
        Program Administrator and including clinical examinations and 
        long-term health monitoring and analysis. In the case of an 
        enrolled WTC responder who is an active member of the Fire 
        Department of New York City, the responder shall receive such 
        benefits as part of the individual's periodic company medical 
        exams.
            ``(2) Provision of monitoring benefits.--The monitoring 
        benefits under paragraph (1) shall be provided through the 
        Clinical Center of Excellence for the type of individual 
        involved or, in the case of an individual residing outside the 
        New York metropolitan area, under an arrangement under section 
        3313.

``SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS FOR WTC-RELATED 
              HEALTH CONDITIONS.

    ``(a) WTC-Related Health Condition Defined.--
            ``(1) In general.--For purposes of this title, the term 
        `WTC-related health condition' means a condition that--
                    ``(A)(i) is an illness or health condition for 
                which exposure to airborne toxins, any other hazard, or 
                any other adverse condition resulting from the 
                September 11, 2001, terrorist attacks, based on an 
                examination by a medical professional with experience 
                in treating or diagnosing the health conditions 
                included in the applicable list of WTC-related health 
                conditions, is substantially likely to be a significant 
                factor in aggravating, contributing to, or causing the 
                illness or health condition, as determined under 
                paragraph (2); or
                    ``(ii) is a mental health condition for which such 
                attacks, based on an examination by a medical 
                professional with experience in treating or diagnosing 
                the health conditions included in the applicable list 
                of WTC-related health conditions, is substantially 
                likely to be a significant factor in aggravating, 
                contributing to, or causing the condition, as 
                determined under paragraph (2); and
                    ``(B) is included in the applicable list of WTC-
                related health conditions or--
                            ``(i) with respect to a WTC responder, is 
                        provided certification of coverage under 
                        subsection (b)(2)(B)(iii); or
                            ``(ii) with respect to a screening-eligible 
                        WTC survivor or certified-eligible WTC 
                        survivor, is provided certification of coverage 
                        under subsection (b)(2)(B)(iii), as applied 
                        under section 3322(a).
        In the case of a WTC responder described in section 
        3311(a)(2)(A)(ii) (relating to a surviving immediate family 
        member of a firefighter), such term does not include an illness 
        or health condition described in subparagraph (A)(i).
            ``(2) Determination.--The determination under paragraph (1) 
        or subsection (b) of whether the September 11, 2001, terrorist 
        attacks were substantially likely to be a significant factor in 
        aggravating, contributing to, or causing an individual's 
        illness or health condition shall be made based on an 
        assessment of the following:
                    ``(A) The individual's exposure to airborne toxins, 
                any other hazard, or any other adverse condition 
                resulting from the terrorist attacks. Such exposure 
                shall be--
                            ``(i) evaluated and characterized through 
                        the use of a standardized, population-
                        appropriate questionnaire approved by the 
                        Director of the National Institute for 
                        Occupational Safety and Health; and
                            ``(ii) assessed and documented by a medical 
                        professional with experience in treating or 
                        diagnosing health conditions included on the 
                        list of WTC-related health conditions.
                    ``(B) The type of symptoms and temporal sequence of 
                symptoms. Such symptoms shall be--
                            ``(i) assessed through the use of a 
                        standardized, population-appropriate medical 
                        questionnaire approved by the Director of the 
                        National Institute for Occupational Safety and 
                        Health and a medical examination; and
                            ``(ii) diagnosed and documented by a 
                        medical professional described in subparagraph 
                        (A)(ii).
            ``(3) List of health conditions for wtc responders.--The 
        list of health conditions for WTC responders consists of the 
        following:
                    ``(A) Aerodigestive disorders.--
                            ``(i) Interstitial lung diseases.
                            ``(ii) Chronic respiratory disorder--fumes/
                        vapors.
                            ``(iii) Asthma.
                            ``(iv) Reactive airways dysfunction 
                        syndrome (RADS).
                            ``(v) WTC-exacerbated chronic obstructive 
                        pulmonary disease (COPD).
                            ``(vi) Chronic cough syndrome.
                            ``(vii) Upper airway hyperreactivity.
                            ``(viii) Chronic rhinosinusitis.
                            ``(ix) Chronic nasopharyngitis.
                            ``(x) Chronic laryngitis.
                            ``(xi) Gastroesophageal reflux disorder 
                        (GERD).
                            ``(xii) Sleep apnea exacerbated by or 
                        related to a condition described in a previous 
                        clause.
                    ``(B) Mental health conditions.--
                            ``(i) Posttraumatic stress disorder (PTSD).
                            ``(ii) Major depressive disorder.
                            ``(iii) Panic disorder.
                            ``(iv) Generalized anxiety disorder.
                            ``(v) Anxiety disorder (not otherwise 
                        specified).
                            ``(vi) Depression (not otherwise 
                        specified).
                            ``(vii) Acute stress disorder.
                            ``(viii) Dysthymic disorder.
                            ``(ix) Adjustment disorder.
                            ``(x) Substance abuse.
                    ``(C) Musculoskeletal disorders for certain wtc 
                responders.--In the case of a WTC responder described 
                in paragraph (4), a condition described in such 
                paragraph.
                    ``(D) Additional conditions.--Any cancer (or type 
                of cancer) or other condition added, pursuant to 
                paragraph (5) or (6), to the list under this paragraph.
            ``(4) Musculoskeletal disorders.--
                    ``(A) In general.--For purposes of this title, in 
                the case of a WTC responder who received any treatment 
                for a WTC-related musculoskeletal disorder on or before 
                September 11, 2003, the list of health conditions in 
                paragraph (3) shall include:
                            ``(i) Low back pain.
                            ``(ii) Carpal tunnel syndrome (CTS).
                            ``(iii) Other musculoskeletal disorders.
                    ``(B) Definition.--The term `WTC-related 
                musculoskeletal disorder' means a chronic or recurrent 
                disorder of the musculoskeletal system caused by heavy 
                lifting or repetitive strain on the joints or 
                musculoskeletal system occurring during rescue or 
                recovery efforts in the New York City disaster area in 
                the aftermath of the September 11, 2001, terrorist 
                attacks.
            ``(5) Cancer.--
                    ``(A) In general.--The WTC Program Administrator 
                shall periodically conduct a review of all available 
                scientific and medical evidence, including findings and 
                recommendations of Clinical Centers of Excellence, 
                published in peer-reviewed journals to determine if, 
                based on such evidence, cancer or a certain type of 
                cancer should be added to the applicable list of WTC-
                related health conditions. The WTC Program 
                Administrator shall conduct the first review under this 
                subparagraph not later than 180 days after the date of 
                the enactment of this title.
                    ``(B) Proposed regulations and rulemaking.--Based 
                on the periodic reviews under subparagraph (A), if the 
                WTC Program Administrator determines that cancer or a 
                certain type of cancer should be added to such list of 
                WTC-related health conditions, the WTC Program 
                Administrator shall propose regulations, through 
                rulemaking, to add cancer or the certain type of cancer 
                to such list.
                    ``(C) Final regulations.--Based on all the 
                available evidence in the rulemaking record, the WTC 
                Program Administrator shall make a final determination 
                of whether cancer or a certain type of cancer should be 
                added to such list of WTC-related health conditions. If 
                such a determination is made to make such an addition, 
                the WTC Program Administrator shall by regulation add 
                cancer or the certain type of cancer to such list.
                    ``(D) Determinations not to add cancer or certain 
                types of cancer.--In the case that the WTC Program 
                Administrator determines under subparagraph (B) or (C) 
                that cancer or a certain type of cancer should not be 
                added to such list of WTC-related health conditions, 
                the WTC Program Administrator shall publish an 
                explanation for such determination in the Federal 
                Register. Any such determination to not make such an 
                addition shall not preclude the addition of cancer or 
                the certain type of cancer to such list at a later 
                date.
            ``(6) Addition of health conditions to list for wtc 
        responders.--
                    ``(A) In general.--Whenever the WTC Program 
                Administrator determines that a proposed rule should be 
                promulgated to add a health condition to the list of 
                health conditions in paragraph (3), the Administrator 
                may request a recommendation of the Advisory Committee 
                or may publish such a proposed rule in the Federal 
                Register in accordance with subparagraph (D).
                    ``(B) Administrator's options after receipt of 
                petition.--In the case that the WTC Program 
                Administrator receives a written petition by an 
                interested party to add a health condition to the list 
                of health conditions in paragraph (3), not later than 
                60 days after the date of receipt of such petition the 
                Administrator shall--
                            ``(i) request a recommendation of the 
                        Advisory Committee;
                            ``(ii) publish a proposed rule in the 
                        Federal Register to add such health condition, 
                        in accordance with subparagraph (D);
                            ``(iii) publish in the Federal Register the 
                        Administrator's determination not to publish 
                        such a proposed rule and the basis for such 
                        determination; or
                            ``(iv) publish in the Federal Register a 
                        determination that insufficient evidence exists 
                        to take action under clauses (i) through (iii).
                    ``(C) Action by advisory committee.--In the case 
                that the Administrator requests a recommendation of the 
                Advisory Committee under this paragraph, with respect 
                to adding a health condition to the list in paragraph 
                (3), the Advisory Committee shall submit to the 
                Administrator such recommendation not later than 60 
                days after the date of such request or by such date 
                (not to exceed 180 days after such date of request) as 
                specified by the Administrator. Not later than 60 days 
                after the date of receipt of such recommendation, the 
                Administrator shall, in accordance with subparagraph 
                (D), publish in the Federal Register a proposed rule 
                with respect to such recommendation or a determination 
                not to propose such a proposed rule and the basis for 
                such determination.
                    ``(D) Publication.--The WTC Program Administrator 
                shall, with respect to any proposed rule under this 
                paragraph--
                            ``(i) publish such proposed rule in 
                        accordance with section 553 of title 5, United 
                        States Code; and
                            ``(ii) provide interested parties a period 
                        of 30 days after such publication to submit 
                        written comments on the proposed rule.
                The WTC Program Administrator may extend the period 
                described in clause (ii) upon a finding of good cause. 
                In the case of such an extension, the Administrator 
                shall publish such extension in the Federal Register.
                    ``(E) Interested party defined.--For purposes of 
                this paragraph, the term `interested party' includes a 
                representative of any organization representing WTC 
                responders, a nationally recognized medical 
                association, a Clinical or Data Center, a State or 
                political subdivision, or any other interested person.
    ``(b) Coverage of Treatment for WTC-Related Health Conditions.--
            ``(1) Determination for enrolled wtc responders based on a 
        wtc-related health condition.--
                    ``(A) In general.--If a physician at a Clinical 
                Center of Excellence that is providing monitoring 
                benefits under section 3311 for an enrolled WTC 
                responder makes a determination that the responder has 
                a WTC-related health condition that is in the list in 
                subsection (a)(3) and that exposure to airborne toxins, 
                other hazards, or adverse conditions resulting from the 
                September 1, 2001, terrorist attacks is substantially 
                likely to be a significant factor in aggravating, 
                contributing to, or causing the condition--
                            ``(i) the physician shall promptly transmit 
                        such determination to the WTC Program 
