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: 

1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

4 2010’’. 

5 (b) TABLE OF CONTENTS.—The table of contents of this 

6 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. 
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‘‘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. 
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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. 

1 TITLE I—WORLD TRADE CENTER 

2 HEALTH PROGRAM 

3 SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 

4 The Public Health Service Act is amended by adding 

5 at the end the following new title: 

6 ‘‘TITLE XXXIII—WORLD TRADE 

7 CENTER HEALTH PROGRAM 

8 ‘‘Subtitle A—Establishment of 

9 Program; Advisory Committee 

10 ‘‘SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER 

11 HEALTH PROGRAM. 

12 ‘‘(a) IN GENERAL.—There is hereby established within 

13 the Department of Health and Human Services a program 

14 to be known as the World Trade Center Health Program, 

15 which shall be administered by the WTC Program Adminis16 trator, to provide beginning on July 1, 2011— 

17 ‘‘(1) medical monitoring and treatment benefits 

18 to eligible emergency responders and recovery and 

19 cleanup workers (including those who are Federal em20 ployees) who responded to the September 11, 2001, 

21 terrorist attacks; and 

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

23 treatment benefits to residents and other building oc-
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1 cupants and area workers in New York City who were 

2 directly impacted and adversely affected by such at3 tacks. 

4 ‘‘(b) COMPONENTS OF PROGRAM.—The WTC Program 

5 includes the following components: 

6 ‘‘(1) MEDICAL MONITORING FOR RESPONDERS.— 

7 Medical monitoring under section 3311, including 

8 clinical examinations and long-term health moni9 toring and analysis for enrolled WTC responders who 

10 were likely to have been exposed to airborne toxins 

11 that were released, or to other hazards, as a result of 

12 the September 11, 2001, terrorist attacks. 

13 ‘‘(2) INITIAL HEALTH EVALUATION FOR SUR14 VIVORS.—An initial health evaluation under section 

15 3321, including an evaluation to determine eligibility 

16 for followup monitoring and treatment. 

17 ‘‘(3) FOLLOWUP MONITORING AND TREATMENT

18 FOR WTC-RELATED HEALTH CONDITIONS FOR RE19 SPONDERS AND SURVIVORS.—Provision under sections 

20 3312, 3322, and 3323 of followup monitoring and 

21 treatment and payment, subject to the provisions of 

22 subsection (d), for all medically necessary health and 

23 mental health care expenses of an individual with re24 spect to a WTC-related health condition (including 

25 necessary prescription drugs). 
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1 ‘‘(4) OUTREACH.—Establishment under section 

2 3303 of an education and outreach program to poten3 tially eligible individuals concerning the benefits 

4 under this title. 

5 ‘‘(5) CLINICAL DATA COLLECTION AND ANAL6 YSIS.—Collection and analysis under section 3304 of 

7 health and mental health data relating to individuals 

8 receiving monitoring or treatment benefits in a uni9 form manner in collaboration with the collection of 

10 epidemiological data under section 3342. 

11 ‘‘(6) RESEARCH ON HEALTH CONDITIONS.—Es12 tablishment under subtitle C of a research program on 

13 health conditions resulting from the September 11, 

14 2001, terrorist attacks. 

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

16 benefits and initial health evaluation benefits are provided 

17 under subtitle B without any deductibles, copayments, or 

18 other cost sharing to an enrolled WTC responder or cer19 tified-eligible WTC survivor. Initial health evaluation bene20 fits are provided under subtitle B without any deductibles, 

21 copayments, or other cost sharing to a screening-eligible 

22 WTC survivor. 

23 ‘‘(d) PREVENTING FRAUD AND UNREASONABLE AD24 MINISTRATIVE COSTS.— 
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1 ‘‘(1) FRAUD.—The Inspector General of the De2 partment of Health and Human Services shall de3 velop and implement a program to review the WTC 

4 Program’s health care expenditures to detect fraudu5 lent or duplicate billing and payment for inappro6 priate services. This title is a Federal health care pro7 gram (as defined in section 1128B(f) of the Social Se8 curity Act) and is a health plan (as defined in section 

9 1128C(c) of such Act) for purposes of applying sec10 tions 1128 through 1128E of such Act. 

11 ‘‘(2) UNREASONABLE ADMINISTRATIVE COSTS.— 

12 The Inspector General of the Department of Health 

13 and Human Services shall develop and implement a 

14 program to review the WTC Program for unreason15 able administrative costs, including with respect to 

16 infrastructure, administration, and claims processing. 

17 ‘‘(e) QUALITY ASSURANCE.—The WTC Program Ad18 ministrator working with the Clinical Centers of Excellence 

19 shall develop and implement a quality assurance program 

20 for the monitoring and treatment delivered by such Centers 

21 of Excellence and any other participating health care pro22 viders. Such program shall include— 

23 ‘‘(1) adherence to monitoring and treatment pro24 tocols; 
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1 ‘‘(2) appropriate diagnostic and treatment refer2 rals for participants; 

3 ‘‘(3) prompt communication of test results to 

4 participants; and 

5 ‘‘(4) such other elements as the Administrator 

6 specifies in consultation with the Clinical Centers of 

7 Excellence. 

8 ‘‘(f) ANNUAL PROGRAM REPORT.— 

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

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

11 Program is in operation, the WTC Program Adminis12 trator shall submit an annual report to the Congress 

13 on the operations of this title for such fiscal year and 

14 for the entire period of operation of the program. 

15 ‘‘(2) CONTENTS INCLUDED IN REPORT.—Each 

16 annual report under paragraph (1) shall include at 

17 least the following: 

18 ‘‘(A) ELIGIBLE INDIVIDUALS.—Information 

19 for each clinical program described in paragraph 

20 (3)— 

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

22 applied for certification under subtitle B 

23 and the number of such individuals who 

24 were so certified; 
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1 ‘‘(ii) of the individuals who were cer2 tified, on the number who received moni3 toring under the program and the number 

4 of such individuals who received medical 

5 treatment under the program; 

6 ‘‘(iii) with respect to individuals so 

7 certified who received such treatment, on the 

8 WTC-related health conditions for which 

9 they were treated; and 

10 ‘‘(iv) on the projected number of indi11 viduals who will be certified under subtitle 

12 B in the succeeding fiscal year and the suc13 ceeding 10-year period. 

14 ‘‘(B) MONITORING, INITIAL HEALTH EVAL15 UATION, AND TREATMENT COSTS.—For each clin16 ical program so described— 

17 ‘‘(i) information on the costs of moni18 toring and initial health evaluation and the 

19 costs of treatment and on the estimated 

20 costs of such monitoring, evaluation, and 

21 treatment in the succeeding fiscal year; and 

22 ‘‘(ii) an estimate of the cost of medical 

23 treatment for WTC-related health conditions 

24 that have been paid for or reimbursed by 

25 workers’ compensation, by public or private 
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1 health plans, or by New York City under 

2 section 3331. 

3 ‘‘(C) ADMINISTRATIVE COSTS.—Information 

4 on the cost of administering the program, includ5 ing costs of program support, data collection and 

6 analysis, and research conducted under the pro7 gram. 

8 ‘‘(D) ADMINISTRATIVE EXPERIENCE.—In9 formation on the administrative performance of 

10 the program, including— 

11 ‘‘(i) the performance of the program in 

12 providing timely evaluation of and treat13 ment to eligible individuals; and 

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

15 Excellence and other providers that are par16 ticipating in the program. 

17 ‘‘(E) SCIENTIFIC REPORTS.—A summary of 

18 the findings of any new scientific reports or 

19 studies on the health effects associated with expo20 sure described in section 3306(1), including the 

21 findings of research conducted under section 

22 3341(a). 

23 ‘‘(F) ADVISORY COMMITTEE RECOMMENDA24 TIONS.—A list of recommendations by the WTC 

25 Scientific/Technical Advisory Committee on ad-
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1 ditional WTC Program eligibility criteria and 

2 on additional WTC-related health conditions and 

3 the action of the WTC Program Administrator 

4 concerning each such recommendation. 

5 ‘‘(3) SEPARATE CLINICAL PROGRAMS DE6 SCRIBED.—In paragraph (2), each of the following 

7 shall be treated as a separate clinical program of the 

8 WTC Program: 

9 ‘‘(A) FIREFIGHTERS AND RELATED PER10 SONNEL.—The benefits provided for enrolled 

11 WTC responders described in section 

12 3311(a)(2)(A). 

13 ‘‘(B) OTHER WTC RESPONDERS.—The bene14 fits provided for enrolled WTC responders not de15 scribed in subparagraph (A). 

16 ‘‘(C) WTC SURVIVORS.—The benefits pro17 vided for screening-eligible WTC survivors and 

18 certified-eligible WTC survivors in section 

19 3321(a). 

20 ‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING 80 

21 PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The Sec22 retary shall promptly notify the Congress of each of the fol23 lowing: 
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1 ‘‘(1) When the number of enrollments of WTC re2 sponders subject to the limit established under section 

3 3311(a)(4) has reached 80 percent of such limit. 

4 ‘‘(2) When the number of certifications for cer5 tified-eligible WTC survivors subject to the limit es6 tablished under section 3321(a)(3) has reached 80 

7 percent of such limit. 

8 ‘‘(h) CONSULTATION.—The WTC Program Adminis9 trator shall engage in ongoing outreach and consultation 

10 with relevant stakeholders, including the WTC Health Pro11 gram Steering Committees and the Advisory Committee 

12 under section 3302, regarding the implementation and im13 provement of programs under this title. 

14 ‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL 

15 ADVISORY COMMITTEE; WTC HEALTH PRO16 GRAM STEERING COMMITTEES. 

17 ‘‘(a) ADVISORY COMMITTEE.— 

18 ‘‘(1) ESTABLISHMENT.—The WTC Program Ad19 ministrator shall establish an advisory committee to 

20 be known as the WTC Health Program Scientific/ 

21 Technical Advisory Committee (in this subsection re22 ferred to as the ‘Advisory Committee’) to review sci23 entific and medical evidence and to make rec24 ommendations to the Administrator on additional 
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1 WTC Program eligibility criteria and on additional 

2 WTC-related health conditions. 

3 ‘‘(2) COMPOSITION.—The WTC Program Admin4 istrator shall appoint the members of the Advisory 

5 Committee and shall include at least— 

6 ‘‘(A) 4 occupational physicians, at least 2 

7 of whom have experience treating WTC rescue 

8 and recovery workers; 

9 ‘‘(B) 1 physician with expertise in pul10 monary medicine; 

11 ‘‘(C) 2 environmental medicine or environ12 mental health specialists; 

13 ‘‘(D) 2 representatives of WTC responders; 

14 ‘‘(E) 2 representatives of certified-eligible 

15 WTC survivors; 

16 ‘‘(F) an industrial hygienist; 

17 ‘‘(G) a toxicologist; 

18 ‘‘(H) an epidemiologist; and 

19 ‘‘(I) a mental health professional. 

20 ‘‘(3) MEETINGS.—The Advisory Committee shall 

21 meet at such frequency as may be required to carry 

22 out its duties. 

23 ‘‘(4) REPORTS.—The WTC Program Adminis24 trator shall provide for publication of recommenda-
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1 tions of the Advisory Committee on the public Web 

2 site established for the WTC Program. 

3 ‘‘(5) DURATION.—Notwithstanding any other 

4 provision of law, the Advisory Committee shall con5 tinue in operation during the period in which the 

6 WTC Program is in operation. 

7 ‘‘(6) APPLICATION OF FACA.—Except as other8 wise specifically provided, the Advisory Committee 

9 shall be subject to the Federal Advisory Committee 

10 Act. 

11 ‘‘(b) WTC HEALTH PROGRAM STEERING COMMIT12 TEES.— 

13 ‘‘(1) CONSULTATION.—The WTC Program Ad14 ministrator shall consult with 2 steering committees 

15 (each in this section referred to as a ‘Steering Com16 mittee’) that are established as follows: 

17 ‘‘(A) WTC RESPONDERS STEERING COM18 MITTEE.—One Steering Committee, to be known 

19 as the WTC Responders Steering Committee, for 

20 the purpose of receiving input from affected 

21 stakeholders and facilitating the coordination of 

22 monitoring and treatment programs for the en23 rolled WTC responders under part 1 of subtitle 

24 B. 
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1 ‘‘(B) WTC SURVIVORS STEERING COM2 MITTEE.—One Steering Committee, to be known 

3 as the WTC Survivors Steering Committee, for 

4 the purpose of receiving input from affected 

5 stakeholders and facilitating the coordination of 

6 initial health evaluations, monitoring, and treat7 ment programs for screening-eligible and cer8 tified-eligible WTC survivors under part 2 of 

9 subtitle B. 

10 ‘‘(2) MEMBERSHIP.— 

11 ‘‘(A) WTC RESPONDERS STEERING COM12 MITTEE.— 

13 ‘‘(i) REPRESENTATION.—The WTC Re14 sponders Steering Committee shall in15 clude— 

16 ‘‘(I) representatives of the Centers 

17 of Excellence providing services to 

18 WTC responders; 

19 ‘‘(II) representatives of labor or20 ganizations representing firefighters, 

21 police, other New York City employees, 

22 and recovery and cleanup workers who 

23 responded to the September 11, 2001, 

24 terrorist attacks; and 
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1 ‘‘(III) 3 representatives of New 

2 York City, 1 of whom will be selected 

3 by the police commissioner of New 

4 York City, 1 by the health commis5 sioner of New York City, and 1 by the 

6 mayor of New York City. 

7 ‘‘(ii) INITIAL MEMBERSHIP.—The WTC 

8 Responders Steering Committee shall ini9 tially be composed of members of the WTC 

10 Monitoring and Treatment Program Steer11 ing Committee (as in existence on the day 

12 before the date of the enactment of this 

13 title). 

14 ‘‘(B) WTC SURVIVORS STEERING COM15 MITTEE.— 

16 ‘‘(i) REPRESENTATION.—The WTC 

17 Survivors Steering Committee shall include 

18 representatives of— 

19 ‘‘(I) the Centers of Excellence pro20 viding services to screening-eligible and 

21 certified-eligible WTC survivors; 

22 ‘‘(II) the population of residents, 

23 students, and area and other workers 

24 affected by the September 11, 2001, ter25 rorist attacks; 
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1 ‘‘(III) screening-eligible and cer2 tified-eligible survivors receiving ini3 tial health evaluations, monitoring, or 

4 treatment under part 2 of subtitle B 

5 and organizations advocating on their 

6 behalf; and 

7 ‘‘(IV) New York City. 

8 ‘‘(ii) INITIAL MEMBERSHIP.—The WTC 

9 Survivors Steering Committee shall ini10 tially be composed of members of the WTC 

11 Environmental Health Center Survivor Ad12 visory Committee (as in existence on the 

13 day before the date of the enactment of this 

14 title). 

15 ‘‘(C) ADDITIONAL APPOINTMENTS.—Each 

16 Steering Committee may recommend, if ap17 proved by a majority of voting members of the 

18 Committee, additional members to the Com19 mittee. 

20 ‘‘(D) VACANCIES.—A vacancy in a Steering 

21 Committee shall be filled by an individual rec22 ommended by the Steering Committee. 

23 ‘‘SEC. 3303. EDUCATION AND OUTREACH. 

24 ‘‘The WTC Program Administrator shall institute a 

25 program that provides education and outreach on the exist-
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1 ence and availability of services under the WTC Program. 

2 The outreach and education program— 

3 ‘‘(1) shall include— 

4 ‘‘(A) the establishment of a public Web site 

5 with information about the WTC Program; 

6 ‘‘(B) meetings with potentially eligible pop7 ulations; 

8 ‘‘(C) development and dissemination of out9 reach materials informing people about the pro10 gram; and 

11 ‘‘(D) the establishment of phone information 

12 services; and 

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

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

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

16 linguistically diverse populations. 

17 ‘‘SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS. 

