IB 

Union Calendar No. 321 

111TH CONGRESS 

2D SESSION H. R. 847 

[Report No. 111–560, Parts I and II] 

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 

JULY 22, 2010 

Reported from the Committee on Energy and Commerce with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

JULY 22, 2010 

Additional sponsors: Ms. BERKLEY, Mr. GENE GREEN of Texas, Ms. 

SCHAKOWSKY, Mr. SMITH of New Jersey, Mr. CONNOLLY of Virginia, 

Mr. LANCE, Mr. KLEIN of Florida, Mr. KUCINICH, Ms. DELAURO, Ms. 

LEE of California, Mr. LEWIS of Georgia, Mr. GRIJALVA, Mr. BISHOP

of Georgia, Mr. DOYLE, Mr. DENT, Mr. MURPHY of Connecticut, Mr. 

HOLT, Mr. LARSON of Connecticut, Mr. SESTAK, Mr. PIERLUISI, Ms. 

SLAUGHTER, Ms. VELA ́ZQUEZ, Mrs. DAHLKEMPER, Mr. ETHERIDGE, Mr. 

CONYERS, Mr. WEXLER, Mrs. CHRISTENSEN, Mr. COHEN, Mr. ANVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H847.RH H847

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DREWS, Mr. BRADY of Pennsylvania, Mr. SCHAUER, Mr. GARRETT of 

New Jersey, Mr. MCCAUL, Mr. HODES, Ms. SCHWARTZ, Mr. MURPHY of 

New York, Mr. FATTAH, Mr. GONZALEZ, Mr. COURTNEY, Mr. JONES, 

Mr. STUPAK, Mrs. CAPPS, Ms. CASTOR of Florida, Mr. SARBANES, Mr. 

TIM MURPHY of Pennsylvania, Mr. SIRES, Mr. LIPINSKI, Mr. THOMPSON

of Mississippi, Mr. RUSH, Ms. BALDWIN, Mr. ELLSWORTH, Mr. CARNEY, 

Ms. JACKSON LEE of Texas, Mr. NEAL of Massachusetts, Mr. PATRICK

J. MURPHY of Pennsylvania, Mr. UPTON, Mr. FILNER, Ms. HARMAN, Ms. 

NORTON, Mr. HOLDEN, Mr. CUMMINGS, Ms. SHEA-PORTER, Mr. ROTHMAN of New Jersey, Mrs. NAPOLITANO, Mr. LYNCH, Mr. CAO, Mr. MARKEY of Massachusetts, Mr. NYE, Mr. WALZ, Ms. MCCOLLUM, Mr. 

BRALEY of Iowa, Mr. REICHERT, Mr. OWENS, Mr. WELCH, Mr. DAVIS

of Illinois, Ms. ESHOO, Mr. BUTTERFIELD, Mr. GARAMENDI, Mr. BACA, 

Mr. MILLER of North Carolina, Mr. OBERSTAR, Mr. LOBIONDO, Ms. 

EDDIE BERNICE JOHNSON of Texas, and Mr. PAYNE

JULY 22, 2010 

Reported from the Committee on the Judiciary with an amendment, committed to the Committee of the Whole House on the State of the Union, 

and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in boldface roman] 

[For text of introduced bill, see copy of bill as introduced on February 4, 2009] 

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. 


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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

6 2010’’. 

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

8 Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 

Sec. 101. World Trade Center Health Program. 

‘‘TITLE XXXIII—WORLD TRADE CENTER HEALTH PROGRAM 

‘‘Subtitle A—Establishment of Program; Advisory Committee 

‘‘Sec. 3301. Establishment of World Trade Center Health Program. 

‘‘Sec. 3302. WTC Health Program Scientific/Technical Advisory Committee; 

WTC Health Program Steering Committees. 

‘‘Sec. 3303. Education and outreach. 

‘‘Sec. 3304. Uniform data collection and analysis. 

‘‘Sec. 3305. Clinical Centers of Excellence and Data Centers. 

‘‘Sec. 3306. Definitions. 

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

Treatment 

‘‘PART 1—WTC RESPONDERS

‘‘Sec. 3311. Identification of WTC responders and provision of WTC-related 

monitoring services. 

‘‘Sec. 3312. Treatment of enrolled WTC responders for WTC-related health 

conditions. 

‘‘Sec. 3313. National arrangement for benefits for eligible individuals outside 

New York. 

‘‘PART 2—WTC SURVIVORS

‘‘Sec. 3321. Identification and initial health evaluation of screening-eligible 

and certified-eligible WTC survivors. 

‘‘Sec. 3322. Followup monitoring and treatment of certified-eligible WTC 

survivors for WTC-related health conditions. 

‘‘Sec. 3323. Followup monitoring and treatment of other individuals with 

WTC-related health conditions. 


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‘‘PART 3—PAYOR PROVISIONS

‘‘Sec. 3331. Payment of claims. 

‘‘Sec. 3332. Administrative arrangement authority. 

‘‘Subtitle C—Research Into Conditions 

‘‘Sec. 3341. Research regarding certain health conditions related to September 11 terrorist attacks in New York City. 

‘‘Sec. 3342. World Trade Center Health Registry. 

‘‘Subtitle D—Funding 

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

TITLE II—SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001 

Sec. 201. Definitions. 

Sec. 202. Extended and expanded eligibility for compensation. 

Sec. 203. Requirement to update regulations. 

Sec. 204. Limited liability for certain claims. 

1 TITLE I—WORLD TRADE CENTER 

2 HEALTH PROGRAM 

3 SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 

4 The Public Health Service Act is amended by adding 

5 at the end the following new title: 

6 ‘‘TITLE XXXIII—WORLD TRADE 

7 CENTER HEALTH PROGRAM 

8 ‘‘Subtitle A—Establishment of 

9 Program; Advisory Committee 

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

11 HEALTH PROGRAM. 

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

13 the Department of Health and Human Services a program 

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

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


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1 ‘‘(1) medical monitoring and treatment benefits 

2 to eligible emergency responders and recovery and 

3 cleanup workers (including those who are Federal em4 ployees) who responded to the September 11, 2001, 

5 terrorist attacks; and 

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

7 treatment benefits to residents and other building oc8 cupants and area workers in New York City who were 

9 directly impacted and adversely affected by such at10 tacks. 

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

12 includes the following components: 

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

14 Medical monitoring under section 3311, including 

15 clinical examinations and long-term health moni16 toring and analysis for enrolled WTC responders who 

17 were likely to have been exposed to airborne toxins 

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

19 the September 11, 2001, terrorist attacks. 

20 ‘‘(2) INITIAL HEALTH EVALUATION FOR SUR21 VIVORS.—An initial health evaluation under section 

22 3321, including an evaluation to determine eligibility 

23 for followup monitoring and treatment. 

24 ‘‘(3) FOLLOWUP MONITORING AND TREATMENT

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1 SPONDERS AND SURVIVORS.—Provision under sections 

2 3312, 3322, and 3323 of followup monitoring and 

3 treatment and payment, subject to the provisions of 

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

5 mental health care expenses of an individual with re6 spect to a WTC-related health condition (including 

7 necessary prescription drugs). 

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

9 3303 of an education and outreach program to poten10 tially eligible individuals concerning the benefits 

11 under this title. 

12 ‘‘(5) CLINICAL DATA COLLECTION AND ANAL13 YSIS.—Collection and analysis under section 3304 of 

14 health and mental health data relating to individuals 

15 receiving monitoring or treatment benefits in a uni16 form manner in collaboration with the collection of 

17 epidemiological data under section 3342. 

18 ‘‘(6) RESEARCH ON HEALTH CONDITIONS.—Es19 tablishment under subtitle C of a research program on 

20 health conditions resulting from the September 11, 

21 2001, terrorist attacks. 

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

23 benefits and initial health evaluation benefits are provided 

24 under subtitle B without any deductibles, copayments, or 

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1 tified-eligible WTC survivor. Initial health evaluation bene2 fits are provided under subtitle B without any deductibles, 

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

4 WTC survivor. 

5 ‘‘(d) PREVENTING FRAUD AND UNREASONABLE AD6 MINISTRATIVE COSTS.— 

7 ‘‘(1) FRAUD.—The Inspector General of the De8 partment of Health and Human Services shall de9 velop and implement a program to review the WTC 

10 Program’s health care expenditures to detect fraudu11 lent or duplicate billing and payment for inappro12 priate services. This title is a Federal health care pro13 gram (as defined in section 1128B(f) of the Social Se14 curity Act) and is a health plan (as defined in section 

15 1128C(c) of such Act) for purposes of applying sec16 tions 1128 through 1128E of such Act. 

17 ‘‘(2) UNREASONABLE ADMINISTRATIVE COSTS.— 

18 The Inspector General of the Department of Health 

19 and Human Services shall develop and implement a 

20 program to review the WTC Program for unreason21 able administrative costs, including with respect to 

22 infrastructure, administration, and claims processing. 

23 ‘‘(e) QUALITY ASSURANCE.—The WTC Program Ad24 ministrator working with the Clinical Centers of Excellence 

25 shall develop and implement a quality assurance program 


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1 for the monitoring and treatment delivered by such Centers 

2 of Excellence and any other participating health care pro3 viders. Such program shall include— 

4 ‘‘(1) adherence to monitoring and treatment pro5 tocols; 

6 ‘‘(2) appropriate diagnostic and treatment refer7 rals for participants; 

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

9 participants; and 

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

11 specifies in consultation with the Clinical Centers of 

12 Excellence. 

13 ‘‘(f) ANNUAL PROGRAM REPORT.— 

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

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

16 Program is in operation, the WTC Program Adminis17 trator shall submit an annual report to the Congress 

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

19 for the entire period of operation of the program. 

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

21 annual report under paragraph (1) shall include at 

22 least the following: 

23 ‘‘(A) ELIGIBLE INDIVIDUALS.—Information 

24 for each clinical program described in paragraph 

25 (3)— 


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

2 applied for certification under subtitle B 

3 and the number of such individuals who 

4 were so certified; 

5 ‘‘(ii) of the individuals who were cer6 tified, on the number who received moni7 toring under the program and the number 

8 of such individuals who received medical 

9 treatment under the program; 

10 ‘‘(iii) with respect to individuals so 

11 certified who received such treatment, on the 

12 WTC-related health conditions for which 

13 they were treated; and 

14 ‘‘(iv) on the projected number of indi15 viduals who will be certified under subtitle 

16 B in the succeeding fiscal year and the suc17 ceeding 10-year period. 

18 ‘‘(B) MONITORING, INITIAL HEALTH EVAL19 UATION, AND TREATMENT COSTS.—For each clin20 ical program so described— 

21 ‘‘(i) information on the costs of moni22 toring and initial health evaluation and the 

23 costs of treatment and on the estimated 

24 costs of such monitoring, evaluation, and 

25 treatment in the succeeding fiscal year; and 


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

2 treatment for WTC-related health conditions 

3 that have been paid for or reimbursed by 

4 workers’ compensation, by public or private 

5 health plans, or by New York City under 

6 section 3331. 

7 ‘‘(C) ADMINISTRATIVE COSTS.—Information 

8 on the cost of administering the program, includ9 ing costs of program support, data collection and 

10 analysis, and research conducted under the pro11 gram. 

12 ‘‘(D) ADMINISTRATIVE EXPERIENCE.—In13 formation on the administrative performance of 

14 the program, including— 

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

16 providing timely evaluation of and treat17 ment to eligible individuals; and 

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

19 Excellence and other providers that are par20 ticipating in the program. 

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

22 the findings of any new scientific reports or 

23 studies on the health effects associated with expo24 sure described in section 3306(1), including the 


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1 findings of research conducted under section 

2 3341(a). 

3 ‘‘(F) ADVISORY COMMITTEE RECOMMENDA4 TIONS.—A list of recommendations by the WTC 

5 Scientific/Technical Advisory Committee on ad6 ditional WTC Program eligibility criteria and 

7 on additional WTC-related health conditions and 

8 the action of the WTC Program Administrator 

9 concerning each such recommendation. 

10 ‘‘(3) SEPARATE CLINICAL PROGRAMS DE11 SCRIBED.—In paragraph (2), each of the following 

12 shall be treated as a separate clinical program of the 

13 WTC Program: 

14 ‘‘(A) FIREFIGHTERS AND RELATED PER15 SONNEL.—The benefits provided for enrolled 

16 WTC responders described in section 

17 3311(a)(2)(A). 

18 ‘‘(B) OTHER WTC RESPONDERS.—The bene19 fits provided for enrolled WTC responders not de20 scribed in subparagraph (A). 

21 ‘‘(C) WTC SURVIVORS.—The benefits pro22 vided for screening-eligible WTC survivors and 

23 certified-eligible WTC survivors in section 

24 3321(a). 


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

2 PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The Sec3 retary shall promptly notify the Congress of each of the fol4 lowing: 

5 ‘‘(1) When the number of enrollments of WTC re6 sponders subject to the limit established under section 

7 3311(a)(4) has reached 80 percent of such limit. 

8 ‘‘(2) When the number of certifications for cer9 tified-eligible WTC survivors subject to the limit es10 tablished under section 3321(a)(3) has reached 80 

11 percent of such limit. 

12 ‘‘(h) CONSULTATION.—The WTC Program Adminis13 trator shall engage in ongoing outreach and consultation 

14 with relevant stakeholders, including the WTC Health Pro15 gram Steering Committees and the Advisory Committee 

16 under section 3302, regarding the implementation and im17 provement of programs under this title. 

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

19 ADVISORY COMMITTEE; WTC HEALTH PRO20 GRAM STEERING COMMITTEES. 

21 ‘‘(a) ADVISORY COMMITTEE.— 

22 ‘‘(1) ESTABLISHMENT.—The WTC Program Ad23 ministrator shall establish an advisory committee to 

24 be known as the WTC Health Program Scientific/ 

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1 ferred to as the ‘Advisory Committee’) to review sci2 entific and medical evidence and to make rec3 ommendations to the Administrator on additional 

4 WTC Program eligibility criteria and on additional 

5 WTC-related health conditions. 

6 ‘‘(2) COMPOSITION.—The WTC Program Admin7 istrator shall appoint the members of the Advisory 

8 Committee and shall include at least— 

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

10 of whom have experience treating WTC rescue 

11 and recovery workers; 

12 ‘‘(B) 1 physician with expertise in pul13 monary medicine; 

14 ‘‘(C) 2 environmental medicine or environ15 mental health specialists; 

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

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

18 WTC survivors; 

19 ‘‘(F) an industrial hygienist; 

20 ‘‘(G) a toxicologist; 

21 ‘‘(H) an epidemiologist; and 

22 ‘‘(I) a mental health professional. 