                        Administrator and provide the Administrator 
                        with the medical facts supporting such 
                        determination; and
                            ``(ii) on and after the date of such 
                        transmittal and subject to subparagraph (B), 
                        the WTC Program shall provide for payment under 
                        subsection (c) for medically necessary 
                        treatment for such condition.
                    ``(B) Review; certification; appeals.--
                            ``(i) Review.--A Federal employee 
                        designated by the WTC Program Administrator 
                        shall review determinations made under 
                        subparagraph (A).
                            ``(ii) Certification.--The Administrator 
                        shall provide a certification of such condition 
                        based upon reviews conducted under clause (i). 
                        Such a certification shall be provided unless 
                        the Administrator determines that the 
                        responder's condition is not a WTC-related 
                        health condition in the list in subsection 
                        (a)(3) or that exposure to airborne toxins, 
                        other hazards, or adverse conditions resulting 
                        from the September 1, 2001, terrorist attacks 
                        is not substantially likely to be a significant 
                        factor in aggravating, contributing to, or 
                        causing the condition.
                            ``(iii) Appeal process.--The Administrator 
                        shall establish, by rule, a process for the 
                        appeal of determinations under clause (ii).
            ``(2) Determination based on medically associated wtc-
        related health conditions.--
                    ``(A) In general.--If a physician at a Clinical 
                Center of Excellence determines pursuant to subsection 
                (a) that the enrolled WTC responder has a health 
                condition described in subsection (a)(1)(A) that is not 
                in the list in subsection (a)(3) but which is medically 
                associated with a WTC-related health condition--
                            ``(i) the physician shall promptly transmit 
                        such determination to the WTC Program 
                        Administrator and provide the Administrator 
                        with the facts supporting such determination; 
                        and
                            ``(ii) the Administrator shall make a 
                        determination under subparagraph (B) with 
                        respect to such physician's determination.
                    ``(B) Procedures for review, certification, and 
                appeal.--The WTC Program Administrator shall, by rule, 
                establish procedures for the review and certification 
                of physician determinations under subparagraph (A). 
                Such rule shall provide for--
                            ``(i) the timely review of such a 
                        determination by a physician panel with 
                        appropriate expertise for the condition and 
                        recommendations to the WTC Program 
                        Administrator;
                            ``(ii) not later than 60 days after the 
                        date of the transmittal under subparagraph 
                        (A)(i), a determination by the WTC Program 
                        Administrator on whether or not the condition 
                        involved is described in subsection (a)(1)(A) 
                        and is medically associated with a WTC-related 
                        health condition;
                            ``(iii) certification in accordance with 
                        paragraph (1)(B)(ii) of coverage of such 
                        condition if determined to be described in 
                        subsection (a)(1)(A) and medically associated 
                        with a WTC-related health condition; and
                            ``(iv) a process for appeals of 
                        determinations relating to such conditions.
                    ``(C) Inclusion in list of health conditions.--If 
                the WTC Program Administrator provides certification 
                under subparagraph (B)(iii) for coverage of a 
                condition, the Administrator may, pursuant to 
                subsection (a)(6), add the condition to the list in 
                subsection (a)(3).
                    ``(D) Conditions already declined for inclusion in 
                list.--If the WTC Program Administrator publishes a 
                determination under subsection (a)(6)(B) not to include 
                a condition in the list in subsection (a)(3), the WTC 
                Program Administrator shall not provide certification 
                under subparagraph (B)(iii) for coverage of the 
                condition. In the case of an individual who is 
                certified under subparagraph (B)(iii) with respect to 
                such condition before the date of the publication of 
                such determination the previous sentence shall not 
                apply.
            ``(3) Requirement of medical necessity.--
                    ``(A) In general.--In providing treatment for a 
                WTC-related health condition, a physician or other 
                provider shall provide treatment that is medically 
                necessary and in accordance with medical treatment 
                protocols established under subsection (d).
                    ``(B) Regulations relating to medical necessity.--
                For the purpose of this title, the WTC Program 
                Administrator shall issue regulations specifying a 
                standard for determining medical necessity with respect 
                to health care services and prescription 
                pharmaceuticals, a process for determining whether 
                treatment furnished and pharmaceuticals prescribed 
                under this title meet such standard (including any 
                prior authorization requirement), and a process for 
                appeal of a determination under subsection (c)(3).
            ``(4) Scope of treatment covered.--
                    ``(A) In general.--The scope of treatment covered 
                under this subsection includes services of physicians 
                and other health care providers, diagnostic and 
                laboratory tests, prescription drugs, inpatient and 
                outpatient hospital services, and other medically 
                necessary treatment.
                    ``(B) Pharmaceutical coverage.--With respect to 
                ensuring coverage of medically necessary outpatient 
                prescription drugs, such drugs shall be provided, under 
                arrangements made by the WTC Program Administrator, 
                directly through participating Clinical Centers of 
                Excellence or through one or more outside vendors.
                    ``(C) Transportation expenses for nationwide 
                network.--The WTC Program Administrator may provide for 
                necessary and reasonable transportation and expenses 
                incident to the securing of medically necessary 
                treatment through the nationwide network under section 
                3313 involving travel of more than 250 miles and for 
                which payment is made under this section in the same 
                manner in which individuals may be furnished necessary 
                and reasonable transportation and expenses incident to 
                services involving travel of more than 250 miles under 
                regulations implementing section 3629(c) of the Energy 
                Employees Occupational Illness Compensation Program Act 
                of 2000 (title XXXVI of Public Law 106-398; 42 U.S.C. 
                7384t(c)).
            ``(5) Provision of treatment pending certification.--With 
        respect to an enrolled WTC responder for whom a determination 
        is made by an examining physician under paragraph (1) or (2), 
        but for whom the WTC Program Administrator has not yet 
        determined whether to certify the determination, the WTC 
        Program Administrator may establish by rule a process through 
        which the Administrator may approve the provision of medical 
        treatment under this subsection (and payment under subsection 
        (c)) with respect to such responder and such responder's WTC-
        related health condition (under such terms and conditions as 
        the Administrator may provide) until the Administrator makes a 
        decision on whether to certify the determination.
    ``(c) Payment for Initial Health Evaluation, Monitoring, and 
Treatment of WTC-Related Health Conditions.--
            ``(1) Medical treatment.--
                    ``(A) Use of feca payment rates.--
                            ``(i) In general.--Subject to clause (ii):
                                    ``(I) Subject to subparagraphs (B) 
                                and (C), the WTC Program Administrator 
                                shall reimburse costs for medically 
                                necessary treatment under this title 
                                for WTC-related health conditions 
                                according to the payment rates that 
                                would apply to the provision of such 
                                treatment and services by the facility 
                                under the Federal Employees 
                                Compensation Act.
                                    ``(II) For treatment not covered 
                                under subclause (i) or subparagraph 
                                (B), the WTC Program Administrator 
                                shall establish by regulation a 
                                reimbursement rate for such treatment.
                            ``(ii) Exception.--In no case shall 
                        payments for products or services under clause 
                        (i) be made at a rate higher than the Office of 
                        Worker's Compensation Programs in the 
                        Department Labor would pay for such products or 
                        services rendered at the time such products or 
                        services were provided.
                    ``(B) Pharmaceuticals.--
                            ``(i) In general.--The WTC Program 
                        Administrator shall establish a program for 
                        paying for the medically necessary outpatient 
                        prescription pharmaceuticals prescribed under 
                        this title for WTC-related health conditions 
                        through one or more contracts with outside 
                        vendors.
                            ``(ii) Competitive bidding.--Under such 
                        program the Administrator shall--
                                    ``(I) select one or more 
                                appropriate vendors through a Federal 
                                competitive bid process; and
                                    ``(II) select the lowest bidder (or 
                                bidders) meeting the requirements for 
                                providing pharmaceutical benefits for 
                                participants in the WTC Program.
                            ``(iii) Treatment of fdny participants.--
                        Under such program the Administrator may enter 
                        into an agreement with a separate vendor to 
                        provide pharmaceutical benefits to enrolled WTC 
                        responders for whom the Clinical Center of 
                        Excellence is described in section 3305 if such 
                        an arrangement is deemed necessary and 
                        beneficial to the program by the WTC Program 
                        Administrator.
                            ``(iv) Pharmaceuticals.--Not later than 
                        July 1, 2011, the Comptroller General of the 
                        United States shall submit to the Committee on 
                        Energy and Commerce of the House of 
                        Representatives and the Committee on Health, 
                        Education, Labor, and Pensions of the Senate a 
                        report on whether existing Federal 
                        pharmaceutical purchasing programs can provide 
                        pharmaceutical benefits more efficiently and 
                        effectively than through the WTC program.
                    ``(C) Improving quality and efficiency through 
                modification of payment amounts and methodologies.--The 
                WTC Program Administrator may modify the amounts and 
                methodologies for making payments for initial health 
                evaluations, monitoring, or treatment, if, taking into 
                account utilization and quality data furnished by the 
                Clinical Centers of Excellence under section 
                3305(b)(1)(B)(iii), the Administrator determines that a 
                bundling, capitation, pay for performance, or other 
                payment methodology would better ensure high quality 
                and efficient delivery of initial health evaluations, 
                monitoring, or treatment to an enrolled WTC responder, 
                screening-eligible WTC survivor, or certified-eligible 
                WTC survivor.
            ``(2) Monitoring and initial health evaluation.--The WTC 
        Program Administrator shall reimburse the costs of monitoring 
        and the costs of an initial health evaluation provided under 
        this title at a rate set by the Administrator by regulation.
            ``(3) Determination of medical necessity.--
                    ``(A) Review of medical necessity and protocols.--
                As part of the process for reimbursement or payment 
                under this subsection, the WTC Program Administrator 
                shall provide for the review of claims for 
                reimbursement or payment for the provision of medical 
                treatment to determine if such treatment is medically 
                necessary and in accordance with medical treatment 
                protocols established under subsection (d).
                    ``(B) Withholding of payment for medically 
                unnecessary treatment.--The Administrator shall 
                withhold such reimbursement or payment for treatment 
                that the Administrator determines is not medically 
                necessary or is not in accordance with such medical 
                treatment protocols.
    ``(d) Medical Treatment Protocols.--
            ``(1) Development.--The Data Centers shall develop medical 
        treatment protocols for the treatment of enrolled WTC 
        responders and certified-eligible WTC survivors for health 
        conditions included in the applicable list of WTC-related 
        health conditions.
            ``(2) Approval.--The medical treatment protocols developed 
        under paragraph (1) shall be subject to approval by the WTC 
        Program Administrator.

``SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS 
              OUTSIDE NEW YORK.

    ``(a) In General.--In order to ensure reasonable access to benefits 
under this subtitle for individuals who are enrolled WTC responders, 
screening-eligible WTC survivors, or certified-eligible WTC survivors 
and who reside in any State, as defined in section 2(f), outside the 
New York metropolitan area, the WTC Program Administrator shall 
establish a nationwide network of health care providers to provide 
monitoring and treatment benefits and initial health evaluations near 
such individuals' areas of residence in such States. Nothing in this 
subsection shall be construed as preventing such individuals from being 
provided such monitoring and treatment benefits or initial health 
evaluation through any Clinical Center of Excellence.
    ``(b) Network Requirements.--Any health care provider participating 
in the network under subsection (a) shall--
            ``(1) meet criteria for credentialing established by the 
        Data Centers;
            ``(2) follow the monitoring, initial health evaluation, and 
        treatment protocols developed under section 3305(a)(2)(A)(ii);
            ``(3) collect and report data in accordance with section 
        3304; and
            ``(4) meet such fraud, quality assurance, and other 
        requirements as the WTC Program Administrator establishes, 
        including sections 1128 through 1128E of the Social Security 
        Act, as applied by section 3301(d).
    ``(c) Training and Technical Assistance.--The WTC Program 
Administer may provide, including through contract, for the provision 
of training and technical assistance to health care providers 
participating in the network under subsection (a).
    ``(d) Provision of Services Through the VA.--
            ``(1) In general.--The WTC Program Administrator may enter 
        into an agreement with the Secretary of Veterans Affairs for 
        the Secretary to provide services under this section through 
        facilities of the Department of Veterans Affairs.
            ``(2) National program.--Not later than July 1, 2011, the 
        Comptroller General of the United States shall submit to the 
        Committee on Energy and Commerce of the House of 
        Representatives and the Committee on Health, Education, Labor, 
        and Pensions of the Senate a report on whether the Department 
        of Veterans Affairs can provide monitoring and treatment 
        services to individuals under this section more efficiently and 
        effectively than through the nationwide network to be 
        established under subsection (a).

                        ``PART 2--WTC SURVIVORS

``SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF SCREENING-
              ELIGIBLE AND CERTIFIED-ELIGIBLE WTC SURVIVORS.

