I 

111TH CONGRESS 

1ST SESSION H. R. 847 

To amend the Public Health Service Act to extend and improve protections 

and services to individuals directly impacted by the terrorist attack in 

New York City on September 11, 2001, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 4, 2009 

Mrs. MALONEY (for herself, Mr. NADLER of New York, Mr. KING of New 

York, Mr. MCMAHON, Mr. RANGEL, Mr. ACKERMAN, Mr. ARCURI, Mr. 

BISHOP of New York, Mr. BURGESS, Mr. CROWLEY, Mr. ENGEL, Mr. 

HALL of New York, Mr. HIGGINS, Mr. HIMES, Mr. HINCHEY, Mr. 

ISRAEL, Mr. LEE of New York, Mrs. LOWEY, Mr. MAFFEI, Mr. MASSA, 

Mrs. MCCARTHY of New York, Mr. MCGOVERN, Mr. MCHUGH, Mr. 

MEEKS of New York, Mr. PASCRELL, Mr. SERRANO, Ms. SUTTON, Mr. 

TONKO, Mr. TOWNS, Mr. WEINER, Ms. WOOLSEY, and Ms. CLARKE) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on the Judiciary, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL 

To amend the Public Health Service Act to extend and 

improve protections and services to individuals directly 

impacted by the terrorist attack in New York City on 

September 11, 2001, and for other purposes. 

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


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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 2009’’. 

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

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Findings. 

TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 

Sec. 101. World Trade Center Health Program. 

‘‘TITLE XXX—WORLD TRADE CENTER HEALTH PROGRAM 

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

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

NIOSH. 

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

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

‘‘Sec. 3004. Community education and outreach. 

‘‘Sec. 3005. Uniform data collection. 

‘‘Sec. 3006. Centers of excellence. 

‘‘Sec. 3007. Entitlement authorities. 

‘‘Sec. 3008. Definitions. 

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

Treatment 

‘‘PART 1—FOR WTC RESPONDERS

‘‘Sec. 3011. Identification of eligible WTC responders and provision of 

WTC-related monitoring services. 

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

‘‘PART 2—COMMUNITY PROGRAM

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

community members. 

‘‘Sec. 3022. Followup monitoring and treatment of certified eligible WTC 

community members for WTC-related health conditions. 

‘‘Sec. 3023. Followup monitoring and treatment of other individuals with 

WTC-related health conditions. 

‘‘PART 3—NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE

INDIVIDUALS OUTSIDE NEW YORK


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

‘‘Subtitle C—Research Into Conditions 

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

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

Mental Hygiene 

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

‘‘Sec. 3052. Mental health services. 

TITLE II—SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 

2001 

Sec. 201. Definitions. 

Sec. 202. Extended and expanded eligibility for compensation. 

Sec. 203. Requirement to update regulations. 

Sec. 204. Limited liability for certain claims. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Thousands of rescue workers who responded 

4 to the areas devastated by the terrorist attacks of 

5 September 11, local residents, office and area work6 ers, and school children continue to suffer significant 

7 medical problems as a result of compromised air 

8 quality and the release of other toxins from the at9 tack sites. 

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

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

14 responders had a new or worsened respiratory symp15 tom that developed during or after their time work16 ing at the World Trade Center; among the respondVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 ers who were asymptomatic before 9/11, 61 percent 

2 developed respiratory symptoms while working at the 

3 World Trade Center; close to 60 percent still had a 

4 new or worsened respiratory symptom at the time of 

5 their examination; one-third had abnormal pul6 monary function tests; and severe respiratory condi7 tions including pneumonia were significantly more 

8 common in the 6 months after 9/11 than in the 

9 prior 6 months. 

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

11 average, a New York City firefighter who responded 

12 to the World Trade Center has experienced a loss of 

13 12 years of lung capacity. 

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

15 near the World Trade Center titled ‘‘The World 

16 Trade Center Residents’ Respiratory Health Study: 

17 New Onset Respiratory Symptoms and Pulmonary 

18 Function’’, found that data demonstrated a three19 fold increase in new-onset, persistent lower res20 piratory symptoms in residents near the former 

21 World Trade Center as compared to a control popu22 lation. 

23 (5) Previous research on the health impacts of 

24 the devastation caused by the September 11 terrorist 

25 attacks has shown relationships between the air 


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1 quality from Ground Zero and a host of health im2 pacts, including lower pregnancy rates, higher rates 

3 of respiratory and lung disorders, and a variety of 

4 post-disaster mental health conditions (including 

5 posttraumatic stress disorder) in workers and resi6 dents near Ground Zero. 

7 (6) A variety of tests conducted by independent 

8 scientists have concluded that significant WTC con9 tamination settled in indoor environments sur10 rounding the disaster site. The Environmental Pro11 tection Agency’s (EPA) cleanup programs for indoor 

12 residential spaces, in 2003 and 2005, though lim13 ited, are an acknowledgment that indoor contamina14 tion continued after the WTC attacks. 

15 (7) At the request of the Department of En16 ergy, the Davis DELTA Group at the University of 

17 California conducted outdoor dust sampling in Octo18 ber 2001 at Varick and Houston Streets (approxi19 mately 1.2 miles north of Ground Zero) and found 

20 that the contamination from the World Trade Cen21 ter ‘‘outdid even the worst pollution from the Ku22 wait oil fields fires’’. Further, the United States Ge23 ological Survey (USGS) reported on November 27, 

24 2001, that dust samples collected from indoor surVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 faces registered at levels that were ‘‘as caustic as 

2 liquid drain cleaners’’. 

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

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

5 General Accountability Offices’s (GAO) report of 

6 September 2007, no comprehensive program has 

7 ever been conducted in order to characterize the full 

8 extent of WTC contamination, and therefore the full 

9 impact of that contamination—geographic or other10 wise—remains unknown. 

11 (9) Such reports found that there has never 

12 been a comprehensive program to remediate WTC 

13 toxins from indoor spaces. Thus, area residents, 

14 workers and students may continue to be exposed to 

15 WTC contamination in their homes, workplaces and 

16 schools. 

17 (10) Because of the failure to release federally 

18 appropriated funds for community care, a lack of 

19 sufficient outreach, the fact that many community 

20 members are receiving care from physicians outside 

21 the current City-funded World Trade Center Envi22 ronmental Health Center program and thus fall out23 side data collection efforts, and other factors, the 

24 number of community members being treated at the 

25 World Trade Center Environmental Health Center 


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1 underrepresents the total number in the community 

2 that have been affected by exposure to Ground Zero 

3 toxins. 

4 (11) Research by Columbia University’s Center 

5 for Children’s Environmental Health has shown neg6 ative health effects on babies born to women living 

7 within 2 miles of the World Trade Center in the 

8 month following 9/11. 

9 (12) Federal funding allocated for the moni10 toring of rescue workers’ health is not sufficient to 

11 ensure the long-term study of health impacts of Sep12 tember 11. 

13 (13) A significant portion of those who have de14 veloped health problems as result of exposures to 

15 airborne toxins or other hazards resulting from the 

16 September 11, 2001, attacks on the World Trade 

17 Center have no health insurance, have lost their 

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

19 inadequate health insurance. 

20 (14) The Federal program to provide medical 

21 treatments to those who responded to the September 

22 11 aftermath, and who continue to experience health 

23 problems as a result, was finally established more 

24 than five years after the attacks, but has no certain 

25 long-term funding. 


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1 (15) Rescue workers and volunteers seeking 

2 workers’ compensation have reported that their ap3 plications have been denied, delayed for months, or 

4 redirected, instead of receiving assistance in a timely 

5 and supportive manner. 

6 (16) A February 2007 report released by the 

7 City of New York estimated that approximately 

8 410,000 people were the most heavily exposed to the 

9 environmental hazards and trauma of the September 

10 11 terrorist attacks. More than 30 percent of the 

11 Fire Department of the City of New York first re12 sponders were still experiencing some respiratory 

13 symptoms more than five years after the attacks and 

14 according to the report, 59 percent of those seen by 

15 the WTC Environmental Health Center at Bellevue 

16 Hospital (which serves community members) are 

17 without insurance and 65 percent have incomes less 

18 than $15,000 per year. The report also found a need 

19 to continue and expand mental health services. 

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

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

22 have been signing up with the monitoring and treat23 ment programs. 

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

25 and Human Services reported to Congress that in 


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1 fiscal year 2007 11,359 patients received medical 

2 treatment in the existing WTC Responder Medical 

3 and Treatment program for WTC-related health 

4 problems, and that number of responders who need 

5 treatment and the severity of health problems is ex6 pected to increase. 

7 (19) The September 11 Victim Compensation 

8 Fund of 2001 was established to provide compensa9 tion to individuals who were physically injured or 

10 killed as a result of the terrorist-related aircraft 

11 crashes of September 11, 2001. 

12 (20) The deadline for filing claims for com13 pensation under the Victim Compensation Fund was 

14 December 22, 2003. 

15 (21) Some individuals did not know they were 

16 eligible to file claims for compensation for injuries or 

17 did not know they had suffered physical harm as a 

18 result of the terrorist-related aircraft crashes until 

19 after the December 22, 2003, deadline. 

20 (22) Further research is needed to evaluate 

21 more comprehensively the extent of the health im22 pacts of September 11, including research for 

23 emerging health problems such as cancer, which 

24 have been predicted. 


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1 (23) Research is needed regarding possible 

2 treatment for the illnesses and injuries of September 

3 11. 

4 (24) The Federal response to medical and fi5 nancial issues arising from the September 11 re6 sponse efforts needs a comprehensive, coordinated 

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

8 the individuals who were exposed to the toxins of 

9 Ground Zero and are suffering health problems from 

10 the disaster. 

11 (25) The failure to extend the appointment of 

12 Dr. John Howard as Director of the National Insti13 tute for Occupational Safety and Health in July 

14 2008 is not in the interests of the administration of 

15 such Institute nor the continued operation of the 

16 World Trade Center Medical Monitoring and Treat17 ment Program which he has headed, and the Sec18 retary of Health and Human Services should recon19 sider extending such appointment. 

20 TITLE I—WORLD TRADE CENTER 

21 HEALTH PROGRAM 

22 SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 

23 The Public Health Service Act is amended by adding 

24 at the end the following new title: 


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1 ‘‘TITLE XXX—WORLD TRADE 

2 CENTER HEALTH PROGRAM 

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

5 Committees 

6 ‘‘SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER 

7 HEALTH PROGRAM WITHIN NIOSH. 

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

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

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

12 program’) to provide— 

13 ‘‘(1) medical monitoring and treatment benefits 

14 to eligible emergency responders and recovery and 

15 clean-up workers (including those who are Federal 

16 employees) who responded to the September 11, 

17 2001, terrorist attacks on the World Trade Center; 

18 and 

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

20 treatment benefits to residents and other building 

21 occupants and area workers in New York City who 

22 were directly impacted and adversely affected by 

23 such attacks. 

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


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1 ‘‘(1) MEDICAL MONITORING FOR RESPOND2 ERS.—Medical monitoring under section 3011, in3 cluding clinical examinations and long-term health 

4 monitoring and analysis for individuals who were 

5 likely to have been exposed to airborne toxins that 

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

7 September 11, 2001, terrorist attacks on the World 

8 Trade Center. 

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

11 under section 3021, including an evaluation to deter12 mine eligibility for followup monitoring and treat13 ment. 

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

17 under sections 3012, 3022, and 3023 of follow-up 

18 monitoring and treatment and payment, subject to 

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

20 necessary health and mental health care expenses 

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

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

24 3004 of an outreach program to potentially eligible 

25 individuals concerning the benefits under this title. 