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

24 meet at such frequency as may be required to carry 

25 out its duties. 


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1 ‘‘(4) REPORTS.—The WTC Program Adminis2 trator shall provide for publication of recommenda3 tions of the Advisory Committee on the public Web 

4 site established for the WTC Program. 

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

6 provision of law, the Advisory Committee shall con7 tinue in operation during the period in which the 

8 WTC Program is in operation. 

9 ‘‘(6) APPLICATION OF FACA.—Except as other10 wise specifically provided, the Advisory Committee 

11 shall be subject to the Federal Advisory Committee 

12 Act. 

13 ‘‘(b) WTC HEALTH PROGRAM STEERING COMMIT14 TEES.— 

15 ‘‘(1) CONSULTATION.—The WTC Program Ad16 ministrator shall consult with 2 steering committees 

17 (each in this section referred to as a ‘Steering Com18 mittee’) that are established as follows: 

19 ‘‘(A) WTC RESPONDERS STEERING COM20 MITTEE.—One Steering Committee, to be known 

21 as the WTC Responders Steering Committee, for 

22 the purpose of receiving input from affected 

23 stakeholders and facilitating the coordination of 

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1 rolled WTC responders under part 1 of subtitle 

2 B. 

3 ‘‘(B) WTC SURVIVORS STEERING COM4 MITTEE.—One Steering Committee, to be known 

5 as the WTC Survivors Steering Committee, for 

6 the purpose of receiving input from affected 

7 stakeholders and facilitating the coordination of 

8 initial health evaluations, monitoring, and treat9 ment programs for screening-eligible and cer10 tified-eligible WTC survivors under part 2 of 

11 subtitle B. 

12 ‘‘(2) MEMBERSHIP.— 

13 ‘‘(A) WTC RESPONDERS STEERING COM14 MITTEE.— 

15 ‘‘(i) REPRESENTATION.—The WTC Re16 sponders Steering Committee shall in17 clude— 

18 ‘‘(I) representatives of the Centers 

19 of Excellence providing services to 

20 WTC responders; 

21 ‘‘(II) representatives of labor or22 ganizations representing firefighters, 

23 police, other New York City employees, 

24 and recovery and cleanup workers who 


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1 responded to the September 11, 2001, 

2 terrorist attacks; and 

3 ‘‘(III) 3 representatives of New 

4 York City, 1 of whom will be selected 

5 by the police commissioner of New 

6 York City, 1 by the health commis7 sioner of New York City, and 1 by the 

8 mayor of New York City. 

9 ‘‘(ii) INITIAL MEMBERSHIP.—The WTC 

10 Responders Steering Committee shall ini11 tially be composed of members of the WTC 

12 Monitoring and Treatment Program Steer13 ing Committee (as in existence on the day 

14 before the date of the enactment of this 

15 title). 

16 ‘‘(B) WTC SURVIVORS STEERING COM17 MITTEE.— 

18 ‘‘(i) REPRESENTATION.—The WTC 

19 Survivors Steering Committee shall include 

20 representatives of— 

21 ‘‘(I) the Centers of Excellence pro22 viding services to screening-eligible and 

23 certified-eligible WTC survivors; 

24 ‘‘(II) the population of residents, 

25 students, and area and other workers 


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1 affected by the September 11, 2001, ter2 rorist attacks; 

3 ‘‘(III) screening-eligible and cer4 tified-eligible survivors receiving ini5 tial health evaluations, monitoring, or 

6 treatment under part 2 of subtitle B 

7 and organizations advocating on their 

8 behalf; and 

9 ‘‘(IV) New York City. 

10 ‘‘(ii) INITIAL MEMBERSHIP.—The WTC 

11 Survivors Steering Committee shall ini12 tially be composed of members of the WTC 

13 Environmental Health Center Survivor Ad14 visory Committee (as in existence on the 

15 day before the date of the enactment of this 

16 title). 

17 ‘‘(C) ADDITIONAL APPOINTMENTS.—Each 

18 Steering Committee may recommend, if ap19 proved by a majority of voting members of the 

20 Committee, additional members to the Com21 mittee. 

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

23 Committee shall be filled by an individual rec24 ommended by the Steering Committee. 


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1 ‘‘SEC. 3303. EDUCATION AND OUTREACH. 

2 ‘‘The WTC Program Administrator shall institute a 

3 program that provides education and outreach on the exist4 ence and availability of services under the WTC Program. 

5 The outreach and education program— 

6 ‘‘(1) shall include— 

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

8 with information about the WTC Program; 

9 ‘‘(B) meetings with potentially eligible pop10 ulations; 

11 ‘‘(C) development and dissemination of out12 reach materials informing people about the pro13 gram; and 

14 ‘‘(D) the establishment of phone information 

15 services; and 

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

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

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

19 linguistically diverse populations. 

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

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

22 shall provide for the uniform collection of data (and anal23 ysis of data and regular reports to the Administrator) on 

24 the prevalence of WTC-related health conditions and the 

25 identification of new WTC-related health conditions. Such 

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1 toring or treatment benefits under subtitle B and regardless 

2 of their place of residence or Clinical Center of Excellence 

3 through which the benefits are provided. The WTC Program 

4 Administrator shall provide, through the Data Centers or 

5 otherwise, for the integration of such data into the moni6 toring and treatment program activities under this title. 

7 ‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL8 LENCE.—Each Clinical Center of Excellence shall collect 

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

10 the corresponding Data Center for analysis by such Data 

11 Center. 

12 ‘‘(c) COLLABORATION WITH WTC HEALTH REG13 ISTRY.—The WTC Program Administrator shall provide for 

14 collaboration between the Data Centers and the World 

15 Trade Center Health Registry described in section 3342. 

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

17 under this section shall be conducted and maintained in 

18 a manner that protects the confidentiality of individually 

19 identifiable health information consistent with applicable 

20 statutes and regulations, including, as applicable, HIPAA 

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

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

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

24 CENTERS. 

25 ‘‘(a) IN GENERAL.— 


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1 ‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF

2 EXCELLENCE.—The WTC Program Administrator 

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

5 in subsection (b)(1)(A))— 

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

7 treatment benefits and initial health evaluation 

8 benefits under subtitle B; 

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

10 to individuals eligible for such monitoring and 

11 treatment benefits, for initial health evaluation 

12 benefits, and for followup to individuals who are 

13 enrolled in the monitoring program; 

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

17 for such benefits; 

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

20 be available under workers’ compensation or 

21 other benefit programs for work-related injuries 

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

24 or private social service agencies and assisting 

25 eligible individuals in applying for such benefits; 


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

2 interpretive services for program participants 

3 who are not English language proficient; and 

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

5 in accordance with section 3304. 

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

7 ‘‘(A) IN GENERAL.—The WTC Program Ad8 ministrator shall enter into contracts with Data 

9 Centers (as defined in subsection (b)(2))— 

10 ‘‘(i) for receiving, analyzing, and re11 porting to the WTC Program Administrator 

12 on data, in accordance with section 3304, 

13 that have been collected and reported to such 

14 Data Centers by the corresponding Clinical 

15 Centers of Excellence under subsection 

16 (b)(1)(B)(iii); 

17 ‘‘(ii) for the development of moni18 toring, initial health evaluation, and treat19 ment protocols, with respect to WTC-related 

20 health conditions; 

21 ‘‘(iii) for coordinating the outreach ac22 tivities conducted under paragraph (1)(B) 

23 by each corresponding Clinical Center of 

24 Excellence; 


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1 ‘‘(iv) for establishing criteria for the 

2 credentialing of medical providers partici3 pating in the nationwide network under 

4 section 3313; 

5 ‘‘(v) for coordinating and admin6 istering the activities of the WTC Health 

7 Program Steering Committees established 

8 under section 3002(b); and 

9 ‘‘(vi) for meeting periodically with the 

10 corresponding Clinical Centers of Excellence 

11 to obtain input on the analysis and report12 ing of data collected under clause (i) and on 

13 the development of monitoring, initial 

14 health evaluation, and treatment protocols 

15 under clause (ii). 

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

17 medical providers under subparagraph (A)(iv) 

18 shall be selected by the WTC Program Adminis19 trator on the basis of their experience treating or 

20 diagnosing the health conditions included in the 

21 list of WTC-related health conditions. 

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

23 out subparagraph (A)(ii), a Data Center shall 

24 engage in clinical discussions across the WTC 


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1 Program to guide treatment approaches for indi2 viduals with a WTC-related health condition. 

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

4 entered into under this subsection with a Data 

5 Center shall require the Data Center to make 

6 any data collected and reported to such Center 

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

8 health researchers and others as provided in the 

9 CDC/ATSDR Policy on Releasing and Sharing 

10 Data. 

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

12 SPECIFIC.—A contract entered into under this sub13 section with a Clinical Center of Excellence or a Data 

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

15 enrolled WTC responders, screening-eligible WTC sur16 vivors, or certified-eligible WTC survivors. 

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

18 contract under this title between the WTC Program 

19 Administrator and a Data Center or a Clinical Cen20 ter of Excellence may be in the form of a cooperative 

21 agreement. 

22 ‘‘(b) CENTERS OF EXCELLENCE.— 

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

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

25 title, the term ‘Clinical Center of Excellence’ 


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1 means a Center that demonstrates to the satisfac2 tion of the Administrator that the Center— 

3 ‘‘(i) uses an integrated, centralized 

4 health care provider approach to create a 

5 comprehensive suite of health services under 

6 this title that are accessible to enrolled WTC 

7 responders, screening-eligible WTC sur8 vivors, or certified-eligible WTC survivors; 

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

10 responders and screening-eligible WTC sur11 vivors or includes health care providers who 

12 have been trained pursuant to section 

13 3313(c); 

14 ‘‘(iii) employs health care provider 

15 staff with expertise that includes, at a min16 imum, occupational medicine, environ17 mental medicine, trauma-related psychiatry 

18 and psychology, and social services coun19 seling; and 

20 ‘‘(iv) meets such other requirements as 

21 specified by the Administrator. 

22 ‘‘(B) CONTRACT REQUIREMENTS.—The 

23 WTC Program Administrator shall not enter 

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1 lence under subsection (a)(1) unless the Center 

2 agrees to do each of the following: 

3 ‘‘(i) Establish a formal mechanism for 

4 consulting with and receiving input from 

5 representatives of eligible populations re6 ceiving monitoring and treatment benefits 

7 under subtitle B from such Center. 

8 ‘‘(ii) Coordinate monitoring and treat9 ment benefits under subtitle B with routine 

10 medical care provided for the treatment of 

11 conditions other than WTC-related health 

12 conditions. 

13 ‘‘(iii) Collect and report to the cor14 responding Data Center data in accordance 

15 with section 3304(b). 

16 ‘‘(iv) Have in place safeguards against 

17 fraud that are satisfactory to the Adminis18 trator, in consultation with the Inspector 

19 General of the Department of Health and 

20 Human Services. 

21 ‘‘(v) Treat or refer for treatment all in22 dividuals who are enrolled WTC responders 

23 or certified-eligible WTC survivors with re24 spect to such Center who present themselves 


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1 for treatment of a WTC-related health con2 dition. 

3 ‘‘(vi) Have in place safeguards, con4 sistent with section 3304(c), to ensure the 

5 confidentiality of an individual’s individ6 ually identifiable health information, in7 cluding requiring that such information not 

8 be disclosed to the individual’s employer 

9 without the authorization of the individual. 

10 ‘‘(vii) Use amounts paid under sub11 section (c)(1) only for costs incurred in car12 rying out the activities described in sub13 section (a), other than those described in 

14 subsection (a)(1)(A). 

15 ‘‘(viii) Utilize health care providers 

16 with occupational and environmental medi17 cine expertise to conduct physical and men18 tal health assessments, in accordance with 

19 protocols developed under subsection 

20 (a)(2)(A)(ii). 

21 ‘‘(ix) Communicate with WTC re22 sponders and screening-eligible and cer23 tified-eligible WTC survivors in appropriate 

24 languages and conduct outreach activities 


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1 with relevant stakeholder worker or commu2 nity associations. 

3 ‘‘(x) Meet all the other applicable re4 quirements of this title, including regula5 tions implementing such requirements. 

6 ‘‘(C) TRANSITION RULE TO ENSURE CON7 TINUITY OF CARE.—The WTC Program Admin8 istrator shall to the maximum extent feasible en9 sure continuity of care in any period of transi10 tion from monitoring and treatment of an en11 rolled WTC responder or certified-eligible WTC 

12 survivor by a provider to a Clinical Center of 

13 Excellence or a health care provider partici14 pating in the nationwide network under section 

15 3313. 

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

17 the term ‘Data Center’ means a Center that the WTC 

18 Program Administrator determines has the capacity 

19 to carry out the responsibilities for a Data Center 

20 under subsection (a)(2). 

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

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

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

24 extent that such Clinical Center and Data Center 

25 serve the same population group. 


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

2 ‘‘(1) IN GENERAL.—The WTC Program Adminis3 trator shall reimburse a Clinical Center of Excellence 

4 for the fixed infrastructure costs of such Center in 

5 carrying out the activities described in subtitle B at 

6 a rate negotiated by the Administrator and such Cen7 ters. Such negotiated rate shall be fair and appro8 priate and take into account the number of enrolled 

9 WTC responders receiving services from such Center 

10 under this title. 

11 ‘‘(2) FIXED INFRASTRUCTURE COSTS.—For pur12 poses of paragraph (1), the term ‘fixed infrastructure 

13 costs’ means, with respect to a Clinical Center of Ex14 cellence, the costs incurred by such Center that are 

15 not reimbursable by the WTC Program Administrator 

16 under section 3312(c). 

17 ‘‘SEC. 3306. DEFINITIONS. 

18 ‘‘In this title: 

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

20 to a health condition, a health condition that existed 

21 on September 11, 2001, and that, as a result of expo22 sure to airborne toxins, any other hazard, or any 

23 other adverse condition resulting from the September 

24 11, 2001, terrorist attacks, requires medical treatment 

25 that is (or will be) in addition to, more frequent than, 


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1 or of longer duration than the medical treatment that 

2 would have been required for such condition in the 

3 absence of such exposure. 

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

5 has the meaning given such term in section 

6 3321(a)(2). 

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

8 and ‘Data Center’ have the meanings given such 

9 terms in section 3305. 

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

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

12 ‘‘(5) The term ‘initial health evaluation’ in13 cludes, with respect to an individual, a medical and 

14 exposure history, a physical examination, and addi15 tional medical testing as needed to evaluate whether 

16 the individual has a WTC-related health condition 

17 and is eligible for treatment under the WTC Program. 