18 ‘‘(a) IN GENERAL.—The WTC Program Administrator 

19 shall provide for the uniform collection of data, including 

20 claims data (and analysis of data and regular reports to 

21 the Administrator) on the prevalence of WTC-related health 

22 conditions and the identification of new WTC-related health 

23 conditions. Such data shall be collected for all individuals 

24 provided monitoring or treatment benefits under subtitle B 

25 and regardless of their place of residence or Clinical Center 
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1 of Excellence through which the benefits are provided. The 

2 WTC Program Administrator shall provide, through the 

3 Data Centers or otherwise, for the integration of such data 

4 into the monitoring and treatment program activities 

5 under this title. 

6 ‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL7 LENCE.—Each Clinical Center of Excellence shall collect 

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

9 the corresponding Data Center for analysis by such Data 

10 Center. 

11 ‘‘(c) COLLABORATION WITH WTC HEALTH REG12 ISTRY.—The WTC Program Administrator shall provide for 

13 collaboration between the Data Centers and the World 

14 Trade Center Health Registry described in section 3342. 

15 ‘‘(d) PRIVACY.—The data collection and analysis 

16 under this section shall be conducted and maintained in 

17 a manner that protects the confidentiality of individually 

18 identifiable health information consistent with applicable 

19 statutes and regulations, including, as applicable, HIPAA 

20 privacy and security law (as defined in section 3009(a)(2)) 

21 and section 552a of title 5, United States Code. 

22 ‘‘SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA 

23 CENTERS. 

24 ‘‘(a) IN GENERAL.— 
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1 ‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF

2 EXCELLENCE.—The WTC Program Administrator 

3 shall, subject to subsection (b)(1)(B), enter into con4 tracts with Clinical Centers of Excellence (as defined 

5 in subsection (b)(1)(A))— 

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

7 treatment benefits and initial health evaluation 

8 benefits under subtitle B; 

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

10 to individuals eligible for such monitoring and 

11 treatment benefits, for initial health evaluation 

12 benefits, and for followup to individuals who are 

13 enrolled in the monitoring program; 

14 ‘‘(C) for the provision of counseling for ben15 efits under subtitle B, with respect to WTC-re16 lated health conditions, for individuals eligible 

17 for such benefits; 

18 ‘‘(D) for the provision of counseling for ben19 efits for WTC-related health conditions that may 

20 be available under workers’ compensation or 

21 other benefit programs for work-related injuries 

22 or illnesses, health insurance, disability insur23 ance, or other insurance plans or through public 

24 or private social service agencies and assisting 

25 eligible individuals in applying for such benefits; 
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1 ‘‘(E) for the provision of translational and 

2 interpretive services for program participants 

3 who are not English language proficient; and 

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

5 data, including claims data, in accordance with 

6 section 3304. 

7 ‘‘(2) CONTRACTS WITH DATA CENTERS.— 

8 ‘‘(A) IN GENERAL.—The WTC Program Ad9 ministrator shall enter into contracts with one or 

10 more Data Centers (as defined in subsection 

11 (b)(2))— 

12 ‘‘(i) for receiving, analyzing, and re13 porting to the WTC Program Administrator 

14 on data, in accordance with section 3304, 

15 that have been collected and reported to such 

16 Data Centers by the corresponding Clinical 

17 Centers of Excellence under subsection 

18 (b)(1)(B)(iii); 

19 ‘‘(ii) for the development of moni20 toring, initial health evaluation, and treat21 ment protocols, with respect to WTC-related 

22 health conditions; 

23 ‘‘(iii) for coordinating the outreach ac24 tivities conducted under paragraph (1)(B) 
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1 by each corresponding Clinical Center of 

2 Excellence; 

3 ‘‘(iv) for establishing criteria for the 

4 credentialing of medical providers partici5 pating in the nationwide network under 

6 section 3313; 

7 ‘‘(v) for coordinating and admin8 istering the activities of the WTC Health 

9 Program Steering Committees established 

10 under section 3002(b); and 

11 ‘‘(vi) for meeting periodically with the 

12 corresponding Clinical Centers of Excellence 

13 to obtain input on the analysis and report14 ing of data collected under clause (i) and on 

15 the development of monitoring, initial 

16 health evaluation, and treatment protocols 

17 under clause (ii). 

18 ‘‘(B) MEDICAL PROVIDER SELECTION.—The 

19 medical providers under subparagraph (A)(iv) 

20 shall be selected by the WTC Program Adminis21 trator on the basis of their experience treating or 

22 diagnosing the health conditions included in the 

23 list of WTC-related health conditions. 

24 ‘‘(C) CLINICAL DISCUSSIONS.—In carrying 

25 out subparagraph (A)(ii), a Data Center shall 
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1 engage in clinical discussions across the WTC 

2 Program to guide treatment approaches for indi3 viduals with a WTC-related health condition. 

4 ‘‘(D) TRANSPARENCY OF DATA.—A contract 

5 entered into under this subsection with a Data 

6 Center shall require the Data Center to make 

7 any data collected and reported to such Center 

8 under subsection (b)(1)(B)(iii) available to 

9 health researchers and others as provided in the 

10 CDC/ATSDR Policy on Releasing and Sharing 

11 Data. 

12 ‘‘(3) AUTHORITY FOR CONTRACTS TO BE CLASS

13 SPECIFIC.—A contract entered into under this sub14 section with a Clinical Center of Excellence or a Data 

15 Center may be with respect to one or more class of 

16 enrolled WTC responders, screening-eligible WTC sur17 vivors, or certified-eligible WTC survivors. 

18 ‘‘(4) USE OF COOPERATIVE AGREEMENTS.—Any 

19 contract under this title between the WTC Program 

20 Administrator and a Data Center or a Clinical Cen21 ter of Excellence may be in the form of a cooperative 

22 agreement. 

23 ‘‘(5) REVIEW ON FEASIBILITY OF CONSOLIDATING

24 DATA CENTERS.—Not later than July 1, 2011, the 

25 Comptroller General of the United States shall submit 
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1 to the Committee on Energy and Commerce of the 

2 House of Representatives and the Committee on 

3 Health, Education, Labor, and Pensions of the Senate 

4 a report on the feasibility of consolidating Data Cen5 ters into a single Data Center. 

6 ‘‘(b) CENTERS OF EXCELLENCE.— 

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

8 ‘‘(A) DEFINITION.—For purposes of this 

9 title, the term ‘Clinical Center of Excellence’ 

10 means a Center that demonstrates to the satisfac11 tion of the Administrator that the Center— 

12 ‘‘(i) uses an integrated, centralized 

13 health care provider approach to create a 

14 comprehensive suite of health services under 

15 this title that are accessible to enrolled WTC 

16 responders, screening-eligible WTC sur17 vivors, or certified-eligible WTC survivors; 

18 ‘‘(ii) has experience in caring for WTC 

19 responders and screening-eligible WTC sur20 vivors or includes health care providers who 

21 have been trained pursuant to section 

22 3313(c); 

23 ‘‘(iii) employs health care provider 

24 staff with expertise that includes, at a min25 imum, occupational medicine, environ-
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1 mental medicine, trauma-related psychiatry 

2 and psychology, and social services coun3 seling; and 

4 ‘‘(iv) meets such other requirements as 

5 specified by the Administrator. 

6 ‘‘(B) CONTRACT REQUIREMENTS.—The 

7 WTC Program Administrator shall not enter 

8 into a contract with a Clinical Center of Excel9 lence under subsection (a)(1) unless the Center 

10 agrees to do each of the following: 

11 ‘‘(i) Establish a formal mechanism for 

12 consulting with and receiving input from 

13 representatives of eligible populations re14 ceiving monitoring and treatment benefits 

15 under subtitle B from such Center. 

16 ‘‘(ii) Coordinate monitoring and treat17 ment benefits under subtitle B with routine 

18 medical care provided for the treatment of 

19 conditions other than WTC-related health 

20 conditions. 

21 ‘‘(iii) Collect and report to the cor22 responding Data Center data, including 

23 claims data, in accordance with section 

24 3304(b). 
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1 ‘‘(iv) Have in place safeguards against 

2 fraud that are satisfactory to the Adminis3 trator, in consultation with the Inspector 

4 General of the Department of Health and 

5 Human Services. 

6 ‘‘(v) Treat or refer for treatment all in7 dividuals who are enrolled WTC responders 

8 or certified-eligible WTC survivors with re9 spect to such Center who present themselves 

10 for treatment of a WTC-related health con11 dition. 

12 ‘‘(vi) Have in place safeguards, con13 sistent with section 3304(c), to ensure the 

14 confidentiality of an individual’s individ15 ually identifiable health information, in16 cluding requiring that such information not 

17 be disclosed to the individual’s employer 

18 without the authorization of the individual. 

19 ‘‘(vii) Use amounts paid under sub20 section (c)(1) only for costs incurred in car21 rying out the activities described in sub22 section (a), other than those described in 

23 subsection (a)(1)(A). 

24 ‘‘(viii) Utilize health care providers 

25 with occupational and environmental medi-
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1 cine expertise to conduct physical and men2 tal health assessments, in accordance with 

3 protocols developed under subsection 

4 (a)(2)(A)(ii). 

5 ‘‘(ix) Communicate with WTC re6 sponders and screening-eligible and cer7 tified-eligible WTC survivors in appropriate 

8 languages and conduct outreach activities 

9 with relevant stakeholder worker or commu10 nity associations. 

11 ‘‘(x) Meet all the other applicable re12 quirements of this title, including regula13 tions implementing such requirements. 

14 ‘‘(C) TRANSITION RULE TO ENSURE CON15 TINUITY OF CARE.—The WTC Program Admin16 istrator shall to the maximum extent feasible en17 sure continuity of care in any period of transi18 tion from monitoring and treatment of an en19 rolled WTC responder or certified-eligible WTC 

20 survivor by a provider to a Clinical Center of 

21 Excellence or a health care provider partici22 pating in the nationwide network under section 

23 3313. 

24 ‘‘(2) DATA CENTERS.—For purposes of this title, 

25 the term ‘Data Center’ means a Center that the WTC 
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1 Program Administrator determines has the capacity 

2 to carry out the responsibilities for a Data Center 

3 under subsection (a)(2). 

4 ‘‘(3) CORRESPONDING CENTERS.—For purposes 

5 of this title, a Clinical Center of Excellence and a 

6 Data Center shall be treated as ‘corresponding’ to the 

7 extent that such Clinical Center and Data Center 

8 serve the same population group. 

9 ‘‘(c) PAYMENT FOR INFRASTRUCTURE COSTS.— 

10 ‘‘(1) IN GENERAL.—The WTC Program Adminis11 trator shall reimburse a Clinical Center of Excellence 

12 for the fixed infrastructure costs of such Center in 

13 carrying out the activities described in subtitle B at 

14 a rate negotiated by the Administrator and such Cen15 ters. Such negotiated rate shall be fair and appro16 priate and take into account the number of enrolled 

17 WTC responders receiving services from such Center 

18 under this title. 

19 ‘‘(2) FIXED INFRASTRUCTURE COSTS.—For pur20 poses of paragraph (1), the term ‘fixed infrastructure 

21 costs’ means, with respect to a Clinical Center of Ex22 cellence, the costs incurred by such Center that are 

23 not otherwise reimbursable by the WTC Program Ad24 ministrator under section 3312(c) for patient evalua25 tion, monitoring, or treatment but which are needed 
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1 to operate the WTC program such as the costs in2 volved in outreach to participants or recruiting par3 ticipants, data collection and analysis, social services 

4 for counseling patients on other available assistance 

5 outside the WTC program, and the development of 

6 treatment protocols. Such term does not include costs 

7 for new construction or other capital costs. 

8 ‘‘(d) GAO ANALYSIS.—Not later than July 1, 2011, 

9 the Comptroller General shall submit to the Committee on 

10 Energy and Commerce of the House of Representatives and 

11 the Committee on Health, Education, Labor, and Pensions 

12 of the Senate an analysis on whether Clinical Centers of 

13 Excellence with which the WTC Program Administrator en14 ters into a contract under this section have financial sys15 tems that will allow for the timely submission of claims 

16 data for purposes of section 3304 and subsections (a)(1)(F) 

17 and (b)(1)(B)(iii). 

18 ‘‘SEC. 3306. DEFINITIONS. 

19 ‘‘In this title: 

20 ‘‘(1) The term ‘aggravating’ means, with respect 

21 to a health condition, a health condition that existed 

22 on September 11, 2001, and that, as a result of expo23 sure to airborne toxins, any other hazard, or any 

24 other adverse condition resulting from the September 

25 11, 2001, terrorist attacks, requires medical treatment 
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1 that is (or will be) in addition to, more frequent than, 

2 or of longer duration than the medical treatment that 

3 would have been required for such condition in the 

4 absence of such exposure. 

5 ‘‘(2) The term ‘certified-eligible WTC survivor’ 

6 has the meaning given such term in section 

7 3321(a)(2). 

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

9 and ‘Data Center’ have the meanings given such 

10 terms in section 3305. 

11 ‘‘(4) The term ‘enrolled WTC responder’ means a 

12 WTC responder enrolled under section 3311(a)(3). 

13 ‘‘(5) The term ‘initial health evaluation’ in14 cludes, with respect to an individual, a medical and 

15 exposure history, a physical examination, and addi16 tional medical testing as needed to evaluate whether 

17 the individual has a WTC-related health condition 

18 and is eligible for treatment under the WTC Program. 

19 ‘‘(6) The term ‘list of WTC-related health condi20 tions’ means— 

21 ‘‘(A) for WTC responders, the health condi22 tions listed in section 3312(a)(3); and 

23 ‘‘(B) for screening-eligible and certified-eli24 gible WTC survivors, the health conditions listed 

25 in section 3322(b). 
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1 ‘‘(7) The term ‘New York City disaster area’ 

2 means the area within New York City that is— 

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

4 Houston Street; and 

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

6 or partially contained within a 1.5-mile radius 

7 of the former World Trade Center site. 

8 ‘‘(8) The term ‘New York metropolitan area’ 

9 means an area, specified by the WTC Program Ad10 ministrator, within which WTC responders and eligi11 ble WTC screening-eligible survivors who reside in 

12 such area are reasonably able to access monitoring 

13 and treatment benefits and initial health evaluation 

14 benefits under this title through a Clinical Center of 

15 Excellence described in subparagraphs (A), (B), or 

16 (C) of section 3305(b)(1). 

17 ‘‘(9) The term ‘screening-eligible WTC survivor’ 

18 has the meaning given such term in section 

19 3321(a)(1). 

20 ‘‘(10) Any reference to ‘September 11, 2001’ shall 

21 be deemed a reference to the period on such date sub22 sequent to the terrorist attacks at the World Trade 

23 Center, Shanksville, Pennsylvania, or the Pentagon, 

24 as applicable, on such date. 
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1 ‘‘(11) The term ‘September 11, 2001, terrorist at2 tacks’ means the terrorist attacks that occurred on 

3 September 11, 2001, in New York City, in 

4 Shanksville, Pennsylvania, and at the Pentagon, and 

5 includes the aftermath of such attacks. 

6 ‘‘(12) The term ‘WTC Health Program Steering 

7 Committee’ means such a Steering Committee estab8 lished under section 3302(b). 

9 ‘‘(13) The term ‘WTC Program’ means the Word 

10 Trade Center Health Program established under sec11 tion 3301(a). 

12 ‘‘(14)(A) The term ‘WTC Program Adminis13 trator’ means— 

14 ‘‘(i) subject to subparagraph (B), with re15 spect to paragraphs (3) and (4) of section 

16 3311(a) (relating to enrollment of WTC respond17 ers), section 3312(c) and the corresponding pro18 visions of section 3322 (relating to payment for 

19 initial health evaluation, monitoring, and treat20 ment, paragraphs (1)(C), (2)(B), and (3) of sec21 tion 3321(a) (relating to determination or cer22 tification of screening-eligible or certified-eligible 

23 WTC responders), and part 3 of subtitle B (re24 lating to payor provisions), an official in the 
32 

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1 Department of Health and Human Services, to 

2 be designated by the Secretary; and 

3 ‘‘(ii) with respect to any other provision of 

4 this title, the Director of the National Institute 

5 for Occupational Safety and Health, or a des6 ignee of such Director. 

7 ‘‘(B) In no case may the Secretary designate 

8 under subparagraph (A)(i) the Director of the Na9 tional Institute for Occupational Safety and Health 

10 or a designee of such Director with respect to section 

11 3322 (relating to payment for initial health evalua12 tion, monitoring, and treatment). 