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

2 under section 3005 of health and mental health data 

3 on individuals receiving monitoring or treatment 

4 benefits, using a uniform system of data collection. 

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

7 health conditions resulting from the September 11, 

8 2001, terrorist attacks on the World Trade Center. 

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

10 benefits and initial health evaluation benefits are provided 

11 under subtitle B without any deductibles, copayments, or 

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

13 eligible WTC community member. 

14 ‘‘(d) PAYOR.— 

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

18 provided under subtitle B shall be paid for by the 

19 WTC program. 

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

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

22 subparagraph (B), payment for treatment 

23 under subtitle B of a WTC-related condition in 

24 an individual that is work-related shall be re25 duced or recouped to the extent that the SecVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 retary determines that payment has been made, 

2 or can reasonably be expected to be made, 

3 under a workers’ compensation law or plan of 

4 the United States or a State, or other work-re5 lated injury or illness benefit plan of the em6 ployer of such individual, for such treatment. 

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

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

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

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

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

13 workers’ compensation law or plan, or other 

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

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

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

19 respect to such a law or plan and an individual 

20 entitled to benefits under title XVIII of such 

21 Act. 

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

23 Administrator certifies that the City of New 

24 York has contributed the matching contribution 

25 required under section 3006(a)(3) for a 12- 


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1 month period (specified by the WTC Program 

2 Administrator), subparagraph (A) shall not 

3 apply for that 12-month period with respect to 

4 a workers’ compensation law or plan, including 

5 line of duty compensation, to which the City is 

6 obligated to make payments. 

7 ‘‘(3) HEALTH INSURANCE COVERAGE.— 

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

10 not work-related and has health coverage for 

11 such condition through any public or private 

12 health plan, the provisions of section 1862(b) of 

13 the Social Security Act (42 U.S.C. 1395y(b)) 

14 shall apply to such a health plan and such indi15 vidual in the same manner as they apply to a 

16 group health plan and an individual entitled to 

17 benefits under title XVIII of such Act pursuant 

18 to section 226(a). Any costs for items and serv19 ices covered under such plan that are not reim20 bursed by such health plan, due to the applica21 tion of deductibles, copayments, coinsurance, 

22 other cost-sharing, or otherwise, are reimburs23 able under this title to the extent that they are 

24 covered under the WTC program. 


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

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

5 reimbursement under a health plan with which 

6 the entity has no contract for reimbursement. 

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

8 purposes of this subsection, a WTC-related condition 

9 shall be treated as a condition that is work-related 

10 if— 

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

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

15 clean-up worker; or 

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

18 under a workers’ compensation law or plan of 

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

22 ‘‘(e) QUALITY ASSURANCE AND MONITORING OF

23 CLINICAL EXPENDITURES.— 

24 ‘‘(1) QUALITY ASSURANCE.—The WTC Pro25 gram Administrator working with the Clinical CenVerDate Nov 24 2008 02:40 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00016 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 ters of Excellence shall develop and implement a 

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

4 Excellence and any other participating health care 

5 providers. Such program shall include— 

6 ‘‘(A) adherence to medical monitoring and 

7 treatment protocols; 

8 ‘‘(B) appropriate diagnostic and treatment 

9 referrals for participants; 

10 ‘‘(C) prompt communication of test results 

11 to participants; and 

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

14 Centers of Excellence. 

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

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

19 payment for inappropriate services. Such program 

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

22 the Social Security Act. This title is a Federal 

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

24 of such Act) and is a health plan (as defined in secVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00017 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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

2 sections 1128 through 1128E of such Act. 

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

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

6 designee of such Director. 

7 ‘‘(g) ANNUAL PROGRAM REPORT.— 

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

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

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

13 year and for the entire period of operation of the 

14 program. 

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

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

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

21 applied for certification under subtitle B 

22 and the number of such individuals who 

23 were so certified; 

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


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1 monitoring under the program and the 

2 number of such individuals who received 

3 medical treatment under the program; 

4 ‘‘(iii) with respect to individuals so 

5 certified who received such treatment, on 

6 the WTC-related health conditions for 

7 which they were treated; and 

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

10 B in the succeeding fiscal year. 

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

13 clinical program so described— 

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

16 costs of treatment and on the estimated 

17 costs of such monitoring, evaluation, and 

18 treatment in the succeeding fiscal year; 

19 and 

20 ‘‘(ii) an estimate of the cost of med21 ical treatment for WTC-related conditions 

22 that have been paid for or reimbursed by 

23 workers’ compensation, by public or private 

24 health plans, or by the City of New York 

25 under section 3012(c)(4). 


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

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

5 the program. 

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

8 the program, including— 

9 ‘‘(i) the performance of the program 

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

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

13 Excellence and other providers that are 

14 participating in the program. 

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

16 of the findings of any new scientific reports or 

17 studies on the health effects associated with 

18 WTC center exposures, including the findings 

19 of research conducted under section 3041(a). 

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

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

24 criteria and on additional WTC-related health 

25 conditions and the action of the WTC Program 


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1 Administrator concerning each such rec2 ommendation. 

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

5 shall be treated as a separate clinical program of the 

6 WTC program: 

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

8 provided for eligible WTC responders described 

9 in section 3006(b)(1)(A). 

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

12 responders not described in subparagraph (A). 

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

15 community members in section 3006(b)(1)(C). 

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

17 PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The 

18 WTC Program Administrator shall promptly notify the 

19 Congress— 

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

22 under section 3011(a)(5) has reached 80 percent of 

23 such limit; and 

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


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1 established under section 3021(a)(5) has reached 80 

2 percent of such limit. 

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

4 date of the enactment of this Act, the Comptroller General 

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

6 on the costs of the monitoring and treatment programs 

7 provided under this title. 

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

9 York may make recommendations to the WTC Program 

10 Administrator on ways to improve the monitoring and 

11 treatment programs under this title for both eligible WTC 

12 responders and eligible WTC community members. 

13 ‘‘SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECH14 NICAL ADVISORY COMMITTEE. 

15 ‘‘(a) ESTABLISHMENT.—The WTC Program Admin16 istrator shall establish an advisory committee to be known 

17 as the WTC Health Program Scientific/Technical Advisory 

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

19 Committee’) to review scientific and medical evidence and 

20 to make recommendations to the Administrator on addi21 tional WTC program eligibility criteria and on additional 

22 WTC-related health conditions. 

23 ‘‘(b) COMPOSITION.—The WTC Program Adminis24 trator shall appoint the members of the Advisory Com25 mittee and shall include at least— 


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

2 whom have experience treating WTC rescue and re3 covery workers; 

4 ‘‘(2) 1 physician with expertise in pulmonary 

5 medicine; 

6 ‘‘(3) 2 environmental medicine or environmental 

7 health specialists; 

8 ‘‘(4) 2 representatives of eligible WTC respond9 ers; 

10 ‘‘(5) 2 representatives of WTC community 

11 members; 

12 ‘‘(6) an industrial hygienist; 

13 ‘‘(7) a toxicologist; 

14 ‘‘(8) an epidemiologist; and 

15 ‘‘(9) a mental health professional. 

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

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

18 its duties. 

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

20 shall provide for publication of recommendations of the 

21 Advisory Committee on the public website established for 

22 the WTC program. 

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

24 purpose of carrying out this section, there are authorized 

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


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

2 fiscal year 2009. 

3 ‘‘(f) DURATION.—Notwithstanding any other provi4 sion of law, the Advisory Committee shall continue in op5 eration during the period in which the WTC program is 

6 in operation. 

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

8 specifically provided, the Advisory Committee shall be sub9 ject to the Federal Advisory Committee Act. 

10 ‘‘SEC. 3003. WTC HEALTH PROGRAM STEERING COMMIT11 TEES. 

12 ‘‘(a) ESTABLISHMENT.—The WTC Program Admin13 istrator shall establish two steering committees (each in 

14 this section referred to as a ‘Steering Committee’) as fol15 lows: 

16 ‘‘(1) WTC RESPONDERS STEERING COM17 MITTEE.—One steering committee, to be known as 

18 the WTC Responders Steering Committee, for the 

19 purpose of facilitating the coordination of medical 

20 monitoring and treatment programs for the eligible 

21 WTC responders under part 1 of subtitle B. 

22 ‘‘(2) WTC COMMUNITY PROGRAM STEERING

23 COMMITTEE.—One steering committee, to be known 

24 as the WTC Community Program Steering Com25 mittee, for the purpose of facilitating the coordinaVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 tion of initial health evaluations, monitoring, and 

2 treatment programs for eligible WTC community 

3 members under part 2 of subtitle B. 

4 ‘‘(b) MEMBERSHIP.— 

5 ‘‘(1) INITIAL MEMBERSHIP OF WTC RESPOND6 ERS STEERING COMMITTEE.—The WTC Responders 

7 Steering Committee shall initially be composed of 

8 members of the WTC Monitoring and Treatment 

9 Program Steering Committee (as in existence on the 

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

11 In addition, the committee membership shall in12 clude— 

13 ‘‘(A) a representative of the Police Com14 missioner of the City of New York; 

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

16 Health of the City of New York; 

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

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

19 New York City, which had a large number of 

20 non-uniformed City workers who responded to 

21 the WTC disaster; and 

22 ‘‘(D) three representatives of eligible WTC 

23 responders; 

24 in order that eligible WTC responders constitute half 

25 the members of the Steering Committee. 


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1 ‘‘(2) INITIAL MEMBERSHIP OF WTC COMMUNITY

2 PROGRAM STEERING COMMITTEE.— 

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

4 Program Steering Committee shall initially be 

5 composed of members of the WTC Environ6 mental Health Center Community Advisory 

7 Committee (as in existence on the day before 

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

9 initially have, as voting members, the following: 

10 ‘‘(i) 11 representatives of the affected 

11 populations of residents, students, area 

12 workers, and other community members. 

13 ‘‘(ii) The Medical Director of the 

14 WTC Environmental Health Center. 

15 ‘‘(iii) The Executive Director of the 

16 WTC Environmental Health Center. 

17 ‘‘(iv) Three physicians, one each rep18 resenting the three WTC Environmental 

19 Health Center treatment sites of Bellevue 

20 Hospital Center, Gouverneur Healthcare 

21 Services, and Elmhurst Hospital Center. 

22 ‘‘(v) Five specialists with WTC re23 lated expertise or experience in treating 

24 non-responder WTC diseases, such as a pe25 diatrician, an epidemiologist, a psychiatrist 


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1 or psychologist, an environmental/occupa2 tional specialists or a social worker from a 

3 WTC Environmental Health Center treat4 ment site, or other relevant specialists. 

5 ‘‘(vi) A representative of the Depart6 ment of Health and Mental Hygiene of the 

7 City of New York. 

8 ‘‘(B) APPOINTMENTS.— 

9 ‘‘(i) WTC EHC COMMUNITY ADVISORY

10 COMMITTEE.—The WTC Environmental 

11 Health Center Community Advisory Com12 mittee as in existence on the date of the 

13 enactment of this title shall nominate 

14 members for positions described in sub15 paragraph (A)(i). 

16 ‘‘(ii) NYC HEALTH AND HOSPITALS

17 CORPORATION.—The New York City 

18 Health and Hospitals Corporation shall 

19 nominate members for positions described 

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

21 (A). 

22 ‘‘(iii) TIMING.—Nominations under 

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

24 to the WTC Program Administrator not 


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1 later than 60 days after the date of the en2 actment of this title. 

3 ‘‘(iv) APPOINTMENT.—The WTC Pro4 gram Administrator shall appoint members 

5 of the WTC Community Program Steering 

6 Committee not later than 90 days after the 

7 date of the enactment of this title. 