    ``(a) Identification of Screening-Eligible WTC Survivors and 
Certified-Eligible WTC Survivors.--
            ``(1) Screening-eligible wtc survivors.--
                    ``(A) Definition.--In this title, the term 
                `screening-eligible WTC survivor' means, subject to 
                subparagraph (C) and paragraph (3), an individual who 
                is described in any of the following clauses:
                            ``(i) Currently identified survivor.--An 
                        individual, including a WTC responder, who has 
                        been identified as eligible for medical 
                        treatment and monitoring by the WTC 
                        Environmental Health Center as of the date of 
                        enactment of this title.
                            ``(ii) Survivor who meets current 
                        eligibility criteria.--An individual who is not 
                        a WTC responder, for purposes of the initial 
                        health evaluation under subsection (b), claims 
                        symptoms of a WTC-related health condition and 
                        meets any of the current eligibility criteria 
                        described in subparagraph (B).
                            ``(iii) Survivor who meets modified 
                        eligibility criteria.--An individual who is not 
                        a WTC responder, for purposes of the initial 
                        health evaluation under subsection (b), claims 
                        symptoms of a WTC-related health condition and 
                        meets such eligibility criteria relating to 
                        exposure to airborne toxins, other hazards, or 
                        adverse conditions resulting from the September 
                        11, 2001, terrorist attacks as the WTC 
                        Administrator determines, after consultation 
                        with the Data Centers described in section 3305 
                        and the WTC Scientific/Technical Advisory 
                        Committee and WTC Health Program Steering 
                        Committees under section 3302.
                The Administrator shall not modify such criteria under 
                clause (iii) on or after the date that the number of 
                certifications for certified-eligible WTC survivors 
                under paragraph (2)(B) has reached 80 percent of the 
                limit described in paragraph (3) or on or after the 
                date that the number of enrollments of WTC responders 
                has reached 80 percent of the limit described in 
                section 3311(a)(4).
                    ``(B) Current eligibility criteria.--The 
                eligibility criteria described in this subparagraph for 
                an individual are that the individual is described in 
                any of the following clauses:
                            ``(i) A person who was present in the New 
                        York City disaster area in the dust or dust 
                        cloud on September 11, 2001.
                            ``(ii) A person who worked, resided, or 
                        attended school, childcare, or adult daycare in 
                        the New York City disaster area for--
                                    ``(I) at least 4 days during the 4-
                                month period beginning on September 11, 
                                2001, and ending on January 10, 2002; 
                                or
                                    ``(II) at least 30 days during the 
                                period beginning on September 11, 2001, 
                                and ending on July 31, 2002.
                            ``(iii) Any person who worked as a cleanup 
                        worker or performed maintenance work in the New 
                        York City disaster area during the 4-month 
                        period described in subparagraph (B)(i) and had 
                        extensive exposure to WTC dust as a result of 
                        such work.
                            ``(iv) A person who was deemed eligible to 
                        receive a grant from the Lower Manhattan 
                        Development Corporation Residential Grant 
                        Program, who possessed a lease for a residence 
                        or purchased a residence in the New York City 
                        disaster area, and who resided in such 
                        residence during the period beginning on 
                        September 11, 2001, and ending on May 31, 2003.
                            ``(v) A person whose place of employment--
                                    ``(I) at any time during the period 
                                beginning on September 11, 2001, and 
                                ending on May 31, 2003, was in the New 
                                York City disaster area; and
                                    ``(II) was deemed eligible to 
                                receive a grant from the Lower 
                                Manhattan Development Corporation WTC 
                                Small Firms Attraction and Retention 
                                Act program or other government 
                                incentive program designed to 
                                revitalize the lower Manhattan economy 
                                after the September 11, 2001, terrorist 
                                attacks.
                    ``(C) Application and determination process for 
                screening eligibility.--
                            ``(i) In general.--The WTC Program 
                        Administrator in consultation with the Data 
                        Centers shall establish a process for 
                        individuals, other than individuals described 
                        in subparagraph (A)(i), to be determined to be 
                        screening-eligible WTC survivors. Under such 
                        process--
                                    ``(I) there shall be no fee charged 
                                to the applicant for making an 
                                application for such determination;
                                    ``(II) the Administrator shall make 
                                a determination on such an application 
                                not later than 60 days after the date 
                                of filing the application;
                                    ``(III) the Administrator shall 
                                make such a determination relating to 
                                an applicant's compliance with this 
                                title and shall not determine that an 
                                individual is not so eligible or deny 
                                written documentation under clause (ii) 
                                to such individual unless the 
                                Administrator determines that--
                                            ``(aa) based on the 
                                        application submitted, the 
                                        individual does not meet the 
                                        eligibility criteria; or
                                            ``(bb) the numerical 
                                        limitation on certifications of 
                                        certified-eligible WTC 
                                        survivors set forth in 
                                        paragraph (3) has been met; and
                                    ``(IV) an individual who is 
                                determined not to be a screening-
                                eligible WTC survivor shall have an 
                                opportunity to appeal such 
                                determination in a manner established 
                                under such process.
                            ``(ii) Written documentation of screening-
                        eligibility.--
                                    ``(I) In general.--In the case of 
                                an individual who is described in 
                                subparagraph (A)(i) or who is 
                                determined under clause (i) (consistent 
                                with paragraph (3)) to be a screening-
                                eligible WTC survivor, the WTC Program 
                                Administrator shall provide an 
                                appropriate written documentation of 
                                such fact.
                                    ``(II) Timing.--
                                            ``(aa) Currently identified 
                                        survivors.--In the case of an 
                                        individual who is described in 
                                        subparagraph (A)(i), the WTC 
                                        Program Administrator shall 
                                        provide the written 
                                        documentation under subclause 
                                        (I) not later than July 1, 
                                        2011.
                                            ``(bb) Other members.--In 
                                        the case of another individual 
                                        who is determined under clause 
                                        (i) and consistent with 
                                        paragraph (3) to be a 
                                        screening-eligible WTC 
                                        survivor, the WTC Program 
                                        Administrator shall provide the 
                                        written documentation under 
                                        subclause (I) at the time of 
                                        such determination.
            ``(2) Certified-eligible wtc survivors.--
                    ``(A) Definition.--The term `certified-eligible WTC 
                survivor' means, subject to paragraph (3), a screening-
                eligible WTC survivor who the WTC Program Administrator 
                certifies under subparagraph (B) to be eligible for 
                followup monitoring and treatment under this part.
                    ``(B) Certification of eligibility for monitoring 
                and treatment.--
                            ``(i) In general.--The WTC Program 
                        Administrator shall establish a certification 
                        process under which the Administrator shall 
                        provide appropriate certification to screening-
                        eligible WTC survivors who, pursuant to the 
                        initial health evaluation under subsection (b), 
                        are determined to be eligible for followup 
                        monitoring and treatment under this part.
                            ``(ii) Timing.--
                                    ``(I) Currently identified 
                                survivors.--In the case of an 
                                individual who is described in 
                                paragraph (1)(A)(i), the WTC Program 
                                Administrator shall provide the 
                                certification under clause (i) not 
                                later than July 1, 2011.
                                    ``(II) Other members.--In the case 
                                of another individual who is determined 
                                under clause (i) to be eligible for 
                                followup monitoring and treatment, the 
                                WTC Program Administrator shall provide 
                                the certification under such clause at 
                                the time of such determination.
            ``(3) Numerical limitation on certified-eligible wtc 
        survivors.--
                    ``(A) In general.--The total number of individuals 
                not described in paragraph (1)(A)(i) who may be 
                certified as certified-eligible WTC survivors under 
                paragraph (2)(B) shall not exceed 25,000 at any time.
                    ``(B) Process.--In implementing subparagraph (A), 
                the WTC Program Administrator shall--
                            ``(i) limit the number of certifications 
                        provided under paragraph (2)(B)--
                                    ``(I) in accordance with such 
                                subparagraph; and
                                    ``(II) to such number, as 
                                determined by the Administrator based 
                                on the best available information and 
                                subject to amounts made available under 
                                section 3351, that will ensure 
                                sufficient funds will be available to 
                                provide treatment and monitoring 
                                benefits under this title, with respect 
                                to all individuals receiving such 
                                certifications through the end of 
                                fiscal year 2020; and
                            ``(ii) provide priority in such 
                        certifications in the order in which 
                        individuals apply for a determination under 
                        paragraph (2)(B).
            ``(4) Disqualification of individuals on terrorist watch 
        list.--No individual who is on the terrorist watch list 
        maintained by the Department of Homeland Security shall qualify 
        as a screening-eligible WTC survivor or a certified-eligible 
        WTC survivor. Before determining any individual to be a 
        screening-eligible WTC survivor under paragraph (1) or 
        certifying any individual as a certified eligible WTC survivor 
        under paragraph (2), the Administrator, in consultation with 
        the Secretary of Homeland Security, shall determine whether the 
        individual is on such list.
    ``(b) Initial Health Evaluation To Determine Eligibility for 
Followup Monitoring or Treatment.--
            ``(1) In general.--In the case of a screening-eligible WTC 
        survivor, the WTC Program shall provide for an initial health 
        evaluation to determine if the survivor has a WTC-related 
        health condition and is eligible for followup monitoring and 
        treatment benefits under the WTC Program. Initial health 
        evaluation protocols under section 3305(a)(2)(A)(ii) shall be 
        subject to approval by the WTC Program Administrator.
            ``(2) Initial health evaluation providers.--The initial 
        health evaluation described in paragraph (1) shall be provided 
        through a Clinical Center of Excellence with respect to the 
        individual involved.
            ``(3) Limitation on initial health evaluation benefits.--
        Benefits for an initial health evaluation under this part for a 
        screening-eligible WTC survivor shall consist only of a single 
        medical initial health evaluation consistent with initial 
        health evaluation protocols described in paragraph (1). Nothing 
        in this paragraph shall be construed as preventing such an 
        individual from seeking additional medical initial health 
        evaluations at the expense of the individual.

``SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED-ELIGIBLE 
              WTC SURVIVORS FOR WTC-RELATED HEALTH CONDITIONS.

    ``(a) In General.--Subject to subsection (b), the provisions of 
sections 3311 and 3312 shall apply to followup monitoring and treatment 
of WTC-related health conditions for certified-eligible WTC survivors 
in the same manner as such provisions apply to the monitoring and 
treatment of WTC-related health conditions for enrolled WTC responders.
    ``(b) List of WTC-Related Health Conditions for Survivors.--The 
list of health conditions for screening-eligible WTC survivors and 
certified-eligible WTC survivors consists of the following:
            ``(1) Aerodigestive disorders.--
                    ``(A) Interstitial lung diseases.
                    ``(B) Chronic respiratory disorder--fumes/vapors.
                    ``(C) Asthma.
                    ``(D) Reactive airways dysfunction syndrome (RADS).
                    ``(E) WTC-exacerbated chronic obstructive pulmonary 
                disease (COPD).
                    ``(F) Chronic cough syndrome.
                    ``(G) Upper airway hyperreactivity.
                    ``(H) Chronic rhinosinusitis.
                    ``(I) Chronic nasopharyngitis.
                    ``(J) Chronic laryngitis.
                    ``(K) Gastroesophageal reflux disorder (GERD).
                    ``(L) Sleep apnea exacerbated by or related to a 
                condition described in a previous clause.
            ``(2) Mental health conditions.--
                    ``(A) Posttraumatic stress disorder (PTSD).
                    ``(B) Major depressive disorder.
                    ``(C) Panic disorder.
                    ``(D) Generalized anxiety disorder.
                    ``(E) Anxiety disorder (not otherwise specified).
                    ``(F) Depression (not otherwise specified).
                    ``(G) Acute stress disorder.
                    ``(H) Dysthymic disorder.
                    ``(I) Adjustment disorder.
                    ``(J) Substance abuse.
            ``(3) Additional conditions.--Any cancer (or type of 
        cancer) or other condition added to the list in section 
        3312(a)(3) pursuant to paragraph (5) or (6) of section 3312(a), 
        as such provisions are applied under subsection (a) with 
        respect to certified-eligible WTC survivors.

``SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS 
              WITH WTC-RELATED HEALTH CONDITIONS.

    ``(a) In General.--Subject to subsection (c), the provisions of 
section 3322 shall apply to the followup monitoring and treatment of 
WTC-related health conditions in the case of individuals described in 
subsection (b) in the same manner as such provisions apply to the 
followup monitoring and treatment of WTC-related health conditions for 
certified-eligible WTC survivors.
    ``(b) Individuals Described.--An individual described in this 
subsection is an individual who, regardless of location of residence--
            ``(1) is not an enrolled WTC responder or a certified-
        eligible WTC survivor; and
            ``(2) is diagnosed at a Clinical Center of Excellence with 
        a WTC-related health condition for certified-eligible WTC 
        survivors.
    ``(c) Limitation.--
            ``(1) In general.--The WTC Program Administrator shall 
        limit benefits for any fiscal year under subsection (a) in a 
        manner so that payments under this section for such fiscal year 
        do not exceed the amount specified in paragraph (2) for such 
        fiscal year.
            ``(2) Limitation.--The amount specified in this paragraph 
        for--
                    ``(A) the last calendar quarter of fiscal year 2011 
                is $5,000,000;
                    ``(B) fiscal year 2012 is $20,000,000; or
                    ``(C) a succeeding fiscal year is the amount 
                specified in this paragraph for the previous fiscal 
                year increased by the annual percentage increase in the 
                medical care component of the consumer price index for 
                all urban consumers.

                       ``PART 3--PAYOR PROVISIONS

``SEC. 3331. PAYMENT OF CLAIMS.

    ``(a) In General.--Except as provided in subsections (b) and (c), 
the cost of monitoring and treatment benefits and initial health 
evaluation benefits provided under parts 1 and 2 of this subtitle shall 
be paid for by the WTC Program from the World Trade Center Health 
Program Fund.
    ``(b) Workers' Compensation Payment.--
            ``(1) In general.--Subject to paragraph (2), payment for 
        treatment under parts 1 and 2 of this subtitle of a WTC-related 
        health condition of an individual that is work-related shall be 
        reduced or recouped to the extent that the WTC Program 
        Administrator determines that payment has been made, or can 
        reasonably be expected to be made, under a workers' 
        compensation law or plan of the United States, a State, or a 
        locality, or other work-related injury or illness benefit plan 
        of the employer of such individual, for such treatment. The 
        provisions of clauses (iii), (iv), (v), and (vi) of paragraph 
        (2)(B) of section 1862(b) of the Social Security Act and 
        paragraphs (3) and (4) of such section shall apply to the 
        recoupment under this subsection of a payment to the WTC 
        Program (with respect to a workers' compensation law or plan, 
        or other work-related injury or illness plan of the employer 
        involved, and such individual) in the same manner as such 
        provisions apply to the reimbursement of a payment under 
        section 1862(b)(2) of such Act to the Secretary (with respect 
        to such a law or plan and an individual entitled to benefits 
        under title XVIII of such Act) except that any reference in 
        such paragraph (4) to payment rates under title XVIII of the 
        Social Security Act shall be deemed a reference to payment 
        rates under this title.
            ``(2) Exception.--Paragraph (1) shall not apply for any 
        quarter, with respect to any workers' compensation law or plan, 
        including line of duty compensation, to which New York City is 
        obligated to make payments, if, in accordance with terms 
        specified under the contract under subsection (d)(1)(A), New 
        York City has made the full payment required under such 
        contract for such quarter.
            ``(3) Rules of construction.--Nothing in this title shall 
        be construed to affect, modify, or relieve any obligations 
        under a worker's compensation law or plan, other work-related 
        injury or illness benefit plan of an employer, or any health 
        insurance plan.
    ``(c) Health Insurance Coverage.--
            ``(1) In general.--In the case of an individual who has a 
        WTC-related health condition that is not work-related and has 
        health coverage for such condition through any public or 
        private health plan (including health benefits under title 
        XVIII, XIX, or XXI of the Social Security Act) the provisions 
        of section 1862(b) of the Social Security Act shall apply to 
        such a health plan and such individual in the same manner as 
        they apply to group health plan and an individual entitled to 
        benefits under title XVIII of such Act pursuant to section 
        226(a) of such Act. Any costs for items and services covered 
        under such plan that are not reimbursed by such health plan, 
        due to the application of deductibles, copayments, coinsurance, 
        other cost sharing, or otherwise, are reimbursable under this 
        title to the extent that they are covered under the WTC 
        Program. The program under this title shall not be treated as a 
        legally liable party for purposes of applying section 
        1902(a)(25) of the Social Security Act.
            ``(2) Recovery by individual providers.--Nothing in 
        paragraph (1) shall be construed as requiring an entity 
        providing monitoring and treatment under this title to seek 
        reimbursement under a health plan with which the entity has no 
        contract for reimbursement.
            ``(3) Maintenance of required minimum essential coverage.--
        No payment may be made for monitoring and treatment under this 
        title for an individual for a month (beginning with July 2014) 
        if with respect to such month the individual--
                    ``(A) is an applicable individual (as defined in 
                subsection (d) of section 5000A of Internal Revenue 
                Code of 1986) for whom the exemption under subsection 
                (e) of such section does not apply; and
                    ``(B) is not covered under minimum essential 
                coverage, as required under subsection (a) of such 
                section.
    ``(d) Required Contribution by New York City in Program Costs.--
            ``(1) Contract requirement.--
                    ``(A) In general.--No funds may be disbursed from 
                the World Trade Center Health Program Fund under 
                section 3351 unless New York City has entered into a 
                contract with the WTC Program Administrator under which 
                New York City agrees, in a form and manner specified by 
                the Administrator, to pay the full contribution 
                described in subparagraph (B) in accordance with this 
                subsection on a timely basis, plus any interest owed 
                pursuant to subparagraph (E)(i). Such contract shall 
                specify the terms under which New York City shall be 
                considered to have made the full payment required for a 
                quarter for purposes of subsection (b)(2).
                    ``(B) Full contribution amount.--Under such 
                contract, with respect to the last calendar quarter of 
                fiscal year 2011 and each calendar quarter in fiscal 
                years 2012 through 2015 the full contribution amount 
                under this subparagraph shall be equal to 10 percent of 
                the expenditures in carrying out this title for the 
                respective quarter and with respect to calendar 
                quarters in fiscal year 2016, such full contribution 
                amount shall be equal to \1/9\ of the Federal 
                expenditures in carrying out this title for the 
                respective quarter.
                    ``(C) Satisfaction of payment obligation.--The 
                payment obligation under such contract may not be 
                satisfied through any of the following:
                            ``(i) An amount derived from Federal 
                        sources.
                            ``(ii) An amount paid before the date of 
                        the enactment of this title.
                            ``(iii) An amount paid to satisfy a 
                        judgment or as part of a settlement related to 
                        injuries or illnesses arising out of the 
                        September 11, 2001, terrorist attacks.
                    ``(D) Timing of contribution.--The payment 
                obligation under such contract for a calendar quarter 
                in a fiscal year shall be paid not later than the last 
                day of the second succeeding calendar quarter.
                    ``(E) Compliance.--
                            ``(i) Interest for late payment.--If New 
                        York City fails to pay to the WTC Program 
                        Administrator pursuant to such contract the 
                        amount required for any calendar quarter by the 
                        day specified in subparagraph (D), interest 
                        shall accrue on the amount not so paid at the 
                        rate (determined by the Administrator) based on 
                        the average yield to maturity, plus 1 
                        percentage point, on outstanding municipal 
                        bonds issued by New York City with a remaining 
                        maturity of at least 1 year.
                            ``(ii) Recovery of amounts owed.--The 
                        amounts owed to the WTC Program Administrator 
                        under such contract shall be recoverable by the 
                        United States in an action in the same manner 
                        as payments made under title XVIII of the 
                        Social Security Act may be recoverable in an 
                        action brought under section 1862(b)(2)(B)(iii) 
                        of such Act.
                    ``(F) Deposit in fund.--The WTC Program Administer 
                shall deposit amounts paid under such contract into the 
                World Trade Center Health Program Fund under section 
                3351.
            ``(2) Payment of new york city share of monitoring and 
        treatment costs.--With respect to each calendar quarter for 
        which a contribution is required by New York City under the 
        contract under paragraph (1), the WTC Program Administrator 
        shall--
                    ``(A) provide New York City with an estimate of 
                such amount of the required contribution at the 
                beginning of such quarter and with an updated estimate 
                of such amount at the beginning of each of the 
                subsequent 2 quarters;
                    ``(B) bill such amount directly to New York City; 
                and
                    ``(C) certify periodically, for purposes of this 
                subsection, whether or not New York City has paid the 
                amount so billed.
        Such amount shall initially be estimated by the WTC Program 
        Administrator and shall be subject to adjustment and 
        reconciliation based upon actual expenditures in carrying out 
        this title.
            ``(3) Rule of construction.--Nothing in this subsection 
        shall be construed as authorizing the WTC Administrator, with 
        respect to a fiscal year, to reduce the numerical limitation 
        under section 3311(a)(4) or 3321(a)(3) for such fiscal year if 
        New York City fails to comply with paragraph (1) for a calendar 
        quarter in such fiscal year.
    ``(e) Work-Related Described.--For the purposes of this section, a 
WTC-related health condition shall be treated as a condition that is 
work-related if--
            ``(1) the condition is diagnosed in an enrolled WTC 
        responder, or in an individual who qualifies as a certified-
        eligible WTC survivor on the basis of being a rescue, recovery, 
        or cleanup worker; or
            ``(2) with respect to the condition the individual has 
        filed and had established a claim under a workers' compensation 
        law or plan of the United States or a State, or other work-
        related injury or illness benefit plan of the employer of such 
        individual.

``SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY.

    ``The WTC Program Administrator may enter into arrangements with 
other government agencies, insurance companies, or other third-party 
administrators to provide for timely and accurate processing of claims 
under sections 3312, 3313, 3322, and 3323.

                 ``Subtitle C--Research Into Conditions

``SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO 
              SEPTEMBER 11 TERRORIST ATTACKS.

    ``(a) In General.--With respect to individuals, including enrolled 
WTC responders and certified-eligible WTC survivors, receiving 
monitoring or treatment under subtitle B, the WTC Program Administrator 
shall conduct or support--
            ``(1) research on physical and mental health conditions 
        that may be related to the September 11, 2001, terrorist 
        attacks;
            ``(2) research on diagnosing WTC-related health conditions 
        of such individuals, in the case of conditions for which there 
        has been diagnostic uncertainty; and
            ``(3) research on treating WTC-related health conditions of 
        such individuals, in the case of conditions for which there has 
        been treatment uncertainty.
The Administrator may provide such support through continuation and 
expansion of research that was initiated before the date of the 
enactment of this title and through the World Trade Center Health 
Registry (referred to in section 3342), through a Clinical Center of 
Excellence, or through a Data Center.
    ``(b) Types of Research.--The research under subsection (a)(1) 
shall include epidemiologic and other research studies on WTC-related 
health conditions or emerging conditions--
            ``(1) among enrolled WTC responders and certified-eligible 
        WTC survivors under treatment; and
            ``(2) in sampled populations outside the New York City 
        disaster area in Manhattan as far north as 14th Street and in 
        Brooklyn, along with control populations, to identify potential 
        for long-term adverse health effects in less exposed 
        populations.
    ``(c) Consultation.--The WTC Program Administrator shall carry out 
this section in consultation with the WTC Scientific/Technical Advisory 
Committee.
    ``(d) Application of Privacy and Human Subject Protections.--The 
privacy and human subject protections applicable to research conducted 
under this section shall not be less than such protections applicable 
to research conducted or funded by the Department of Health and Human 
Services.

``SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY.

    ``For the purpose of ensuring ongoing data collection relating to 
victims of the September 11, 2001, terrorist attacks, the WTC Program 
Administrator shall ensure that a registry of such victims is 
maintained that is at least as comprehensive as the World Trade Center 
Health Registry maintained under the arrangements in effect as of April 
20, 2009, with the New York City Department of Health and Mental 
Hygiene.

                         ``Subtitle D--Funding

``SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM FUND.

    ``(a) Establishment of Fund.--
            ``(1) In general.--There is established a fund to be known 
        as the World Trade Center Health Program Fund (referred to in 
        this section as the `Fund').
            ``(2) Funding.--Out of any money in the Treasury not 
        otherwise appropriated, there shall be deposited into the Fund 
        for each of fiscal years 2012 through 2016 (and the last 
        calendar quarter of fiscal year 2011)--
                    ``(A) the Federal share, consisting of an amount 
                equal to the lesser of--
                            ``(i) 90 percent of the expenditures in 
                        carrying out this title for the respective 
                        fiscal year (initially based on estimates, 
                        subject to subsequent reconciliation based on 
                        actual expenditures); or
                            ``(ii)(I) $71,000,000 for the last calendar 
                        quarter of fiscal year 2011, $318,000,000 for 
                        fiscal year 2012, $354,000,000 for fiscal year 
                        2013, $382,000,000 for fiscal year 2014, and 
                        $431,000,000 for fiscal year 2015; and
                            ``(II) subject to paragraph (4), an 
                        additional amount for fiscal year 2016 from 
                        unexpended amounts for previous fiscal years; 
                        plus
                    ``(B) the New York City share, consisting of the 
                amount contributed under the contract under section 
                3331(d).
            ``(3) Contract requirement.--
                    ``(A) In general.--No funds may be disbursed from 
                the Fund unless New York City has entered into a 
                contract with the WTC Program Administrator under 
                section 3331(d)(1).
                    ``(B) Breach of contract.--In the case of a failure 
                to pay the amount so required under the contract--
                            ``(i) the amount is recoverable under 
                        subparagraph (E)(ii) of such section;
                            ``(ii) such failure shall not affect the 
                        disbursement of amounts from the Fund; and
                            ``(iii) the Federal share described in 
                        paragraph (2)(A) shall not be increased by the 
                        amount so unpaid.
            ``(4) Aggregate limitation on funding beginning with fiscal 
        year 2016.--Beginning with fiscal year 2016, in no case shall 
        the share of Federal funds deposited into the Fund under 
        paragraph (2) for such fiscal year and previous fiscal years 
        and quarters exceed the sum of the amounts specified in 
        paragraph (2)(A)(ii)(I).
    ``(b) Mandatory Funds for Monitoring, Initial Health Evaluations, 
Treatment, and Claims Processing.--
            ``(1) In general.--The amounts deposited into the Fund 
        under subsection (a)(2) shall be available, without further 
        appropriation, consistent with paragraph (2) and subsection 
        (c), to carry out subtitle B and sections 3302(a), 3303, 3304, 
        3305(a)(2), 3305(c), 3341, and 3342.
            ``(2) Limitation on mandatory funding.--This title does not 
        establish any Federal obligation for payment of amounts in 
        excess of the amounts available from the Fund for such purpose.
            ``(3) Limitation on authorization for further 
        appropriations.--This title does not establish any 
        authorization for appropriation of amounts in excess of the 
        amounts available from the Fund under paragraph (1).
    ``(c) Limits on Spending for Certain Purposes.--Of the amounts made 
available under subsection (b)(1), not more than each of the following 
amounts may be available for each of the following purposes:
            ``(1) Surviving immediate family members of firefighters.--
        For the purposes of carrying out subtitle B with respect to WTC 
        responders described in section 3311(a)(2)(A)(ii)--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $100,000;
                    ``(B) for fiscal year 2012, $400,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all 
                items; United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(2) WTC health program scientific/technical advisory 
        committee.--For the purpose of carrying out section 3302(a)--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $25,000;
                    ``(B) for fiscal year 2012, $100,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all 
                items; United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(3) Education and outreach.--For the purpose of carrying 
        out section 3303--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $500,000;
                    ``(B) for fiscal year 2012, $2,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all 
                items; United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(4) Uniform data collection.--For the purpose of carrying 
        out section 3304 and for reimbursing Data Centers (as defined 
        in section 3305(b)(2)) for the costs incurred by such Centers 
        in carrying out activities under contracts entered into under 
        section 3305(a)(2)--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $2,500,000;
                    ``(B) for fiscal year 2012, $10,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all 
                items; United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(5) Research regarding certain health conditions.--For 
        the purpose of carrying out section 3341--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $3,750,000;
                    ``(B) for fiscal year 2012, $15,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all 
                items; United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.
            ``(6) World trade center health registry.--For the purpose 
        of carrying out section 3342--
                    ``(A) for the last calendar quarter of fiscal year 
                2011, $1,750,000;
                    ``(B) for fiscal year 2012, $7,000,000; and
                    ``(C) for each subsequent fiscal year, the amount 
                specified under this paragraph for the previous fiscal 
                year increased by the percentage increase in the 
                consumer price index for all urban consumers (all 
                items; United States city average) as estimated by the 
                Secretary for the 12-month period ending with March of 
                the previous year.''.

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

SEC. 201. DEFINITIONS.