18 ‘‘(6) The term ‘list of WTC-related health condi19 tions’ means— 

20 ‘‘(A) for WTC responders, the health condi21 tions listed in section 3312(a)(3); and 

22 ‘‘(B) for screening-eligible and certified-eli23 gible WTC survivors, the health conditions listed 

24 in section 3322(b). 


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1 ‘‘(7) The term ‘New York City disaster area’ 

2 means the area within New York City that is— 

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

4 Houston Street; and 

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

6 or partially contained within a 1.5-mile radius 

7 of the former World Trade Center site. 

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

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

12 such area are reasonably able to access monitoring 

13 and treatment benefits and initial health evaluation 

14 benefits under this title through a Clinical Center of 

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

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

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

18 has the meaning given such term in section 

19 3321(a)(1). 

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

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

23 Center, Shanksville, Pennsylvania, or the Pentagon, 

24 as applicable, on such date. 


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1 ‘‘(11) The term ‘September 11, 2001, terrorist at2 tacks’ means the terrorist attacks that occurred on 

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

4 Shanksville, Pennsylvania, and at the Pentagon, and 

5 includes the aftermath of such attacks. 

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

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

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

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

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

13 means— 

14 ‘‘(A) with respect to paragraphs (3) and (4) 

15 of section 3311(a) (relating to enrollment of 

16 WTC responders), section 3312(c) and the cor17 responding provisions of section 3322 (relating 

18 to payment for initial health evaluation, moni19 toring, and treatment), paragraphs (1)(C), 

20 (2)(B), and (3) of section 3321(a) (relating to 

21 determination or certification of screening-eligi22 ble or certified-eligible WTC responders), and 

23 part 3 of subtitle B (relating to payor provi24 sions), an official in the Department of Health 


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1 and Human Services, to be designated by the 

2 Secretary; and 

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

4 this title, the Director of the National Institute 

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

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

8 defined in section 3312(a). 

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

10 section 3311(a). 

11 ‘‘(17) The term ‘WTC Scientific/Technical Advi12 sory Committee’ means such Committee established 

13 under section 3302(a). 

14 ‘‘Subtitle B—Program of Moni15 toring, Initial Health Evalua16 tions, and Treatment 

17 ‘‘PART 1—WTC RESPONDERS 

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

19 PROVISION OF WTC-RELATED MONITORING 

20 SERVICES. 

21 ‘‘(a) WTC RESPONDER DEFINED.— 

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

23 term ‘WTC responder’ means any of the following in24 dividuals, subject to paragraph (4): 


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1 ‘‘(A) CURRENTLY IDENTIFIED RE2 SPONDER.—An individual who has been identi3 fied as eligible for monitoring under the arrange4 ments as in effect on the date of the enactment 

5 of this title between the National Institute for 

6 Occupational Safety and Health and— 

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

8 Sinai Hospital in New York City that co9 ordinates the monitoring and treatment for 

10 enrolled WTC responders other than with 

11 respect to those covered under the arrange12 ment with the Fire Department of New 

13 York City; or 

14 ‘‘(ii) the Fire Department of New York 

15 City. 

16 ‘‘(B) RESPONDER WHO MEETS CURRENT

17 ELIGIBILITY CRITERIA.—An individual who 

18 meets the current eligibility criteria described in 

19 paragraph (2). 

20 ‘‘(C) RESPONDER WHO MEETS MODIFIED

21 ELIGIBILITY CRITERIA.—An individual who— 

22 ‘‘(i) performed rescue, recovery, demoli23 tion, debris cleanup, or other related serv24 ices in the New York City disaster area in 

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1 rorist attacks, regardless of whether such 

2 services were performed by a State or Fed3 eral employee or member of the National 

4 Guard or otherwise; and 

5 ‘‘(ii) meets such eligibility criteria re6 lating to exposure to airborne toxins, other 

7 hazards, or adverse conditions resulting 

8 from the September 11, 2001, terrorist at9 tacks as the WTC Program Administrator, 

10 after consultation with the WTC Scientific/ 

11 Technical Advisory Committee, determines 

12 appropriate. 

13 The WTC Program Administrator shall not mod14 ify such eligibility criteria on or after the date 

15 that the number of enrollments of WTC respond16 ers has reached 80 percent of the limit described 

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

18 number of certifications for certified-eligible 

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

20 reached 80 percent of the limit described in sec21 tion 3321(a)(3). 

22 ‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eli23 gibility criteria described in this paragraph for an 

24 individual is that the individual is described in any 

25 of the following categories: 


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1 ‘‘(A) FIREFIGHTERS AND RELATED PER2 SONNEL.—The individual— 

3 ‘‘(i) was a member of the Fire Depart4 ment of New York City (whether fire or 

5 emergency personnel, active or retired) who 

6 participated at least one day in the rescue 

7 and recovery effort at any of the former 

8 World Trade Center sites (including Ground 

9 Zero, Staten Island Landfill, and the New 

10 York City Chief Medical Examiner’s Office) 

11 for any time during the period beginning 

12 on September 11, 2001, and ending on July 

13 31, 2002; or 

14 ‘‘(ii)(I) is a surviving immediate fam15 ily member of an individual who was a 

16 member of the Fire Department of New 

17 York City (whether fire or emergency per18 sonnel, active or retired) and was killed at 

19 the World Trade site on September 11, 

20 2001; and 

21 ‘‘(II) received any treatment for a 

22 WTC-related health condition described in 

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

24 health conditions) on or before September 1, 

25 2008. 


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1 ‘‘(B) LAW ENFORCEMENT OFFICERS AND

2 WTC RESCUE, RECOVERY, AND CLEANUP WORK3 ERS.—The individual— 

4 ‘‘(i) worked or volunteered onsite in 

5 rescue, recovery, debris cleanup, or related 

6 support services in lower Manhattan (south 

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

8 the barge loading piers, for at least 4 hours 

9 during the period beginning on September 

10 11, 2001, and ending on September 14, 

11 2001, for at least 24 hours during the pe12 riod beginning on September 11, 2001, and 

13 ending on September 30, 2001, or for at 

14 least 80 hours during the period beginning 

15 on September 11, 2001, and ending on July 

16 31, 2002; 

17 ‘‘(ii)(I) was a member of the Police De18 partment of New York City (whether active 

19 or retired) or a member of the Port Author20 ity Police of the Port Authority of New York 

21 and New Jersey (whether active or retired) 

22 who participated onsite in rescue, recovery, 

23 debris cleanup, or related services in lower 

24 Manhattan (south of Canal St.), including 

25 Ground Zero, the Staten Island Landfill, or 


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1 the barge loading piers, for at least 4 hours 

2 during the period beginning September 11, 

3 2001, and ending on September 14, 2001; 

4 ‘‘(II) participated onsite in rescue, re5 covery, debris cleanup, or related services in 

6 at Ground Zero, the Staten Island Landfill, 

7 or the barge loading piers, for at least one 

8 day during the period beginning on Sep9 tember 11, 2001, and ending on July 31, 

10 2002; 

11 ‘‘(III) participated onsite in rescue, re12 covery, debris cleanup, or related services in 

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

14 least 24 hours during the period beginning 

15 on September 11, 2001, and ending on Sep16 tember 30, 2001; or 

17 ‘‘(IV) participated onsite in rescue, re18 covery, debris cleanup, or related services in 

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

20 least 80 hours during the period beginning 

21 on September 11, 2001, and ending on July 

22 31, 2002; 

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

24 the Chief Medical Examiner of New York 

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1 dling of human remains from the World 

2 Trade Center attacks, or other morgue work3 er who performed similar post-September 11 

4 functions for such Office staff, during the 

5 period beginning on September 11, 2001, 

6 and ending on July 31, 2002; 

7 ‘‘(iv) was a worker in the Port Author8 ity Trans-Hudson Corporation Tunnel for 

9 at least 24 hours during the period begin10 ning on February 1, 2002, and ending on 

11 July 1, 2002; or 

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

13 who was exposed to debris from the former 

14 World Trade Center while retrieving, driv15 ing, cleaning, repairing, and maintaining 

16 vehicles contaminated by airborne toxins 

17 from the September 11, 2001, terrorist at18 tacks during a duration and period de19 scribed in subparagraph (A). 

20 ‘‘(C) RESPONDERS TO THE SEPTEMBER 11

21 ATTACKS AT THE PENTAGON AND SHANKSVILLE, 

22 PENNSYLVANIA.—The individual— 

23 ‘‘(i)(I) was a member of a fire or po24 lice department (whether fire or emergency 

25 personnel, active or retired), worked for a 


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1 recovery or cleanup contractor, or was a 

2 volunteer; and performed rescue, recovery, 

3 demolition, debris cleanup, or other related 

4 services at the Pentagon site of the terrorist5 related aircraft crash of September 11, 

6 2001, during the period beginning on Sep7 tember 11, 2001, and ending on the date on 

8 which the cleanup of the site was concluded, 

9 as determined by the WTC Program Ad10 ministrator; or 

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

12 department (whether fire or emergency per13 sonnel, active or retired), worked for a re14 covery or cleanup contractor, or was a vol15 unteer; and performed rescue, recovery, 

16 demolition, debris cleanup, or other related 

17 services at the Shanksville, Pennsylvania, 

18 site of the terrorist-related aircraft crash of 

19 September 11, 2001, during the period be20 ginning on September 11, 2001, and ending 

21 on the date on which the cleanup of the site 

22 was concluded, as determined by the WTC 

23 Program Administrator; and 

24 ‘‘(ii) is determined by the WTC Pro25 gram Administrator to be at an increased 


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1 risk of developing a WTC-related health 

2 condition as a result of exposure to airborne 

3 toxins, other hazards, or adverse conditions 

4 resulting from the September 11, 2001, ter5 rorist attacks, and meets such eligibility cri6 teria related to such exposures, as the WTC 

7 Program Administrator determines are ap8 propriate, after consultation with the WTC 

9 Scientific/Technical Advisory Committee. 

10 ‘‘(3) ENROLLMENT PROCESS.— 

11 ‘‘(A) IN GENERAL.—The WTC Program Ad12 ministrator shall establish a process for enrolling 

13 WTC responders in the WTC Program. Under 

14 such process— 

15 ‘‘(i) WTC responders described in 

16 paragraph (1)(A) shall be deemed to be en17 rolled in such Program; 

18 ‘‘(ii) subject to clause (iii), the Admin19 istrator shall enroll in such program indi20 viduals who are determined to be WTC re21 sponders; 

22 ‘‘(iii) the Administrator shall deny 

23 such enrollment to an individual if the Ad24 ministrator determines that the numerical 


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1 limitation in paragraph (4) on enrollment 

2 of WTC responders has been met; 

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

4 the applicant for making an application for 

5 such enrollment; 

6 ‘‘(v) the Administrator shall make a 

7 determination on such an application not 

8 later than 60 days after the date of filing 

9 the application; and 

10 ‘‘(vi) an individual who is denied en11 rollment in such Program shall have an op12 portunity to appeal such determination in 

13 a manner established under such process. 

14 ‘‘(B) TIMING.— 

15 ‘‘(i) CURRENTLY IDENTIFIED RE16 SPONDERS.—In accordance with subpara17 graph (A)(i), the WTC Program Adminis18 trator shall enroll an individual described 

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

20 not later than July 1, 2011. 

21 ‘‘(ii) OTHER RESPONDERS.—In ac22 cordance with subparagraph (A)(ii) and 

23 consistent with paragraph (4), the WTC 

24 Program Administrator shall enroll any 

25 other individual who is determined to be a 


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1 WTC responder in the WTC Program at the 

2 time of such determination. 

3 ‘‘(4) NUMERICAL LIMITATION ON ELIGIBLE WTC

4 RESPONDERS.— 

5 ‘‘(A) IN GENERAL.—The total number of in6 dividuals not described in paragraph (1)(A) or 

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

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

9 which no more than 2,500 may be individuals 

10 enrolled based on modified eligibility criteria es11 tablished under paragraph (1)(C). 

12 ‘‘(B) PROCESS.—In implementing subpara13 graph (A), the WTC Program Administrator 

14 shall— 

15 ‘‘(i) limit the number of enrollments 

16 made under paragraph (3)— 

17 ‘‘(I) in accordance with such sub18 paragraph; and 

19 ‘‘(II) to such number, as deter20 mined by the Administrator based on 

21 the best available information and sub22 ject to amounts available under section 

23 3351, that will ensure sufficient funds 

24 will be available to provide treatment 

25 and monitoring benefits under this 


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1 title, with respect to all individuals 

2 who are enrolled through the end of fis3 cal year 2020; and 

4 ‘‘(ii) provide priority (subject to para5 graph (3)(A)(i)) in such enrollments in the 

6 order in which individuals apply for enroll7 ment under paragraph (3). 

8 ‘‘(5) DISQUALIFICATION OF INDIVIDUALS ON

9 TERRORIST WATCH LIST.—No individual who is on 

10 the terrorist watch list maintained by the Department 

11 of Homeland Security shall qualify as an eligible 

12 WTC responder. Before enrolling any individual as a 

13 WTC responder in the WTC Program under para14 graph (3), the Administrator, in consultation with the 

15 Secretary of Homeland Security, shall determine 

16 whether the individual is on such list. 

17 ‘‘(b) MONITORING BENEFITS.— 

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

19 WTC responder (other than one described in sub20 section (a)(2)(A)(ii)), the WTC Program shall provide 

21 for monitoring benefits that include monitoring con22 sistent with protocols approved by the WTC Program 

23 Administrator and including clinical examinations 

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

25 case of an enrolled WTC responder who is an active 


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

2 responder shall receive such benefits as part of the in3 dividual’s periodic company medical exams. 

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

5 monitoring benefits under paragraph (1) shall be pro6 vided through the Clinical Center of Excellence for the 

7 type of individual involved or, in the case of an indi8 vidual residing outside the New York metropolitan 

9 area, under an arrangement under section 3313. 