8 ‘‘(v) GENERAL REPRESENTATIVES.— 

9 Of the members appointed under subpara10 graph (A)(i)— 

11 ‘‘(I) the representation shall re12 flect the broad and diverse WTC-af13 fected populations and constituencies 

14 and the diversity of impacted neigh15 borhoods, including residents, hard-to16 reach populations, students, area 

17 workers, school parents, community18 based organizations, Community 

19 Boards, WTC Environmental Health 

20 Center patients, labor unions, and 

21 labor advocacy organizations; and 

22 ‘‘(II) no one individual organiza23 tion can have more than one rep24 resentative. 


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1 ‘‘(3) ADDITIONAL APPOINTMENTS.—Each 

2 Steering Committee may appoint, if approved by a 

3 majority of voting members of the Committee, addi4 tional members to the Committee. 

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

6 Committee shall be filled by the Steering Committee, 

7 subject to the approval of the WTC Program Ad8 ministrator, so long as— 

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

10 Steering Committee, the composition of the 

11 Committee includes representatives of eligible 

12 WTC responders and representatives of each 

13 Clinical Center of Excellence and each Coordi14 nating Center of Excellence that serves eligible 

15 WTC responders and such composition has eli16 gible WTC responders constituting half of the 

17 membership of the Steering Committee; or 

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

19 Program Steering Committee, the composition 

20 of the Committee includes representatives of eli21 gible WTC community members and represent22 atives of each Clinical Center of Excellence and 

23 each Coordinating Center of Excellence that 

24 serves eligible WTC community members and 


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1 the nominating process is consistent with para2 graph (2)(B). 

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

4 STEERING COMMITTEE.—The WTC Community Pro5 gram Steering Committee shall have two Co-Chairs 

6 as follows: 

7 ‘‘(A) COMMUNITY/LABOR CO-CHAIR.—A 

8 Community/Labor Co-Chair who shall be chosen 

9 by the community and labor-based members of 

10 the Steering Committee. 

11 ‘‘(B) ENVIRONMENTAL HEALTH CLINIC

12 CO-CHAIR.—A WTC Environmental Health 

13 Clinic Co-Chair who shall be chosen by the 

14 WTC Environmental Health Center members 

15 on the Steering Committee. 

16 ‘‘(c) RELATION TO FACA.—Each Steering Com17 mittee shall not be subject to the Federal Advisory Com18 mittee Act. 

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

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

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

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

23 the voting membership of the other Steering Committee 

24 for the purpose of exchanging information regarding the 

25 WTC program. 


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1 ‘‘(e) DURATION.—Notwithstanding any other provi2 sion of law, each Steering Committee shall continue in op3 eration during the period in which the WTC program is 

4 in operation. 

5 ‘‘SEC. 3004. COMMUNITY EDUCATION AND OUTREACH. 

6 ‘‘(a) IN GENERAL.—The WTC Program Adminis7 trator shall institute a program that provides education 

8 and outreach on the existence and availability of services 

9 under the WTC program. The outreach and education 

10 program— 

11 ‘‘(1) shall include— 

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

13 with information about the WTC program; 

14 ‘‘(B) meetings with potentially eligible pop15 ulations; 

16 ‘‘(C) development and dissemination of 

17 outreach materials informing people about the 

18 program; and 

19 ‘‘(D) the establishment of phone informa20 tion services; and 

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

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

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

24 linguistically diverse populations. 


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1 ‘‘(b) PARTNERSHIPS.—To the greatest extent pos2 sible, in carrying out this section, the WTC Program Ad3 ministrator shall enter into partnerships with local govern4 ments and organizations with experience performing out5 reach to the affected populations, including community 

6 and labor-based organizations. 

7 ‘‘SEC. 3005. UNIFORM DATA COLLECTION. 

8 ‘‘(a) IN GENERAL.—The WTC Program Adminis9 trator shall provide for the uniform collection of data (and 

10 analysis of data and regular reports to the Administrator) 

11 on the utilization of monitoring and treatment benefits 

12 provided to eligible WTC responders and eligible WTC 

13 community members, the prevalence of WTC-related 

14 health conditions, and the identification of new WTC-re15 lated medical conditions. Such data shall be collected for 

16 all individuals provided monitoring or treatment benefits 

17 under subtitle B and regardless of their place of residence 

18 or Clinical Center of Excellence through which the benefits 

19 are provided. 

20 ‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL21 LENCE.—Each Clinical Center of Excellence shall collect 

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

23 the corresponding Coordinating Center of Excellence for 

24 analysis by such Coordinating Center of Excellence. 


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

2 under this section shall be conducted in a manner that 

3 protects the confidentiality of individually identifiable 

4 health information consistent with applicable legal require5 ments. 

6 ‘‘SEC. 3006. CENTERS OF EXCELLENCE. 

7 ‘‘(a) IN GENERAL.— 

8 ‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF

9 EXCELLENCE.—The WTC Program Administrator 

10 shall enter into contracts with Clinical Centers of 

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

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

13 treatment benefits and initial health evaluation 

14 benefits under subtitle B; 

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

16 to individuals eligible for such monitoring and 

17 treatment benefits, for initial health evaluation 

18 benefits, and for follow-up to individuals who 

19 are enrolled in the monitoring program; 

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

21 benefits under subtitle B, with respect to WTC22 related health conditions, for individuals eligible 

23 for such benefits; 

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

25 benefits for WTC-related health conditions that 


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1 may be available under Workers’ Compensation 

2 or other benefit programs for work-related inju3 ries or illnesses, health insurance, disability in4 surance, or other insurance plans or through 

5 public or private social service agencies and as6 sisting eligible individuals in applying for such 

7 benefits; 

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

9 interpretive services as for program participants 

10 who are not English language proficient; and 

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

12 data in accordance with section 3005. 

13 ‘‘(2) CONTRACTS WITH COORDINATING CEN14 TERS OF EXCELLENCE.—The WTC Program Ad15 ministrator shall enter into contracts with Coordi16 nating Centers of Excellence specified in subsection 

17 (b)(2)— 

18 ‘‘(A) for receiving, analyzing, and report19 ing to the WTC Program Administrator on 

20 data, in accordance with section 3005, that has 

21 been collected and reported to such Coordi22 nating Centers by the corresponding Clinical 

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

24 ‘‘(B) for the development of medical moni25 toring, initial health evaluation, and treatment 


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1 protocols, with respect to WTC-related health 

2 conditions; 

3 ‘‘(C) for coordinating the outreach activi4 ties conducted under paragraph (1)(B) by each 

5 corresponding Clinical Center of Excellence; 

6 ‘‘(D) for establishing criteria for the 

7 credentialing of medical providers participating 

8 in the nationwide network under section 3031; 

9 ‘‘(E) for coordinating and administrating 

10 the activities of the WTC Health Program 

11 Steering Committees established under section 

12 3003(a); and 

13 ‘‘(F) for meeting periodically with the cor14 responding Clinical Centers of Excellence to ob15 tain input on the analysis and reporting of data 

16 collected under subparagraph (A) and on the 

17 development of medical monitoring, initial 

18 health evaluation, and treatment protocols 

19 under subparagraph (B). 

20 The medical providers under subparagraph (D) shall 

21 be selected by the WTC Program Administrator on 

22 the basis of their experience treating or diagnosing 

23 the medical conditions included in the list of identi24 fied WTC-related conditions for responders and of 


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1 identified WTC-related conditions for community 

2 members. 

3 ‘‘(3) REQUIRED PARTICIPATION BY NEW YORK

4 CITY IN MONITORING AND TREATMENT PROGRAM

5 AND COSTS.— 

6 ‘‘(A) IN GENERAL.—In order for New 

7 York City, any agency or Department thereof, 

8 or the New York City Health and Hospitals 

9 Corporation to qualify for a contract for the 

10 provision of monitoring and treatment benefits 

11 and other services under section 3006, New 

12 York City is required to contribute a matching 

13 amount of 10 percent of the amount of the cov14 ered monitoring and treatment payment (as de15 fined in subparagraph (B)). 

16 ‘‘(B) COVERED MONITORING AND TREAT17 MENT PAYMENT DEFINED.—For the purposes 

18 of this paragraph, the term ‘covered monitoring 

19 and treatment payment’ means payment under 

20 paragraphs (1) and (2), including under such 

21 paragraph as applied under section 3021(b), 

22 3022(a), and 3023, and reimbursement under 

23 3006(c) for items and services furnished by a 

24 Clinical Center of Excellence or Coordinating 

25 Center of Excellence, and providers designated 


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1 by the WTC Program under section 3031, after 

2 the application of paragraphs (2) and (3) of 

3 section 3001 (d). 

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

5 OF MONITORING AND TREATMENT COSTS.—The 

6 WTC Program Administrator shall— 

7 ‘‘(i) bill the amount specified in sub8 paragraph (A) directly to New York City; 

9 and 

10 ‘‘(ii) certify periodically, for purposes 

11 of section 3001(d)(2), whether or not New 

12 York City has paid the amount so billed. 

13 ‘‘(D) LIMITATION ON REQUIRED

14 AMOUNT.—In no case is New York City re15 quired under this paragraph to contribute more 

16 than a total of $500,000,000 over any 10-year 

17 period. 

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

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

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

21 means the following: 

22 ‘‘(A) FOR FDNY RESPONDERS.—With re23 spect to an eligible WTC responder who re24 sponded to the 9/11 attacks as an employee of 


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1 the Fire Department of the City of New York 

2 and who— 

3 ‘‘(i) is an active employee of such De4 partment— 

5 ‘‘(I) with respect to monitoring, 

6 such Fire Department; and 

7 ‘‘(II) with respect to treatment, 

8 such Fire Department (or such entity 

9 as has entered into a contract with 

10 the Fire Department for treatment of 

11 such responders) or any other Clinical 

12 Center of Excellence described in sub13 paragraph (B), (C), or (D); or 

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

15 Department, such Fire Department (or 

16 such entity as has entered into a contract 

17 with the Fire Department for monitoring 

18 or treatment of such responders) or any 

19 other or any other Clinical Center of Ex20 cellence described in subparagraph (B), 

21 (C), or (D). 

22 ‘‘(B) OTHER ELIGIBLE WTC RESPOND23 ERS.—With respect to other eligible WTC re24 sponders, whether or not they reside in the New 

25 York Metropolitan area, the Mt. Sinai coordiVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00038 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 nated consortium, Queens College, State Uni2 versity of New York at Stony Brook, University 

3 of Medicine and Dentistry of New Jersey, and 

4 Bellevue Hospital. 

5 ‘‘(C) WTC COMMUNITY MEMBERS.—With 

6 respect to eligible WTC community members, 

7 whether or not they reside in the New York 

8 Metropolitan area, the World Trade Center En9 vironmental Health Center at Bellevue Hospital 

10 and such hospitals or other facilities, including 

11 but not limited to those within the New York 

12 City Health and Hospitals Corporation, as are 

13 identified by the WTC Program Administrator. 

14 ‘‘(D) ALL ELIGIBLE WTC RESPONDERS

15 AND ELIGIBLE WTC COMMUNITY MEMBERS.— 

16 With respect to all eligible WTC responders and 

17 eligible WTC community members, such other 

18 hospitals or other facilities as are identified by 

19 the WTC Program Administrator. 

20 The WTC Program Administrator shall limit the 

21 number of additional Centers of Excellence identified 

22 under subparagraph (D) to ensure that the partici23 pating centers have adequate experience in the treat24 ment and diagnosis of identified WTC-related med25 ical conditions. 


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1 ‘‘(2) COORDINATING CENTER OF EXCEL2 LENCE.—In this title, the term ‘Coordinating Center 

3 of Excellence’ means the following: 

4 ‘‘(A) FOR FDNY RESPONDERS.—With re5 spect to an eligible WTC responder who re6 sponded to the 9/11 attacks as an employee of 

7 the Fire Department of the City of New York, 

8 such Fire Department. 