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

14 defined in section 3312(a). 

15 ‘‘(16) The term ‘WTC responder’ is defined in 

16 section 3311(a). 

17 ‘‘(17) The term ‘WTC Scientific/Technical Advi18 sory Committee’ means such Committee established 

19 under section 3302(a). 
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1 ‘‘Subtitle B—Program of Moni2 toring, Initial Health Evalua3 tions, and Treatment 

4 ‘‘PART 1—WTC RESPONDERS 

5 ‘‘SEC. 3311. IDENTIFICATION OF WTC RESPONDERS AND 

6 PROVISION OF WTC-RELATED MONITORING 

7 SERVICES. 

8 ‘‘(a) WTC RESPONDER DEFINED.— 

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

10 term ‘WTC responder’ means any of the following in11 dividuals, subject to paragraph (4): 

12 ‘‘(A) CURRENTLY IDENTIFIED RE13 SPONDER.—An individual who has been identi14 fied as eligible for monitoring under the arrange15 ments as in effect on the date of the enactment 

16 of this title between the National Institute for 

17 Occupational Safety and Health and— 

18 ‘‘(i) the consortium coordinated by Mt. 

19 Sinai Hospital in New York City that co20 ordinates the monitoring and treatment for 

21 enrolled WTC responders other than with 

22 respect to those covered under the arrange23 ment with the Fire Department of New 

24 York City; or 
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1 ‘‘(ii) the Fire Department of New York 

2 City. 

3 ‘‘(B) RESPONDER WHO MEETS CURRENT

4 ELIGIBILITY CRITERIA.—An individual who 

5 meets the current eligibility criteria described in 

6 paragraph (2). 

7 ‘‘(C) RESPONDER WHO MEETS MODIFIED

8 ELIGIBILITY CRITERIA.—An individual who— 

9 ‘‘(i) performed rescue, recovery, demoli10 tion, debris cleanup, or other related serv11 ices in the New York City disaster area in 

12 response to the September 11, 2001, ter13 rorist attacks, regardless of whether such 

14 services were performed by a State or Fed15 eral employee or member of the National 

16 Guard or otherwise; and 

17 ‘‘(ii) meets such eligibility criteria re18 lating to exposure to airborne toxins, other 

19 hazards, or adverse conditions resulting 

20 from the September 11, 2001, terrorist at21 tacks as the WTC Program Administrator, 

22 after consultation with the WTC Scientific/ 

23 Technical Advisory Committee, determines 

24 appropriate. 
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1 The WTC Program Administrator shall not mod2 ify such eligibility criteria on or after the date 

3 that the number of enrollments of WTC respond4 ers has reached 80 percent of the limit described 

5 in paragraph (4) or on or after the date that the 

6 number of certifications for certified-eligible 

7 WTC survivors under section 3321(a)(2)(B) has 

8 reached 80 percent of the limit described in sec9 tion 3321(a)(3). 

10 ‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eli11 gibility criteria described in this paragraph for an 

12 individual is that the individual is described in any 

13 of the following categories: 

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

16 ‘‘(i) was a member of the Fire Depart17 ment of New York City (whether fire or 

18 emergency personnel, active or retired) who 

19 participated at least one day in the rescue 

20 and recovery effort at any of the former 

21 World Trade Center sites (including Ground 

22 Zero, Staten Island Landfill, and the New 

23 York City Chief Medical Examiner’s Office) 

24 for any time during the period beginning 
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1 on September 11, 2001, and ending on July 

2 31, 2002; or 

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

5 member of the Fire Department of New 

6 York City (whether fire or emergency per7 sonnel, active or retired) and was killed at 

8 the World Trade site on September 11, 

9 2001; and 

10 ‘‘(II) received any treatment for a 

11 WTC-related health condition described in 

12 section 3312(a)(1)(A)(ii) (relating to mental 

13 health conditions) on or before September 1, 

14 2008. 

15 ‘‘(B) LAW ENFORCEMENT OFFICERS AND

16 WTC RESCUE, RECOVERY, AND CLEANUP WORK17 ERS.—The individual— 

18 ‘‘(i) worked or volunteered onsite in 

19 rescue, recovery, debris cleanup, or related 

20 support services in lower Manhattan (south 

21 of Canal St.), the Staten Island Landfill, or 

22 the barge loading piers, for at least 4 hours 

23 during the period beginning on September 

24 11, 2001, and ending on September 14, 

25 2001, for at least 24 hours during the pe-
37 

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1 riod beginning on September 11, 2001, and 

2 ending on September 30, 2001, or for at 

3 least 80 hours during the period beginning 

4 on September 11, 2001, and ending on July 

5 31, 2002; 

6 ‘‘(ii)(I) was a member of the Police De7 partment of New York City (whether active 

8 or retired) or a member of the Port Author9 ity Police of the Port Authority of New York 

10 and New Jersey (whether active or retired) 

11 who participated onsite in rescue, recovery, 

12 debris cleanup, or related services in lower 

13 Manhattan (south of Canal St.), including 

14 Ground Zero, the Staten Island Landfill, or 

15 the barge loading piers, for at least 4 hours 

16 during the period beginning September 11, 

17 2001, and ending on September 14, 2001; 

18 ‘‘(II) participated onsite in rescue, re19 covery, debris cleanup, or related services at 

20 Ground Zero, the Staten Island Landfill, or 

21 the barge loading piers, for at least one day 

22 during the period beginning on September 

23 11, 2001, and ending on July 31, 2002; 

24 ‘‘(III) participated onsite in rescue, re25 covery, debris cleanup, or related services in 
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1 lower Manhattan (south of Canal St.) for at 

2 least 24 hours during the period beginning 

3 on September 11, 2001, and ending on Sep4 tember 30, 2001; or 

5 ‘‘(IV) participated onsite in rescue, re6 covery, debris cleanup, or related services in 

7 lower Manhattan (south of Canal St.) for at 

8 least 80 hours during the period beginning 

9 on September 11, 2001, and ending on July 

10 31, 2002; 

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

12 the Chief Medical Examiner of New York 

13 City involved in the examination and han14 dling of human remains from the World 

15 Trade Center attacks, or other morgue work16 er who performed similar post-September 11 

17 functions for such Office staff, during the 

18 period beginning on September 11, 2001, 

19 and ending on July 31, 2002; 

20 ‘‘(iv) was a worker in the Port Author21 ity Trans-Hudson Corporation Tunnel for 

22 at least 24 hours during the period begin23 ning on February 1, 2002, and ending on 

24 July 1, 2002; or 
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1 ‘‘(v) was a vehicle-maintenance worker 

2 who was exposed to debris from the former 

3 World Trade Center while retrieving, driv4 ing, cleaning, repairing, and maintaining 

5 vehicles contaminated by airborne toxins 

6 from the September 11, 2001, terrorist at7 tacks during a duration and period de8 scribed in subparagraph (A). 

9 ‘‘(C) RESPONDERS TO THE SEPTEMBER 11

10 ATTACKS AT THE PENTAGON AND SHANKSVILLE, 

11 PENNSYLVANIA.—The individual— 

12 ‘‘(i)(I) was a member of a fire or po13 lice department (whether fire or emergency 

14 personnel, active or retired), worked for a 

15 recovery or cleanup contractor, or was a 

16 volunteer; and performed rescue, recovery, 

17 demolition, debris cleanup, or other related 

18 services at the Pentagon site of the terrorist19 related aircraft crash of September 11, 

20 2001, during the period beginning on Sep21 tember 11, 2001, and ending on the date on 

22 which the cleanup of the site was concluded, 

23 as determined by the WTC Program Ad24 ministrator; or 
40 

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1 ‘‘(II) was a member of a fire or police 

2 department (whether fire or emergency per3 sonnel, active or retired), worked for a re4 covery or cleanup contractor, or was a vol5 unteer; and performed rescue, recovery, 

6 demolition, debris cleanup, or other related 

7 services at the Shanksville, Pennsylvania, 

8 site of the terrorist-related aircraft crash of 

9 September 11, 2001, during the period be10 ginning on September 11, 2001, and ending 

11 on the date on which the cleanup of the site 

12 was concluded, as determined by the WTC 

13 Program Administrator; and 

14 ‘‘(ii) is determined by the WTC Pro15 gram Administrator to be at an increased 

16 risk of developing a WTC-related health 

17 condition as a result of exposure to airborne 

18 toxins, other hazards, or adverse conditions 

19 resulting from the September 11, 2001, ter20 rorist attacks, and meets such eligibility cri21 teria related to such exposures, as the WTC 

22 Program Administrator determines are ap23 propriate, after consultation with the WTC 

24 Scientific/Technical Advisory Committee. 

25 ‘‘(3) ENROLLMENT PROCESS.— 
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1 ‘‘(A) IN GENERAL.—The WTC Program Ad2 ministrator shall establish a process for enrolling 

3 WTC responders in the WTC Program. Under 

4 such process— 

5 ‘‘(i) WTC responders described in 

6 paragraph (1)(A) shall be deemed to be en7 rolled in such Program; 

8 ‘‘(ii) subject to clause (iii), the Admin9 istrator shall enroll in such program indi10 viduals who are determined to be WTC re11 sponders; 

12 ‘‘(iii) the Administrator shall deny 

13 such enrollment to an individual if the Ad14 ministrator determines that the numerical 

15 limitation in paragraph (4) on enrollment 

16 of WTC responders has been met; 

17 ‘‘(iv) there shall be no fee charged to 

18 the applicant for making an application for 

19 such enrollment; 

20 ‘‘(v) the Administrator shall make a 

21 determination on such an application not 

22 later than 60 days after the date of filing 

23 the application; and 

24 ‘‘(vi) an individual who is denied en25 rollment in such Program shall have an op-
42 

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1 portunity to appeal such determination in 

2 a manner established under such process. 

3 ‘‘(B) TIMING.— 

4 ‘‘(i) CURRENTLY IDENTIFIED RE5 SPONDERS.—In accordance with subpara6 graph (A)(i), the WTC Program Adminis7 trator shall enroll an individual described 

8 in paragraph (1)(A) in the WTC Program 

9 not later than July 1, 2011. 

10 ‘‘(ii) OTHER RESPONDERS.—In ac11 cordance with subparagraph (A)(ii) and 

12 consistent with paragraph (4), the WTC 

13 Program Administrator shall enroll any 

14 other individual who is determined to be a 

15 WTC responder in the WTC Program at the 

16 time of such determination. 

17 ‘‘(4) NUMERICAL LIMITATION ON ELIGIBLE WTC

18 RESPONDERS.— 

19 ‘‘(A) IN GENERAL.—The total number of in20 dividuals not described in paragraph (1)(A) or 

21 (2)(A)(ii) who may be enrolled under paragraph 

22 (3)(A)(ii) shall not exceed 25,000 at any time, of 

23 which no more than 2,500 may be individuals 

24 enrolled based on modified eligibility criteria es25 tablished under paragraph (1)(C). 
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1 ‘‘(B) PROCESS.—In implementing subpara2 graph (A), the WTC Program Administrator 

3 shall— 

4 ‘‘(i) limit the number of enrollments 

5 made under paragraph (3)— 

6 ‘‘(I) in accordance with such sub7 paragraph; and 

8 ‘‘(II) to such number, as deter9 mined by the Administrator based on 

10 the best available information and sub11 ject to amounts available under section 

12 3351, that will ensure sufficient funds 

13 will be available to provide treatment 

14 and monitoring benefits under this 

15 title, with respect to all individuals 

16 who are enrolled through the end of fis17 cal year 2020; and 

18 ‘‘(ii) provide priority (subject to para19 graph (3)(A)(i)) in such enrollments in the 

20 order in which individuals apply for enroll21 ment under paragraph (3). 

22 ‘‘(5) DISQUALIFICATION OF INDIVIDUALS ON

23 TERRORIST WATCH LIST.—No individual who is on 

24 the terrorist watch list maintained by the Department 

25 of Homeland Security shall qualify as an eligible 
44 

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1 WTC responder. Before enrolling any individual as a 

2 WTC responder in the WTC Program under para3 graph (3), the Administrator, in consultation with the 

4 Secretary of Homeland Security, shall determine 

5 whether the individual is on such list. 

6 ‘‘(b) MONITORING BENEFITS.— 

7 ‘‘(1) IN GENERAL.—In the case of an enrolled 

8 WTC responder (other than one described in sub9 section (a)(2)(A)(ii)), the WTC Program shall provide 

10 for monitoring benefits that include monitoring con11 sistent with protocols approved by the WTC Program 

12 Administrator and including clinical examinations 

13 and long-term health monitoring and analysis. In the 

14 case of an enrolled WTC responder who is an active 

15 member of the Fire Department of New York City, the 

16 responder shall receive such benefits as part of the in17 dividual’s periodic company medical exams. 

18 ‘‘(2) PROVISION OF MONITORING BENEFITS.—The 

19 monitoring benefits under paragraph (1) shall be pro20 vided through the Clinical Center of Excellence for the 

21 type of individual involved or, in the case of an indi22 vidual residing outside the New York metropolitan 

23 area, under an arrangement under section 3313. 
45 

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1 ‘‘SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS 

2 FOR WTC-RELATED HEALTH CONDITIONS. 

3 ‘‘(a) WTC-RELATED HEALTH CONDITION DEFINED.— 

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

5 term ‘WTC-related health condition’ means a condi6 tion that— 

7 ‘‘(A)(i) is an illness or health condition for 

8 which exposure to airborne toxins, any other 

9 hazard, or any other adverse condition resulting 

10 from the September 11, 2001, terrorist attacks, 

11 based on an examination by a medical profes12 sional with experience in treating or diagnosing 

13 the health conditions included in the applicable 

14 list of WTC-related health conditions, is substan15 tially likely to be a significant factor in aggra16 vating, contributing to, or causing the illness or 

17 health condition, as determined under paragraph 

18 (2); or 

19 ‘‘(ii) is a mental health condition for which 

20 such attacks, based on an examination by a med21 ical professional with experience in treating or 

22 diagnosing the health conditions included in the 

23 applicable list of WTC-related health conditions, 

24 is substantially likely to be a significant factor 

25 in aggravating, contributing to, or causing the 
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1 condition, as determined under paragraph (2); 

2 and 

3 ‘‘(B) is included in the applicable list of 

4 WTC-related health conditions or— 

5 ‘‘(i) with respect to a WTC responder, 

6 is provided certification of coverage under 

7 subsection (b)(2)(B)(iii); or 

8 ‘‘(ii) with respect to a screening-eligi9 ble WTC survivor or certified-eligible WTC 

10 survivor, is provided certification of cov11 erage under subsection (b)(2)(B)(iii), as ap12 plied under section 3322(a). 

13 In the case of a WTC responder described in section 

14 3311(a)(2)(A)(ii) (relating to a surviving immediate 

15 family member of a firefighter), such term does not 

16 include an illness or health condition described in 

17 subparagraph (A)(i). 

18 ‘‘(2) DETERMINATION.—The determination 

19 under paragraph (1) or subsection (b) of whether the 

20 September 11, 2001, terrorist attacks were substan21 tially likely to be a significant factor in aggravating, 

22 contributing to, or causing an individual’s illness or 

23 health condition shall be made based on an assess24 ment of the following: 
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1 ‘‘(A) The individual’s exposure to airborne 

2 toxins, any other hazard, or any other adverse 

3 condition resulting from the terrorist attacks. 

4 Such exposure shall be— 

5 ‘‘(i) evaluated and characterized 

6 through the use of a standardized, popu7 lation-appropriate questionnaire approved 

8 by the Director of the National Institute for 

9 Occupational Safety and Health; and 

10 ‘‘(ii) assessed and documented by a 

11 medical professional with experience in 

12 treating or diagnosing health conditions in13 cluded on the list of WTC-related health 

14 conditions. 