    Section 402 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) in paragraph (6) by inserting ``, or debris removal, 
        including under the World Trade Center Health Program 
        established under section 3001 of the Public Health Service 
        Act, and payments made pursuant to the settlement of a civil 
        action described in section 405(c)(3)(C)(iii)'' after 
        ``September 11, 2001'';
            (2) by inserting after paragraph (6) the following new 
        paragraphs and redesignating subsequent paragraphs accordingly:
            ``(7) Contractor and subcontractor.--The term `contractor 
        and subcontractor' means any contractor or subcontractor (at 
        any tier of a subcontracting relationship), including any 
        general contractor, construction manager, prime contractor, 
        consultant, or any parent, subsidiary, associated or allied 
        company, affiliated company, corporation, firm, organization, 
        or joint venture thereof that participated in debris removal at 
        any 9/11 crash site. Such term shall not include any entity, 
        including the Port Authority of New York and New Jersey, with a 
        property interest in the World Trade Center, on September 11, 
        2001, whether fee simple, leasehold or easement, direct or 
        indirect.
            ``(8) Debris removal.--The term `debris removal' means 
        rescue and recovery efforts, removal of debris, cleanup, 
        remediation, and response during the immediate aftermath of the 
        terrorist-related aircraft crashes of September 11, 2001, with 
        respect to a 9/11 crash site.'';
            (3) by inserting after paragraph (10), as so redesignated, 
        the following new paragraph and redesignating the subsequent 
        paragraphs accordingly:
            ``(11) Immediate aftermath.--The term `immediate aftermath' 
        means any period beginning with the terrorist-related aircraft 
        crashes of September 11, 2001, and ending on May 30, 2002.''; 
        and
            (4) by adding at the end the following new paragraph:
            ``(14) 9/11 crash site.--The term `9/11 crash site' means--
                    ``(A) the World Trade Center site, Pentagon site, 
                and Shanksville, Pennsylvania site;
                    ``(B) the buildings or portions of buildings that 
                were destroyed as a result of the terrorist-related 
                aircraft crashes of September 11, 2001;
                    ``(C) any area contiguous to a site of such crashes 
                that the Special Master determines was sufficiently 
                close to the site that there was a demonstrable risk of 
                physical harm resulting from the impact of the aircraft 
                or any subsequent fire, explosions, or building 
                collapses (including the immediate area in which the 
                impact occurred, fire occurred, portions of buildings 
                fell, or debris fell upon and injured individuals); and
                    ``(D) any area related to, or along, routes of 
                debris removal, such as barges and Fresh Kills.''.

SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.

    (a) Information on Losses Resulting From Debris Removal Included in 
Contents of Claim Form.--Section 405(a)(2)(B) of the Air Transportation 
Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) in clause (i), by inserting ``, or debris removal 
        during the immediate aftermath'' after ``September 11, 2001'';
            (2) in clause (ii), by inserting ``or debris removal during 
        the immediate aftermath'' after ``crashes''; and
            (3) in clause (iii), by inserting ``or debris removal 
        during the immediate aftermath'' after ``crashes''.
    (b) Extension of Deadline for Claims Under September 11th Victim 
Compensation Fund of 2001.--Section 405(a)(3) of such Act is amended to 
read as follows:
            ``(3) Limitation.--
                    ``(A) In general.--Except as provided by 
                subparagraph (B), no claim may be filed under paragraph 
                (1) after the date that is 2 years after the date on 
                which regulations are promulgated under section 407(a).
                    ``(B) Exception.--A claim may be filed under 
                paragraph (1), in accordance with subsection 
                (c)(3)(A)(i), by an individual (or by a personal 
                representative on behalf of a deceased individual) 
                during the period beginning on the date on which the 
                regulations are updated under section 407(b) and ending 
                on the date that is 5 years after the date on which 
                such regulations are updated.''.
    (c) Requirements for Filing Claims During Extended Filing Period.--
Section 405(c)(3) of such Act is amended--
            (1) by redesignating subparagraphs (A) and (B) as 
        subparagraphs (B) and (C), respectively; and
            (2) by inserting before subparagraph (B), as so 
        redesignated, the following new subparagraph:
                    ``(A) Requirements for filing claims during 
                extended filing period.--
                            ``(i) Timing requirements for filing 
                        claims.--An individual (or a personal 
                        representative on behalf of a deceased 
                        individual) may file a claim during the period 
                        described in subsection (a)(3)(B) as follows:
                                    ``(I) In the case that the Special 
                                Master determines the individual knew 
                                (or reasonably should have known) 
                                before the date specified in clause 
                                (iii) that the individual suffered a 
                                physical harm at a 9/11 crash site as a 
                                result of the terrorist-related 
                                aircraft crashes of September 11, 2001, 
                                or as a result of debris removal, and 
                                that the individual knew (or should 
                                have known) before such specified date 
                                that the individual was eligible to 
                                file a claim under this title, the 
                                individual may file a claim not later 
                                than the date that is 2 years after 
                                such specified date.
                                    ``(II) In the case that the Special 
                                Master determines the individual first 
                                knew (or reasonably should have known) 
                                on or after the date specified in 
                                clause (iii) that the individual 
                                suffered such a physical harm or that 
                                the individual first knew (or should 
                                have known) on or after such specified 
                                date that the individual was eligible 
                                to file a claim under this title, the 
                                individual may file a claim not later 
                                than the last day of the 2-year period 
                                beginning on the date the Special 
                                Master determines the individual first 
                                knew (or should have known) that the 
                                individual both suffered from such harm 
                                and was eligible to file a claim under 
                                this title.
                            ``(ii) Other eligibility requirements for 
                        filing claims.--An individual may file a claim 
                        during the period described in subsection 
                        (a)(3)(B) only if--
                                    ``(I) the individual was treated by 
                                a medical professional for suffering 
                                from a physical harm described in 
                                clause (i)(I) within a reasonable time 
                                from the date of discovering such harm; 
                                and
                                    ``(II) the individual's physical 
                                harm is verified by contemporaneous 
                                medical records created by or at the 
                                direction of the medical professional 
                                who provided the medical care.
                            ``(iii) Date specified.--The date specified 
                        in this clause is the date on which the 
                        regulations are updated under section 
                        407(a).''.
    (d) Clarifying Applicability to All 9/11 Crash Sites.--Section 
405(c)(2)(A)(i) of such Act is amended by striking ``or the site of the 
aircraft crash at Shanksville, Pennsylvania'' and inserting ``the site 
of the aircraft crash at Shanksville, Pennsylvania, or any other 9/11 
crash site''.
    (e) Inclusion of Physical Harm Resulting From Debris Removal.--
Section 405(c) of such Act is amended in paragraph (2)(A)(ii), by 
inserting ``or debris removal'' after ``air crash''.
    (f) Limitations on Civil Actions.--
            (1) Application to damages related to debris removal.--
        Clause (i) of section 405(c)(3)(C) of such Act, as redesignated 
        by subsection (c), is amended by inserting ``, or for damages 
        arising from or related to debris removal'' after ``September 
        11, 2001''.
            (2) Pending actions.--Clause (ii) of such section, as so 
        redesignated, is amended to read as follows:
                            ``(ii) Pending actions.--In the case of an 
                        individual who is a party to a civil action 
                        described in clause (i), such individual may 
                        not submit a claim under this title--
                                    ``(I) during the period described 
                                in subsection (a)(3)(A) unless such 
                                individual withdraws from such action 
                                by the date that is 90 days after the 
                                date on which regulations are 
                                promulgated under section 407(a); and
                                    ``(II) during the period described 
                                in subsection (a)(3)(B) unless such 
                                individual withdraws from such action 
                                by the date that is 90 days after the 
                                date on which the regulations are 
                                updated under section 407(b).''.
            (3) Settled actions.--Such section, as so redesignated, is 
        further amended by adding at the end the following new clause:
                            ``(iii) Settled actions.--In the case of an 
                        individual who settled a civil action described 
                        in clause (i), such individual may not submit a 
                        claim under this title unless such action was 
                        commenced after December 22, 2003, and a 
                        release of all claims in such action was 
                        tendered prior to the date on which the James 
                        Zadroga 9/11 Health and Compensation Act of 
                        2010 was enacted.''.

SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.

    Section 407 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) by striking ``Not later than'' and inserting ``(a) In 
        General.--Not later than''; and
            (2) by adding at the end the following new subsection:
    ``(b) Updated Regulations.--Not later than 180 days after the date 
of the enactment of the James Zadroga 9/11 Health and Compensation Act 
of 2010, the Special Master shall update the regulations promulgated 
under subsection (a) to the extent necessary to comply with the 
provisions of title II of such Act.''.

SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.