9 ‘‘(B) OTHER WTC RESPONDERS.—With re10 spect to other eligible WTC responders, the Mt. 

11 Sinai coordinated consortium. 

12 ‘‘(C) WTC COMMUNITY MEMBERS.—With 

13 respect to eligible WTC community members, 

14 the World Trade Center Environmental Health 

15 Center at Bellevue Hospital. 

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

17 a Clinical Center of Excellence and a Coordinating 

18 Center of Excellence shall be treated as ‘cor19 responding’ to the extent that such Clinical Center 

20 and Coordinating Center serve the same population 

21 group. 

22 ‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, NON23 MONITORING PROGRAM COSTS.—A Clinical or Coordi24 nating Center of Excellence with a contract under this sec25 tion shall be reimbursed for the costs of such Center in 


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

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

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

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

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

6 subsection (a)(1)— 

7 ‘‘(A) CLINICAL CENTER FOR FDNY RE8 SPONDERS IN NEW YORK.—The Clinical Center 

9 of Excellence for FDNY Responders in New 

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

11 reimbursed— 

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

13 under this section, $600 per certified eligi14 ble WTC responder in the medical treat15 ment program, and $300 per certified eli16 gible WTC responder in the monitoring 

17 program; and 

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

19 subject to paragraph (3), at the rates spec20 ified in this subparagraph for the previous 

21 contract year adjusted by the WTC Pro22 gram Administrator to reflect the rate of 

23 medical care inflation during the previous 

24 contract year. 


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1 ‘‘(B) CLINICAL CENTERS SERVING OTHER

2 ELIGIBLE WTC RESPONDERS IN NEW YORK.—A 

3 Clinical Center of Excellence for other WTC re4 sponders in New York specified in subsection 

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

6 specified in subparagraph (A). 

7 ‘‘(C) CLINICAL CENTERS SERVING WTC

8 COMMUNITY MEMBERS.—A Clinical Center of 

9 Excellence for eligible WTC community mem10 bers in New York specified in subsection 

11 (b)(1)(C) shall be reimbursed— 

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

13 under this section, for each certified eligi14 ble WTC community member in a medical 

15 treatment program enrolled at a non-hos16 pital-based facility, $600, and for each cer17 tified eligible WTC community member in 

18 a medical treatment program enrolled at a 

19 hospital-based facility, $300; and 

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

21 subject to paragraph (3), at the rates spec22 ified in this subparagraph for the previous 

23 contract year adjusted by the WTC Pro24 gram Administrator to reflect the rate of 


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1 medical care inflation during the previous 

2 contract year. 

3 ‘‘(D) OTHER CLINICAL CENTERS.—A Clin4 ical Center of Excellence or other providers not 

5 described in a previous subparagraph shall be 

6 reimbursed at a rate set by the WTC Program 

7 Administrator. 

8 ‘‘(E) REIMBURSEMENT RULES.—The reim9 bursement provided under subparagraphs (A), 

10 (B) and (C) shall be made for each certified eli11 gible WTC responder and for each WTC com12 munity member in the WTC program per year 

13 that the member receives such services, regard14 less of the volume or cost of services required. 

15 ‘‘(2) COORDINATING CENTERS OF EXCEL16 LENCE.—A Coordinating Centers of Excellence spec17 ified in section (a)(2) shall be reimbursed for the 

18 provision of services set forth in this section at such 

19 levels as are established by the WTC Program Ad20 ministrator. 

21 ‘‘(3) REVIEW OF RATES.— 

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

23 the third contract year of the WTC program, 

24 the WTC Program Administrator shall conduct 

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1 ment rates set forth in this subsection provide 

2 fair and appropriate reimbursement for such 

3 program services. Based on such review, the 

4 Administrator may, by rule beginning with the 

5 fourth contract year, may modify such rates, 

6 taking into account a reasonable and fair rate 

7 for the services being provided. 

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

9 fourth contract year, the WTC Program Ad10 ministrator shall conduct periodic reviews to de11 termine whether the reimbursement rates in ef12 fect under this subsection provide fair and ap13 propriate reimbursement for such program serv14 ices. Based upon such a review, the Adminis15 trator may by rule modify such rates, taking 

16 into account a reasonable and fair rate for the 

17 services being provided. 

18 ‘‘(C) GAO REVIEW.—The Comptroller 

19 General of the United States shall review the 

20 WTC Program Administrator’s determinations 

21 regarding fair and appropriate reimbursement 

22 for program services under this paragraph. 

23 ‘‘(d) REQUIREMENTS.—The WTC Program Adminis24 trator shall not enter into a contract with a Clinical Center 

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


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

2 for consulting with and receiving input from rep3 resentatives of eligible populations receiving moni4 toring and treatment benefits under subtitle B from 

5 such Center; 

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

7 monitoring and treatment benefits under subtitle B 

8 with routine medical care provided for the treatment 

9 of conditions other than WTC-related health condi10 tions; 

11 ‘‘(3) the Center collects and reports to the cor12 responding Coordinating Center of Excellence data 

13 in accordance with section 3005; 

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

15 fraud that are satisfactory to the Administrator; 

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

17 treatment all individuals who are eligible WTC re18 sponders or eligible WTC community members with 

19 respect to such Center who present themselves for 

20 treatment of a WTC-related health condition; 

21 ‘‘(6) the Center has in place safeguards to en22 sure the confidentiality of an individual’s individ23 ually identifiable health information, including re24 quiring that such information not be disclosed to the 


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1 individual’s employer without the authorization of 

2 the individual; 

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

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

5 for costs incurred in carrying out the activities de6 scribed in subsection (a), other than those described 

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

8 ‘‘(8) the Center agrees to meet all the other ap9 plicable requirements of this title, including regula10 tions implementing such requirements. 

11 ‘‘SEC. 3007. ENTITLEMENT AUTHORITIES. 

12 ‘‘Subject to subsections (b)(4)(C) and (c)(5) of sec13 tion 3012, subtitle B constitutes budget authority in ad14 vance of appropriations Acts and represents the obligation 

15 of the Federal Government to provide for the payment for 

16 monitoring, initial health evaluations, and treatment in ac17 cordance with such subtitle and section 3006(c) con18 stitutes such budget authority and represents the obliga19 tion of the Federal Government to provide for the payment 

20 described in such section. 

21 ‘‘SEC. 3008. DEFINITIONS. 

22 ‘‘In this title: 

23 ‘‘(1) The term ‘aggravating’ means, with re24 spect to a health condition, a health condition that 

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


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

2 any other adverse condition resulting from the Sep3 tember 11, 2001, terrorist attacks on the World 

4 Trade Center requires medical treatment that is (or 

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

6 longer duration than the medical treatment that 

7 would have been required for such condition in the 

8 absence of such exposure. 

9 ‘‘(2) The terms ‘certified eligible WTC re10 sponder’ and ‘certified eligible WTC community 

11 member’ mean an individual who has been certified 

12 as an eligible WTC responder under section 

13 3011(a)(4) or an eligible WTC community member 

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

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

16 and ‘Coordinating Center of Excellence’ have the 

17 meanings given such terms in section 3006(b). 

18 ‘‘(4) The term ‘current consortium arrange19 ments’ means the arrangements as in effect on the 

20 date of the enactment of this title between the Na21 tional Institute for Occupational Safety and Health 

22 and the Mt. Sinai-coordinated consortium and the 

23 Fire Department of the City of New York. 


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

2 ‘eligible WTC community member’ are defined in 

3 sections 3011(a) and 3021(a), respectively. 

4 ‘‘(6) The term ‘initial health evaluation’ in5 cludes, with respect to an individual, a medical and 

6 exposure history, a physical examination, and addi7 tional medical testing as needed to evaluate whether 

8 the individual has a WTC-related health condition 

9 and is eligible for treatment under the WTC pro10 gram. 

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

12 health conditions’ means— 

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

14 identified WTC-related health condition for eli15 gible WTC responders under section 3012(a)(3) 

16 or 3012(a)(4); or 

17 ‘‘(B) for eligible WTC community mem18 bers, the identified WTC-related health condi19 tion for WTC community members under sec20 tion 3022(b)(1) or 3022(b)(2). 

21 ‘‘(8) The term ‘Mt.-Sinai-coordinated consor22 tium’ means the consortium coordinated by Mt. 

23 Sinai hospital in New York City that coordinates the 

24 monitoring and treatment under the current consor25 tium arrangements for eligible WTC responders 


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1 other than with respect to those covered under the 

2 arrangement with the Fire Department of the City 

3 of New York. 

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

5 means the area within New York City that is— 

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

7 of Houston Street; and 

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

9 or partially contained within a 1.5-mile radius 

10 of the former World Trade Center site. 

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

12 means an area, specified by the WTC Program Ad13 ministrator, within which eligible WTC responders 

14 and eligible WTC community members who reside in 

15 such area are reasonably able to access monitoring 

16 and treatment benefits and initial health evaluation 

17 benefits under this title through a Clinical Centers 

18 of Excellence described in subparagraphs (A), (B), 

19 or (C) of section 3006(b)(1). 

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

21 shall be deemed a reference to the period on such 

22 date subsequent to the terrorist attacks on the 

23 World Trade Center on such date. 

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

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1 rorist attacks that occurred on September 11, 2001, 

2 in New York City and includes the aftermath of 

3 such attacks. 

4 ‘‘(13) The term ‘WTC Health Program Steer5 ing Committee’ means such a Steering Committee 

6 established under section 3003. 

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

8 means the individual responsible under section 

9 3001(f) for the administration of the WTC program. 

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

11 is defined in section 3012(a). 

12 ‘‘(16) The term ‘WTC Scientific/Technical Ad13 visory Committee’ means such Committee estab14 lished under section 3002. 

15 ‘‘Subtitle B—Program of Moni16 toring, Initial Health Evalua17 tions, and Treatment 

18 ‘‘PART 1—FOR WTC RESPONDERS 

19 ‘‘SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPOND20 ERS AND PROVISION OF WTC-RELATED MONI21 TORING SERVICES. 

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

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

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

25 following individuals, subject to paragraph (5): 


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1 ‘‘(A) CURRENTLY IDENTIFIED RE2 SPONDER.—An individual who has been identi3 fied as eligible for medical monitoring under the 

4 current consortium arrangements (as defined in 

5 section 3008(4)). 

6 ‘‘(B) RESPONDER WHO MEETS CURRENT

7 ELIGIBILITY CRITERIA.—An individual who 

8 meets the current eligibility criteria described in 

9 paragraph (2). 

10 ‘‘(C) RESPONDER WHO MEETS MODIFIED

11 ELIGIBILITY CRITERIA.—An individual who— 

12 ‘‘(i) performed rescue, recovery, demo13 lition, debris cleanup, or other related serv14 ices in the New York City disaster area in 

15 response to the September 11, 2001, ter16 rorist attacks on the World Trade Center, 

17 regardless of whether such services were 

18 performed by a State or Federal employee 

19 or member of the National Guard or other20 wise; and 

21 ‘‘(ii) meets such eligibility criteria re22 lating to exposure to airborne toxins, other 

23 hazards, or adverse conditions resulting 

24 from the September 11, 2001, terrorist at25 tacks on the World Trade Center as the 


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1 WTC Program Administrator, after con2 sultation with the WTC Responders Steer3 ing Committee and the WTC Scientific/ 

4 Technical Advisory Committee, determines 

5 appropriate. 

6 The WTC Program Administrator shall not 

7 modify such eligibility criteria on or after the 

8 date that the number of certifications for eligi9 ble responders has reached 80 percent of the 

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

11 the date that the number of certifications for el12 igible community members has reached 80 per13 cent of the limit described in section 

14 3021(a)(5). 