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

11 FOR WTC-RELATED HEALTH CONDITIONS. 

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

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

14 term ‘WTC-related health condition’ means a condi15 tion that— 

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

17 which exposure to airborne toxins, any other 

18 hazard, or any other adverse condition resulting 

19 from the September 11, 2001, terrorist attacks, 

20 based on an examination by a medical profes21 sional with experience in treating or diagnosing 

22 the health conditions included in the applicable 

23 list of WTC-related health conditions, is substan24 tially likely to be a significant factor in aggra25 vating, contributing to, or causing the illness or 


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1 health condition, as determined under paragraph 

2 (2); or 

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

4 such attacks, based on an examination by a med5 ical professional with experience in treating or 

6 diagnosing the health conditions included in the 

7 applicable list of WTC-related health conditions, 

8 is substantially likely to be a significant factor 

9 in aggravating, contributing to, or causing the 

10 condition, as determined under paragraph (2); 

11 and 

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

13 WTC-related health conditions or— 

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

15 is provided certification of coverage under 

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

17 ‘‘(ii) with respect to a screening-eligi18 ble WTC survivor or certified-eligible WTC 

19 survivor, is provided certification of cov20 erage under subsection (b)(2)(B)(iii), as ap21 plied under section 3322(a). 

22 In the case of a WTC responder described in section 

23 3311(a)(2)(A)(ii) (relating to a surviving immediate 

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


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1 include an illness or health condition described in 

2 subparagraph (A)(i). 

3 ‘‘(2) DETERMINATION.—The determination 

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

5 September 11, 2001, terrorist attacks were substan6 tially likely to be a significant factor in aggravating, 

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

8 health condition shall be made based on an assess9 ment of the following: 

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

11 toxins, any other hazard, or any other adverse 

12 condition resulting from the terrorist attacks. 

13 Such exposure shall be— 

14 ‘‘(i) evaluated and characterized 

15 through the use of a standardized, popu16 lation-appropriate questionnaire approved 

17 by the Director of the National Institute for 

18 Occupational Safety and Health; and 

19 ‘‘(ii) assessed and documented by a 

20 medical professional with experience in 

21 treating or diagnosing health conditions in22 cluded on the list of WTC-related health 

23 conditions. 

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

25 sequence of symptoms. Such symptoms shall be— 


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

2 standardized, population-appropriate med3 ical questionnaire approved by the Director 

4 of the National Institute for Occupational 

5 Safety and Health and a medical examina6 tion; and 

7 ‘‘(ii) diagnosed and documented by a 

8 medical professional described in subpara9 graph (A)(ii). 

10 ‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC RE11 SPONDERS.—The list of health conditions for WTC re12 sponders consists of the following: 

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 obstruc21 tive 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) Gastroesophageal reflux disorder 

3 (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) Posttraumatic 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 ‘‘(C) MUSCULOSKELETAL DISORDERS FOR

22 CERTAIN WTC RESPONDERS.—In the case of a 

23 WTC responder described in paragraph (4), a 

24 condition described in such paragraph. 


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1 ‘‘(D) ADDITIONAL CONDITIONS.—Any can2 cer (or type of cancer) or other condition added, 

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

4 under this paragraph. 

5 ‘‘(4) MUSCULOSKELETAL DISORDERS.— 

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

7 title, in the case of a WTC responder who re8 ceived any treatment for a WTC-related mus9 culoskeletal disorder on or before September 11, 

10 2003, the list of health conditions in paragraph 

11 (3) shall include: 

12 ‘‘(i) Low back pain. 

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

14 ‘‘(iii) Other musculoskeletal disorders. 

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

16 musculoskeletal disorder’ means a chronic or re17 current disorder of the musculoskeletal system 

18 caused by heavy lifting or repetitive strain on 

19 the joints or musculoskeletal system occurring 

20 during rescue or recovery efforts in the New York 

21 City disaster area in the aftermath of the Sep22 tember 11, 2001, terrorist attacks. 

23 ‘‘(5) CANCER.— 

24 ‘‘(A) IN GENERAL.—The WTC Program Ad25 ministrator shall periodically conduct a review 


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1 of all available scientific and medical evidence, 

2 including findings and recommendations of 

3 Clinical Centers of Excellence, published in peer4 reviewed journals to determine if, based on such 

5 evidence, cancer or a certain type of cancer 

6 should be added to the applicable list of WTC-re7 lated health conditions. The WTC Program Ad8 ministrator shall conduct the first review under 

9 this subparagraph not later than 180 days after 

10 the date of the enactment of this title. 

11 ‘‘(B) PROPOSED REGULATIONS AND RULE12 MAKING.—Based on the periodic reviews under 

13 subparagraph (A), if the WTC Program Admin14 istrator determines that cancer or a certain type 

15 of cancer should be added to such list of WTC16 related health conditions, the WTC Program Ad17 ministrator shall propose regulations, through 

18 rulemaking, to add cancer or the certain type of 

19 cancer to such list. 

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

21 the available evidence in the rulemaking record, 

22 the WTC Program Administrator shall make a 

23 final determination of whether cancer or a cer24 tain type of cancer should be added to such list 

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1 termination is made to make such an addition, 

2 the WTC Program Administrator shall by regu3 lation add cancer or the certain type of cancer 

4 to such list. 

5 ‘‘(D) DETERMINATIONS NOT TO ADD CAN6 CER OR CERTAIN TYPES OF CANCER.—In the case 

7 that the WTC Program Administrator deter8 mines under subparagraph (B) or (C) that can9 cer or a certain type of cancer should not be 

10 added to such list of WTC-related health condi11 tions, the WTC Program Administrator shall 

12 publish an explanation for such determination 

13 in the Federal Register. Any such determination 

14 to not make such an addition shall not preclude 

15 the addition of cancer or the certain type of can16 cer to such list at a later date. 

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

18 FOR WTC RESPONDERS.— 

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

20 Program Administrator determines that a pro21 posed rule should be promulgated to add a health 

22 condition to the list of health conditions in para23 graph (3), the Administrator may request a rec24 ommendation of the Advisory Committee or may 


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1 publish such a proposed rule in the Federal Reg2 ister in accordance with subparagraph (D). 

3 ‘‘(B) ADMINISTRATOR’S OPTIONS AFTER RE4 CEIPT OF PETITION.—In the case that the WTC 

5 Program Administrator receives a written peti6 tion by an interested party to add a health con7 dition to the list of health conditions in para8 graph (3), not later than 60 days after the date 

9 of receipt of such petition the Administrator 

10 shall— 

11 ‘‘(i) request a recommendation of the 

12 Advisory Committee; 

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

14 Federal Register to add such health condi15 tion, in accordance with subparagraph (D); 

16 ‘‘(iii) publish in the Federal Register 

17 the Administrator’s determination not to 

18 publish such a proposed rule and the basis 

19 for such determination; or 

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

21 determination that insufficient evidence ex22 ists to take action under clauses (i) through 

23 (iii). 

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

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1 ommendation of the Advisory Committee under 

2 this paragraph, with respect to adding a health 

3 condition to the list in paragraph (3), the Advi4 sory Committee shall submit to the Adminis5 trator such recommendation not later than 60 

6 days after the date of such request or by such 

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

8 request) as specified by the Administrator. Not 

9 later than 60 days after the date of receipt of 

10 such recommendation, the Administrator shall, 

11 in accordance with subparagraph (D), publish in 

12 the Federal Register a proposed rule with respect 

13 to such recommendation or a determination not 

14 to propose such a proposed rule and the basis for 

15 such determination. 

16 ‘‘(D) PUBLICATION.—The WTC Program 

17 Administrator shall, with respect to any pro18 posed rule under this paragraph— 

19 ‘‘(i) publish such proposed rule in ac20 cordance with section 553 of title 5, United 

21 States Code; and 

22 ‘‘(ii) provide interested parties a pe23 riod of 30 days after such publication to 

24 submit written comments on the proposed 

25 rule. 


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1 The WTC Program Administrator may extend 

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

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

4 the Administrator shall publish such extension in 

5 the Federal Register. 

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

7 purposes of this paragraph, the term ‘interested 

8 party’ includes a representative of any organiza9 tion representing WTC responders, a nationally 

10 recognized medical association, a Clinical or 

11 Data Center, a State or political subdivision, or 

12 any other interested person. 

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

14 HEALTH CONDITIONS.— 

15 ‘‘(1) DETERMINATION FOR ENROLLED WTC RE16 SPONDERS BASED ON A WTC-RELATED HEALTH CON17 DITION.— 

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

19 Clinical Center of Excellence that is providing 

20 monitoring benefits under section 3311 for an 

21 enrolled WTC responder makes a determination 

22 that the responder has a WTC-related health con23 dition that is in the list in subsection (a)(3) and 

24 that exposure to airborne toxins, other hazards, 

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1 tember 1, 2001, terrorist attacks is substantially 

2 likely to be a significant factor in aggravating, 

3 contributing to, or causing the condition— 

4 ‘‘(i) the physician shall promptly 

5 transmit such determination to the WTC 

6 Program Administrator and provide the 

7 Administrator with the medical facts sup8 porting such determination; and 

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

10 transmittal and subject to subparagraph 

11 (B), the WTC Program shall provide for 

12 payment under subsection (c) for medically 

13 necessary treatment for such condition. 

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

15 ‘‘(i) REVIEW.—A Federal employee 

16 designated by the WTC Program Adminis17 trator shall review determinations made 

18 under subparagraph (A). 

19 ‘‘(ii) CERTIFICATION.—The Adminis20 trator shall provide a certification of such 

21 condition based upon reviews conducted 

22 under clause (i). Such a certification shall 

23 be provided unless the Administrator deter24 mines that the responder’s condition is not 

25 a WTC-related health condition in the list 


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1 in subsection (a)(3) or that exposure to air2 borne toxins, other hazards, or adverse con3 ditions resulting from the September 1, 

4 2001, terrorist attacks is not substantially 

5 likely to be a significant factor in aggra6 vating, contributing to, or causing the con7 dition. 

8 ‘‘(iii) APPEAL PROCESS.—The Admin9 istrator shall establish, by rule, a process for 

10 the appeal of determinations under clause 

11 (ii). 

12 ‘‘(2) DETERMINATION BASED ON MEDICALLY AS13 SOCIATED WTC-RELATED HEALTH CONDITIONS.— 

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

15 Clinical Center of Excellence determines pursu16 ant to subsection (a) that the enrolled WTC re17 sponder has a health condition described in sub18 section (a)(1)(A) that is not in the list in sub19 section (a)(3) but which is medically associated 

20 with a WTC-related health condition— 

21 ‘‘(i) the physician shall promptly 

22 transmit such determination to the WTC 

23 Program Administrator and provide the 

24 Administrator with the facts supporting 

25 such determination; and 


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1 ‘‘(ii) the Administrator shall make a 

2 determination under subparagraph (B) 

3 with respect to such physician’s determina4 tion. 

5 ‘‘(B) PROCEDURES FOR REVIEW, CERTIFI6 CATION, AND APPEAL.—The WTC Program Ad7 ministrator shall, by rule, establish procedures 

8 for the review and certification of physician de9 terminations under subparagraph (A). Such rule 

10 shall provide for— 

11 ‘‘(i) the timely review of such a deter12 mination by a physician panel with appro13 priate expertise for the condition and rec14 ommendations to the WTC Program Ad15 ministrator; 

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

17 date of the transmittal under subparagraph 

18 (A)(i), a determination by the WTC Pro19 gram Administrator on whether or not the 

20 condition involved is described in subsection 

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

22 a WTC-related health condition; 

23 ‘‘(iii) certification in accordance with 

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

25 condition if determined to be described in 


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1 subsection (a)(1)(A) and medically associ2 ated with a WTC-related health condition; 

3 and 

4 ‘‘(iv) a process for appeals of deter5 minations relating to such conditions. 

6 ‘‘(C) INCLUSION IN LIST OF HEALTH CONDI7 TIONS.—If the WTC Program Administrator 

8 provides certification under subparagraph 

9 (B)(iii) for coverage of a condition, the Adminis10 trator may, pursuant to subsection (a)(6), add 

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

12 ‘‘(D) CONDITIONS ALREADY DECLINED FOR

13 INCLUSION IN LIST.—If the WTC Program Ad14 ministrator publishes a determination under 

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

16 in the list in subsection (a)(3), the WTC Pro17 gram Administrator shall not provide certifi18 cation under subparagraph (B)(iii) for coverage 

19 of the condition. In the case of an individual 

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

21 with respect to such condition before the date of 

22 the publication of such determination the pre23 vious sentence shall not apply. 

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


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

2 for a WTC-related health condition, a physician 

3 or other provider shall provide treatment that is 

4 medically necessary and in accordance with 

5 medical treatment protocols established under 

6 subsection (d). 

7 ‘‘(B) REGULATIONS RELATING TO MEDICAL

8 NECESSITY.—For the purpose of this title, the 

9 WTC Program Administrator shall issue regula10 tions specifying a standard for determining med11 ical necessity with respect to health care services 

12 and prescription pharmaceuticals, a process for 

13 determining whether treatment furnished and 

14 pharmaceuticals prescribed under this title meet 

15 such standard (including any prior authoriza16 tion requirement), and a process for appeal of a 

17 determination under subsection (c)(3). 

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

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

20 covered under this subsection includes services of 

21 physicians and other health care providers, diag22 nostic and laboratory tests, prescription drugs, 

23 inpatient and outpatient hospital services, and 

24 other medically necessary treatment. 


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1 ‘‘(B) PHARMACEUTICAL COVERAGE.—With 

2 respect to ensuring coverage of medically nec3 essary outpatient prescription drugs, such drugs 

4 shall be provided, under arrangements made by 

5 the WTC Program Administrator, directly 

6 through participating Clinical Centers of Excel7 lence or through one or more outside vendors. 

8 ‘‘(C) TRANSPORTATION EXPENSES FOR NA9 TIONWIDE NETWORK.—The WTC Program Ad10 ministrator may provide for necessary and rea11 sonable transportation and expenses incident to 

12 the securing of medically necessary treatment 

13 through the nationwide network under section 

14 3313 involving travel of more than 250 miles 

15 and for which payment is made under this sec16 tion in the same manner in which individuals 

17 may be furnished necessary and reasonable 

18 transportation and expenses incident to services 

19 involving travel of more than 250 miles under 

20 regulations implementing section 3629(c) of the 

21 Energy Employees Occupational Illness Com22 pensation Program Act of 2000 (title XXXVI of 

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

24 ‘‘(5) PROVISION OF TREATMENT PENDING CER25 TIFICATION.—With respect to an enrolled WTC reVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00060 Fmt 6652 Sfmt 6203 E:\BILLS\H847.RH H847

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1 sponder for whom a determination is made by an ex2 amining physician under paragraph (1) or (2), but 

3 for whom the WTC Program Administrator has not 

4 yet determined whether to certify the determination, 

5 the WTC Program Administrator may establish by 

6 rule a process through which the Administrator may 

7 approve the provision of medical treatment under this 

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

9 respect to such responder and such responder’s WTC10 related health condition (under such terms and condi11 tions as the Administrator may provide) until the 

12 Administrator makes a decision on whether to certify 

13 the determination. 