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

16 sequence of symptoms. Such symptoms shall be— 

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

18 standardized, population-appropriate med19 ical questionnaire approved by the Director 

20 of the National Institute for Occupational 

21 Safety and Health and a medical examina22 tion; and 

23 ‘‘(ii) diagnosed and documented by a 

24 medical professional described in subpara25 graph (A)(ii). 
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1 ‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC RE2 SPONDERS.—The list of health conditions for WTC re3 sponders consists of the following: 

4 ‘‘(A) AERODIGESTIVE DISORDERS.— 

5 ‘‘(i) Interstitial lung diseases. 

6 ‘‘(ii) Chronic respiratory disorder— 

7 fumes/vapors. 

8 ‘‘(iii) Asthma. 

9 ‘‘(iv) Reactive airways dysfunction 

10 syndrome (RADS). 

11 ‘‘(v) WTC-exacerbated chronic obstruc12 tive pulmonary disease (COPD). 

13 ‘‘(vi) Chronic cough syndrome. 

14 ‘‘(vii) Upper airway hyperreactivity. 

15 ‘‘(viii) Chronic rhinosinusitis. 

16 ‘‘(ix) Chronic nasopharyngitis. 

17 ‘‘(x) Chronic laryngitis. 

18 ‘‘(xi) Gastroesophageal reflux disorder 

19 (GERD). 

20 ‘‘(xii) Sleep apnea exacerbated by or 

21 related to a condition described in a pre22 vious clause. 

23 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

24 ‘‘(i) Posttraumatic stress disorder 

25 (PTSD). 
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1 ‘‘(ii) Major depressive disorder. 

2 ‘‘(iii) Panic disorder. 

3 ‘‘(iv) Generalized anxiety disorder. 

4 ‘‘(v) Anxiety disorder (not otherwise 

5 specified). 

6 ‘‘(vi) Depression (not otherwise speci7 fied). 

8 ‘‘(vii) Acute stress disorder. 

9 ‘‘(viii) Dysthymic disorder. 

10 ‘‘(ix) Adjustment disorder. 

11 ‘‘(x) Substance abuse. 

12 ‘‘(C) MUSCULOSKELETAL DISORDERS FOR

13 CERTAIN WTC RESPONDERS.—In the case of a 

14 WTC responder described in paragraph (4), a 

15 condition described in such paragraph. 

16 ‘‘(D) ADDITIONAL CONDITIONS.—Any can17 cer (or type of cancer) or other condition added, 

18 pursuant to paragraph (5) or (6), to the list 

19 under this paragraph. 

20 ‘‘(4) MUSCULOSKELETAL DISORDERS.— 

21 ‘‘(A) IN GENERAL.—For purposes of this 

22 title, in the case of a WTC responder who re23 ceived any treatment for a WTC-related mus24 culoskeletal disorder on or before September 11, 
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1 2003, the list of health conditions in paragraph 

2 (3) shall include: 

3 ‘‘(i) Low back pain. 

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

5 ‘‘(iii) Other musculoskeletal disorders. 

6 ‘‘(B) DEFINITION.—The term ‘WTC-related 

7 musculoskeletal disorder’ means a chronic or re8 current disorder of the musculoskeletal system 

9 caused by heavy lifting or repetitive strain on 

10 the joints or musculoskeletal system occurring 

11 during rescue or recovery efforts in the New York 

12 City disaster area in the aftermath of the Sep13 tember 11, 2001, terrorist attacks. 

14 ‘‘(5) CANCER.— 

15 ‘‘(A) IN GENERAL.—The WTC Program Ad16 ministrator shall periodically conduct a review 

17 of all available scientific and medical evidence, 

18 including findings and recommendations of 

19 Clinical Centers of Excellence, published in peer20 reviewed journals to determine if, based on such 

21 evidence, cancer or a certain type of cancer 

22 should be added to the applicable list of WTC-re23 lated health conditions. The WTC Program Ad24 ministrator shall conduct the first review under 
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1 this subparagraph not later than 180 days after 

2 the date of the enactment of this title. 

3 ‘‘(B) PROPOSED REGULATIONS AND RULE4 MAKING.—Based on the periodic reviews under 

5 subparagraph (A), if the WTC Program Admin6 istrator determines that cancer or a certain type 

7 of cancer should be added to such list of WTC8 related health conditions, the WTC Program Ad9 ministrator shall propose regulations, through 

10 rulemaking, to add cancer or the certain type of 

11 cancer to such list. 

12 ‘‘(C) FINAL REGULATIONS.—Based on all 

13 the available evidence in the rulemaking record, 

14 the WTC Program Administrator shall make a 

15 final determination of whether cancer or a cer16 tain type of cancer should be added to such list 

17 of WTC-related health conditions. If such a de18 termination is made to make such an addition, 

19 the WTC Program Administrator shall by regu20 lation add cancer or the certain type of cancer 

21 to such list. 

22 ‘‘(D) DETERMINATIONS NOT TO ADD CAN23 CER OR CERTAIN TYPES OF CANCER.—In the case 

24 that the WTC Program Administrator deter25 mines under subparagraph (B) or (C) that can-
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1 cer or a certain type of cancer should not be 

2 added to such list of WTC-related health condi3 tions, the WTC Program Administrator shall 

4 publish an explanation for such determination 

5 in the Federal Register. Any such determination 

6 to not make such an addition shall not preclude 

7 the addition of cancer or the certain type of can8 cer to such list at a later date. 

9 ‘‘(6) ADDITION OF HEALTH CONDITIONS TO LIST

10 FOR WTC RESPONDERS.— 

11 ‘‘(A) IN GENERAL.—Whenever the WTC 

12 Program Administrator determines that a pro13 posed rule should be promulgated to add a health 

14 condition to the list of health conditions in para15 graph (3), the Administrator may request a rec16 ommendation of the Advisory Committee or may 

17 publish such a proposed rule in the Federal Reg18 ister in accordance with subparagraph (D). 

19 ‘‘(B) ADMINISTRATOR’S OPTIONS AFTER RE20 CEIPT OF PETITION.—In the case that the WTC 

21 Program Administrator receives a written peti22 tion by an interested party to add a health con23 dition to the list of health conditions in para24 graph (3), not later than 60 days after the date 
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1 of receipt of such petition the Administrator 

2 shall— 

3 ‘‘(i) request a recommendation of the 

4 Advisory Committee; 

5 ‘‘(ii) publish a proposed rule in the 

6 Federal Register to add such health condi7 tion, in accordance with subparagraph (D); 

8 ‘‘(iii) publish in the Federal Register 

9 the Administrator’s determination not to 

10 publish such a proposed rule and the basis 

11 for such determination; or 

12 ‘‘(iv) publish in the Federal Register a 

13 determination that insufficient evidence ex14 ists to take action under clauses (i) through 

15 (iii). 

16 ‘‘(C) ACTION BY ADVISORY COMMITTEE.—In 

17 the case that the Administrator requests a rec18 ommendation of the Advisory Committee under 

19 this paragraph, with respect to adding a health 

20 condition to the list in paragraph (3), the Advi21 sory Committee shall submit to the Adminis22 trator such recommendation not later than 60 

23 days after the date of such request or by such 

24 date (not to exceed 180 days after such date of 

25 request) as specified by the Administrator. Not 
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1 later than 60 days after the date of receipt of 

2 such recommendation, the Administrator shall, 

3 in accordance with subparagraph (D), publish in 

4 the Federal Register a proposed rule with respect 

5 to such recommendation or a determination not 

6 to propose such a proposed rule and the basis for 

7 such determination. 

8 ‘‘(D) PUBLICATION.—The WTC Program 

9 Administrator shall, with respect to any pro10 posed rule under this paragraph— 

11 ‘‘(i) publish such proposed rule in ac12 cordance with section 553 of title 5, United 

13 States Code; and 

14 ‘‘(ii) provide interested parties a pe15 riod of 30 days after such publication to 

16 submit written comments on the proposed 

17 rule. 

18 The WTC Program Administrator may extend 

19 the period described in clause (ii) upon a finding 

20 of good cause. In the case of such an extension, 

21 the Administrator shall publish such extension in 

22 the Federal Register. 

23 ‘‘(E) INTERESTED PARTY DEFINED.—For 

24 purposes of this paragraph, the term ‘interested 

25 party’ includes a representative of any organiza-
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1 tion representing WTC responders, a nationally 

2 recognized medical association, a Clinical or 

3 Data Center, a State or political subdivision, or 

4 any other interested person. 

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

6 HEALTH CONDITIONS.— 

7 ‘‘(1) DETERMINATION FOR ENROLLED WTC RE8 SPONDERS BASED ON A WTC-RELATED HEALTH CON9 DITION.— 

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

11 Clinical Center of Excellence that is providing 

12 monitoring benefits under section 3311 for an 

13 enrolled WTC responder makes a determination 

14 that the responder has a WTC-related health con15 dition that is in the list in subsection (a)(3) and 

16 that exposure to airborne toxins, other hazards, 

17 or adverse conditions resulting from the Sep18 tember 1, 2001, terrorist attacks is substantially 

19 likely to be a significant factor in aggravating, 

20 contributing to, or causing the condition— 

21 ‘‘(i) the physician shall promptly 

22 transmit such determination to the WTC 

23 Program Administrator and provide the 

24 Administrator with the medical facts sup25 porting such determination; and 
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1 ‘‘(ii) on and after the date of such 

2 transmittal and subject to subparagraph 

3 (B), the WTC Program shall provide for 

4 payment under subsection (c) for medically 

5 necessary treatment for such condition. 

6 ‘‘(B) REVIEW; CERTIFICATION; APPEALS.— 

7 ‘‘(i) REVIEW.—A Federal employee 

8 designated by the WTC Program Adminis9 trator shall review determinations made 

10 under subparagraph (A). 

11 ‘‘(ii) CERTIFICATION.—The Adminis12 trator shall provide a certification of such 

13 condition based upon reviews conducted 

14 under clause (i). Such a certification shall 

15 be provided unless the Administrator deter16 mines that the responder’s condition is not 

17 a WTC-related health condition in the list 

18 in subsection (a)(3) or that exposure to air19 borne toxins, other hazards, or adverse con20 ditions resulting from the September 1, 

21 2001, terrorist attacks is not substantially 

22 likely to be a significant factor in aggra23 vating, contributing to, or causing the con24 dition. 
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1 ‘‘(iii) APPEAL PROCESS.—The Admin2 istrator shall establish, by rule, a process for 

3 the appeal of determinations under clause 

4 (ii). 

5 ‘‘(2) DETERMINATION BASED ON MEDICALLY AS6 SOCIATED WTC-RELATED HEALTH CONDITIONS.— 

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

8 Clinical Center of Excellence determines pursu9 ant to subsection (a) that the enrolled WTC re10 sponder has a health condition described in sub11 section (a)(1)(A) that is not in the list in sub12 section (a)(3) but which is medically associated 

13 with a WTC-related health condition— 

14 ‘‘(i) the physician shall promptly 

15 transmit such determination to the WTC 

16 Program Administrator and provide the 

17 Administrator with the facts supporting 

18 such determination; and 

19 ‘‘(ii) the Administrator shall make a 

20 determination under subparagraph (B) 

21 with respect to such physician’s determina22 tion. 

23 ‘‘(B) PROCEDURES FOR REVIEW, CERTIFI24 CATION, AND APPEAL.—The WTC Program Ad25 ministrator shall, by rule, establish procedures 
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1 for the review and certification of physician de2 terminations under subparagraph (A). Such rule 

3 shall provide for— 

4 ‘‘(i) the timely review of such a deter5 mination by a physician panel with appro6 priate expertise for the condition and rec7 ommendations to the WTC Program Ad8 ministrator; 

9 ‘‘(ii) not later than 60 days after the 

10 date of the transmittal under subparagraph 

11 (A)(i), a determination by the WTC Pro12 gram Administrator on whether or not the 

13 condition involved is described in subsection 

14 (a)(1)(A) and is medically associated with 

15 a WTC-related health condition; 

16 ‘‘(iii) certification in accordance with 

17 paragraph (1)(B)(ii) of coverage of such 

18 condition if determined to be described in 

19 subsection (a)(1)(A) and medically associ20 ated with a WTC-related health condition; 

21 and 

22 ‘‘(iv) a process for appeals of deter23 minations relating to such conditions. 

24 ‘‘(C) INCLUSION IN LIST OF HEALTH CONDI25 TIONS.—If the WTC Program Administrator 
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1 provides certification under subparagraph 

2 (B)(iii) for coverage of a condition, the Adminis3 trator may, pursuant to subsection (a)(6), add 

4 the condition to the list in subsection (a)(3). 

5 ‘‘(D) CONDITIONS ALREADY DECLINED FOR

6 INCLUSION IN LIST.—If the WTC Program Ad7 ministrator publishes a determination under 

8 subsection (a)(6)(B) not to include a condition 

9 in the list in subsection (a)(3), the WTC Pro10 gram Administrator shall not provide certifi11 cation under subparagraph (B)(iii) for coverage 

12 of the condition. In the case of an individual 

13 who is certified under subparagraph (B)(iii) 

14 with respect to such condition before the date of 

15 the publication of such determination the pre16 vious sentence shall not apply. 

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

18 ‘‘(A) IN GENERAL.—In providing treatment 

19 for a WTC-related health condition, a physician 

20 or other provider shall provide treatment that is 

21 medically necessary and in accordance with 

22 medical treatment protocols established under 

23 subsection (d). 

24 ‘‘(B) REGULATIONS RELATING TO MEDICAL

25 NECESSITY.—For the purpose of this title, the 
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1 WTC Program Administrator shall issue regula2 tions specifying a standard for determining med3 ical necessity with respect to health care services 

4 and prescription pharmaceuticals, a process for 

5 determining whether treatment furnished and 

6 pharmaceuticals prescribed under this title meet 

7 such standard (including any prior authoriza8 tion requirement), and a process for appeal of a 

9 determination under subsection (c)(3). 

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

11 ‘‘(A) IN GENERAL.—The scope of treatment 

12 covered under this subsection includes services of 

13 physicians and other health care providers, diag14 nostic and laboratory tests, prescription drugs, 

15 inpatient and outpatient hospital services, and 

16 other medically necessary treatment. 

17 ‘‘(B) PHARMACEUTICAL COVERAGE.—With 

18 respect to ensuring coverage of medically nec19 essary outpatient prescription drugs, such drugs 

20 shall be provided, under arrangements made by 

21 the WTC Program Administrator, directly 

22 through participating Clinical Centers of Excel23 lence or through one or more outside vendors. 

24 ‘‘(C) TRANSPORTATION EXPENSES FOR NA25 TIONWIDE NETWORK.—The WTC Program Ad-
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1 ministrator may provide for necessary and rea2 sonable transportation and expenses incident to 

3 the securing of medically necessary treatment 

4 through the nationwide network under section 

5 3313 involving travel of more than 250 miles 

6 and for which payment is made under this sec7 tion in the same manner in which individuals 

8 may be furnished necessary and reasonable 

9 transportation and expenses incident to services 

10 involving travel of more than 250 miles under 

11 regulations implementing section 3629(c) of the 

12 Energy Employees Occupational Illness Com13 pensation Program Act of 2000 (title XXXVI of 

14 Public Law 106–398; 42 U.S.C. 7384t(c)). 

15 ‘‘(5) PROVISION OF TREATMENT PENDING CER16 TIFICATION.—With respect to an enrolled WTC re17 sponder for whom a determination is made by an ex18 amining physician under paragraph (1) or (2), but 

19 for whom the WTC Program Administrator has not 

20 yet determined whether to certify the determination, 

21 the WTC Program Administrator may establish by 

22 rule a process through which the Administrator may 

23 approve the provision of medical treatment under this 

24 subsection (and payment under subsection (c)) with 

25 respect to such responder and such responder’s WTC- 
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1 related health condition (under such terms and condi2 tions as the Administrator may provide) until the 

3 Administrator makes a decision on whether to certify 

4 the determination. 

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

6 MONITORING, AND TREATMENT OF WTC-RELATED HEALTH

7 CONDITIONS.— 

8 ‘‘(1) MEDICAL TREATMENT.— 

9 ‘‘(A) USE OF FECA PAYMENT RATES.— 

10 ‘‘(i) IN GENERAL.—Subject to clause 

11 (ii): 

12 ‘‘(I) Subject to subparagraphs (B) 

13 and (C), the WTC Program Adminis14 trator shall reimburse costs for medi15 cally necessary treatment under this 

16 title for WTC-related health conditions 

17 according to the payment rates that 

18 would apply to the provision of such 

19 treatment and services by the facility 

20 under the Federal Employees Com21 pensation Act. 