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

16 eligibility criteria described in this paragraph for an 

17 individual is that the individual is described in either 

18 of the following categories: 

19 ‘‘(A) FIRE FIGHTERS AND RELATED PER20 SONNEL.—The individual— 

21 ‘‘(i) was a member of the Fire De22 partment of the City of New York (wheth23 er fire or emergency personnel, active or 

24 retired) who participated at least one day 

25 in the rescue and recovery effort at any of 


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1 the former World Trade sites (including 

2 Ground Zero, Staten Island land fill, and 

3 the NYC Chief Medical Examiner’s office) 

4 for any time during the period beginning 

5 on September 11, 2001, and ending on 

6 July 31, 2002; or 

7 ‘‘(ii)(I) is a surviving immediate fam8 ily member of an individual who was a 

9 member of the Fire Department of the 

10 City of New York (whether fire or emer11 gency personnel, active or retired) and was 

12 killed at the World Trade site on Sep13 tember 11, 2001; and 

14 ‘‘(II) received any treatment for a 

15 WTC-related mental health condition de16 scribed in section 3012(a)(1)(B) on or be17 fore September 1, 2008. 

18 ‘‘(B) LAW ENFORCEMENT OFFICERS AND

19 WTC RESCUE, RECOVERY, AND CLEAN-UP

20 WORKERS.—The individual— 

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

22 rescue, recovery, debris-cleanup or related 

23 support services in lower Manhattan (south 

24 of Canal St.), the Staten Island Landfill, 

25 or the barge loading piers, for at least 4 


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1 hours during the period beginning on Sep2 tember 11, 2001, and ending on Sep3 tember 14, 2001, for at least 24 hours 

4 during the period beginning on September 

5 11, 2001, and ending on September 30, 

6 2001, or for at least 80 hours during the 

7 period beginning on September 11, 2001, 

8 and ending on July 31, 2002; 

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

10 Department of the City of New York 

11 (whether active or retired) or a member of 

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

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

16 clean-up, or related services in lower Man17 hattan (south of Canal St.), including 

18 Ground Zero, the Staten Island Landfill or 

19 the barge loading piers, for at least 4 

20 hours during the period beginning Sep21 tember 11, 2001, and ending on Sep22 tember 14, 2001; 

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

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


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1 Landfill or the barge loading piers, for at 

2 least one day during the period beginning 

3 on September 11, 2001, and ending on 

4 July 31, 2002; 

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

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

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

9 beginning on September 11, 2001, and 

10 ending on September 30, 2001; or 

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

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

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

15 beginning on September 11, 2001, and 

16 ending on July 31, 2002; 

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

18 the Chief Medical Examiner of the City of 

19 New York involved in the examination and 

20 handling of human remains from the 

21 World Trade Center attacks, or other 

22 morgue worker who performed similar 

23 post-September 11 functions for such Of24 fice staff, during the period beginning on 


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1 September 11, 2001 and ending on July 

2 31, 2002; 

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

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

7 on July 1, 2002; or 

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

9 who was exposed to debris from the former 

10 World Trade Center while retrieving, driv11 ing, cleaning, repairing, and maintaining 

12 vehicles contaminated by airborne toxins 

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

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

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

23 process— 


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

2 applicant for making an application for such 

3 determination; 

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

6 60 days after the date of filing the application; 

7 and 

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

9 to be an eligible WTC responder shall have an 

10 opportunity to appeal such determination before 

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

13 ‘‘(4) CERTIFICATION.— 

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

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

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

20 of such fact and of eligibility for monitoring 

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

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


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

3 that— 

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

6 eligibility criteria; or 

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

9 (5) has been met. 

10 ‘‘(B) TIMING.— 

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

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

14 WTC Program Administrator shall provide 

15 the certification under subparagraph (A) 

16 not later than 60 days after the date of the 

17 enactment of this title. 

18 ‘‘(ii) OTHER RESPONDERS.—In the 

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

21 with paragraph (5) to be an eligible WTC 

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

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


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1 ‘‘(5) NUMERICAL LIMITATION ON ELIGIBLE

2 WTC RESPONDERS.— 

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

4 individuals not described in subparagraph (C) 

5 who may qualify as eligible WTC responders for 

6 purposes of this title, and be certified as eligible 

7 WTC responders under paragraph (4), shall not 

8 exceed 15,000, subject to adjustment under 

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

10 may be individuals certified based on modified 

11 eligibility criteria established under paragraph 

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

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

15 such numerical limitation. 

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

18 shall— 

19 ‘‘(i) limit the number of certifications 

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

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

24 apply for a determination under paragraph 

25 (3). 


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

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

5 ‘‘(6) POTENTIAL ADJUSTMENT IN NUMERICAL

6 LIMITATIONS DEPENDENT UPON ACTUAL SPENDING

7 RELATIVE TO ESTIMATED SPENDING.— 

8 ‘‘(A) INITIAL CALCULATION FOR FISCAL

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

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

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

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

16 may increase the numerical limitation under 

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

18 under section 3021(a)(5), or both, by a number 

19 of percentage points not to exceed the number 

20 of percentage points specified in subparagraph 

21 (C) for such period of fiscal years. 

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

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1 ages for fiscal years 2009 through 2015 and for 

2 fiscal years 2012 through 2015 do not exceed 

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

4 WTC Program Administrator may increase the 

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

6 the numerical limitation under section 

7 3021(a)(5), or both, as in effect after the appli8 cation of subparagraph (A), by a number of 

9 percentage points not to exceed twice the lesser 

10 of— 

11 ‘‘(i) the number of percentage points 

12 specified in subparagraph (C) for fiscal 

13 years 2009 through 2012, or 

14 ‘‘(ii) the number of percentage points 

15 specified in subparagraph (C) for fiscal 

16 years 2012 through 2015. 

17 ‘‘(C) MAXIMUM PERCENTAGE INCREASE IN

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

20 specified in this clause for a period of fiscal 

21 years is— 

22 ‘‘(i) 100 percentage points, multiplied 

23 by 

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


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

3 estimate under this title for such period. 

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

5 paragraph: 

6 ‘‘(i) NET FEDERAL SPENDING.—The 

7 term ‘net Federal WTC spending’ means, 

8 with respect to a period of fiscal years, the 

9 net Federal spending under this title for 

10 such fiscal years. 

11 ‘‘(ii) CBO WTC SPENDING ESTIMATE

12 UNDER THIS TITLE.—The term ‘CBO 

13 WTC medical spending estimate under this 

14 title’ means, with respect to— 

15 ‘‘(I) fiscal years 2009 through 

16 2011, $900,000,000; 

17 ‘‘(II) fiscal years 2012 through 

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

19 ‘‘(III) fiscal years 2009 through 

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

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

24 expenditure-to-estimate percentage’ means, 


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1 with respect to a period of fiscal years, the 

2 ratio (expressed as a percentage) of— 

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

5 ‘‘(II) the CBO WTC spending es6 timate under this title for such period. 

7 ‘‘(b) MONITORING BENEFITS.— 

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

9 WTC responder under section 3011(a)(4) (other 

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

11 WTC program shall provide for monitoring benefits 

12 that include medical monitoring consistent with pro13 tocols approved by the WTC Program Administrator 

14 and including clinical examinations and long-term 

15 health monitoring and analysis. In the case of an eli16 gible WTC responder who is an active member of 

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

18 responder shall receive such benefits as part of the 

19 individual’s periodic company medical exams. 

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

21 The monitoring benefits under paragraph (1) shall 

22 be provided through the Clinical Center of Excel23 lence for the type of individual involved or, in the 

24 case of an individual residing outside the New York 


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1 metropolitan area, under an arrangement under sec2 tion 3031. 

3 ‘‘SEC. 3012. TREATMENT OF CERTIFIED ELIGIBLE WTC RE4 SPONDERS FOR WTC-RELATED HEALTH CON5 DITIONS. 

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

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

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

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

11 which exposure to airborne toxins, any other 

12 hazard, or any other adverse condition resulting 

13 from the September 11, 2001, terrorist attacks 

14 on the World Trade Center, based on an exam15 ination by a medical professional with experi16 ence in treating or diagnosing the medical con17 ditions included in the applicable list of identi18 fied WTC-related conditions, is substantially 

19 likely to be a significant factor in aggravating, 

20 contributing to, or causing the illness or health 

21 condition, as determined under paragraph (2); 

22 or 

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

24 such attacks, based on an examination by a 

25 medical professional with experience in treating 


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1 or diagnosing the medical conditions included in 

2 the applicable list of identified WTC-related 

3 conditions, is substantially likely be a signifi4 cant factor in aggravating, contributing to, or 

5 causing the condition, as determined under 

6 paragraph (2). 

7 In the case of an eligible WTC responder described 

8 in section 3011(a)(2)(A)(ii), such term only includes 

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

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

12 whether the September 11, 2001, terrorist attacks 

13 on the World Trade Center were substantially likely 

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

16 condition shall be made based on an assessment of 

17 the following: 

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

19 toxins, any other hazard, or any other adverse 

20 condition resulting from the terrorist attacks. 

21 Such exposure shall be— 

22 ‘‘(i) evaluated and characterized 

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


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1 by the Director of the National Institute 

2 for Occupational Safety and Health; and 

3 ‘‘(ii) assessed and documented by a 

4 medical professional with experience in 

5 treating or diagnosing medical conditions 

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

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

9 sequence of symptoms. Such symptoms shall 

10 be— 

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

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

14 the National Institute for Occupational 

15 Safety and Health and a medical examina16 tion; and 

17 ‘‘(ii) diagnosed and documented by a 

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

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

21 HEALTH CONDITIONS FOR CERTIFIED ELIGIBLE WTC

22 RESPONDERS.—For purposes of this title, the term 

23 ‘identified WTC-related health condition for eligible 

24 WTC responders’ means any of the following health 

25 conditions: 


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1 ‘‘(A) AERODIGESTIVE DISORDERS.— 

2 ‘‘(i) Interstitial lung diseases. 

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

5 ‘‘(iii) Asthma. 

6 ‘‘(iv) Reactive airways dysfunction 

7 syndrome (RADS). 

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

10 ‘‘(vi) Chronic cough syndrome. 

11 ‘‘(vii) Upper airway hyperreactivity. 

12 ‘‘(viii) Chronic rhinosinusitis. 

13 ‘‘(ix) Chronic nasopharyngitis. 

14 ‘‘(x) Chronic laryngitis. 

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

17 ‘‘(xii) Sleep apnea exacerbated by or 

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

20 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

21 ‘‘(i) Post traumatic stress disorder 

22 (PTSD). 

23 ‘‘(ii) Major depressive disorder. 

24 ‘‘(iii) Panic disorder. 

25 ‘‘(iv) Generalized anxiety disorder. 


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1 ‘‘(v) Anxiety disorder (not otherwise 

2 specified). 

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

5 ‘‘(vii) Acute stress disorder. 

6 ‘‘(viii) Dysthymic disorder. 

7 ‘‘(ix) Adjustment disorder. 

8 ‘‘(x) Substance abuse. 

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

11 as marital problems, parenting problems 

12 etc.), secondary to another identified 

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

15 ‘‘(C) MUSCULOSKELETAL DISORDERS.— 

16 ‘‘(i) Low back pain. 

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

18 ‘‘(iii) Other musculoskeletal disorders. 