    Section 408(a) of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended by adding at the 
end the following new paragraphs:
            ``(4) Liability for certain claims.--Notwithstanding any 
        other provision of law, liability for all claims and actions 
        (including claims or actions that have been previously 
        resolved, that are currently pending, and that may be filed) 
        for compensatory damages, contribution or indemnity, or any 
        other form or type of relief, arising from or related to debris 
        removal, against the City of New York, any entity (including 
        the Port Authority of New York and New Jersey) with a property 
        interest in the World Trade Center on September 11, 2001 
        (whether fee simple, leasehold or easement, or direct or 
        indirect) and any contractors and subcontractors, shall not be 
        in an amount that exceeds the sum of the following, as may be 
        applicable:
                    ``(A) The amount of funds of the WTC Captive 
                Insurance Company, including the cumulative interest.
                    ``(B) The amount of all available insurance 
                identified in schedule 2 of the WTC Captive Insurance 
                Company insurance policy.
                    ``(C) As it relates to the limitation of liability 
                of the City of New York, the amount that is the greater 
                of the City of New York's insurance coverage or 
                $350,000,000. In determining the amount of the City's 
                insurance coverage for purposes of the previous 
                sentence, any amount described in subparagraphs (A) and 
                (B) shall not be included.
                    ``(D) As it relates to the limitation of liability 
                of any entity, including the Port Authority of New York 
                and New Jersey, with a property interest in the World 
                Trade Center on September 11, 2001 (whether fee simple, 
                leasehold or easement, or direct or indirect), the 
                amount of all available liability insurance coverage 
                maintained by any such entity.
                    ``(E) As it relates to the limitation of liability 
                of any individual contractor or subcontractor, the 
                amount of all available liability insurance coverage 
                maintained by such contractor or subcontractor on 
                September 11, 2001.
            ``(5) Priority of claims payments.--Payments to plaintiffs 
        who obtain a settlement or judgment with respect to a claim or 
        action to which paragraph (4) applies, shall be paid solely 
        from the following funds in the following order, as may be 
        applicable:
                    ``(A) The funds described in subparagraph (A) or 
                (B) of paragraph (4).
                    ``(B) If there are no funds available as described 
                in subparagraph (A) or (B) of paragraph (4), the funds 
                described in subparagraph (C) of such paragraph.
                    ``(C) If there are no funds available as described 
                in subparagraph (A), (B), or (C) of paragraph (4), the 
                funds described in subparagraph (D) of such paragraph.
                    ``(D) If there are no funds available as described 
                in subparagraph (A), (B), (C), or (D) of paragraph (4), 
                the funds described in subparagraph (E) of such 
                paragraph.
            ``(6) Declaratory judgment actions and direct action.--Any 
        claimant to a claim or action to which paragraph (4) applies 
        may, with respect to such claim or action, either file an 
        action for a declaratory judgment for insurance coverage or 
        bring a direct action against the insurance company involved, 
        except that no such action for declaratory judgment or direct 
        action may be commenced until after the funds available in 
        subparagraph (A), (B), (C), and (D) of paragraph (5) have been 
        exhausted consistent with the order described in such paragraph 
        for payment.''.

SEC. 205. FUNDING; ATTORNEY FEES.

    Section 406 of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended--
            (1) in subsection (a), by striking ``Not later than'' and 
        inserting ``Subject to the limitations under subsection (d), 
        not later than'';
            (2) in subsection (b)--
                    (A) by inserting ``in the amounts provided under 
                subsection (d)(1)'' after ``appropriations Acts''; and
                    (B) by inserting ``subject to the limitations under 
                subsection (d)'' before the period; and
            (3) by adding at the end the following new subsections:
    ``(d) Limitation.--
            ``(1) In general.--The total amount of Federal funds paid 
        for compensation under this title, with respect to claims filed 
        on or after the date on which the regulations are updated under 
        section 407(b), shall not exceed $2,775,000,000. Of such 
        amounts, not to exceed $875,000,000 shall be available to pay 
        such claims during the 5-year period beginning on such date.
            ``(2) Pro-ration and payment of remaining claims.--
                    ``(A) In general.--The Special Master shall ratably 
                reduce the amount of compensation due claimants under 
                this title in a manner to ensure, to the extent 
                possible, that--
                            ``(i) all claimants who, before application 
                        of the limitation under the second sentence of 
                        paragraph (1), would have been determined to be 
                        entitled to a payment under this title during 
                        such 5-year period, receive a payment during 
                        such period; and
                            ``(ii) the total amount of all such 
                        payments made during such 5-year period do not 
                        exceed the amount available under the second 
                        sentence of paragraph (1) to pay claims during 
                        such period.
                    ``(B) Payment of remainder of claim amounts.--In 
                any case in which the amount of a claim is ratably 
                reduced pursuant to subparagraph (A), on or after the 
                first day after the 5-year period described in 
                paragraph (1), but in no event later than 1 year after 
                such 5-year period, the Special Master shall pay to the 
                claimant the amount that is equal to the difference 
                between--
                            ``(i) the amount that the claimant would 
                        have been paid under this title during such 
                        period without regard to the limitation under 
                        the second sentence of paragraph (1) applicable 
                        to such period; and
                            ``(ii) the amount the claimant was paid 
                        under this title during such period.
                    ``(C) Termination.--Upon completion of all payments 
                pursuant to this subsection, the Victim's Compensation 
                Fund shall be permanently closed.
    ``(e) Attorney Fees.--
            ``(1) In general.--Notwithstanding any contract, the 
        representative of an individual may not charge, for services 
        rendered in connection with the claim of an individual under 
        this title, more than 10 percent of an award made under this 
        title on such claim.
            ``(2) Limitation.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), in the case of an individual who was 
                charged a legal fee in connection with the settlement 
                of a civil action described in section 
                405(c)(3)(C)(iii), the representative of the individual 
                may not charge any amount for compensation for services 
                rendered in connection with a claim filed under this 
                title.
                    ``(B) Exception.--If the legal fee charged in 
                connection with the settlement of a civil action 
                described in section 405(c)(3)(C)(iii) of an individual 
                is less than 10 percent of the aggregate amount of 
                compensation awarded to such individual through such 
                settlement, the representative of such individual may 
                charge an amount for compensation for services rendered 
                to the extent that such amount charged is not more 
                than--
                            ``(i) 10 percent of such aggregate amount 
                        through the settlement, minus
                            ``(ii) the total amount of all legal fees 
                        charged for services rendered in connection 
                        with such settlement.
            ``(3) Discretion to lower fee.--In the event that the 
        special master finds that the fee limit set by paragraph (1) or 
        (2) provides excessive compensation for services rendered in 
        connection with such claim, the Special Master may, in the 
        discretion of the Special Master, award as reasonable 
        compensation for services rendered an amount lesser than that 
        permitted for in paragraph (1).''.

                 TITLE III--REVENUE RELATED PROVISIONS

SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCUREMENT.

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

                   ``CHAPTER 50--FOREIGN PROCUREMENT

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

``SEC. 5000C. IMPOSITION OF TAX ON CERTAIN FOREIGN PROCUREMENT.

    ``(a) Imposition of Tax.--There is hereby imposed on any foreign 
person that receives a specified Federal procurement payment a tax 
equal to 2 percent of the amount of such specified Federal procurement 
payment.
    ``(b) Specified Federal Procurement Payment.--For purposes of this 
section, the term `specified Federal procurement payment' means any 
payment made pursuant to a contract with the Government of the United 
States for--
            ``(1) the provision of goods, if such goods are 
        manufactured or produced in any country which is not a party to 
        an international procurement agreement with the United States, 
        or
            ``(2) the provision of services, if such services are 
        provided in any country which is not a party to an 
        international procurement agreement with the United States.
    ``(c) Foreign Person.--For purposes of this section, the term 
`foreign person' means any person other than a United States person.
    ``(d) Administrative Provisions.--
            ``(1) Withholding.--The amount deducted and withheld under 
        chapter 3 shall be increased by the amount of tax imposed by 
        this section on such payment.
            ``(2) Other administrative provisions.--For purposes of 
        subtitle F, any tax imposed by this section shall be treated as 
        a tax imposed by subtitle A.''.
            (2) Clerical amendment.--The table of chapters for subtitle 
        D of the Internal Revenue Code of 1986 is amended by adding at 
        the end the following new item:

                  ``Chapter 50--Foreign Procurement''.

            (3) Effective date.--The amendments made by this subsection 
        shall apply to payments received pursuant to contracts entered 
        into on and after the date of the enactment of this Act.
    (b) Prohibition on Reimbursement of Fees.--
            (1) In general.--The head of each executive agency shall 
        take any and all measures necessary to ensure that no funds are 
        disbursed to any foreign contractor in order to reimburse the 
        tax imposed under section 5000C of the Internal Revenue Code of 
        1986.
            (2) Annual review.--The Administrator for Federal 
        Procurement Policy shall annually review the contracting 
        activities of each executive agency to monitor compliance with 
        the requirements of paragraph (1).
            (3) Executive agency.--For purposes of this subsection, the 
        term ``executive agency'' has the meaning given the term in 
        section 4 of the Office of Federal Procurement Policy Act (41 
        U.S.C. 403).
    (c) Application.--This section and the amendments made by this 
section shall be applied in a manner consistent with United States 
obligations under international agreements.

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

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

                      TITLE IV--BUDGETARY EFFECTS

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

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

            Attest:

                                                             Secretary.
111th CONGRESS

  2d Session

                                H.R. 847

_______________________________________________________________________

                               AMENDMENT
```