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

15 MONITORING, AND TREATMENT OF WTC-RELATED HEALTH

16 CONDITIONS.— 

17 ‘‘(1) MEDICAL TREATMENT.— 

18 ‘‘(A) USE OF FECA PAYMENT RATES.—Sub19 ject to subparagraphs (B) and (C), the WTC 

20 Program Administrator shall reimburse costs for 

21 medically necessary treatment under this title for 

22 WTC-related health conditions according to the 

23 payment rates that would apply to the provision 

24 of such treatment and services by the facility 

25 under the Federal Employees Compensation Act. 


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1 For treatment not covered under the previous 

2 sentence or subparagraph (B), the WTC Program 

3 Administrator shall establish by regulation a re4 imbursement rate for such treatment. 

5 ‘‘(B) PHARMACEUTICALS.— 

6 ‘‘(i) IN GENERAL.—The WTC Program 

7 Administrator shall establish a program for 

8 paying for the medically necessary out9 patient prescription pharmaceuticals pre10 scribed under this title for WTC-related 

11 health conditions through one or more con12 tracts with outside vendors. 

13 ‘‘(ii) COMPETITIVE BIDDING.—Under 

14 such program the Administrator shall— 

15 ‘‘(I) select one or more appro16 priate vendors through a Federal com17 petitive bid process; and 

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

19 bidders) meeting the requirements for 

20 providing pharmaceutical benefits for 

21 participants in the WTC Program. 

22 ‘‘(iii) TREATMENT OF FDNY PARTICI23 PANTS.—Under such program the Adminis24 trator may enter into an agreement with a 

25 separate vendor to provide pharmaceutical 


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1 benefits to enrolled WTC responders for 

2 whom the Clinical Center of Excellence is 

3 described in section 3305 if such an ar4 rangement is deemed necessary and bene5 ficial to the program by the WTC Program 

6 Administrator. 

7 ‘‘(C) IMPROVING QUALITY AND EFFICIENCY

8 THROUGH MODIFICATION OF PAYMENT AMOUNTS

9 AND METHODOLOGIES.—The WTC Program Ad10 ministrator may modify the amounts and meth11 odologies for making payments for initial health 

12 evaluations, monitoring, or treatment, if, taking 

13 into account utilization and quality data fur14 nished by the Clinical Centers of Excellence 

15 under section 3305(b)(1)(B)(iii), the Adminis16 trator determines that a bundling, capitation, 

17 pay for performance, or other payment method18 ology would better ensure high quality and effi19 cient delivery of initial health evaluations, moni20 toring, or treatment to an enrolled WTC re21 sponder, screening-eligible WTC survivor, or cer22 tified-eligible WTC survivor. 

23 ‘‘(2) MONITORING AND INITIAL HEALTH EVALUA24 TION.—The WTC Program Administrator shall reim25 burse the costs of monitoring and the costs of an iniVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00063 Fmt 6652 Sfmt 6203 E:\BILLS\H847.RH H847

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1 tial health evaluation provided under this title at a 

2 rate set by the Administrator by regulation. 

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

4 ‘‘(A) REVIEW OF MEDICAL NECESSITY AND

5 PROTOCOLS.—As part of the process for reim6 bursement or payment under this subsection, the 

7 WTC Program Administrator shall provide for 

8 the review of claims for reimbursement or pay9 ment for the provision of medical treatment to 

10 determine if such treatment is medically nec11 essary and in accordance with medical treatment 

12 protocols established under subsection (d). 

13 ‘‘(B) WITHHOLDING OF PAYMENT FOR

14 MEDICALLY UNNECESSARY TREATMENT.—The 

15 Administrator shall withhold such reimburse16 ment or payment for treatment that the Admin17 istrator determines is not medically necessary or 

18 is not in accordance with such medical treatment 

19 protocols. 

20 ‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

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

22 develop medical treatment protocols for the treatment 

23 of enrolled WTC responders and certified-eligible 

24 WTC survivors for health conditions included in the 

25 applicable list of WTC-related health conditions. 


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1 ‘‘(2) APPROVAL.—The medical treatment proto2 cols developed under paragraph (1) shall be subject to 

3 approval by the WTC Program Administrator. 

4 ‘‘SEC. 3313. 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 enrolled WTC responders, screening-eligible WTC survivors, 

9 or certified-eligible WTC survivors and who reside in any 

10 State, as defined in section 2(f), outside the New York met11 ropolitan area, the WTC Program Administrator shall es12 tablish a nationwide network of health care providers to 

13 provide monitoring and treatment benefits and initial 

14 health evaluations near such individuals’ areas of residence 

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

16 as preventing such individuals from being provided such 

17 monitoring and treatment benefits or initial health evalua18 tion through any 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 Data Centers; 


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1 ‘‘(2) follow the monitoring, initial health evalua2 tion, and treatment protocols developed under section 

3 3305(a)(2)(A)(ii); 

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

5 section 3304; and 

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

7 other requirements as the WTC Program Adminis8 trator establishes, including sections 1128 through 

9 1128E of the Social Security Act, as applied by sec10 tion 3301(d). 

11 ‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.—The 

12 WTC Program Administer may provide, including through 

13 contract, for the provision of training and technical assist14 ance to health care providers participating in the network 

15 under subsection (a). 

16 ‘‘PART 2—WTC SURVIVORS 

17 ‘‘SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUA18 TION OF SCREENING-ELIGIBLE AND CER19 TIFIED-ELIGIBLE WTC SURVIVORS. 

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

21 SURVIVORS AND CERTIFIED-ELIGIBLE WTC SURVIVORS.— 

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

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

24 ‘screening-eligible WTC survivor’ means, subject 

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1 dividual who is described in any of the following 

2 clauses: 

3 ‘‘(i) CURRENTLY IDENTIFIED SUR4 VIVOR.—An individual, including a WTC 

5 responder, who has been identified as eligi6 ble for medical treatment and monitoring 

7 by the WTC Environmental Health Center 

8 as of the date of enactment of this title. 

9 ‘‘(ii) SURVIVOR WHO MEETS CURRENT

10 ELIGIBILITY CRITERIA.—An individual who 

11 is not a WTC responder, for purposes of the 

12 initial health evaluation under subsection 

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

14 health condition and meets any of the cur15 rent eligibility criteria described in sub16 paragraph (B). 

17 ‘‘(iii) SURVIVOR WHO MEETS MODI18 FIED ELIGIBILITY CRITERIA.—An indi19 vidual who is not a WTC responder, for 

20 purposes of the initial health evaluation 

21 under subsection (b), claims symptoms of a 

22 WTC-related health condition and meets 

23 such eligibility criteria relating to exposure 

24 to airborne toxins, other hazards, or adverse 

25 conditions resulting from the September 11, 


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1 2001, terrorist attacks as the WTC Admin2 istrator determines, after consultation with 

3 the Data Centers described in section 3305 

4 and the WTC Scientific/Technical Advisory 

5 Committee and WTC Health Program 

6 Steering Committees under section 3302. 

7 The Administrator shall not modify such criteria 

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

9 number of certifications for certified-eligible 

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

11 reached 80 percent of the limit described in 

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

13 number of enrollments of WTC responders has 

14 reached 80 percent of the limit described in sec15 tion 3311(a)(4). 

16 ‘‘(B) CURRENT ELIGIBILITY CRITERIA.—The 

17 eligibility criteria described in this subpara18 graph for an individual are that the individual 

19 is described in any of the following clauses: 

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

21 New York City disaster area in the dust or 

22 dust cloud on September 11, 2001. 

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

24 attended school, childcare, or adult daycare 

25 in the New York City disaster area for— 


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

2 month period beginning on September 

3 11, 2001, and ending on January 10, 

4 2002; or 

5 ‘‘(II) at least 30 days during the 

6 period beginning on September 11, 

7 2001, and ending on July 31, 2002. 

8 ‘‘(iii) Any person who worked as a 

9 cleanup worker or performed maintenance 

10 work in the New York City disaster area 

11 during the 4-month period described in sub12 paragraph (B)(i) and had extensive expo13 sure to WTC dust as a result of such work. 

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

15 to receive a grant from the Lower Manhat16 tan Development Corporation Residential 

17 Grant Program, who possessed a lease for a 

18 residence or purchased a residence in the 

19 New York City disaster area, and who re20 sided in such residence during the period 

21 beginning on September 11, 2001, and end22 ing on May 31, 2003. 

23 ‘‘(v) A person whose place of employ24 ment— 


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1 ‘‘(I) at any time during the pe2 riod beginning on September 11, 2001, 

3 and ending on May 31, 2003, was in 

4 the New York City disaster area; and 

5 ‘‘(II) was deemed eligible to re6 ceive a grant from the Lower Manhat7 tan Development Corporation WTC 

8 Small Firms Attraction and Retention 

9 Act program or other government in10 centive program designed to revitalize 

11 the lower Manhattan economy after the 

12 September 11, 2001, terrorist attacks. 

13 ‘‘(C) APPLICATION AND DETERMINATION

14 PROCESS FOR SCREENING ELIGIBILITY.— 

15 ‘‘(i) IN GENERAL.—The WTC Program 

16 Administrator in consultation with the 

17 Data Centers shall establish a process for 

18 individuals, other than individuals de19 scribed in subparagraph (A)(i), to be deter20 mined to be screening-eligible WTC sur21 vivors. Under such process— 

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

23 to the applicant for making an appli24 cation for such determination; 


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1 ‘‘(II) the Administrator shall 

2 make a determination on such an ap3 plication not later than 60 days after 

4 the date of filing the application; 

5 ‘‘(III) the Administrator shall 

6 make such a determination relating to 

7 an applicant’s compliance with this 

8 title and shall not determine that an 

9 individual is not so eligible or deny 

10 written documentation under clause 

11 (ii) to such individual unless the Ad12 ministrator determines that— 

13 ‘‘(aa) based on the applica14 tion submitted, the individual 

15 does not meet the eligibility cri16 teria; or 

17 ‘‘(bb) the numerical limita18 tion on certifications of certified19 eligible WTC survivors set forth in 

20 paragraph (3) has been met; and 

21 ‘‘(IV) an individual who is deter22 mined not to be a screening-eligible 

23 WTC survivor shall have an oppor24 tunity to appeal such determination in 


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1 a manner established under such proc2 ess. 

3 ‘‘(ii) WRITTEN DOCUMENTATION OF

4 SCREENING-ELIGIBILITY.— 

5 ‘‘(I) IN GENERAL.—In the case of 

6 an individual who is described in sub7 paragraph (A)(i) or who is determined 

8 under clause (i) (consistent with para9 graph (3)) to be a screening-eligible 

10 WTC survivor, the WTC Program Ad11 ministrator shall provide an appro12 priate written documentation of such 

13 fact. 

14 ‘‘(II) TIMING.— 

15 ‘‘(aa) CURRENTLY IDENTI16 FIED SURVIVORS.—In the case of 

17 an individual who is described in 

18 subparagraph (A)(i), the WTC 

19 Program Administrator shall pro20 vide the written documentation 

21 under subclause (I) not later than 

22 July 1, 2011. 

23 ‘‘(bb) OTHER MEMBERS.—In 

24 the case of another individual who 

25 is determined under clause (i) 


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1 and consistent with paragraph (3) 

2 to be a screening-eligible WTC 

3 survivor, the WTC Program Ad4 ministrator shall provide the 

5 written documentation under sub6 clause (I) at the time of such de7 termination. 

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

9 ‘‘(A) DEFINITION.—The term ‘certified-eligi10 ble WTC survivor’ means, subject to paragraph 

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

12 WTC Program Administrator certifies under 

13 subparagraph (B) to be eligible for followup 

14 monitoring and treatment under this part. 

15 ‘‘(B) CERTIFICATION OF ELIGIBILITY FOR

16 MONITORING AND TREATMENT.— 

17 ‘‘(i) IN GENERAL.—The WTC Program 

18 Administrator shall establish a certification 

19 process under which the Administrator shall 

20 provide appropriate certification to screen21 ing-eligible WTC survivors who, pursuant 

22 to the initial health evaluation under sub23 section (b), are determined to be eligible for 

24 followup monitoring and treatment under 

25 this part. 


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1 ‘‘(ii) TIMING.— 

2 ‘‘(I) CURRENTLY IDENTIFIED SUR3 VIVORS.—In the case of an individual 

4 who is described in paragraph 

5 (1)(A)(i), the WTC Program Adminis6 trator shall provide the certification 

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

8 2011. 

9 ‘‘(II) OTHER MEMBERS.—In the 

10 case of another individual who is de11 termined under clause (i) to be eligible 

12 for followup monitoring and treatment, 

13 the WTC Program Administrator shall 

14 provide the certification under such 

15 clause at the time of such determina16 tion. 

17 ‘‘(3) NUMERICAL LIMITATION ON CERTIFIED-ELI18 GIBLE WTC SURVIVORS.— 

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

21 who may be certified as certified-eligible WTC 

22 survivors under paragraph (2)(B) shall not ex23 ceed 25,000 at any time. 


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1 ‘‘(B) PROCESS.—In implementing subpara2 graph (A), the WTC Program Administrator 

3 shall— 

4 ‘‘(i) limit the number of certifications 

5 provided under paragraph (2)(B)— 

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

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

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

12 section 3351, that will ensure sufficient 

13 funds will be available to provide 

14 treatment and monitoring benefits 

15 under this title, with respect to all in16 dividuals receiving such certifications 

17 through the end of fiscal year 2020; 

18 and 

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

21 apply for a determination under paragraph 

22 (2)(B). 

23 ‘‘(4) DISQUALIFICATION OF INDIVIDUALS ON

24 TERRORIST WATCH LIST.—No individual who is on 

25 the terrorist watch list maintained by the Department 


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1 of Homeland Security shall qualify as a screening-eli2 gible WTC survivor or a certified-eligible WTC sur3 vivor. Before determining any individual to be a 

4 screening-eligible WTC survivor under paragraph (1) 

5 or certifying any individual as a certified eligible 

6 WTC survivor under paragraph (2), the Adminis7 trator, in consultation with the Secretary of Home8 land Security, shall determine whether the individual 

9 is on such list. 

10 ‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE

11 ELIGIBILITY FOR FOLLOWUP MONITORING OR TREAT12 MENT.— 

13 ‘‘(1) IN GENERAL.—In the case of a screening-el14 igible WTC survivor, the WTC Program shall provide 

15 for an initial health evaluation to determine if the 

16 survivor has a WTC-related health condition and is 

17 eligible for followup monitoring and treatment bene18 fits under the WTC Program. Initial health evalua19 tion protocols under section 3305(a)(2)(A)(ii) shall be 

20 subject to approval by the WTC Program Adminis21 trator. 