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

20 HEALTH CONDITIONS FOR ELIGIBLE WTC RESPOND21 ERS.— 

22 ‘‘(A) IN GENERAL.—The WTC Program 

23 Administrator may promulgate regulations to 

24 add an illness or health condition not described 

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1 tified WTC-related conditions for eligible WTC 

2 responders. In promulgating such regulations, 

3 the Secretary shall provide for notice and op4 portunity for a public hearing and at least 90 

5 days of public comment. In promulgating such 

6 regulations, the WTC Program Administrator 

7 shall take into account the findings and rec8 ommendations of Clinical Centers of Excellence 

9 published in peer reviewed journals in the deter10 mination of whether an additional illness or 

11 health condition, such as cancer, should be 

12 added to the list of identified WTC-related 

13 health conditions for eligible WTC responders. 

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

15 the WTC Health Program Scientific/Technical 

16 Advisory Committee) may petition the WTC 

17 Program Administrator to propose regulations 

18 described in subparagraph (A). Unless clearly 

19 frivolous, or initiated by such Committee, any 

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

22 ‘‘(i) receipt of any recommendation of 

23 the Committee; or 

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


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

4 or publish in the Federal Register a statement 

5 of reasons for not conducting such proceeding. 

6 ‘‘(C) EFFECTIVENESS.—Any addition 

7 under subparagraph (A) of an illness or health 

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

10 filed after the effective date of such regulation. 

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

12 Except with respect to a regulation rec13 ommended by the WTC Health Program Sci14 entific/Technical Advisory Committee), the 

15 WTC Program Administrator may not propose 

16 a regulation under this paragraph, unless the 

17 Administrator has first provided to the Com18 mittee a copy of the proposed regulation, re19 quested recommendations and comments by the 

20 Committee, and afforded the Committee at 

21 least 90 days to make such recommendations. 

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

23 HEALTH CONDITIONS.— 


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

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

5 Clinical Center of Excellence that is providing 

6 monitoring benefits under section 3011 for a 

7 certified eligible WTC responder determines 

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

10 a clinical determination that exposure to air11 borne toxins, other hazards, or adverse condi12 tions resulting from the 9/11 terrorist attacks is 

13 substantially likely to be a significant factor in 

14 aggravating, contributing to, or causing the 

15 condition— 

16 ‘‘(i) the physician shall promptly 

17 transmit such determination to the WTC 

18 Program Administrator and provide the 

19 Administrator with the medical facts sup20 porting such determination; and 

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

22 transmittal and subject to subparagraph 

23 (B), the WTC program shall provide for 

24 payment under subsection (c) for medically 

25 necessary treatment for such condition. 


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1 ‘‘(B) REVIEW; CERTIFICATION; AP2 PEALS.— 

3 ‘‘(i) REVIEW.—A Federal employee 

4 designated by the WTC Program Adminis5 trator shall review determinations made 

6 under subparagraph (A) of a WTC-related 

7 health condition. 

8 ‘‘(ii) CERTIFICATION.—The Adminis9 trator shall provide a certification of such 

10 condition based upon reviews conducted 

11 under clause (i). Such a certification shall 

12 be provided unless the Administrator de13 termines that the responder’s condition is 

14 not an identified WTC-related health con15 dition or that exposure to airborne toxins, 

16 other hazards, or adverse conditions result17 ing from the 9/11 terrorist attacks is not 

18 substantially likely to be a significant fac19 tor in significantly aggravating, contrib20 uting to, or causing the condition. 

21 ‘‘(iii) APPEAL PROCESS.—The Admin22 istrator shall provide a process for the ap23 peal of determinations under clause (ii) be24 fore an administrative law judge. 


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1 ‘‘(2) DETERMINATION BASED ON OTHER WTC2 RELATED HEALTH CONDITION.— 

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

4 Clinical Center of Excellence determines pursu5 ant to subsection (a) that the certified eligible 

6 WTC responder has a WTC-related health con7 dition that is not an identified WTC-related 

8 health condition for eligible WTC responders— 

9 ‘‘(i) the physician shall promptly 

10 transmit such determination to the WTC 

11 Program Administrator and provide the 

12 Administrator with the facts supporting 

13 such determination; and 

14 ‘‘(ii) the Administrator shall make a 

15 determination under subparagraph (B) 

16 with respect to such physician’s determina17 tion. 

18 ‘‘(B) REVIEW; CERTIFICATION.— 

19 ‘‘(i) USE OF PHYSICIAN PANEL.— 

20 With respect to each determination relat21 ing to a WTC-related health condition 

22 transmitted under subparagraph (A)(i), 

23 the WTC Program Administrator shall 

24 provide for the review of the condition to 

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1 priate expertise appointed by the WTC 

2 Program Administrator. Such a panel shall 

3 make recommendations to the Adminis4 trator on the evidence supporting such de5 termination. 

6 ‘‘(ii) REVIEW OF RECOMMENDATIONS

7 OF PANEL; CERTIFICATION.—The Adminis8 trator, based on such recommendations 

9 shall determine, within 60 days after the 

10 date of the transmittal under subpara11 graph (A)(i), whether or not the condition 

12 is a WTC-related health condition and, if 

13 it is, provide for a certification under para14 graph (1)(B)(ii) of coverage of such condi15 tion. The Administrator shall provide a 

16 process for the appeal of determinations 

17 that the responder’s condition is not a 

18 WTC-related health condition before an 

19 administrative law judge. 

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

21 ‘‘(A) IN GENERAL.—In providing treat22 ment for a WTC-health condition, a physician 

23 shall provide treatment that is medically nec24 essary and in accordance with medical protocols 

25 established under subsection (d). 


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1 ‘‘(B) MEDICALLY NECESSARY STAND2 ARD.—For the purpose of this title, health care 

3 services shall be treated as medically necessary 

4 for an individual if a physician, exercising pru5 dent clinical judgment, would consider the serv6 ices to be medically necessary for the individual 

7 for the purpose of evaluating, diagnosing, or 

8 treating an illness, injury, disease or its symp9 toms, and that are— 

10 ‘‘(i) in accordance with the generally 

11 accepted standards of medical practice; 

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

13 type, frequency, extent, site, and duration, 

14 and considered effective for the individual’s 

15 illness, injury, or disease; and 

16 ‘‘(iii) not primarily for the conven17 ience of the patient or physician, or an18 other physician, and not more costly than 

19 an alternative service or sequence of serv20 ices at least as likely to produce equivalent 

21 therapeutic or diagnostic results as to the 

22 diagnosis or treatment of the individual’s 

23 illness, injury, or disease. 

24 ‘‘(C) DETERMINATION OF MEDICAL NE25 CESSITY.— 


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1 ‘‘(i) REVIEW OF MEDICAL NECES2 SITY.—As part of the reimbursement pay3 ment process under subsection (c), the 

4 WTC Program Administrator shall review 

5 claims for reimbursement for the provision 

6 of medical treatment to determine if such 

7 treatment is medically necessary. 

8 ‘‘(ii) WITHHOLDING OF PAYMENT FOR

9 MEDICALLY UNNECESSARY TREATMENT.— 

10 The Administrator may withhold such pay11 ment for treatment that the Administrator 

12 determines is not medically necessary. 

13 ‘‘(iii) REVIEW OF DETERMINATIONS

14 OF MEDICAL NECESSITY.—The Adminis15 trator shall provide a process for providers 

16 to appeal a determination under clause (ii) 

17 that medical treatment is not medically 

18 necessary. Such appeals shall be reviewed 

19 through the use of a physician panel with 

20 appropriate expertise. 

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

22 ‘‘(A) IN GENERAL.—The scope of treat23 ment covered under such paragraphs includes 

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1 tion drugs, inpatient and outpatient hospital 

2 services, and other medically necessary treat3 ment. 

4 ‘‘(B) PHARMACEUTICAL COVERAGE.—With 

5 respect to ensuring coverage of medically nec6 essary outpatient prescription drugs, such drugs 

7 shall be provided, under arrangements made by 

8 the WTC Program Administrator, directly 

9 through participating Clinical Centers of Excel10 lence or through one or more outside vendors. 

11 ‘‘(C) TRANSPORTATION EXPENSES.—To 

12 the extent provided in advance in appropria13 tions Acts, the WTC Program Administrator 

14 may provide for necessary and reasonable 

15 transportation and expenses incident to the se16 curing of medically necessary treatment involv17 ing travel of more than 250 miles and for which 

18 payment is made under this section in the same 

19 manner in which individuals may be furnished 

20 necessary and reasonable transportation and ex21 penses incident to services involving travel of 

22 more than 250 miles under regulations imple23 menting section 3629(c) of the Energy Employ24 ees Occupational Illness Compensation Program 


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

2 398; 42 U.S.C. 7384t(c)). 

3 ‘‘(5) PROVISION OF TREATMENT PENDING CER4 TIFICATION.—In the case of a certified eligible WTC 

5 responder who has been determined by an examining 

6 physician under subsection (b)(1) to have an identi7 fied WTC-related health condition, but for whom a 

8 certification of the determination has not yet been 

9 made by the WTC Program Administrator, medical 

10 treatment may be provided under this subsection, 

11 subject to paragraph (6), until the Administrator 

12 makes a decision on such certification. Medical 

13 treatment provided under this paragraph shall be 

14 considered to be medical treatment for which pay15 ment may be made under subsection (c). 

16 ‘‘(6) PRIOR APPROVAL PROCESS FOR NON-CER17 TIFIED NON-EMERGENCY INPATIENT HOSPITAL

18 SERVICES.—Non-emergency inpatient hospital serv19 ices for a WTC-related health condition identified by 

20 an examining physician under paragraph (b)(1) that 

21 is not certified under paragraph (1)(B)(ii) is not 

22 covered unless the services have been determined to 

23 be medically necessary and approved through a proc24 ess established by the WTC Program Administrator. 

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1 quest for such services within 15 days of the date 

2 of receipt of the request. The WTC Administrator 

3 shall provide a process for the appeal of a decision 

4 that the services are not medically necessary. 

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

6 MEDICAL MONITORING, AND TREATMENT OF WTC-RE7 LATED HEALTH CONDITIONS.— 

8 ‘‘(1) MEDICAL TREATMENT.— 

9 ‘‘(A) USE OF FECA PAYMENT RATES.— 

10 Subject to subparagraph (B), the WTC Pro11 gram Administrator shall reimburse costs for 

12 medically necessary treatment under this title 

13 for WTC-related health conditions according to 

14 the payment rates that would apply to the pro15 vision of such treatment and services by the fa16 cility under the Federal Employees Compensa17 tion Act. 

18 ‘‘(B) PHARMACEUTICALS.— 

19 ‘‘(i) IN GENERAL.—The WTC Pro20 gram Administrator shall establish a pro21 gram for paying for the medically nec22 essary outpatient prescription pharma23 ceuticals prescribed under this title for 

24 WTC-related conditions through one or 

25 more contracts with outside vendors. 


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1 ‘‘(ii) COMPETITIVE BIDDING.—Under 

2 such program the Administrator shall— 

3 ‘‘(I) select one or more appro4 priate vendors through a Federal com5 petitive bid process; and 

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

7 bidders) meeting the requirements for 

8 providing pharmaceutical benefits for 

9 participants in the WTC program. 

10 ‘‘(iii) TREATMENT OF FDNY PARTICI11 PANTS.—Under such program the Admin12 istrator may enter select a separate vendor 

13 to provide pharmaceutical benefits to cer14 tified eligible WTC responders for whom 

15 the Clinical Center of Excellence is de16 scribed in section 3006(b)(1)(A) if such an 

17 arrangement is deemed necessary and ben18 eficial to the program by the WTC Pro19 gram Administrator. 

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

21 not covered under a preceding subparagraph, 

22 the WTC Program Administrator shall des23 ignate a reimbursement rate for each such serv24 ice. 