22 ‘‘(II) For treatment not covered 

23 under subclause (i) or subparagraph 

24 (B), the WTC Program Administrator 
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1 shall establish by regulation a reim2 bursement rate for such treatment. 

3 ‘‘(ii) EXCEPTION.—In no case shall 

4 payments for products or services under 

5 clause (i) be made at a rate higher than the 

6 Office of Worker’s Compensation Programs 

7 in the Department Labor would pay for 

8 such products or services rendered at the 

9 time such products or services were pro10 vided. 

11 ‘‘(B) PHARMACEUTICALS.— 

12 ‘‘(i) IN GENERAL.—The WTC Program 

13 Administrator shall establish a program for 

14 paying for the medically necessary out15 patient prescription pharmaceuticals pre16 scribed under this title for WTC-related 

17 health conditions through one or more con18 tracts with outside vendors. 

19 ‘‘(ii) COMPETITIVE BIDDING.—Under 

20 such program the Administrator shall— 

21 ‘‘(I) select one or more appro22 priate vendors through a Federal com23 petitive bid process; and 

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

25 bidders) meeting the requirements for 
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1 providing pharmaceutical benefits for 

2 participants in the WTC Program. 

3 ‘‘(iii) TREATMENT OF FDNY PARTICI4 PANTS.—Under such program the Adminis5 trator may enter into an agreement with a 

6 separate vendor to provide pharmaceutical 

7 benefits to enrolled WTC responders for 

8 whom the Clinical Center of Excellence is 

9 described in section 3305 if such an ar10 rangement is deemed necessary and bene11 ficial to the program by the WTC Program 

12 Administrator. 

13 ‘‘(iv) PHARMACEUTICALS.—Not later 

14 than July 1, 2011, the Comptroller General 

15 of the United States shall submit to the 

16 Committee on Energy and Commerce of the 

17 House of Representatives and the Committee 

18 on Health, Education, Labor, and Pensions 

19 of the Senate a report on whether existing 

20 Federal pharmaceutical purchasing pro21 grams can provide pharmaceutical benefits 

22 more efficiently and effectively than through 

23 the WTC program. 

24 ‘‘(C) IMPROVING QUALITY AND EFFICIENCY

25 THROUGH MODIFICATION OF PAYMENT AMOUNTS
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1 AND METHODOLOGIES.—The WTC Program Ad2 ministrator may modify the amounts and meth3 odologies for making payments for initial health 

4 evaluations, monitoring, or treatment, if, taking 

5 into account utilization and quality data fur6 nished by the Clinical Centers of Excellence 

7 under section 3305(b)(1)(B)(iii), the Adminis8 trator determines that a bundling, capitation, 

9 pay for performance, or other payment method10 ology would better ensure high quality and effi11 cient delivery of initial health evaluations, moni12 toring, or treatment to an enrolled WTC re13 sponder, screening-eligible WTC survivor, or cer14 tified-eligible WTC survivor. 

15 ‘‘(2) MONITORING AND INITIAL HEALTH EVALUA16 TION.—The WTC Program Administrator shall reim17 burse the costs of monitoring and the costs of an ini18 tial health evaluation provided under this title at a 

19 rate set by the Administrator by regulation. 

20 ‘‘(3) DETERMINATION OF MEDICAL NECESSITY.— 

21 ‘‘(A) REVIEW OF MEDICAL NECESSITY AND

22 PROTOCOLS.—As part of the process for reim23 bursement or payment under this subsection, the 

24 WTC Program Administrator shall provide for 

25 the review of claims for reimbursement or pay-
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1 ment for the provision of medical treatment to 

2 determine if such treatment is medically nec3 essary and in accordance with medical treatment 

4 protocols established under subsection (d). 

5 ‘‘(B) WITHHOLDING OF PAYMENT FOR

6 MEDICALLY UNNECESSARY TREATMENT.—The 

7 Administrator shall withhold such reimburse8 ment or payment for treatment that the Admin9 istrator determines is not medically necessary or 

10 is not in accordance with such medical treatment 

11 protocols. 

12 ‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

13 ‘‘(1) DEVELOPMENT.—The Data Centers shall 

14 develop medical treatment protocols for the treatment 

15 of enrolled WTC responders and certified-eligible 

16 WTC survivors for health conditions included in the 

17 applicable list of WTC-related health conditions. 

18 ‘‘(2) APPROVAL.—The medical treatment proto19 cols developed under paragraph (1) shall be subject to 

20 approval by the WTC Program Administrator. 

21 ‘‘SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR 

22 ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 

23 ‘‘(a) IN GENERAL.—In order to ensure reasonable ac24 cess to benefits under this subtitle for individuals who are 

25 enrolled WTC responders, screening-eligible WTC survivors, 
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1 or certified-eligible WTC survivors and who reside in any 

2 State, as defined in section 2(f), outside the New York met3 ropolitan area, the WTC Program Administrator shall es4 tablish a nationwide network of health care providers to 

5 provide monitoring and treatment benefits and initial 

6 health evaluations near such individuals’ areas of residence 

7 in such States. Nothing in this subsection shall be construed 

8 as preventing such individuals from being provided such 

9 monitoring and treatment benefits or initial health evalua10 tion through any Clinical Center of Excellence. 

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

12 provider participating in the network under subsection (a) 

13 shall— 

14 ‘‘(1) meet criteria for credentialing established 

15 by the Data Centers; 

16 ‘‘(2) follow the monitoring, initial health evalua17 tion, and treatment protocols developed under section 

18 3305(a)(2)(A)(ii); 

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

20 section 3304; and 

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

22 other requirements as the WTC Program Adminis23 trator establishes, including sections 1128 through 

24 1128E of the Social Security Act, as applied by sec25 tion 3301(d). 
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1 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.—The 

2 WTC Program Administer may provide, including through 

3 contract, for the provision of training and technical assist4 ance to health care providers participating in the network 

5 under subsection (a). 

6 ‘‘(d) PROVISION OF SERVICES THROUGH THE VA.— 

7 ‘‘(1) IN GENERAL.—The WTC Program Adminis8 trator may enter into an agreement with the Sec9 retary of Veterans Affairs for the Secretary to provide 

10 services under this section through facilities of the De11 partment of Veterans Affairs. 

12 ‘‘(2) NATIONAL PROGRAM.—Not later than July 

13 1, 2011, the Comptroller General of the United States 

14 shall submit to the Committee on Energy and Com15 merce of the House of Representatives and the Com16 mittee on Health, Education, Labor, and Pensions of 

17 the Senate a report on whether the Department of 

18 Veterans Affairs can provide monitoring and treat19 ment services to individuals under this section more 

20 efficiently and effectively than through the nationwide 

21 network to be established under subsection (a). 
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1 ‘‘PART 2—WTC SURVIVORS 

2 ‘‘SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUA3 TION OF SCREENING-ELIGIBLE AND CER4 TIFIED-ELIGIBLE WTC SURVIVORS. 

5 ‘‘(a) IDENTIFICATION OF SCREENING-ELIGIBLE WTC 

6 SURVIVORS AND CERTIFIED-ELIGIBLE WTC SURVIVORS.— 

7 ‘‘(1) SCREENING-ELIGIBLE WTC SURVIVORS.— 

8 ‘‘(A) DEFINITION.—In this title, the term 

9 ‘screening-eligible WTC survivor’ means, subject 

10 to subparagraph (C) and paragraph (3), an in11 dividual who is described in any of the following 

12 clauses: 

13 ‘‘(i) CURRENTLY IDENTIFIED SUR14 VIVOR.—An individual, including a WTC 

15 responder, who has been identified as eligi16 ble for medical treatment and monitoring 

17 by the WTC Environmental Health Center 

18 as of the date of enactment of this title. 

19 ‘‘(ii) SURVIVOR WHO MEETS CURRENT

20 ELIGIBILITY CRITERIA.—An individual who 

21 is not a WTC responder, for purposes of the 

22 initial health evaluation under subsection 

23 (b), claims symptoms of a WTC-related 

24 health condition and meets any of the cur25 rent eligibility criteria described in sub26 paragraph (B). 
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1 ‘‘(iii) SURVIVOR WHO MEETS MODI2 FIED ELIGIBILITY CRITERIA.—An indi3 vidual who is not a WTC responder, for 

4 purposes of the initial health evaluation 

5 under subsection (b), claims symptoms of a 

6 WTC-related health condition and meets 

7 such eligibility criteria relating to exposure 

8 to airborne toxins, other hazards, or adverse 

9 conditions resulting from the September 11, 

10 2001, terrorist attacks as the WTC Admin11 istrator determines, after consultation with 

12 the Data Centers described in section 3305 

13 and the WTC Scientific/Technical Advisory 

14 Committee and WTC Health Program 

15 Steering Committees under section 3302. 

16 The Administrator shall not modify such criteria 

17 under clause (iii) on or after the date that the 

18 number of certifications for certified-eligible 

19 WTC survivors under paragraph (2)(B) has 

20 reached 80 percent of the limit described in 

21 paragraph (3) or on or after the date that the 

22 number of enrollments of WTC responders has 

23 reached 80 percent of the limit described in sec24 tion 3311(a)(4). 
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1 ‘‘(B) CURRENT ELIGIBILITY CRITERIA.—The 

2 eligibility criteria described in this subpara3 graph for an individual are that the individual 

4 is described in any of the following clauses: 

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

6 New York City disaster area in the dust or 

7 dust cloud on September 11, 2001. 

8 ‘‘(ii) A person who worked, resided, or 

9 attended school, childcare, or adult daycare 

10 in the New York City disaster area for— 

11 ‘‘(I) at least 4 days during the 4- 

12 month period beginning on September 

13 11, 2001, and ending on January 10, 

14 2002; or 

15 ‘‘(II) at least 30 days during the 

16 period beginning on September 11, 

17 2001, and ending on July 31, 2002. 

18 ‘‘(iii) Any person who worked as a 

19 cleanup worker or performed maintenance 

20 work in the New York City disaster area 

21 during the 4-month period described in sub22 paragraph (B)(i) and had extensive expo23 sure to WTC dust as a result of such work. 

24 ‘‘(iv) A person who was deemed eligible 

25 to receive a grant from the Lower Manhat-
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1 tan Development Corporation Residential 

2 Grant Program, who possessed a lease for a 

3 residence or purchased a residence in the 

4 New York City disaster area, and who re5 sided in such residence during the period 

6 beginning on September 11, 2001, and end7 ing on May 31, 2003. 

8 ‘‘(v) A person whose place of employ9 ment— 

10 ‘‘(I) at any time during the pe11 riod beginning on September 11, 2001, 

12 and ending on May 31, 2003, was in 

13 the New York City disaster area; and 

14 ‘‘(II) was deemed eligible to re15 ceive a grant from the Lower Manhat16 tan Development Corporation WTC 

17 Small Firms Attraction and Retention 

18 Act program or other government in19 centive program designed to revitalize 

20 the lower Manhattan economy after the 

21 September 11, 2001, terrorist attacks. 

22 ‘‘(C) APPLICATION AND DETERMINATION

23 PROCESS FOR SCREENING ELIGIBILITY.— 

24 ‘‘(i) IN GENERAL.—The WTC Program 

25 Administrator in consultation with the 
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1 Data Centers shall establish a process for 

2 individuals, other than individuals de3 scribed in subparagraph (A)(i), to be deter4 mined to be screening-eligible WTC sur5 vivors. Under such process— 

6 ‘‘(I) there shall be no fee charged 

7 to the applicant for making an appli8 cation for such determination; 

9 ‘‘(II) the Administrator shall 

10 make a determination on such an ap11 plication not later than 60 days after 

12 the date of filing the application; 

13 ‘‘(III) the Administrator shall 

14 make such a determination relating to 

15 an applicant’s compliance with this 

16 title and shall not determine that an 

17 individual is not so eligible or deny 

18 written documentation under clause 

19 (ii) to such individual unless the Ad20 ministrator determines that— 

21 ‘‘(aa) based on the applica22 tion submitted, the individual 

23 does not meet the eligibility cri24 teria; or 
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1 ‘‘(bb) the numerical limita2 tion on certifications of certified3 eligible WTC survivors set forth in 

4 paragraph (3) has been met; and 

5 ‘‘(IV) an individual who is deter6 mined not to be a screening-eligible 

7 WTC survivor shall have an oppor8 tunity to appeal such determination in 

9 a manner established under such proc10 ess. 

11 ‘‘(ii) WRITTEN DOCUMENTATION OF

12 SCREENING-ELIGIBILITY.— 

13 ‘‘(I) IN GENERAL.—In the case of 

14 an individual who is described in sub15 paragraph (A)(i) or who is determined 

16 under clause (i) (consistent with para17 graph (3)) to be a screening-eligible 

18 WTC survivor, the WTC Program Ad19 ministrator shall provide an appro20 priate written documentation of such 

21 fact. 

22 ‘‘(II) TIMING.— 

23 ‘‘(aa) CURRENTLY IDENTI24 FIED SURVIVORS.—In the case of 

25 an individual who is described in 
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1 subparagraph (A)(i), the WTC 

2 Program Administrator shall pro3 vide the written documentation 

4 under subclause (I) not later than 

5 July 1, 2011. 

6 ‘‘(bb) OTHER MEMBERS.—In 

7 the case of another individual who 

8 is determined under clause (i) 

9 and consistent with paragraph (3) 

10 to be a screening-eligible WTC 

11 survivor, the WTC Program Ad12 ministrator shall provide the 

13 written documentation under sub14 clause (I) at the time of such de15 termination. 

16 ‘‘(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.— 

17 ‘‘(A) DEFINITION.—The term ‘certified-eligi18 ble WTC survivor’ means, subject to paragraph 

19 (3), a screening-eligible WTC survivor who the 

20 WTC Program Administrator certifies under 

21 subparagraph (B) to be eligible for followup 

22 monitoring and treatment under this part. 

23 ‘‘(B) CERTIFICATION OF ELIGIBILITY FOR

24 MONITORING AND TREATMENT.— 
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1 ‘‘(i) IN GENERAL.—The WTC Program 

2 Administrator shall establish a certification 

3 process under which the Administrator shall 

4 provide appropriate certification to screen5 ing-eligible WTC survivors who, pursuant 

6 to the initial health evaluation under sub7 section (b), are determined to be eligible for 

8 followup monitoring and treatment under 

9 this part. 

10 ‘‘(ii) TIMING.— 

11 ‘‘(I) CURRENTLY IDENTIFIED SUR12 VIVORS.—In the case of an individual 

13 who is described in paragraph 

14 (1)(A)(i), the WTC Program Adminis15 trator shall provide the certification 

16 under clause (i) not later than July 1, 

17 2011. 

18 ‘‘(II) OTHER MEMBERS.—In the 

19 case of another individual who is de20 termined under clause (i) to be eligible 

21 for followup monitoring and treatment, 

22 the WTC Program Administrator shall 

23 provide the certification under such 

24 clause at the time of such determina25 tion. 
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1 ‘‘(3) NUMERICAL LIMITATION ON CERTIFIED-ELI2 GIBLE WTC SURVIVORS.— 

3 ‘‘(A) IN GENERAL.—The total number of in4 dividuals not described in paragraph (1)(A)(i) 

5 who may be certified as certified-eligible WTC 

6 survivors under paragraph (2)(B) shall not ex7 ceed 25,000 at any time. 

8 ‘‘(B) PROCESS.—In implementing subpara9 graph (A), the WTC Program Administrator 

10 shall— 

11 ‘‘(i) limit the number of certifications 

12 provided under paragraph (2)(B)— 

13 ‘‘(I) in accordance with such sub14 paragraph; and 

15 ‘‘(II) to such number, as deter16 mined by the Administrator based on 

17 the best available information and sub18 ject to amounts made available under 

19 section 3351, that will ensure sufficient 

20 funds will be available to provide 

21 treatment and monitoring benefits 

22 under this title, with respect to all in23 dividuals receiving such certifications 

24 through the end of fiscal year 2020; 

25 and 
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1 ‘‘(ii) provide priority in such certifi2 cations in the order in which individuals 

3 apply for a determination under paragraph 

4 (2)(B). 