22 ‘‘(2) INITIAL HEALTH EVALUATION PRO23 VIDERS.—The initial health evaluation described in 

24 paragraph (1) shall be provided through a Clinical 


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1 Center of Excellence with respect to the individual in2 volved. 

3 ‘‘(3) LIMITATION ON INITIAL HEALTH EVALUA4 TION BENEFITS.—Benefits for an initial health eval5 uation under this part for a screening-eligible WTC 

6 survivor shall consist only of a single medical initial 

7 health evaluation consistent with initial health eval8 uation protocols described in paragraph (1). Nothing 

9 in this paragraph shall be construed as preventing 

10 such an individual from seeking additional medical 

11 initial health evaluations at the expense of the indi12 vidual. 

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

14 CERTIFIED-ELIGIBLE WTC SURVIVORS FOR 

15 WTC-RELATED HEALTH CONDITIONS. 

16 ‘‘(a) IN GENERAL.—Subject to subsection (b), the pro17 visions of sections 3311 and 3312 shall apply to followup 

18 monitoring and treatment of WTC-related health conditions 

19 for certified-eligible WTC survivors in the same manner as 

20 such provisions apply to the monitoring and treatment of 

21 WTC-related health conditions for enrolled WTC responders. 

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

23 FOR SURVIVORS.—The list of health conditions for screen24 ing-eligible WTC survivors and certified-eligible WTC sur25 vivors consists of the following: 


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1 ‘‘(1) AERODIGESTIVE DISORDERS.— 

2 ‘‘(A) Interstitial lung diseases. 

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

4 vapors. 

5 ‘‘(C) Asthma. 

6 ‘‘(D) Reactive airways dysfunction syn7 drome (RADS). 

8 ‘‘(E) WTC-exacerbated chronic obstructive 

9 pulmonary disease (COPD). 

10 ‘‘(F) Chronic cough syndrome. 

11 ‘‘(G) Upper airway hyperreactivity. 

12 ‘‘(H) Chronic rhinosinusitis. 

13 ‘‘(I) Chronic nasopharyngitis. 

14 ‘‘(J) Chronic laryngitis. 

15 ‘‘(K) Gastroesophageal reflux disorder 

16 (GERD). 

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

18 to a condition described in a previous clause. 

19 ‘‘(2) MENTAL HEALTH CONDITIONS.— 

20 ‘‘(A) Posttraumatic stress disorder (PTSD). 

21 ‘‘(B) Major depressive disorder. 

22 ‘‘(C) Panic disorder. 

23 ‘‘(D) Generalized anxiety disorder. 

24 ‘‘(E) Anxiety disorder (not otherwise speci25 fied). 


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

2 ‘‘(G) Acute stress disorder. 

3 ‘‘(H) Dysthymic disorder. 

4 ‘‘(I) Adjustment disorder. 

5 ‘‘(J) Substance abuse. 

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

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

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

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

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

11 WTC survivors. 

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

13 OTHER INDIVIDUALS WITH WTC-RELATED 

14 HEALTH CONDITIONS. 

15 ‘‘(a) IN GENERAL.—Subject to subsection (c), the pro16 visions of section 3322 shall apply to the followup moni17 toring and treatment of WTC-related health conditions in 

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

19 same manner as such provisions apply to the followup mon20 itoring and treatment of WTC-related health conditions for 

21 certified-eligible WTC survivors. 

22 ‘‘(b) INDIVIDUALS DESCRIBED.—An individual de23 scribed in this subsection is an individual who, regardless 

24 of location of residence— 


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1 ‘‘(1) is not an enrolled WTC responder or a cer2 tified-eligible WTC survivor; and 

3 ‘‘(2) is diagnosed at a Clinical Center of Excel4 lence with a WTC-related health condition for cer5 tified-eligible WTC survivors. 

6 ‘‘(c) LIMITATION.— 

7 ‘‘(1) IN GENERAL.—The WTC Program Adminis8 trator shall limit benefits for any fiscal year under 

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

10 this section for such fiscal year do not exceed the 

11 amount specified in paragraph (2) for such fiscal 

12 year. 

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

14 paragraph for— 

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

16 2011 is $5,000,000; 

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

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

19 specified in this paragraph for the previous fis20 cal year increased by the annual percentage in21 crease in the medical care component of the con22 sumer price index for all urban consumers. 


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1 ‘‘PART 3—PAYOR PROVISIONS 

2 ‘‘SEC. 3331. PAYMENT OF CLAIMS. 

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

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

5 and initial health evaluation benefits provided under parts 

6 1 and 2 of this subtitle shall be paid for by the WTC Pro7 gram from the World Trade Center Health Program Fund. 

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

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

10 payment for treatment under parts 1 and 2 of this 

11 subtitle of a WTC-related health condition of an indi12 vidual that is work-related shall be reduced or re13 couped to the extent that the WTC Program Adminis14 trator determines that payment has been made, or 

15 can reasonably be expected to be made, under a work16 ers’ compensation law or plan of the United States, 

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

18 illness benefit plan of the employer of such individual, 

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

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

21 1862(b) of the Social Security Act and paragraphs 

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

23 recoupment under this subsection of a payment to the 

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1 vidual) in the same manner as such provisions apply 

2 to the reimbursement of a payment under section 

3 1862(b)(2) of such Act to the Secretary (with respect 

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

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

6 reference in such paragraph (4) to payment rates 

7 under title XVIII of the Social Security Act shall be 

8 deemed a reference to payment rates under this title. 

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

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

11 compensation law or plan, including line of duty 

12 compensation, to which New York City is obligated to 

13 make payments, if, in accordance with terms specified 

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

15 York City has made the full payment required under 

16 such contract for such quarter. 

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

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

19 any obligations under a worker’s compensation law or 

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

21 of an employer, or any health insurance plan. 

22 ‘‘(c) HEALTH INSURANCE COVERAGE.— 

23 ‘‘(1) IN GENERAL.—In the case of an individual 

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

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1 tion through any public or private health plan (in2 cluding health benefits under title XVIII, XIX, or XXI 

3 of the Social Security Act) the provisions of section 

4 1862(b) of the Social Security Act shall apply to such 

5 a health plan and such individual in the same man6 ner as they apply to group health plan and an indi7 vidual entitled to benefits under title XVIII of such 

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

9 for items and services covered under such plan that 

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

11 application of deductibles, copayments, coinsurance, 

12 other cost sharing, or otherwise, are reimbursable 

13 under this title to the extent that they are covered 

14 under the WTC Program. The program under this 

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

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

17 Security Act. 

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

19 Nothing in paragraph (1) shall be construed as re20 quiring an entity providing monitoring and treat21 ment under this title to seek reimbursement under a 

22 health plan with which the entity has no contract for 

23 reimbursement. 

24 ‘‘(3) MAINTENANCE OF REQUIRED MINIMUM ES25 SENTIAL COVERAGE.—No payment may be made for 


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1 monitoring and treatment under this title for an in2 dividual for a month (beginning with July 2014) if 

3 with respect to such month the individual— 

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

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

6 Revenue Code of 1986) for whom the exemption 

7 under subsection (e) of such section does not 

8 apply; and 

9 ‘‘(B) is not covered under minimum essen10 tial coverage, as required under subsection (a) of 

11 such section. 

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

13 PROGRAM COSTS.— 

14 ‘‘(1) CONTRACT REQUIREMENT.— 

15 ‘‘(A) IN GENERAL.—No funds may be dis16 bursed from the World Trade Center Health Pro17 gram Fund under section 3351 unless New York 

18 City has entered into a contract with the WTC 

19 Program Administrator under which New York 

20 City agrees, in a form and manner specified by 

21 the Administrator, to pay the full contribution 

22 described in subparagraph (B) in accordance 

23 with this subsection on a timely basis, plus any 

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

25 Such contract shall specify the terms under 


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1 which New York City shall be considered to have 

2 made the full payment required for a quarter for 

3 purposes of subsection (b)(2). 

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

5 such contract, with respect to the last calendar 

6 quarter of fiscal year 2011 and each calendar 

7 quarter in fiscal years 2012 through 2020 the 

8 full contribution amount under this subpara9 graph shall be equal to 10 percent of the expendi10 tures in carrying out this title for the respective 

11 quarter. 

12 ‘‘(C) SATISFACTION OF PAYMENT OBLIGA13 TION.—The payment obligation under such con14 tract may not be satisfied through any of the fol15 lowing: 

16 ‘‘(i) An amount derived from Federal 

17 sources. 

18 ‘‘(ii) An amount paid before the date 

19 of the enactment of this title. 

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

21 judgment or as part of a settlement related 

22 to injuries or illnesses arising out of the 

23 September 11, 2001, terrorist attacks. 

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1 endar quarter in a fiscal year shall be paid not 

2 later than the last day of the second succeeding 

3 calendar quarter. 

4 ‘‘(E) COMPLIANCE.— 

5 ‘‘(i) INTEREST FOR LATE PAYMENT.— 

6 If New York City fails to pay to the WTC 

7 Program Administrator pursuant to such 

8 contract the amount required for any cal9 endar quarter by the day specified in sub10 paragraph (D), interest shall accrue on the 

11 amount not so paid at the rate (determined 

12 by the Administrator) based on the average 

13 yield to maturity, plus 1 percentage point, 

14 on outstanding municipal bonds issued by 

15 New York City with a remaining maturity 

16 of at least 1 year. 

17 ‘‘(ii) RECOVERY OF AMOUNTS OWED.— 

18 The amounts owed to the WTC Program 

19 Administrator under such contract shall be 

20 recoverable by the United States in an ac21 tion in the same manner as payments made 

22 under title XVIII of the Social Security Act 

23 may be recoverable in an action brought 

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


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1 ‘‘(F) DEPOSIT IN FUND.—The WTC Pro2 gram Administer shall deposit amounts paid 

3 under such contract into the World Trade Center 

4 Health Program Fund under section 3351. 

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

6 MONITORING AND TREATMENT COSTS.—With respect 

7 to each calendar quarter for which a contribution is 

8 required by New York City under the contract under 

9 paragraph (1), the WTC Program Administrator 

10 shall— 

11 ‘‘(A) provide New York City with an esti12 mate of such amount of the required contribution 

13 at the beginning of such quarter and with an up14 dated estimate of such amount at the beginning 

15 of each of the subsequent 2 quarters; 

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

17 City; and 

18 ‘‘(C) certify periodically, for purposes of 

19 this subsection, whether or not New York City 

20 has paid the amount so billed. 

21 Such amount shall initially be estimated by the WTC 

22 Program Administrator and shall be subject to adjust23 ment and reconciliation based upon actual expendi24 tures in carrying out this title. 


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

2 subsection shall be construed as authorizing the WTC 

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

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

5 3321(a)(3) for such fiscal year if New York City fails 

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

7 in such fiscal year. 

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

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

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

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

12 WTC responder, or in an individual who qualifies as 

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

14 a rescue, recovery, or cleanup worker; or 

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

16 has filed and had established a claim under a work17 ers’ compensation law or plan of the United States or 

18 a State, or other work-related injury or illness benefit 

19 plan of the employer of such individual. 

20 ‘‘SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY. 

21 ‘‘The WTC Program Administrator may enter into ar22 rangements with other government agencies, insurance com23 panies, or other third-party administrators to provide for 

24 timely and accurate processing of claims under sections 

25 3312, 3313, 3322, and 3323. 


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1 ‘‘Subtitle C—Research Into 

2 Conditions 

3 ‘‘SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CON4 DITIONS RELATED TO SEPTEMBER 11 TER5 RORIST ATTACKS. 

6 ‘‘(a) IN GENERAL.—With respect to individuals, in7 cluding enrolled WTC responders and certified-eligible WTC 

8 survivors, receiving monitoring or treatment under subtitle 

9 B, the WTC Program Administrator shall conduct or sup10 port— 

11 ‘‘(1) research on physical and mental health con12 ditions that may be related to the September 11, 

13 2001, terrorist attacks; 

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

15 conditions of such individuals, in the case of condi16 tions for which there has been diagnostic uncertainty; 

17 and 

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

19 conditions of such individuals, in the case of condi20 tions for which there has been treatment uncertainty. 

21 The Administrator may provide such support through con22 tinuation and expansion of research that was initiated be23 fore the date of the enactment of this title and through the 

24 World Trade Center Health Registry (referred to in section 


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1 3342), through a Clinical Center of Excellence, or through 

2 a Data Center. 

3 ‘‘(b) TYPES OF RESEARCH.—The research under sub4 section (a)(1) shall include epidemiologic and other research 

5 studies on WTC-related health conditions or emerging con6 ditions— 

7 ‘‘(1) among enrolled WTC responders and cer8 tified-eligible WTC survivors under treatment; and 

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

10 York City disaster area in Manhattan as far north as 

11 14th Street and in Brooklyn, along with control pop12 ulations, to identify potential for long-term adverse 

13 health effects in less exposed populations. 

14 ‘‘(c) CONSULTATION.—The WTC Program Adminis15 trator shall carry out this section in consultation with the 

16 WTC Scientific/Technical Advisory Committee. 

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

18 PROTECTIONS.—The privacy and human subject protec19 tions applicable to research conducted under this section 

20 shall not be less than such protections applicable to research 

21 conducted or funded by the Department of Health and 

22 Human Services. 

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

24 ‘‘For the purpose of ensuring ongoing data collection 

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1 tacks, the WTC Program Administrator shall ensure that 

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

3 as comprehensive as the World Trade Center Health Reg4 istry maintained under the arrangements in effect as of 

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

6 Health and Mental Hygiene. 

7 ‘‘Subtitle D—Funding 

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

9 FUND. 

10 ‘‘(a) ESTABLISHMENT OF FUND.— 

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

12 to be known as the World Trade Center Health Pro13 gram Fund (referred to in this section as the ‘Fund’). 

14 ‘‘(2) FUNDING.—Out of any money in the Treas15 ury not otherwise appropriated, there shall be depos16 ited into the Fund for each of fiscal years 2012 

17 through 2020 (and the last calendar quarter of fiscal 

18 year 2011)— 

19 ‘‘(A) the Federal share, consisting of an 

20 amount equal to the lesser of— 

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

22 carrying out this title for the respective fis23 cal year (initially based on estimates, sub24 ject to subsequent reconciliation based on 

25 actual expenditures); or 


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1 ‘‘(ii) $71,000,000 for the last calendar 

2 quarter of fiscal year 2011, $318,000,000 

3 for fiscal year 2012, $354,000,000 for fiscal 

4 year 2013, $382,000,000 for fiscal year 

5 2014, $431,000,000 for fiscal year 2015, 

6 $481,000,000 for fiscal year 2016, 

7 $537,000,000 for fiscal year 2017, 

8 $601,000,000 for fiscal year 2018, 

9 $672,000,000 for fiscal year 2019, and 

10 $743,000,000 for fiscal year 2020; plus 

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

12 the amount contributed under the contract under 

13 section 3331(d). 