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1 ‘‘(2) MEDICAL MONITORING AND INITIAL

2 HEALTH EVALUATION.—The WTC Program Admin3 istrator shall reimburse the costs of medical moni4 toring and the costs of an initial health evaluation 

5 provided under this title at a rate set by the Admin6 istrator. 

7 ‘‘(3) ADMINISTRATIVE ARRANGEMENT AUTHOR8 ITY.—The WTC Program Administrator may enter 

9 into arrangements with other government agencies, 

10 insurance companies, or other third-party adminis11 trators to provide for timely and accurate processing 

12 of claims under this section. 

13 ‘‘(4) CLAIMS PROCESSING SUBJECT TO APPRO14 PRIATIONS.—The payment by the WTC Program 

15 Administrator for the processing of claims under 

16 this title is limited to the amounts provided in ad17 vance in appropriations Acts. 

18 ‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

19 ‘‘(1) DEVELOPMENT.—The Coordinating Cen20 ters of Excellence shall develop medical treatment 

21 protocols for the treatment of certified eligible WTC 

22 responders and certified eligible WTC community 

23 members for identified WTC-related health condi24 tions. 


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1 ‘‘(2) APPROVAL.—The WTC Program Adminis2 trator shall approve the medical treatment protocols, 

3 in consultation with the WTC Health Program 

4 Steering Committees. 

5 ‘‘PART 2—COMMUNITY PROGRAM 

6 ‘‘SEC. 3021. IDENTIFICATION AND INITIAL HEALTH EVALUA7 TION OF ELIGIBLE WTC COMMUNITY MEM8 BERS. 

9 ‘‘(a) ELIGIBLE WTC COMMUNITY MEMBER DE10 FINED.— 

11 ‘‘(1) IN GENERAL.—In this title, the term ‘eligi12 ble WTC community member’ means, subject to 

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

14 symptoms of a WTC-related health condition and is 

15 described in any of the following subparagraphs: 

16 ‘‘(A) CURRENTLY IDENTIFIED COMMUNITY

17 MEMBER.—An individual, including an eligible 

18 WTC responder, who has been identified as eli19 gible for medical treatment or monitoring by 

20 the WTC Environmental Health Center as of 

21 the date of enactment of this title. 

22 ‘‘(B) COMMUNITY MEMBER WHO MEETS

23 CURRENT ELIGIBILITY CRITERIA.—An indi24 vidual who is not an eligible WTC responder 


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1 and meets any of the current eligibility criteria 

2 described in a subparagraph of paragraph (2). 

3 ‘‘(C) COMMUNITY MEMBER WHO MEETS

4 MODIFIED ELIGIBILITY CRITERIA.—An indi5 vidual who is not an eligible WTC responder 

6 and meets such eligibility criteria relating to ex7 posure to airborne toxins, other hazards, or ad8 verse conditions resulting from the September 

9 11, 2001, terrorist attacks on the World Trade 

10 Center as the WTC Administrator determines 

11 eligible, after consultation with the WTC Com12 munity Program Steering Committee, Coordi13 nating Centers of Excellence described in sec14 tion 3006(b)(1)(C), and the WTC Scientific/ 

15 Technical Advisory Committee. 

16 The Administrator shall not modify such criteria 

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

18 the number of certifications for eligible community 

19 members has reached 80 percent of the limit de20 scribed in paragraph (5) or on or after the date that 

21 the number of certifications for eligible responders 

22 has reached 80 percent of the limit described in sec23 tion 3021(a)(5). 

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

25 eligibility criteria described in this paragraph for an 


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1 individual are that the individual is described in any 

2 of the following subparagraphs: 

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

4 York City disaster area in the dust or dust 

5 cloud on September 11, 2001. 

6 ‘‘(B) A person who worked, resided or at7 tended school, child care or adult day care in 

8 the New York City disaster area for— 

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

10 month period beginning on September 11, 

11 2001, and ending on January 10, 2002; or 

12 ‘‘(ii) at least 30 days during the pe13 riod beginning on September 11, 2001, 

14 and ending on July 31, 2002. 

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

16 worker or performed maintenance work in the 

17 New York City disaster area during the 4- 

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

19 and had extensive exposure to WTC dust as a 

20 result of such work. 

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

22 receive a grant from the Lower Manhattan De23 velopment Corporation Residential Grant Pro24 gram, who possessed a lease for a residence or 

25 purchased a residence in the New York City 


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1 disaster area, and who resided in such residence 

2 during the period beginning on September 11, 

3 2001, and ending on May 31, 2003. 

4 ‘‘(E) A person whose place of employ5 ment— 

6 ‘‘(i) at any time during the period be7 ginning on September 11, 2001, and end8 ing on May 31, 2003, was in the New 

9 York City disaster area; and 

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

11 grant from the Lower Manhattan Develop12 ment Corporation WTC Small Firms At13 traction and Retention Act program or 

14 other government incentive program de15 signed to revitalize the Lower Manhattan 

16 economy after the September 11, 2001, 

17 terrorist attacks on the World Trade Cen18 ter. 

19 ‘‘(3) APPLICATION PROCESS.—The WTC Pro20 gram Administrator in consultation with the Coordi21 nating Centers of Excellence shall establish a proc22 ess for individuals, other than individuals described 

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

24 community member. Under such process— 


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

2 applicant for making an application for such 

3 determination; 

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

6 60 days after the date of filing the application; 

7 and 

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

9 to be an eligible WTC community member shall 

10 have an opportunity to appeal such determina11 tion before an administrative law judge in a 

12 manner established under such process. 

13 ‘‘(4) CERTIFICATION.— 

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

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

18 WTC community member, the WTC Program 

19 Administrator shall provide an appropriate cer20 tification of such fact and of eligibility for fol21 lowup monitoring and treatment benefits under 

22 this part. The Administrator shall make deter23 minations of eligibility relating to an applicant’s 

24 compliance with this title, including the 

25 verification of information submitted in support 


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1 of the application and shall not deny such a 

2 certification to an individual unless the Admin3 istrator determines that— 

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

6 eligibility criteria; or 

7 ‘‘(ii) the numerical limitation on cer8 tification of eligible WTC community mem9 bers set forth in paragraph (5) has been 

10 met. 

11 ‘‘(B) TIMING.— 

12 ‘‘(i) CURRENTLY IDENTIFIED COMMU13 NITY MEMBERS.—In the case of an indi14 vidual who is described in paragraph 

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

16 shall provide the certification under sub17 paragraph (A) not later than 60 days after 

18 the date of the enactment of this title. 

19 ‘‘(ii) OTHER MEMBERS.—In the case 

20 of another individual who is determined 

21 under paragraph (3) and consistent with 

22 paragraph (5) to be an eligible WTC com23 munity member, the WTC Program Ad24 ministrator shall provide the certification 


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1 under subparagraph (A) at the time of 

2 such determination. 

3 ‘‘(5) NUMERICAL LIMITATION ON CERTIFI4 CATION OF ELIGIBLE WTC COMMUNITY MEMBERS.— 

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

6 individuals not described in subparagraph (C) 

7 who may be certified as eligible WTC commu8 nity members under paragraph (4) shall not ex9 ceed 15,000. In applying the previous sentence, 

10 any individual who at any time so qualifies as 

11 an eligible WTC community member shall be 

12 counted against such numerical limitation. 

13 ‘‘(B) PROCESS.—In implementing subpara14 graph (A), the WTC Program Administrator 

15 shall— 

16 ‘‘(i) limit the number of certifications 

17 provided under paragraph (4) in accord18 ance with such subparagraph; and 

19 ‘‘(ii) provide priority in such certifi20 cations in the order in which individuals 

21 apply for a determination under paragraph 

22 (4). 

23 ‘‘(C) INDIVIDUALS CURRENTLY RECEIVING

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1 scribed in this subparagraph are individuals 

2 who— 

3 ‘‘(i) are described in paragraph 

4 (1)(A); or 

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

6 of this title, have received monitoring or 

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

9 Hospital Center, Gouverneur Health Care 

10 Services, or Elmhurst Hospital Center. 

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

13 the date of enactment of this title, enter into 

14 arrangements with the Mt. Sinai Data and 

15 Clinical Coordination Center for the reporting 

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

19 and consistent with applicable Federal and 

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

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

25 WTC Program Administrator determines that 


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

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

5 such determination. Such report shall include 

6 an estimate of the number of such individuals 

7 in excess of such numerical limitation and of 

8 the additional expenditures that would result 

9 under this title if such numerical limitation 

10 were removed. 

11 ‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE

12 ELIGIBILITY FOR FOLLOWUP MONITORING OR TREAT13 MENT.— 

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

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

19 treatment benefits under the WTC program. Initial 

20 health evaluation protocols shall be approved by the 

21 WTC Program Administrator, in consultation with 

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

24 Program Steering Committee. 


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

3 paragraph (1) shall be provided through a Clinical 

4 Center of Excellence with respect to the individual 

5 involved. 

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

9 member shall consist only of a single medical initial 

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

12 in this paragraph shall be construed as preventing 

13 such an individual from seeking additional medical 

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

16 ‘‘SEC. 3022. FOLLOWUP MONITORING AND TREATMENT OF 

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

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

21 provisions of sections 3011 and 3012 shall apply to fol22 lowup monitoring and treatment of WTC-related health 

23 conditions for certified eligible WTC community members 

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


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1 conditions for certified eligible WTC responders, except 

2 that such monitoring shall only be available to those cer3 tified as eligible for treatment under this title. Under sec4 tion 3006(a)(3), the City of New York is required to con5 tribute a share of the costs of such treatment. 

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

7 CONDITIONS FOR WTC COMMUNITY MEMBERS.— 

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

11 health conditions for WTC community members’ 

12 means any of the following health conditions: 

13 ‘‘(A) AERODIGESTIVE DISORDERS.— 

14 ‘‘(i) Interstitial lung diseases. 

15 ‘‘(ii) Chronic respiratory disorder— 

16 fumes/vapors. 

17 ‘‘(iii) Asthma. 

18 ‘‘(iv) Reactive airways dysfunction 

19 syndrome (RADS). 

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

22 ‘‘(vi) Chronic cough syndrome. 

23 ‘‘(vii) Upper airway hyperreactivity. 

24 ‘‘(viii) Chronic rhinosinusitis. 

25 ‘‘(ix) Chronic nasopharyngitis. 


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1 ‘‘(x) Chronic laryngitis. 

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

4 ‘‘(xii) Sleep apnea exacerbated by or 

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

7 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

8 ‘‘(i) Post traumatic stress disorder 

9 (PTSD). 

10 ‘‘(ii) Major depressive disorder. 

11 ‘‘(iii) Panic disorder. 

12 ‘‘(iv) Generalized anxiety disorder. 

13 ‘‘(v) Anxiety disorder (not otherwise 

14 specified). 

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

17 ‘‘(vii) Acute stress disorder. 

18 ‘‘(viii) Dysthymic disorder. 

19 ‘‘(ix) Adjustment disorder. 

20 ‘‘(x) Substance abuse. 

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

23 as marital problems, parenting problems 

24 etc.), secondary to another identified 


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1 WTC-related health condition for WTC 

2 community members. 

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

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

6 3012(a) shall apply with respect to an addition to 

7 the list of identified WTC-related conditions for eli8 gible WTC community members under paragraph 

9 (1) in the same manner as such provisions apply to 

10 an addition to the list of identified WTC-related con11 ditions for eligible WTC responders under section 

12 3012(a)(3). 

13 ‘‘SEC. 3023. FOLLOWUP MONITORING AND TREATMENT OF 

14 OTHER INDIVIDUALS WITH WTC-RELATED 

15 HEALTH CONDITIONS. 

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

17 provisions of section 3022 shall apply to the followup mon18 itoring and treatment of WTC-related health conditions 

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

21 as such provisions apply to the followup monitoring and 

22 treatment of WTC-related health conditions for WTC 

23 community members. Under section 3006(a)(3), the City 

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

25 of such monitoring and treatment. 