5 ‘‘(4) DISQUALIFICATION OF INDIVIDUALS ON

6 TERRORIST WATCH LIST.—No individual who is on 

7 the terrorist watch list maintained by the Department 

8 of Homeland Security shall qualify as a screening-eli9 gible WTC survivor or a certified-eligible WTC sur10 vivor. Before determining any individual to be a 

11 screening-eligible WTC survivor under paragraph (1) 

12 or certifying any individual as a certified eligible 

13 WTC survivor under paragraph (2), the Adminis14 trator, in consultation with the Secretary of Home15 land Security, shall determine whether the individual 

16 is on such list. 

17 ‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE

18 ELIGIBILITY FOR FOLLOWUP MONITORING OR TREAT19 MENT.— 

20 ‘‘(1) IN GENERAL.—In the case of a screening-el21 igible WTC survivor, the WTC Program shall provide 

22 for an initial health evaluation to determine if the 

23 survivor has a WTC-related health condition and is 

24 eligible for followup monitoring and treatment bene25 fits under the WTC Program. Initial health evalua-
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1 tion protocols under section 3305(a)(2)(A)(ii) shall be 

2 subject to approval by the WTC Program Adminis3 trator. 

4 ‘‘(2) INITIAL HEALTH EVALUATION PRO5 VIDERS.—The initial health evaluation described in 

6 paragraph (1) shall be provided through a Clinical 

7 Center of Excellence with respect to the individual in8 volved. 

9 ‘‘(3) LIMITATION ON INITIAL HEALTH EVALUA10 TION BENEFITS.—Benefits for an initial health eval11 uation under this part for a screening-eligible WTC 

12 survivor shall consist only of a single medical initial 

13 health evaluation consistent with initial health eval14 uation protocols described in paragraph (1). Nothing 

15 in this paragraph shall be construed as preventing 

16 such an individual from seeking additional medical 

17 initial health evaluations at the expense of the indi18 vidual. 

19 ‘‘SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF 

20 CERTIFIED-ELIGIBLE WTC SURVIVORS FOR 

21 WTC-RELATED HEALTH CONDITIONS. 

22 ‘‘(a) IN GENERAL.—Subject to subsection (b), the pro23 visions of sections 3311 and 3312 shall apply to followup 

24 monitoring and treatment of WTC-related health conditions 

25 for certified-eligible WTC survivors in the same manner as 
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1 such provisions apply to the monitoring and treatment of 

2 WTC-related health conditions for enrolled WTC responders. 

3 ‘‘(b) LIST OF WTC-RELATED HEALTH CONDITIONS

4 FOR SURVIVORS.—The list of health conditions for screen5 ing-eligible WTC survivors and certified-eligible WTC sur6 vivors consists of the following: 

7 ‘‘(1) AERODIGESTIVE DISORDERS.— 

8 ‘‘(A) Interstitial lung diseases. 

9 ‘‘(B) Chronic respiratory disorder—fumes/ 

10 vapors. 

11 ‘‘(C) Asthma. 

12 ‘‘(D) Reactive airways dysfunction syn13 drome (RADS). 

14 ‘‘(E) WTC-exacerbated chronic obstructive 

15 pulmonary disease (COPD). 

16 ‘‘(F) Chronic cough syndrome. 

17 ‘‘(G) Upper airway hyperreactivity. 

18 ‘‘(H) Chronic rhinosinusitis. 

19 ‘‘(I) Chronic nasopharyngitis. 

20 ‘‘(J) Chronic laryngitis. 

21 ‘‘(K) Gastroesophageal reflux disorder 

22 (GERD). 

23 ‘‘(L) Sleep apnea exacerbated by or related 

24 to a condition described in a previous clause. 

25 ‘‘(2) MENTAL HEALTH CONDITIONS.— 
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1 ‘‘(A) Posttraumatic stress disorder (PTSD). 

2 ‘‘(B) Major depressive disorder. 

3 ‘‘(C) Panic disorder. 

4 ‘‘(D) Generalized anxiety disorder. 

5 ‘‘(E) Anxiety disorder (not otherwise speci6 fied). 

7 ‘‘(F) Depression (not otherwise specified). 

8 ‘‘(G) Acute stress disorder. 

9 ‘‘(H) Dysthymic disorder. 

10 ‘‘(I) Adjustment disorder. 

11 ‘‘(J) Substance abuse. 

12 ‘‘(3) ADDITIONAL CONDITIONS.—Any cancer (or 

13 type of cancer) or other condition added to the list in 

14 section 3312(a)(3) pursuant to paragraph (5) or (6) 

15 of section 3312(a), as such provisions are applied 

16 under subsection (a) with respect to certified-eligible 

17 WTC survivors. 

18 ‘‘SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF 

19 OTHER INDIVIDUALS WITH WTC-RELATED 

20 HEALTH CONDITIONS. 

21 ‘‘(a) IN GENERAL.—Subject to subsection (c), the pro22 visions of section 3322 shall apply to the followup moni23 toring and treatment of WTC-related health conditions in 

24 the case of individuals described in subsection (b) in the 

25 same manner as such provisions apply to the followup mon-
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1 itoring and treatment of WTC-related health conditions for 

2 certified-eligible WTC survivors. 

3 ‘‘(b) INDIVIDUALS DESCRIBED.—An individual de4 scribed in this subsection is an individual who, regardless 

5 of location of residence— 

6 ‘‘(1) is not an enrolled WTC responder or a cer7 tified-eligible WTC survivor; and 

8 ‘‘(2) is diagnosed at a Clinical Center of Excel9 lence with a WTC-related health condition for cer10 tified-eligible WTC survivors. 

11 ‘‘(c) LIMITATION.— 

12 ‘‘(1) IN GENERAL.—The WTC Program Adminis13 trator shall limit benefits for any fiscal year under 

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

15 this section for such fiscal year do not exceed the 

16 amount specified in paragraph (2) for such fiscal 

17 year. 

18 ‘‘(2) LIMITATION.—The amount specified in this 

19 paragraph for— 

20 ‘‘(A) the last calendar quarter of fiscal year 

21 2011 is $5,000,000; 

22 ‘‘(B) fiscal year 2012 is $20,000,000; or 

23 ‘‘(C) a succeeding fiscal year is the amount 

24 specified in this paragraph for the previous fis25 cal year increased by the annual percentage in-
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1 crease in the medical care component of the con2 sumer price index for all urban consumers. 

3 ‘‘PART 3—PAYOR PROVISIONS 

4 ‘‘SEC. 3331. PAYMENT OF CLAIMS. 

5 ‘‘(a) IN GENERAL.—Except as provided in subsections 

6 (b) and (c), the cost of monitoring and treatment benefits 

7 and initial health evaluation benefits provided under parts 

8 1 and 2 of this subtitle shall be paid for by the WTC Pro9 gram from the World Trade Center Health Program Fund. 

10 ‘‘(b) WORKERS’ COMPENSATION PAYMENT.— 

11 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

12 payment for treatment under parts 1 and 2 of this 

13 subtitle of a WTC-related health condition of an indi14 vidual that is work-related shall be reduced or re15 couped to the extent that the WTC Program Adminis16 trator determines that payment has been made, or 

17 can reasonably be expected to be made, under a work18 ers’ compensation law or plan of the United States, 

19 a State, or a locality, or other work-related injury or 

20 illness benefit plan of the employer of such individual, 

21 for such treatment. The provisions of clauses (iii), 

22 (iv), (v), and (vi) of paragraph (2)(B) of section 

23 1862(b) of the Social Security Act and paragraphs 

24 (3) and (4) of such section shall apply to the 

25 recoupment under this subsection of a payment to the 
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1 WTC Program (with respect to a workers’ compensa2 tion law or plan, or other work-related injury or ill3 ness plan of the employer involved, and such indi4 vidual) in the same manner as such provisions apply 

5 to the reimbursement of a payment under section 

6 1862(b)(2) of such Act to the Secretary (with respect 

7 to such a law or plan and an individual entitled to 

8 benefits under title XVIII of such Act) except that any 

9 reference in such paragraph (4) to payment rates 

10 under title XVIII of the Social Security Act shall be 

11 deemed a reference to payment rates under this title. 

12 ‘‘(2) EXCEPTION.—Paragraph (1) shall not 

13 apply for any quarter, with respect to any workers’ 

14 compensation law or plan, including line of duty 

15 compensation, to which New York City is obligated to 

16 make payments, if, in accordance with terms specified 

17 under the contract under subsection (d)(1)(A), New 

18 York City has made the full payment required under 

19 such contract for such quarter. 

20 ‘‘(3) RULES OF CONSTRUCTION.—Nothing in this 

21 title shall be construed to affect, modify, or relieve 

22 any obligations under a worker’s compensation law or 

23 plan, other work-related injury or illness benefit plan 

24 of an employer, or any health insurance plan. 

25 ‘‘(c) HEALTH INSURANCE COVERAGE.— 
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1 ‘‘(1) IN GENERAL.—In the case of an individual 

2 who has a WTC-related health condition that is not 

3 work-related and has health coverage for such condi4 tion through any public or private health plan (in5 cluding health benefits under title XVIII, XIX, or XXI 

6 of the Social Security Act) the provisions of section 

7 1862(b) of the Social Security Act shall apply to such 

8 a health plan and such individual in the same man9 ner as they apply to group health plan and an indi10 vidual entitled to benefits under title XVIII of such 

11 Act pursuant to section 226(a) of such Act. Any costs 

12 for items and services covered under such plan that 

13 are not reimbursed by such health plan, due to the 

14 application of deductibles, copayments, coinsurance, 

15 other cost sharing, or otherwise, are reimbursable 

16 under this title to the extent that they are covered 

17 under the WTC Program. The program under this 

18 title shall not be treated as a legally liable party for 

19 purposes of applying section 1902(a)(25) of the Social 

20 Security Act. 

21 ‘‘(2) RECOVERY BY INDIVIDUAL PROVIDERS.— 

22 Nothing in paragraph (1) shall be construed as re23 quiring an entity providing monitoring and treat24 ment under this title to seek reimbursement under a 
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1 health plan with which the entity has no contract for 

2 reimbursement. 

3 ‘‘(3) MAINTENANCE OF REQUIRED MINIMUM ES4 SENTIAL COVERAGE.—No payment may be made for 

5 monitoring and treatment under this title for an in6 dividual for a month (beginning with July 2014) if 

7 with respect to such month the individual— 

8 ‘‘(A) is an applicable individual (as defined 

9 in subsection (d) of section 5000A of Internal 

10 Revenue Code of 1986) for whom the exemption 

11 under subsection (e) of such section does not 

12 apply; and 

13 ‘‘(B) is not covered under minimum essen14 tial coverage, as required under subsection (a) of 

15 such section. 

16 ‘‘(d) REQUIRED CONTRIBUTION BY NEW YORK CITY IN

17 PROGRAM COSTS.— 

18 ‘‘(1) CONTRACT REQUIREMENT.— 

19 ‘‘(A) IN GENERAL.—No funds may be dis20 bursed from the World Trade Center Health Pro21 gram Fund under section 3351 unless New York 

22 City has entered into a contract with the WTC 

23 Program Administrator under which New York 

24 City agrees, in a form and manner specified by 

25 the Administrator, to pay the full contribution 
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1 described in subparagraph (B) in accordance 

2 with this subsection on a timely basis, plus any 

3 interest owed pursuant to subparagraph (E)(i). 

4 Such contract shall specify the terms under 

5 which New York City shall be considered to have 

6 made the full payment required for a quarter for 

7 purposes of subsection (b)(2). 

8 ‘‘(B) FULL CONTRIBUTION AMOUNT.—Under 

9 such contract, with respect to the last calendar 

10 quarter of fiscal year 2011 and each calendar 

11 quarter in fiscal years 2012 through 2015 the 

12 full contribution amount under this subpara13 graph shall be equal to 10 percent of the expendi14 tures in carrying out this title for the respective 

15 quarter and with respect to calendar quarters in 

16 fiscal year 2016, such full contribution amount 

shall be equal to 1 17 ⁄9 of the Federal expenditures 

18 in carrying out this title for the respective quar19 ter. 

20 ‘‘(C) SATISFACTION OF PAYMENT OBLIGA21 TION.—The payment obligation under such con22 tract may not be satisfied through any of the fol23 lowing: 

24 ‘‘(i) An amount derived from Federal 

25 sources. 
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1 ‘‘(ii) An amount paid before the date 

2 of the enactment of this title. 

3 ‘‘(iii) An amount paid to satisfy a 

4 judgment or as part of a settlement related 

5 to injuries or illnesses arising out of the 

6 September 11, 2001, terrorist attacks. 

7 ‘‘(D) TIMING OF CONTRIBUTION.—The pay8 ment obligation under such contract for a cal9 endar quarter in a fiscal year shall be paid not 

10 later than the last day of the second succeeding 

11 calendar quarter. 

12 ‘‘(E) COMPLIANCE.— 

13 ‘‘(i) INTEREST FOR LATE PAYMENT.— 

14 If New York City fails to pay to the WTC 

15 Program Administrator pursuant to such 

16 contract the amount required for any cal17 endar quarter by the day specified in sub18 paragraph (D), interest shall accrue on the 

19 amount not so paid at the rate (determined 

20 by the Administrator) based on the average 

21 yield to maturity, plus 1 percentage point, 

22 on outstanding municipal bonds issued by 

23 New York City with a remaining maturity 

24 of at least 1 year. 
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1 ‘‘(ii) RECOVERY OF AMOUNTS OWED.— 

2 The amounts owed to the WTC Program 

3 Administrator under such contract shall be 

4 recoverable by the United States in an ac5 tion in the same manner as payments made 

6 under title XVIII of the Social Security Act 

7 may be recoverable in an action brought 

8 under section 1862(b)(2)(B)(iii) of such Act. 

9 ‘‘(F) DEPOSIT IN FUND.—The WTC Pro10 gram Administer shall deposit amounts paid 

11 under such contract into the World Trade Center 

12 Health Program Fund under section 3351. 

13 ‘‘(2) PAYMENT OF NEW YORK CITY SHARE OF

14 MONITORING AND TREATMENT COSTS.—With respect 

15 to each calendar quarter for which a contribution is 

16 required by New York City under the contract under 

17 paragraph (1), the WTC Program Administrator 

18 shall— 

19 ‘‘(A) provide New York City with an esti20 mate of such amount of the required contribution 

21 at the beginning of such quarter and with an up22 dated estimate of such amount at the beginning 

23 of each of the subsequent 2 quarters; 

24 ‘‘(B) bill such amount directly to New York 

25 City; and 
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1 ‘‘(C) certify periodically, for purposes of 

2 this subsection, whether or not New York City 

3 has paid the amount so billed. 

4 Such amount shall initially be estimated by the WTC 

5 Program Administrator and shall be subject to adjust6 ment and reconciliation based upon actual expendi7 tures in carrying out this title. 

8 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in this 

9 subsection shall be construed as authorizing the WTC 

10 Administrator, with respect to a fiscal year, to reduce 

11 the numerical limitation under section 3311(a)(4) or 

12 3321(a)(3) for such fiscal year if New York City fails 

13 to comply with paragraph (1) for a calendar quarter 

14 in such fiscal year. 

15 ‘‘(e) WORK-RELATED DESCRIBED.—For the purposes 

16 of this section, a WTC-related health condition shall be 

17 treated as a condition that is work-related if— 

18 ‘‘(1) the condition is diagnosed in an enrolled 

19 WTC responder, or in an individual who qualifies as 

20 a certified-eligible WTC survivor on the basis of being 

21 a rescue, recovery, or cleanup worker; or 

22 ‘‘(2) with respect to the condition the individual 

23 has filed and had established a claim under a work24 ers’ compensation law or plan of the United States or 
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1 a State, or other work-related injury or illness benefit 

2 plan of the employer of such individual. 

3 ‘‘SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY. 