14 ‘‘(3) CONTRACT REQUIREMENT.— 

15 ‘‘(A) IN GENERAL.—No funds may be dis16 bursed from the Fund unless New York City has 

17 entered into a contract with the WTC Program 

18 Administrator under section 3331(d)(1). 

19 ‘‘(B) BREACH OF CONTRACT.— In the case 

20 of a failure to pay the amount so required under 

21 the contract— 

22 ‘‘(i) the amount is recoverable under 

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


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

2 disbursement of amounts from the Fund; 

3 and 

4 ‘‘(iii) the Federal share described in 

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

6 the amount so unpaid. 

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

8 HEALTH EVALUATIONS, TREATMENT, AND CLAIMS PROC9 ESSING.— 

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

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

12 without further appropriation, consistent with para13 graph (2) and subsection (c), to carry out subtitle B 

14 and sections 3302(a), 3303, 3304, 3305(a)(2), 

15 3305(c), 3341, and 3342. 

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

17 This title does not establish any Federal obligation for 

18 payment of amounts in excess of the amounts avail19 able from the Fund for such purpose. 

20 ‘‘(3) LIMITATION ON AUTHORIZATION FOR FUR21 THER APPROPRIATIONS.—This title does not establish 

22 any authorization for appropriation of amounts in 

23 excess of the amounts available from the Fund under 

24 paragraph (1). 


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

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

3 more than each of the following amounts may be available 

4 for each of the following purposes: 

5 ‘‘(1) SURVIVING IMMEDIATE FAMILY MEMBERS

6 OF FIREFIGHTERS.—For the purposes of carrying out 

7 subtitle B with respect to WTC responders described 

8 in section 3311(a)(2)(A)(ii)— 

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

10 year 2011, $100,000; 

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

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

13 amount specified under this paragraph for the 

14 previous fiscal year increased by the percentage 

15 increase in the consumer price index for all 

16 urban consumers (all items; United States city 

17 average) as estimated by the Secretary for the 

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

20 ‘‘(2) WTC HEALTH PROGRAM SCIENTIFIC/TECH21 NICAL ADVISORY COMMITTEE.—For the purpose of 

22 carrying out section 3302(a)— 

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

24 year 2011, $25,000; 

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


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

2 amount specified under this paragraph for the 

3 previous fiscal year increased by the percentage 

4 increase in the consumer price index for all 

5 urban consumers (all items; United States city 

6 average) as estimated by the Secretary for the 

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

9 ‘‘(3) EDUCATION AND OUTREACH.—For the pur10 pose of carrying out section 3303— 

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

12 year 2011, $500,000; 

13 ‘‘(B) for fiscal year 2012, $2,000,000; and 

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

15 amount specified under this paragraph for the 

16 previous fiscal year increased by the percentage 

17 increase in the consumer price index for all 

18 urban consumers (all items; United States city 

19 average) as estimated by the Secretary for the 

20 12-month period ending with March of the pre21 vious year. 

22 ‘‘(4) UNIFORM DATA COLLECTION.—For the pur23 pose of carrying out section 3304 and for reimbursing 

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

25 the costs incurred by such Centers in carrying out acVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00095 Fmt 6652 Sfmt 6203 E:\BILLS\H847.RH H847

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1 tivities under contracts entered into under section 

2 3305(a)(2)— 

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

4 year 2011, $2,500,000; 

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

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

7 amount specified under this paragraph for the 

8 previous fiscal year increased by the percentage 

9 increase in the consumer price index for all 

10 urban consumers (all items; United States city 

11 average) as estimated by the Secretary for the 

12 12-month period ending with March of the pre13 vious year. 

14 ‘‘(5) RESEARCH REGARDING CERTAIN HEALTH

15 CONDITIONS.—For the purpose of carrying out section 

16 3341— 

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

18 year 2011, $3,750,000; 

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

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

21 amount specified under this paragraph for the 

22 previous fiscal year increased by the percentage 

23 increase in the consumer price index for all 

24 urban consumers (all items; United States city 

25 average) as estimated by the Secretary for the 


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1 12-month period ending with March of the pre2 vious year. 

3 ‘‘(6) WORLD TRADE CENTER HEALTH REG4 ISTRY.—For the purpose of carrying out section 

5 3342— 

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

7 year 2011, $1,750,000; 

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

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

10 amount specified under this paragraph for the 

11 previous fiscal year increased by the percentage 

12 increase in the consumer price index for all 

13 urban consumers (all items; United States city 

14 average) as estimated by the Secretary for the 

15 12-month period ending with March of the pre16 vious year.’’. 

17 TITLE II—SEPTEMBER 11TH VIC18 TIM COMPENSATION FUND OF 

19 2001 

20 SEC. 201. DEFINITIONS. 

21 Section 402 of the Air Transportation Safety and Sys22 tem Stabilization Act (49 U.S.C. 40101 note) is amended— 

23 (1) in paragraph (6) by inserting ‘‘, or debris re24 moval, including under the World Trade Center 

25 Health Program established under section 3001 of the 


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1 Public Health Service Act,’’ after ‘‘September 11, 

2 2001’’; 

3 (2) by inserting after paragraph (6) the fol4 lowing new paragraphs and redesignating subsequent 

5 paragraphs accordingly: 

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

7 term ‘contractor and subcontractor’ means any con8 tractor or subcontractor (at any tier of a subcon9 tracting relationship), including any general con10 tractor, construction manager, prime contractor, con11 sultant, or any parent, subsidiary, associated or al12 lied company, affiliated company, corporation, firm, 

13 organization, or joint venture thereof that partici14 pated in debris removal at any 9/11 crash site. Such 

15 term shall not include any entity, including the Port 

16 Authority of New York and New Jersey, with a prop17 erty interest in the World Trade Center, on September 

18 11, 2001, whether fee simple, leasehold or easement, 

19 direct or indirect. 

20 ‘‘(8) DEBRIS REMOVAL.—The term ‘debris re21 moval’ means rescue and recovery efforts, removal of 

22 debris, cleanup, remediation, and response during the 

23 immediate aftermath of the terrorist-related aircraft 

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

25 crash site.’’; 


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1 (3) by inserting after paragraph (10), as so re2 designated, the following new paragraph and redesig3 nating the subsequent paragraphs accordingly: 

4 ‘‘(11) IMMEDIATE AFTERMATH.—The term ‘im5 mediate aftermath’ means any period beginning with 

6 the terrorist-related aircraft crashes of September 11, 

7 2001, and ending on August 30, 2002.’’; and 

8 (4) by adding at the end the following new para9 graph: 

10 ‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash 

11 site’ means— 

12 ‘‘(A) the World Trade Center site, Pentagon 

13 site, and Shanksville, Pennsylvania site; 

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

15 that were destroyed as a result of the terrorist16 related aircraft crashes of September 11, 2001; 

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

18 crashes that the Special Master determines was 

19 sufficiently close to the site that there was a de20 monstrable risk of physical harm resulting from 

21 the impact of the aircraft or any subsequent fire, 

22 explosions, or building collapses (including the 

23 immediate area in which the impact occurred, 

24 fire occurred, portions of buildings fell, or debris 

25 fell upon and injured individuals); and 


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

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

3 SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 

4 COMPENSATION. 

5 (a) INFORMATION ON LOSSES RESULTING FROM DE6 BRIS REMOVAL INCLUDED IN CONTENTS OF CLAIM

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

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

9 note) is amended— 

10 (1) in clause (i), by inserting ‘‘, or debris re11 moval during the immediate aftermath’’ after ‘‘Sep12 tember 11, 2001’’; 

13 (2) in clause (ii), by inserting ‘‘or debris re14 moval during the immediate aftermath’’ after ‘‘crash15 es’’; and 

16 (3) in clause (iii), by inserting ‘‘or debris re17 moval during the immediate aftermath’’ after ‘‘crash18 es’’. 

19 (b) EXTENSION OF DEADLINE FOR CLAIMS UNDER

20 SEPTEMBER 11TH VICTIM COMPENSATION FUND OF

21 2001.—Section 405(a)(3) of such Act is amended to read 

22 as follows: 

23 ‘‘(3) LIMITATION.— 

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

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


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

2 the date on which regulations are promulgated 

3 under section 407(a). 

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

5 under paragraph (1), in accordance with sub6 section (c)(3)(A)(i), by an individual (or by a 

7 personal representative on behalf of a deceased 

8 individual) during the period beginning on the 

9 date on which the regulations are updated under 

10 section 407(b) and ending on December 22, 

11 2031.’’. 

12 (c) REQUIREMENTS FOR FILING CLAIMS DURING EX13 TENDED FILING PERIOD.—Section 405(c)(3) of such Act is 

14 amended— 

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

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

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

18 redesignated, the following new subparagraph: 

19 ‘‘(A) REQUIREMENTS FOR FILING CLAIMS

20 DURING EXTENDED FILING PERIOD.— 

21 ‘‘(i) TIMING REQUIREMENTS FOR FIL22 ING CLAIMS.—An individual (or a personal 

23 representative on behalf of a deceased indi24 vidual) may file a claim during the period 

25 described in subsection (a)(3)(B) as follows: 


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1 ‘‘(I) In the case that the Special 

2 Master determines the individual knew 

3 (or reasonably should have known) be4 fore the date specified in clause (iii) 

5 that the individual suffered a physical 

6 harm at a 9/11 crash site as a result 

7 of the terrorist-related aircraft crashes 

8 of September 11, 2001, or as a result 

9 of debris removal, and that the indi10 vidual knew (or should have known) 

11 before such specified date that the indi12 vidual was eligible to file a claim 

13 under this title, the individual may 

14 file a claim not later than the date 

15 that is 2 years after such specified 

16 date. 

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

18 Master determines the individual first 

19 knew (or reasonably should have 

20 known) on or after the date specified 

21 in clause (iii) that the individual suf22 fered such a physical harm or that the 

23 individual first knew (or should have 

24 known) on or after such specified date 

25 that the individual was eligible to file 


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1 a claim under this title, the individual 

2 may file a claim not later than the last 

3 day of the 2-year period beginning on 

4 the date the Special Master determines 

5 the individual first knew (or should 

6 have known) that the individual both 

7 suffered from such harm and was eligi8 ble to file a claim under this title. 

9 ‘‘(ii) OTHER ELIGIBILITY REQUIRE10 MENTS FOR FILING CLAIMS.—An individual 

11 may file a claim during the period de12 scribed in subsection (a)(3)(B) only if— 

13 ‘‘(I) the individual was treated by 

14 a medical professional for suffering 

15 from a physical harm described in 

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

17 from the date of discovering such harm; 

18 and 

19 ‘‘(II) the individual’s physical 

20 harm is verified by contemporaneous 

21 medical records created by or at the di22 rection of the medical professional who 

23 provided the medical care. 

24 ‘‘(iii) DATE SPECIFIED.—The date 

25 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 by 

5 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 site’’. 

8 (e) INCLUSION OF PHYSICAL HARM RESULTING FROM

9 DEBRIS REMOVAL.—Section 405(c) of such Act is amended 

10 in paragraph (2)(A)(ii), by inserting ‘‘or debris removal’’ 

11 after ‘‘air crash’’. 

12 (f) LIMITATIONS ON CIVIL ACTIONS.— 

13 (1) APPLICATION TO DAMAGES RELATED TO DE14 BRIS REMOVAL.—Clause (i) of section 405(c)(3)(C) of 

15 such Act, as redesignated by subsection (c), is amend16 ed by inserting ‘‘, or for damages arising from or re17 lated to debris removal’’ after ‘‘September 11, 2001’’. 

18 (2) PENDING ACTIONS.—Clause (ii) of such sec19 tion, as so redesignated, is amended to read as fol20 lows: 

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

22 of an individual who is a party to a civil 

23 action described in clause (i), such indi24 vidual may not submit a claim under this 

25 title— 


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1 ‘‘(I) during the period described 

2 in subsection (a)(3)(A) unless such in3 dividual withdraws from such action 

4 by the date that is 90 days after the 

5 date on which regulations are promul6 gated under section 407(a); and 

7 ‘‘(II) during the period described 

8 in subsection (a)(3)(B) unless such in9 dividual withdraws from such action 

10 by the date that is 90 days after the 

11 date on which the regulations are up12 dated under section 407(b).’’. 

13 (3) AUTHORITY TO REINSTITUTE CERTAIN LAW14 SUITS.—Such section, as so redesignated, is further 

15 amended by adding at the end the following new 

16 clause: 

17 ‘‘(iii) AUTHORITY TO REINSTITUTE

18 CERTAIN LAWSUITS.—In the case of a 

19 claimant who was a party to a civil action 

20 described in clause (i), who withdrew from 

21 such action pursuant to clause (ii), and 

22 who is subsequently determined to not be an 

23 eligible individual for purposes of this sub24 section, such claimant may reinstitute such 

25 action without prejudice during the 90-day 


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1 period beginning after the date of such in2 eligibility determination.’’. 

3 SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

4 Section 407 of the Air Transportation Safety and Sys5 tem Stabilization Act (49 U.S.C. 40101 note) is amended— 

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

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

8 (2) by adding at the end the following new sub9 section: 

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

11 after the date of the enactment of the James Zadroga 9/ 

12 11 Health and Compensation Act of 2008, the Special Mas13 ter shall update the regulations promulgated under sub14 section (a) to the extent necessary to comply with the provi15 sions of title II of such Act.’’. 

16 SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 

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

18 System Stabilization Act (49 U.S.C. 40101 note) is amend19 ed by adding at the end the following new paragraphs: 

20 ‘‘(4) LIABILITY FOR CERTAIN CLAIMS.— 

21 ‘‘(A) IN GENERAL.—Notwithstanding any 

22 other provision of law, subject to subparagraph 

23 (B), liability for all claims and actions (includ24 ing claims or actions that have been previously 

25 resolved, that are currently pending, and that 


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1 may be filed through December 22, 2031) for 

2 compensatory damages, contribution or indem3 nity, or any other form or type of relief, arising 

4 from or related to debris removal, against New 

5 York City, any entity (including the Port Au6 thority of New York and New Jersey) with a 

7 property interest in the World Trade Center on 

8 September 11, 2001 (whether fee simple, lease9 hold or easement, or direct or indirect) and any 

10 contractors and subcontractors thereof, shall not 

11 be in an amount that exceeds the sum of the fol12 lowing: 

13 ‘‘(i) The amount of funds of the WTC 

14 Captive Insurance Company, including the 

15 cumulative interest. 