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

3 of location of residence— 

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

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

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

10 ‘‘(c) LIMITATION.— 

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

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

14 this section for such fiscal year do not exceed the 

15 amount specified in paragraph (2) for such fiscal 

16 year. 

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

18 this paragraph for— 

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

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

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

24 of the consumer price index for all urban con25 sumers. 


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

3 NEW YORK 

4 ‘‘SEC. 3031. NATIONAL ARRANGEMENT FOR BENEFITS FOR 

5 ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 

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

8 eligible WTC responders or eligible WTC community 

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

11 WTC Program Administrator shall establish a nationwide 

12 network of health care providers to provide monitoring 

13 and treatment benefits and initial health evaluations near 

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

16 such individuals from being provided such monitoring and 

17 treatment benefits or initial health evaluation through any 

18 Clinical Center of Excellence. 

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

20 provider participating in the network under subsection (a) 

21 shall— 

22 ‘‘(1) meet criteria for credentialing established 

23 by the Coordinating Centers of Excellence; 

24 ‘‘(2) follow the monitoring, initial health evalua25 tion, and treatment protocols developed under sec26 tion 3006(a)(2)(B); 


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

2 section 3005; and 

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

4 other requirements as the WTC Program Adminis5 trator establishes. 

6 ‘‘Subtitle C—Research Into 

7 Conditions 

8 ‘‘SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CON9 DITIONS RELATED TO SEPTEMBER 11 TER10 RORIST ATTACKS IN NEW YORK CITY. 

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

14 subtitle B, the WTC Program Administrator shall conduct 

15 or support— 

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

17 conditions that may be related to the September 11, 

18 2001, terrorist attacks; 

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

20 health conditions of such individuals, in the case of 

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

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

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1 tions for which there has been treatment uncer2 tainty. 

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

6 the World Trade Center Health Registry (referred to in 

7 section 3051), through a Clinical Center of Excellence, or 

8 through a Coordinating Center of Excellence. 

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

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

12 conditions— 

13 ‘‘(1) among WTC responders and community 

14 members under treatment; and 

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

16 York City disaster area in Manhattan as far north 

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

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

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

22 WTC Health Program Steering Committees and the WTC 

23 Scientific/Technical Advisory Committee. 

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


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1 protections applicable to research conducted under this 

2 section shall not be less than such protections applicable 

3 to research otherwise conducted by the National Institutes 

4 of Health. 

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

6 purpose of carrying out this section, there are authorized 

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

8 addition to any other authorizations of appropriations that 

9 are available for such purpose. 

10 ‘‘Subtitle D—Programs of the New 

11 York City Department of Health 

12 and Mental Hygiene 

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

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

17 Center, the WTC Program Administrator, shall extend 

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

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

20 Mental Hygiene that provide for the World Trade Center 

21 Health Registry. 

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

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


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1 ‘‘SEC. 3052. MENTAL HEALTH SERVICES. 

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

4 of Health and Mental Hygiene to provide mental health 

5 services to address mental health needs relating to the 

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

7 Center. 

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

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

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

13 2001 

14 SEC. 201. DEFINITIONS. 

15 Section 402 of the Air Transportation Safety and 

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

17 amended— 

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

19 removal, including under the World Trade Center 

20 Health Program established under section 3001 of 

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

22 11, 2001’’; 

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


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

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

6 consultant, or any parent, subsidiary, associated or 

7 allied company, affiliated company, corporation, 

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

10 Such term shall not include any entity, including the 

11 Port Authority of New York and New Jersey, with 

12 a property interest in the World Trade Center, on 

13 September 11, 2001, whether fee simple, leasehold 

14 or easement, direct or indirect. 

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

17 debris, cleanup, remediation, and response during 

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

20 a 9/11 crash site.’’; 

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

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


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1 the terrorist-related aircraft crashes of September 

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

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

4 paragraph: 

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

6 site’ means— 

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

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

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

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

13 crashes that the Special Master determines was 

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

16 the impact of the aircraft or any subsequent 

17 fire, explosions, or building collapses (including 

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

20 or debris fell upon and injured individuals); and 

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

22 of debris removal, such as barges and Fresh 

23 Kills.’’. 


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1 SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 

2 COMPENSATION. 

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

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

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

7 note) is amended— 

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

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

13 ‘‘crashes’’; and 

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

16 ‘‘crashes’’. 

17 (b) EXTENSION OF DEADLINE FOR CLAIMS UNDER

18 SEPTEMBER 11TH VICTIM COMPENSATION FUND OF

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

20 as follows: 

21 ‘‘(3) LIMITATION.— 

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

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

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

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


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

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

4 personal representative on behalf of a deceased 

5 individual) during the period beginning on the 

6 date on which the regulations are updated 

7 under section 407(b) and ending on December 

8 22, 2031.’’. 

9 (c) REQUIREMENTS FOR FILING CLAIMS DURING

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

11 Act is amended— 

12 (1) by redesignating subparagraphs (A) and 

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

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

15 redesignated, the following new subparagraph: 

16 ‘‘(A) REQUIREMENTS FOR FILING CLAIMS

17 DURING EXTENDED FILING PERIOD.— 

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

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

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

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

25 Master determines the individual 


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1 knew (or reasonably should have 

2 known) before the date specified in 

3 clause (iii) that the individual suffered 

4 a physical harm at a 9/11 crash site 

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

7 or as a result of debris removal, and 

8 that the individual knew (or should 

9 have known) before such specified 

10 date that the individual was eligible to 

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

13 the date that is 2 years after such 

14 specified date. 

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

16 Master determines the individual first 

17 knew (or reasonably should have 

18 known) on or after the date specified 

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

21 individual first knew (or should have 

22 known) on or after such specified date 

23 that the individual was eligible to file 

24 a claim under this title, the individual 

25 may file a claim not later than the 


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

3 determines the individual first knew 

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

6 and was eligible to file a claim under 

7 this title. 

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

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

12 ‘‘(I) the individual was treated by 

13 a medical professional for suffering 

14 from a physical harm described in 

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

16 from the date of discovering such 

17 harm; and 

18 ‘‘(II) the individual’s physical 

19 harm is verified by contemporaneous 

20 medical records created by or at the 

21 direction of the medical professional 

22 who provided the medical care. 

23 ‘‘(iii) DATE SPECIFIED.—The date 

24 specified in this clause is the date on which 


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1 the regulations are updated under section 

2 407(a).’’. 

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

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

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

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

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

8 site’’. 

9 (e) INCLUSION OF PHYSICAL HARM RESULTING

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

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

12 removal’’ after ‘‘air crash’’. 

13 (f) LIMITATIONS ON CIVIL ACTIONS.— 

14 (1) APPLICATION TO DAMAGES RELATED TO

15 DEBRIS REMOVAL.—Clause (i) of section 

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

19 ‘‘September 11, 2001’’. 

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

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

24 of an individual who is a party to a civil 

25 action described in clause (i), such indiVerDate Nov 24 2008 00:56 Feb 10, 2009 Jkt 079200 PO 00000 Frm 00107 Fmt 6652 Sfmt 6201 E:\BILLS\H847.IH H847

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1 vidual may not submit a claim under this 

2 title— 

3 ‘‘(I) during the period described 

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

6 by the date that is 90 days after the 

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

9 ‘‘(II) during the period described 

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

12 by the date that is 90 days after the 

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

15 (3) AUTHORITY TO REINSTITUTE CERTAIN

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

18 new clause: 

19 ‘‘(iii) AUTHORITY TO REINSTITUTE

20 CERTAIN LAWSUITS.—In the case of a 

21 claimant who was a party to a civil action 

22 described in clause (i), who withdrew from 

23 such action pursuant to clause (ii), and 

24 who is subsequently determined to not be 

25 an eligible individual for purposes of this 


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1 subsection, such claimant may reinstitute 

2 such action without prejudice during the 

3 90-day period beginning after the date of 

4 such ineligibility determination.’’. 

5 SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

6 Section 407 of the Air Transportation Safety and 

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

8 amended— 

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

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

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

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

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

15 9/11 Health and Compensation Act of 2008, the Special 

16 Master shall update the regulations promulgated under 

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

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

19 SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 

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

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

22 amended by adding at the end the following new para23 graphs: 

24 ‘‘(4) LIABILITY FOR CERTAIN CLAIMS.— 


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1 ‘‘(A) IN GENERAL.—Notwithstanding any 

2 other provision of law, subject to subparagraph 

3 (B), liability for all claims and actions (includ4 ing claims or actions that have been previously 

5 resolved, that are currently pending, and that 

6 may be filed through December 22, 2031) for 

7 compensatory damages, contribution or indem8 nity, or any other form or type of relief, arising 

9 from or related to debris removal, against the 

10 City of New York, any entity (including the 

11 Port Authority of New York and New Jersey) 

12 with a property interest in the World Trade 

13 Center on September 11, 2001 (whether fee 

14 simple, leasehold or easement, or direct or indi15 rect) and any contractors and subcontractors 

16 thereof, shall not be in an amount that exceeds 

17 the sum of the following: 

18 ‘‘(i) The amount of funds of the WTC 

19 Captive Insurance Company, including the 

20 cumulative interest. 

21 ‘‘(ii) The amount of all available in22 surance identified in schedule 2 of the 

23 WTC Captive Insurance Company insur24 ance policy. 


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1 ‘‘(iii) The amount that is the greater 

2 of the City of New York’s insurance cov3 erage or $350,000,000. In determining the 

4 amount of the City’s insurance coverage 

5 for purposes of the previous sentence, any 

6 amount described in clauses (i) and (ii) 

7 shall not be included. 

8 ‘‘(iv) The amount of all available li9 ability insurance coverage maintained by 

10 any entity, including the Port Authority of 

11 New York and New Jersey, with a prop12 erty interest in the World Trade Center, 

13 on September 11, 2001, whether fee sim14 ple, leasehold or easement, or direct or in15 direct. 

16 ‘‘(v) The amount of all available liabil17 ity insurance coverage maintained by con18 tractors and subcontractors. 

19 ‘‘(B) EXCEPTION.—Subparagraph (A) 

20 shall not apply to claims or actions based upon 

21 conduct held to be intentionally tortious in na22 ture or to acts of gross negligence or other such 

23 acts to the extent to which punitive damages 

24 are awarded as a result of such conduct or acts. 


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1 ‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Pay2 ments to plaintiffs who obtain a settlement or judg3 ment with respect to a claim or action to which 

4 paragraph (4)(A) applies, shall be paid solely from 

5 the following funds in the following order: 

6 ‘‘(A) The funds described in clause (i) or 

7 (ii) of paragraph (4)(A). 

8 ‘‘(B) If there are no funds available as de9 scribed in clause (i) or (ii) of paragraph (4)(A), 

10 the funds described in clause (iii) of such para11 graph. 

12 ‘‘(C) If there are no funds available as de13 scribed in clause (i), (ii), or (iii) of paragraph 

14 (4)(A), the funds described in clause (iv) of 

15 such paragraph. 

16 ‘‘(D) If there are no funds available as de17 scribed in clause (i), (ii), (iii), or (iv) of para18 graph (4)(A), the funds described in clause (v) 

19 of such paragraph. 

20 ‘‘(6) DECLARATORY JUDGMENT ACTIONS AND

21 DIRECT ACTION.—Any party to a claim or action to 

22 which paragraph (4)(A) applies may, with respect to 

23 such claim or action, either file an action for a de24 claratory judgment for insurance coverage or bring 


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1 a direct action against the insurance company in2 volved.’’. 

Æ 


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