4 ‘‘The WTC Program Administrator may enter into ar5 rangements with other government agencies, insurance com6 panies, or other third-party administrators to provide for 

7 timely and accurate processing of claims under sections 

8 3312, 3313, 3322, and 3323. 

9 ‘‘Subtitle C—Research Into 

10 Conditions 

11 ‘‘SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CON12 DITIONS RELATED TO SEPTEMBER 11 TER13 RORIST ATTACKS. 

14 ‘‘(a) IN GENERAL.—With respect to individuals, in15 cluding enrolled WTC responders and certified-eligible WTC 

16 survivors, receiving monitoring or treatment under subtitle 

17 B, the WTC Program Administrator shall conduct or sup18 port— 

19 ‘‘(1) research on physical and mental health con20 ditions that may be related to the September 11, 

21 2001, terrorist attacks; 

22 ‘‘(2) research on diagnosing WTC-related health 

23 conditions of such individuals, in the case of condi24 tions for which there has been diagnostic uncertainty; 

25 and 
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1 ‘‘(3) research on treating WTC-related health 

2 conditions of such individuals, in the case of condi3 tions for which there has been treatment uncertainty. 

4 The Administrator may provide such support through con5 tinuation and expansion of research that was initiated be6 fore the date of the enactment of this title and through the 

7 World Trade Center Health Registry (referred to in section 

8 3342), through a Clinical Center of Excellence, or through 

9 a Data Center. 

10 ‘‘(b) TYPES OF RESEARCH.—The research under sub11 section (a)(1) shall include epidemiologic and other research 

12 studies on WTC-related health conditions or emerging con13 ditions— 

14 ‘‘(1) among enrolled WTC responders and cer15 tified-eligible WTC survivors under treatment; and 

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

17 York City disaster area in Manhattan as far north as 

18 14th Street and in Brooklyn, along with control pop19 ulations, to identify potential for long-term adverse 

20 health effects in less exposed populations. 

21 ‘‘(c) CONSULTATION.—The WTC Program Adminis22 trator shall carry out this section in consultation with the 

23 WTC Scientific/Technical Advisory Committee. 

24 ‘‘(d) APPLICATION OF PRIVACY AND HUMAN SUBJECT

25 PROTECTIONS.—The privacy and human subject protec-
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1 tions applicable to research conducted under this section 

2 shall not be less than such protections applicable to research 

3 conducted or funded by the Department of Health and 

4 Human Services. 

5 ‘‘SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY. 

6 ‘‘For the purpose of ensuring ongoing data collection 

7 relating to victims of the September 11, 2001, terrorist at8 tacks, the WTC Program Administrator shall ensure that 

9 a registry of such victims is maintained that is at least 

10 as comprehensive as the World Trade Center Health Reg11 istry maintained under the arrangements in effect as of 

12 April 20, 2009, with the New York City Department of 

13 Health and Mental Hygiene. 

14 ‘‘Subtitle D—Funding 

15 ‘‘SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM 

16 FUND. 

17 ‘‘(a) ESTABLISHMENT OF FUND.— 

18 ‘‘(1) IN GENERAL.—There is established a fund 

19 to be known as the World Trade Center Health Pro20 gram Fund (referred to in this section as the ‘Fund’). 

21 ‘‘(2) FUNDING.—Out of any money in the Treas22 ury not otherwise appropriated, there shall be depos23 ited into the Fund for each of fiscal years 2012 

24 through 2016 (and the last calendar quarter of fiscal 

25 year 2011)— 
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1 ‘‘(A) the Federal share, consisting of an 

2 amount equal to the lesser of— 

3 ‘‘(i) 90 percent of the expenditures in 

4 carrying out this title for the respective fis5 cal year (initially based on estimates, sub6 ject to subsequent reconciliation based on 

7 actual expenditures); or 

8 ‘‘(ii)(I) $71,000,000 for the last cal9 endar quarter of fiscal year 2011, 

10 $318,000,000 for fiscal year 2012, 

11 $354,000,000 for fiscal year 2013, 

12 $382,000,000 for fiscal year 2014, and 

13 $431,000,000 for fiscal year 2015; and 

14 ‘‘(II) subject to paragraph (4), an ad15 ditional amount for fiscal year 2016 from 

16 unexpended amounts for previous fiscal 

17 years; plus 

18 ‘‘(B) the New York City share, consisting of 

19 the amount contributed under the contract under 

20 section 3331(d). 

21 ‘‘(3) CONTRACT REQUIREMENT.— 

22 ‘‘(A) IN GENERAL.—No funds may be dis23 bursed from the Fund unless New York City has 

24 entered into a contract with the WTC Program 

25 Administrator under section 3331(d)(1). 
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1 ‘‘(B) BREACH OF CONTRACT.—In the case of 

2 a failure to pay the amount so required under 

3 the contract— 

4 ‘‘(i) the amount is recoverable under 

5 subparagraph (E)(ii) of such section; 

6 ‘‘(ii) such failure shall not affect the 

7 disbursement of amounts from the Fund; 

8 and 

9 ‘‘(iii) the Federal share described in 

10 paragraph (2)(A) shall not be increased by 

11 the amount so unpaid. 

12 ‘‘(4) AGGREGATE LIMITATION ON FUNDING BE13 GINNING WITH FISCAL YEAR 2016.—Beginning with 

14 fiscal year 2016, in no case shall the share of Federal 

15 funds deposited into the Fund under paragraph (2) 

16 for such fiscal year and previous fiscal years and 

17 quarters exceed the sum of the amounts specified in 

18 paragraph (2)(A)(ii)(I). 

19 ‘‘(b) MANDATORY FUNDS FOR MONITORING, INITIAL

20 HEALTH EVALUATIONS, TREATMENT, AND CLAIMS PROC21 ESSING.— 

22 ‘‘(1) IN GENERAL.—The amounts deposited into 

23 the Fund under subsection (a)(2) shall be available, 

24 without further appropriation, consistent with para25 graph (2) and subsection (c), to carry out subtitle B 
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1 and sections 3302(a), 3303, 3304, 3305(a)(2), 

2 3305(c), 3341, and 3342. 

3 ‘‘(2) LIMITATION ON MANDATORY FUNDING.— 

4 This title does not establish any Federal obligation for 

5 payment of amounts in excess of the amounts avail6 able from the Fund for such purpose. 

7 ‘‘(3) LIMITATION ON AUTHORIZATION FOR FUR8 THER APPROPRIATIONS.—This title does not establish 

9 any authorization for appropriation of amounts in 

10 excess of the amounts available from the Fund under 

11 paragraph (1). 

12 ‘‘(c) LIMITS ON SPENDING FOR CERTAIN PURPOSES.— 

13 Of the amounts made available under subsection (b)(1), not 

14 more than each of the following amounts may be available 

15 for each of the following purposes: 

16 ‘‘(1) SURVIVING IMMEDIATE FAMILY MEMBERS

17 OF FIREFIGHTERS.—For the purposes of carrying out 

18 subtitle B with respect to WTC responders described 

19 in section 3311(a)(2)(A)(ii)— 

20 ‘‘(A) for the last calendar quarter of fiscal 

21 year 2011, $100,000; 

22 ‘‘(B) for fiscal year 2012, $400,000; and 

23 ‘‘(C) for each subsequent fiscal year, the 

24 amount specified under this paragraph for the 

25 previous fiscal year increased by the percentage 
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1 increase in the consumer price index for all 

2 urban consumers (all items; United States city 

3 average) as estimated by the Secretary for the 

4 12-month period ending with March of the pre5 vious year. 

6 ‘‘(2) WTC HEALTH PROGRAM SCIENTIFIC/TECH7 NICAL ADVISORY COMMITTEE.—For the purpose of 

8 carrying out section 3302(a)— 

9 ‘‘(A) for the last calendar quarter of fiscal 

10 year 2011, $25,000; 

11 ‘‘(B) for fiscal year 2012, $100,000; and 

12 ‘‘(C) for each subsequent fiscal year, the 

13 amount specified under this paragraph for the 

14 previous fiscal year increased by the percentage 

15 increase in the consumer price index for all 

16 urban consumers (all items; United States city 

17 average) as estimated by the Secretary for the 

18 12-month period ending with March of the pre19 vious year. 

20 ‘‘(3) EDUCATION AND OUTREACH.—For the pur21 pose of carrying out section 3303— 

22 ‘‘(A) for the last calendar quarter of fiscal 

23 year 2011, $500,000; 

24 ‘‘(B) for fiscal year 2012, $2,000,000; and 
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1 ‘‘(C) for each subsequent fiscal year, the 

2 amount specified under this paragraph for the 

3 previous fiscal year increased by the percentage 

4 increase in the consumer price index for all 

5 urban consumers (all items; United States city 

6 average) as estimated by the Secretary for the 

7 12-month period ending with March of the pre8 vious year. 

9 ‘‘(4) UNIFORM DATA COLLECTION.—For the pur10 pose of carrying out section 3304 and for reimbursing 

11 Data Centers (as defined in section 3305(b)(2)) for 

12 the costs incurred by such Centers in carrying out ac13 tivities under contracts entered into under section 

14 3305(a)(2)— 

15 ‘‘(A) for the last calendar quarter of fiscal 

16 year 2011, $2,500,000; 

17 ‘‘(B) for fiscal year 2012, $10,000,000; and 

18 ‘‘(C) for each subsequent fiscal year, the 

19 amount specified under this paragraph for the 

20 previous fiscal year increased by the percentage 

21 increase in the consumer price index for all 

22 urban consumers (all items; United States city 

23 average) as estimated by the Secretary for the 

24 12-month period ending with March of the pre25 vious year. 
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1 ‘‘(5) RESEARCH REGARDING CERTAIN HEALTH

2 CONDITIONS.—For the purpose of carrying out section 

3 3341— 

4 ‘‘(A) for the last calendar quarter of fiscal 

5 year 2011, $3,750,000; 

6 ‘‘(B) for fiscal year 2012, $15,000,000; and 

7 ‘‘(C) for each subsequent fiscal year, the 

8 amount specified under this paragraph for the 

9 previous fiscal year increased by the percentage 

10 increase in the consumer price index for all 

11 urban consumers (all items; United States city 

12 average) as estimated by the Secretary for the 

13 12-month period ending with March of the pre14 vious year. 

15 ‘‘(6) WORLD TRADE CENTER HEALTH REG16 ISTRY.—For the purpose of carrying out section 

17 3342— 

18 ‘‘(A) for the last calendar quarter of fiscal 

19 year 2011, $1,750,000; 

20 ‘‘(B) for fiscal year 2012, $7,000,000; and 

21 ‘‘(C) for each subsequent fiscal year, the 

22 amount specified under this paragraph for the 

23 previous fiscal year increased by the percentage 

24 increase in the consumer price index for all 

25 urban consumers (all items; United States city 
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1 average) as estimated by the Secretary for the 

2 12-month period ending with March of the pre3 vious year.’’. 

4 TITLE II—SEPTEMBER 11TH VIC5 TIM COMPENSATION FUND OF 

6 2001 

7 SEC. 201. DEFINITIONS. 

8 Section 402 of the Air Transportation Safety and Sys9 tem Stabilization Act (49 U.S.C. 40101 note) is amended— 

10 (1) in paragraph (6) by inserting ‘‘, or debris re11 moval, including under the World Trade Center 

12 Health Program established under section 3001 of the 

13 Public Health Service Act, and payments made pur14 suant to the settlement of a civil action described in 

15 section 405(c)(3)(C)(iii)’’ after ‘‘September 11, 2001’’; 

16 (2) by inserting after paragraph (6) the fol17 lowing new paragraphs and redesignating subsequent 

18 paragraphs accordingly: 

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

20 term ‘contractor and subcontractor’ means any con21 tractor or subcontractor (at any tier of a subcon22 tracting relationship), including any general con23 tractor, construction manager, prime contractor, con24 sultant, or any parent, subsidiary, associated or al25 lied company, affiliated company, corporation, firm, 
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1 organization, or joint venture thereof that partici2 pated in debris removal at any 9/11 crash site. Such 

3 term shall not include any entity, including the Port 

4 Authority of New York and New Jersey, with a prop5 erty interest in the World Trade Center, on September 

6 11, 2001, whether fee simple, leasehold or easement, 

7 direct or indirect. 

8 ‘‘(8) DEBRIS REMOVAL.—The term ‘debris re9 moval’ means rescue and recovery efforts, removal of 

10 debris, cleanup, remediation, and response during the 

11 immediate aftermath of the terrorist-related aircraft 

12 crashes of September 11, 2001, with respect to a 9/11 

13 crash site.’’; 

14 (3) by inserting after paragraph (10), as so re15 designated, the following new paragraph and redesig16 nating the subsequent paragraphs accordingly: 

17 ‘‘(11) IMMEDIATE AFTERMATH.—The term ‘im18 mediate aftermath’ means any period beginning with 

19 the terrorist-related aircraft crashes of September 11, 

20 2001, and ending on May 30, 2002.’’; and 

21 (4) by adding at the end the following new para22 graph: 

23 ‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash 

24 site’ means— 
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1 ‘‘(A) the World Trade Center site, Pentagon 

2 site, and Shanksville, Pennsylvania site; 

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

4 that were destroyed as a result of the terrorist5 related aircraft crashes of September 11, 2001; 

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

7 crashes that the Special Master determines was 

8 sufficiently close to the site that there was a de9 monstrable risk of physical harm resulting from 

10 the impact of the aircraft or any subsequent fire, 

11 explosions, or building collapses (including the 

12 immediate area in which the impact occurred, 

13 fire occurred, portions of buildings fell, or debris 

14 fell upon and injured individuals); and 

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

16 debris removal, such as barges and Fresh Kills.’’. 

17 SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 

18 COMPENSATION. 

19 (a) INFORMATION ON LOSSES RESULTING FROM DE20 BRIS REMOVAL INCLUDED IN CONTENTS OF CLAIM

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

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

23 note) is amended— 
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1 (1) in clause (i), by inserting ‘‘, or debris re2 moval during the immediate aftermath’’ after ‘‘Sep3 tember 11, 2001’’; 

4 (2) in clause (ii), by inserting ‘‘or debris re5 moval during the immediate aftermath’’ after ‘‘crash6 es’’; and 

7 (3) in clause (iii), by inserting ‘‘or debris re8 moval during the immediate aftermath’’ after ‘‘crash9 es’’. 

10 (b) EXTENSION OF DEADLINE FOR CLAIMS UNDER

11 SEPTEMBER 11TH VICTIM COMPENSATION FUND OF

12 2001.—Section 405(a)(3) of such Act is amended to read 

13 as follows: 

14 ‘‘(3) LIMITATION.— 

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

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

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

18 the date on which regulations are promulgated 

19 under section 407(a). 

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

21 under paragraph (1), in accordance with sub22 section (c)(3)(A)(i), by an individual (or by a 

23 personal representative on behalf of a deceased 

24 individual) during the period beginning on the 

25 date on which the regulations are updated under 
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1 section 407(b) and ending on the date that is 5 

2 years after the date on which such regulations 

3 are updated.’’. 

4 (c) REQUIREMENTS FOR FILING CLAIMS DURING EX5 TENDED FILING PERIOD.—Section 405(c)(3) of such Act is 

6 amended— 

7 (1) by redesignating subparagraphs (A) and (B) 

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

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

10 redesignated, the following new subparagraph: 

11 ‘‘(A) REQUIREMENTS FOR FILING CLAIMS

12 DURING EXTENDED FILING PERIOD.— 

13 ‘‘(i) TIMING REQUIREMENTS FOR FIL14 ING CLAIMS.—An individual (or a personal 

15 representative on behalf of a deceased indi16 vidual) may file a claim during the period 

17 described in subsection (a)(3)(B) as follows: 

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

19 Master determines the individual knew 

20 (or reasonably should have known) be21 fore the date specified in clause (iii) 

22 that the individual suffered a physical 

23 harm at a 9/11 crash site as a result 

24 of the terrorist-related aircraft crashes 

25 of September 11, 2001, or as a result 
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1 of debris removal, and that the indi2 vidual knew (or should have known) 

3 before such specified date that the indi4 vidual was eligible to file a claim 

5 under this title, the individual may 

6 file a claim not later than the date 

7 that is 2 years after such specified 

8 date. 

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

10 Master determines the individual first 

11 knew (or reasonably should have 

12 known) on or after the date specified 

13 in clause (iii) that the individual suf14 fered such a physical harm or that the 

15 individual first knew (or should have 

16 known) on or after such specified date 

17 that the individual was eligible to file 

18 a claim under this title, the individual 

19 may file a claim not later than the last 

20 day of the 2-year period beginning on 

21 the date the Special Master determines 

22 the individual first knew (or should 

23 have known) that the individual both 

24 suffered from such harm and was eligi25 ble to file a claim under this title. 
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1 ‘‘(ii) OTHER ELIGIBILITY REQUIRE2 MENTS FOR FILING CLAIMS.—An individual 

3 may file a claim during the period de4 scribed in subsection (a)(3)(B) only if— 

5 ‘‘(I) the individual was treated by 

6 a medical professional for suffering 

7 from a physical harm described in 

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

9 from the date of discovering such harm; 

10 and 

11 ‘‘(II) the individual’s physical 

12 harm is verified by contemporaneous 

13 medical records created by or at the di14 rection of the medical professional who 

15 provided the medical care. 

16 ‘‘(iii) DATE SPECIFIED.—The date 

17 specified in this clause is the date on which 

18 the regulations are updated under section 

19 407(a).’’. 

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

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

22 striking ‘‘or the site of the aircraft crash at Shanksville, 

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

24 at Shanksville, Pennsylvania, or any other 9/11 crash site’’. 
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1 (e) INCLUSION OF PHYSICAL HARM RESULTING FROM

2 DEBRIS REMOVAL.—Section 405(c) of such Act is amended 

3 in paragraph (2)(A)(ii), by inserting ‘‘or debris removal’’ 

4 after ‘‘air crash’’. 

5 (f) LIMITATIONS ON CIVIL ACTIONS.— 

6 (1) APPLICATION TO DAMAGES RELATED TO DE7 BRIS REMOVAL.—Clause (i) of section 405(c)(3)(C) of 

8 such Act, as redesignated by subsection (c), is amend9 ed by inserting ‘‘, or for damages arising from or re10 lated to debris removal’’ after ‘‘September 11, 2001’’. 

11 (2) PENDING ACTIONS.—Clause (ii) of such sec12 tion, as so redesignated, is amended to read as fol13 lows: 

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

15 of an individual who is a party to a civil 

16 action described in clause (i), such indi17 vidual may not submit a claim under this 

18 title— 

19 ‘‘(I) during the period described 

20 in subsection (a)(3)(A) unless such in21 dividual withdraws from such action 

22 by the date that is 90 days after the 

23 date on which regulations are promul24 gated under section 407(a); and 
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1 ‘‘(II) during the period described 

2 in subsection (a)(3)(B) unless such in3 dividual withdraws from such action 

4 by the date that is 90 days after the 

5 date on which the regulations are up6 dated under section 407(b).’’. 

7 (3) SETTLED ACTIONS.—Such section, as so re8 designated, is further amended by adding at the end 

9 the following new clause: 

10 ‘‘(iii) SETTLED ACTIONS.—In the case 

11 of an individual who settled a civil action 

12 described in clause (i), such individual may 

13 not submit a claim under this title unless 

14 such action was commenced after December 

15 22, 2003, and a release of all claims in such 

16 action was tendered prior to the date on 

17 which the James Zadroga 9/11 Health and 

18 Compensation Act of 2010 was enacted.’’. 

19 SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

20 Section 407 of the Air Transportation Safety and Sys21 tem Stabilization Act (49 U.S.C. 40101 note) is amended— 

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

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

24 (2) by adding at the end the following new sub25 section: 
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1 ‘‘(b) UPDATED REGULATIONS.—Not later than 180 

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

3 9/11 Health and Compensation Act of 2010, the Special 

4 Master shall update the regulations promulgated under sub5 section (a) to the extent necessary to comply with the provi6 sions of title II of such Act.’’. 

7 SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 

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

9 System Stabilization Act (49 U.S.C. 40101 note) is amend10 ed by adding at the end the following new paragraphs: 

11 ‘‘(4) LIABILITY FOR CERTAIN CLAIMS.—Notwith12 standing any other provision of law, liability for all 

13 claims and actions (including claims or actions that 

14 have been previously resolved, that are currently 

15 pending, and that may be filed) for compensatory 

16 damages, contribution or indemnity, or any other 

17 form or type of relief, arising from or related to de18 bris removal, against the City of New York, any enti19 ty (including the Port Authority of New York and 

20 New Jersey) with a property interest in the World 

21 Trade Center on September 11, 2001 (whether fee 

22 simple, leasehold or easement, or direct or indirect) 

23 and any contractors and subcontractors, shall not be 

24 in an amount that exceeds the sum of the following, 

25 as may be applicable: 
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1 ‘‘(A) The amount of funds of the WTC Cap2 tive Insurance Company, including the cumu3 lative interest. 

4 ‘‘(B) The amount of all available insurance 

5 identified in schedule 2 of the WTC Captive In6 surance Company insurance policy. 

7 ‘‘(C) As it relates to the limitation of liabil8 ity of the City of New York, the amount that is 

9 the greater of the City of New York’s insurance 

10 coverage or $350,000,000. In determining the 

11 amount of the City’s insurance coverage for pur12 poses of the previous sentence, any amount de13 scribed in subparagraphs (A) and (B) shall not 

14 be included. 

15 ‘‘(D) As it relates to the limitation of liabil16 ity of any entity, including the Port Authority 

17 of New York and New Jersey, with a property 

18 interest in the World Trade Center on September 

19 11, 2001 (whether fee simple, leasehold or ease20 ment, or direct or indirect), the amount of all 

21 available liability insurance coverage main22 tained by any such entity. 

23 ‘‘(E) As it relates to the limitation of liabil24 ity of any individual contractor or subcon25 tractor, the amount of all available liability in-
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1 surance coverage maintained by such contractor 

2 or subcontractor on September 11, 2001. 

3 ‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Pay4 ments to plaintiffs who obtain a settlement or judg5 ment with respect to a claim or action to which para6 graph (4) applies, shall be paid solely from the fol7 lowing funds in the following order, as may be appli8 cable: 

9 ‘‘(A) The funds described in subparagraph 

10 (A) or (B) of paragraph (4). 

11 ‘‘(B) If there are no funds available as de12 scribed in subparagraph (A) or (B) of paragraph 

13 (4), the funds described in subparagraph (C) of 

14 such paragraph. 

15 ‘‘(C) If there are no funds available as de16 scribed in subparagraph (A), (B), or (C) of 

17 paragraph (4), the funds described in subpara18 graph (D) of such paragraph. 

19 ‘‘(D) If there are no funds available as de20 scribed in subparagraph (A), (B), (C), or (D) of 

21 paragraph (4), the funds described in subpara22 graph (E) of such paragraph. 

23 ‘‘(6) DECLARATORY JUDGMENT ACTIONS AND DI24 RECT ACTION.—Any claimant to a claim or action to 

25 which paragraph (4) applies may, with respect to 
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1 such claim or action, either file an action for a de2 claratory judgment for insurance coverage or bring a 

3 direct action against the insurance company involved, 

4 except that no such action for declaratory judgment 

5 or direct action may be commenced until after the 

6 funds available in subparagraph (A), (B), (C), and 

7 (D) of paragraph (5) have been exhausted consistent 

8 with the order described in such paragraph for pay9 ment.’’. 

10 SEC. 205. FUNDING; ATTORNEY FEES. 

11 Section 406 of the Air Transportation Safety and Sys12 tem Stabilization Act (49 U.S.C. 40101 note) is amended— 

13 (1) in subsection (a), by striking ‘‘Not later 

14 than’’ and inserting ‘‘Subject to the limitations under 

15 subsection (d), not later than’’; 

16 (2) in subsection (b)— 

17 (A) by inserting ‘‘in the amounts provided 

18 under subsection (d)(1)’’ after ‘‘appropriations 

19 Acts’’; and 

20 (B) by inserting ‘‘subject to the limitations 

21 under subsection (d)’’ before the period; and 

22 (3) by adding at the end the following new sub23 sections: 

24 ‘‘(d) LIMITATION.— 
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1 ‘‘(1) IN GENERAL.—The total amount of Federal 

2 funds paid for compensation under this title, with re3 spect to claims filed on or after the date on which the 

4 regulations are updated under section 407(b), shall 

5 not exceed $2,775,000,000. Of such amounts, not to 

6 exceed $875,000,000 shall be available to pay such 

7 claims during the 5-year period beginning on such 

8 date. 

9 ‘‘(2) PRO-RATION AND PAYMENT OF REMAINING

10 CLAIMS.— 

11 ‘‘(A) IN GENERAL.—The Special Master 

12 shall ratably reduce the amount of compensation 

13 due claimants under this title in a manner to 

14 ensure, to the extent possible, that— 

15 ‘‘(i) all claimants who, before applica16 tion of the limitation under the second sen17 tence of paragraph (1), would have been de18 termined to be entitled to a payment under 

19 this title during such 5-year period, receive 

20 a payment during such period; and 

21 ‘‘(ii) the total amount of all such pay22 ments made during such 5-year period do 

23 not exceed the amount available under the 

24 second sentence of paragraph (1) to pay 

25 claims during such period. 
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1 ‘‘(B) PAYMENT OF REMAINDER OF CLAIM

2 AMOUNTS.—In any case in which the amount of 

3 a claim is ratably reduced pursuant to subpara4 graph (A), on or after the first day after the 5- 

5 year period described in paragraph (1), but in 

6 no event later than 1 year after such 5-year pe7 riod, the Special Master shall pay to the claim8 ant the amount that is equal to the difference be9 tween— 

10 ‘‘(i) the amount that the claimant 

11 would have been paid under this title dur12 ing such period without regard to the limi13 tation under the second sentence of para14 graph (1) applicable to such period; and 

15 ‘‘(ii) the amount the claimant was 

16 paid under this title during such period. 

17 ‘‘(C) TERMINATION.—Upon completion of 

18 all payments pursuant to this subsection, the 

19 Victim’s Compensation Fund shall be perma20 nently closed. 

21 ‘‘(e) ATTORNEY FEES.— 

22 ‘‘(1) IN GENERAL.—Notwithstanding any con23 tract, the representative of an individual may not 

24 charge, for services rendered in connection with the 

25 claim of an individual under this title, more than 10 
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1 percent of an award made under this title on such 

2 claim. 

3 ‘‘(2) LIMITATION.— 

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

5 subparagraph (B), in the case of an individual 

6 who was charged a legal fee in connection with 

7 the settlement of a civil action described in sec8 tion 405(c)(3)(C)(iii), the representative of the 

9 individual may not charge any amount for com10 pensation for services rendered in connection 

11 with a claim filed under this title. 

12 ‘‘(B) EXCEPTION.—If the legal fee charged 

13 in connection with the settlement of a civil ac14 tion described in section 405(c)(3)(C)(iii) of an 

15 individual is less than 10 percent of the aggre16 gate amount of compensation awarded to such 

17 individual through such settlement, the rep18 resentative of such individual may charge an 

19 amount for compensation for services rendered to 

20 the extent that such amount charged is not more 

21 than— 

22 ‘‘(i) 10 percent of such aggregate 

23 amount through the settlement, minus 
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1 ‘‘(ii) the total amount of all legal fees 

2 charged for services rendered in connection 

3 with such settlement. 

4 ‘‘(3) DISCRETION TO LOWER FEE.—In the event 

5 that the special master finds that the fee limit set by 

6 paragraph (1) or (2) provides excessive compensation 

7 for services rendered in connection with such claim, 

8 the Special Master may, in the discretion of the Spe9 cial Master, award as reasonable compensation for 

10 services rendered an amount lesser than that per11 mitted for in paragraph (1).’’. 

12 TITLE III—REVENUE RELATED 

13 PROVISIONS 

14 SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCURE15 MENT. 

16 (a) IMPOSITION OF TAX.— 

17 (1) IN GENERAL.—Subtitle D of the Internal 

18 Revenue Code of 1986 is amended by adding at the 

19 end the following new chapter: 

20 ‘‘CHAPTER 50—FOREIGN PROCUREMENT 

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

21 ‘‘SEC. 5000C. IMPOSITION OF TAX ON CERTAIN FOREIGN 

22 PROCUREMENT. 

23 ‘‘(a) IMPOSITION OF TAX.—There is hereby imposed on 

24 any foreign person that receives a specified Federal procure-
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1 ment payment a tax equal to 2 percent of the amount of 

2 such specified Federal procurement payment. 

3 ‘‘(b) SPECIFIED FEDERAL PROCUREMENT PAY4 MENT.—For purposes of this section, the term ‘specified 

5 Federal procurement payment’ means any payment made 

6 pursuant to a contract with the Government of the United 

7 States for— 

8 ‘‘(1) the provision of goods, if such goods are 

9 manufactured or produced in any country which is 

10 not a party to an international procurement agree11 ment with the United States, or 

12 ‘‘(2) the provision of services, if such services are 

13 provided in any country which is not a party to an 

14 international procurement agreement with the United 

15 States. 

16 ‘‘(c) FOREIGN PERSON.—For purposes of this section, 

17 the term ‘foreign person’ means any person other than a 

18 United States person. 

19 ‘‘(d) ADMINISTRATIVE PROVISIONS.— 

20 ‘‘(1) WITHHOLDING.—The amount deducted and 

21 withheld under chapter 3 shall be increased by the 

22 amount of tax imposed by this section on such pay23 ment. 
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1 ‘‘(2) OTHER ADMINISTRATIVE PROVISIONS.—For 

2 purposes of subtitle F, any tax imposed by this sec3 tion shall be treated as a tax imposed by subtitle A.’’. 

4 (2) CLERICAL AMENDMENT.—The table of chap5 ters for subtitle D of the Internal Revenue Code of 

6 1986 is amended by adding at the end the following 

7 new item: 

‘‘CHAPTER 50—FOREIGN PROCUREMENT’’. 

8 (3) EFFECTIVE DATE.—The amendments made 

9 by this subsection shall apply to payments received 

10 pursuant to contracts entered into on and after the 

11 date of the enactment of this Act. 

12 (b) PROHIBITION ON REIMBURSEMENT OF FEES.— 

13 (1) IN GENERAL.—The head of each executive 

14 agency shall take any and all measures necessary to 

15 ensure that no funds are disbursed to any foreign con16 tractor in order to reimburse the tax imposed under 

17 section 5000C of the Internal Revenue Code of 1986. 

18 (2) ANNUAL REVIEW.—The Administrator for 

19 Federal Procurement Policy shall annually review the 

20 contracting activities of each executive agency to mon21 itor compliance with the requirements of paragraph 

22 (1). 

23 (3) EXECUTIVE AGENCY.—For purposes of this 

24 subsection, the term ‘‘executive agency’’ has the mean-
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1 ing given the term in section 4 of the Office of Federal 

2 Procurement Policy Act (41 U.S.C. 403). 

3 (c) APPLICATION.—This section and the amendments 

4 made by this section shall be applied in a manner con5 sistent with United States obligations under international 

6 agreements. 

7 SEC. 302. RENEWAL OF FEES FOR VISA-DEPENDENT EM8 PLOYERS. 

9 Subsections (a), (b), and (c) of section 402 of Public 

10 Law 111-230 are amended by striking ‘‘2014’’ each place 

11 that such appears and inserting ‘‘2015’’. 

12 TITLE IV—BUDGETARY EFFECTS 

13 SEC. 401. COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO 

14 ACT OF 2010. 

15 The budgetary effects of this Act, for the purpose of 

16 complying with the Statutory Pay-As-You-Go-Act of 2010, 

17 shall be determined by reference to the latest statement titled 

18 ‘‘Budgetary Effects of PAYGO Legislation’’ for this Act, 

19 submitted for printing in the Congressional Record by the 

20 Chairman of the Senate Budget Committee, provided that 
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1 such statement has been submitted prior to the vote on pas2 sage. 

Attest: 

Secretary. 

111TH CONGRESS 

2D SESSION H.R. 847 

AMENDMENT