16 ‘‘(ii) The amount of all available in17 surance identified in schedule 2 of the WTC 

18 Captive Insurance Company insurance pol19 icy. 

20 ‘‘(iii) The amount that is the greater of 

21 New York City’s insurance coverage or 

22 $350,000,000. In determining the amount of 

23 the City’s insurance coverage for purposes of 

24 the previous sentence, any amount described 

25 in clauses (i) and (ii) shall not be included. 


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1 ‘‘(iv) The amount of all available li2 ability insurance coverage maintained by 

3 any entity, including the Port Authority of 

4 New York and New Jersey, with a property 

5 interest in the World Trade Center, on Sep6 tember 11, 2001, whether fee simple, lease7 hold or easement, or direct or indirect. 

8 ‘‘(v) The amount of all available liabil9 ity insurance coverage maintained by con10 tractors and subcontractors. 

11 ‘‘(B) EXCEPTION.—Subparagraph (A) shall 

12 not apply to claims or actions based upon con13 duct held to be intentionally tortious in nature 

14 or to acts of gross negligence or other such acts 

15 to the extent to which punitive damages are 

16 awarded as a result of such conduct or acts. 

17 ‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Pay18 ments to plaintiffs who obtain a settlement or judg19 ment with respect to a claim or action to which para20 graph (4)(A) applies, shall be paid solely from the fol21 lowing funds in the following order: 

22 ‘‘(A) The funds described in clause (i) or 

23 (ii) of paragraph (4)(A). 

24 ‘‘(B) If there are no funds available as de25 scribed in clause (i) or (ii) of paragraph (4)(A), 


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1 the funds described in clause (iii) of such para2 graph. 

3 ‘‘(C) If there are no funds available as de4 scribed in clause (i), (ii), or (iii) of paragraph 

5 (4)(A), the funds described in clause (iv) of such 

6 paragraph. 

7 ‘‘(D) If there are no funds available as de8 scribed in clause (i), (ii), (iii), or (iv) of para9 graph (4)(A), the funds described in clause (v) of 

10 such paragraph. 

11 ‘‘(6) DECLARATORY JUDGMENT ACTIONS AND DI12 RECT ACTION.—Any party to a claim or action to 

13 which paragraph (4)(A) applies may, with respect to 

14 such claim or action, either file an action for a de15 claratory judgment for insurance coverage or bring a 

16 direct action against the insurance company in17 volved.’’. 

18 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

20 the ‘‘James Zadroga 9/11 Health and Com21 pensation Act of 2010’’. 

22 (b) TABLE OF CONTENTS.—The table of con23 tents of 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. 


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‘‘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

‘‘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. 


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Sec. 203. Requirement to update regulations. 

Sec. 204. Limited liability for certain claims. 

Sec. 205. Funding; attorney fees. 

1 SEC. 2. FINDINGS. 

2 Congress finds the following: 

3 (1) Thousands of rescue workers who 

4 responded to the areas devastated by the 

5 terrorist attacks of September 11, local 

6 residents, office and area workers, and 

7 school children continue to suffer signifi8 cant medical problems as a result of com9 promised air quality and the release of 

10 other toxins from the attack sites. 

11 (2) In a September 2006 peer-re12 viewed study conducted by the World 

13 Trade Center Medical Monitoring Pro14 gram, of 9,500 World Trade Center re15 sponders, almost 70 percent of World 

16 Trade Center responders had a new or 

17 worsened respiratory symptom that de18 veloped during or after their time work19 ing at the World Trade Center; among the 

20 responders who were asymptomatic be21 fore 9/11, 61 percent developed res22 piratory symptoms while working at the 

23 World Trade Center; close to 60 percent 

24 still had a new or worsened respiratory 


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1 symptom at the time of their examina2 tion; one-third had abnormal pulmonary 

3 function tests; and severe respiratory 

4 conditions including pneumonia were sig5 nificantly more common in the 6 months 

6 after 9/11 than in the prior 6 months. 

7 (3) An April 2006 study documented 

8 that, on average, a New York City fire9 fighter who responded to the World 

10 Trade Center has experienced a loss of 12 

11 years of lung capacity. 

12 (4) A peer-reviewed study of residents 

13 who lived near the World Trade Center 

14 titled ‘‘The World Trade Center Resi15 dents’ Respiratory Health Study: New 

16 Onset Respiratory Symptoms and Pul17 monary Function’’, found that data dem18 onstrated a three-fold increase in new19 onset, persistent lower respiratory symp20 toms in residents near the former World 

21 Trade Center as compared to a control 

22 population. 

23 (5) Previous research on the health 

24 impacts of the devastation caused by the 

25 September 11 terrorist attacks has shown 


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1 relationships between the air quality 

2 from Ground Zero and a host of health 

3 impacts, including lower pregnancy 

4 rates, higher rates of respiratory and 

5 lung disorders, and a variety of post-dis6 aster mental health conditions (including 

7 posttraumatic stress disorder) in workers 

8 and residents near Ground Zero. 

9 (6) A variety of tests conducted by 

10 independent scientists have concluded 

11 that significant WTC contamination set12 tled in indoor environments surrounding 

13 the disaster site. The Environmental Pro14 tection Agency’s (EPA) cleanup programs 

15 for indoor residential spaces, in 2003 and 

16 2005, though limited, are an acknowledg17 ment that indoor contamination contin18 ued after the WTC attacks. 

19 (7) At the request of the Department 

20 of Energy, the Davis DELTA Group at the 

21 University of California conducted out22 door dust sampling in October 2001 at 

23 Varick and Houston Streets (approxi24 mately 1.2 miles north of Ground Zero) 

25 and found that the contamination from 


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1 the World Trade Center ‘‘outdid even the 

2 worst pollution from the Kuwait oil fields 

3 fires’’. Further, the United States Geologi4 cal Survey (USGS) reported on November 

5 27, 2001, that dust samples collected from 

6 indoor surfaces registered at levels that 

7 were ‘‘as caustic as liquid drain clean8 ers’’. 

9 (8) According to both the EPA’s own 

10 Inspector General’s (EPA IG) report of 

11 August 21, 2003 and General Account12 ability Offices’s (GAO) report of Sep13 tember 2007, no comprehensive program 

14 has ever been conducted in order to char15 acterize the full extent of WTC contami16 nation, and therefore the full impact of 

17 that contamination—geographic or other18 wise—remains unknown. 

19 (9) Such reports found that there has 

20 never been a comprehensive program to 

21 remediate WTC toxins from indoor 

22 spaces. Thus, area residents, workers and 

23 students may continue to be exposed to 

24 WTC contamination in their homes, work25 places and schools. 


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1 (10) Because of the failure to release 

2 federally appropriated funds for commu3 nity care, a lack of sufficient outreach, 

4 the fact that many community members 

5 are receiving care from physicians out6 side the current City-funded World Trade 

7 Center Environmental Health Center pro8 gram and thus fall outside data collection 

9 efforts, and other factors, the number of 

10 community members being treated at the 

11 World Trade Center Environmental 

12 Health Center underrepresents the total 

13 number in the community that have been 

14 affected by exposure to Ground Zero tox15 ins. 

16 (11) Research by Columbia Univer17 sity’s Center for Children’s Environ18 mental Health has shown negative health 

19 effects on babies born to women living 

20 within 2 miles of the World Trade Center 

21 in the month following 9/11. 

22 (12) Federal funding allocated for the 

23 monitoring of rescue workers’ health is 

24 not sufficient to ensure the long-term 

25 study of health impacts of September 11. 


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1 (13) A significant portion of those 

2 who have developed health problems as 

3 result of exposures to airborne toxins or 

4 other hazards resulting from the Sep5 tember 11, 2001, attacks on the World 

6 Trade Center have no health insurance, 

7 have lost their health insurance as a re8 sult of the attacks, or have inadequate 

9 health insurance. 

10 (14) The Federal program to provide 

11 medical treatments to those who re12 sponded to the September 11 aftermath, 

13 and who continue to experience health 

14 problems as a result, was finally estab15 lished more than five years after the at16 tacks, but has no certain long-term fund17 ing. 

18 (15) Rescue workers and volunteers 

19 seeking workers’ compensation have re20 ported that their applications have been 

21 denied, delayed for months, or redi22 rected, instead of receiving assistance in 

23 a timely and supportive manner. 

24 (16) A February 2007 report released 

25 by the City of New York estimated that 


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1 approximately 410,000 people were the 

2 most heavily exposed to the environ3 mental hazards and trauma of the Sep4 tember 11 terrorist attacks. More than 30 

5 percent of the Fire Department of the 

6 City of New York first responders were 

7 still experiencing some respiratory symp8 toms more than five years after the at9 tacks and according to the report, 59 per10 cent of those seen by the WTC Environ11 mental Health Center at Bellevue Hos12 pital (which serves community members) 

13 are without insurance and 65 percent 

14 have incomes less than $15,000 per year. 

15 The report also found a need to continue 

16 and expand mental health services. 

17 (17) Since the 5th anniversary of the 

18 attack (September 11, 2006), hundreds of 

19 workers a month have been signing up 

20 with the monitoring and treatment pro21 grams. 

22 (18) In April 2008, the Department of 

23 Health and Human Services reported to 

24 Congress that in fiscal year 2007 11,359 

25 patients received medical treatment in 


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1 the existing WTC Responder Medical and 

2 Treatment program for WTC-related 

3 health problems, and that number of re4 sponders who need treatment and the se5 verity of health problems is expected to 

6 increase. 

7 (19) The September 11 Victim Com8 pensation Fund of 2001 was established 

9 to provide compensation to individuals 

10 who were physically injured or killed as 

11 a result of the terrorist-related aircraft 

12 crashes of September 11, 2001. 

13 (20) The deadline for filing claims for 

14 compensation under the Victim Com15 pensation Fund was December 22, 2003. 

16 (21) Some individuals did not know 

17 they were eligible to file claims for com18 pensation for injuries or did not know 

19 they had suffered physical harm as a re20 sult of the terrorist-related aircraft 

21 crashes until after the December 22, 2003, 

22 deadline. 

23 (22) Further research is needed to 

24 evaluate more comprehensively the ex25 tent of the health impacts of September 


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1 11, including research for emerging 

2 health problems such as cancer, which 

3 have been predicted. 

4 (23) Research is needed regarding 

5 possible treatment for the illnesses and 

6 injuries of September 11. 

7 (24) The Federal response to medical 

8 and financial issues arising from the Sep9 tember 11 response efforts needs a com10 prehensive, coordinated long-term re11 sponse in order to meet the needs of all 

12 the individuals who were exposed to the 

13 toxins of Ground Zero and are suffering 

14 health problems from the disaster. 

15 (25) The failure to extend the ap16 pointment of Dr. John Howard as Direc17 tor of the National Institute for Occupa18 tional Safety and Health in July 2008 is 

19 not in the interests of the administration 

20 of such Institute nor the continued oper21 ation of the World Trade Center Medical 

22 Monitoring and Treatment Program 

23 which he has headed, and the Secretary 

24 of Health and Human Services should re25 consider extending such appointment. 


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1 TITLE I—WORLD TRADE CENTER 

2 HEALTH PROGRAM 

3 SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 

4 The Public Health Service Act is amended 

5 by adding at the end the following new title: 

6 ‘‘TITLE XXX—WORLD TRADE 

7 CENTER HEALTH PROGRAM 

8 ‘‘Subtitle A—Establishment of Pro9 gram; Advisory and Steering 

10 Committees 

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

12 HEALTH PROGRAM WITHIN NIOSH. 

13 ‘‘(a) IN GENERAL.—There is hereby estab14 lished within the National Institute for Occu15 pational Safety and Health a program to be 

16 known as the ‘World Trade Center Health 

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

18 program’) to provide— 

19 ‘‘(1) medical monitoring and treat20 ment benefits to eligible emergency re21 sponders and recovery and clean-up 

22 workers (including those who are Federal 

23 employees) who responded to the Sep24 tember 11, 2001, terrorist attacks on the 

25 World Trade Center; and 


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1 ‘‘(2) initial health evaluation, moni2 toring, and treatment benefits to resi3 dents and other building occupants and 

4 area workers in New York City who were 

5 directly impacted and adversely affected 

6 by such attacks. 

7 ‘‘(b) COMPONENTS OF PROGRAM.—The WTC 

8 program includes the following components: 

9 ‘‘(1) MEDICAL MONITORING FOR RE10 SPONDERS.—Medical monitoring under 

11 section 3011, including clinical examina12 tions and long-term health monitoring 

13 and analysis for individuals who were 

14 likely to have been exposed to airborne 

15 toxins that were released, or to other 

16 hazards, as a result of the September 11, 

17 2001, terrorist attacks on the World 

18 Trade Center. 

19 ‘‘(2) INITIAL HEALTH EVALUATION FOR

20 COMMUNITY MEMBERS.—An initial health 

21 evaluation under section 3021, including 

22 an evaluation to determine eligibility for 

23 followup monitoring and treatment. 

24 ‘‘(3) FOLLOW-UP MONITORING AND

25 TREATMENT FOR WTC-RELATED CONDITIONS


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1 FOR RESPONDERS AND COMMUNITY MEM2 BERS.—Provision under sections 3012, 

3 3022, and 3023 of follow-up monitoring 

4 and treatment and payment, subject to 

5 the provisions of subsection (d), for all 

6 medically necessary health and mental 

7 health care expenses (including nec8 essary prescription drugs) of individuals 

9 with a WTC-related health condition. 

10 ‘‘(4) OUTREACH.—Establishment under 

11 section 3004 of an outreach program to 

12 potentially eligible individuals con13 cerning the benefits under this title. 

14 ‘‘(5) UNIFORM DATA COLLECTION.—Col15 lection under section 3005 of health and 

16 mental health data on individuals receiv17 ing monitoring or treatment benefits, 

18 using a uniform system of data collection. 

19 ‘‘(6) RESEARCH ON WTC CONDITIONS.— 

20 Establishment under subtitle C of a re21 search program on health conditions re22 sulting from the September 11, 2001, ter23 rorist attacks on the World Trade Center. 

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

25 treatment benefits and initial health evaluaVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00122 Fmt 6652 Sfmt 6202 E:\BILLS\H847.RH H847

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1 tion benefits are provided under subtitle B 

2 without any deductibles, copayments, or 

3 other cost-sharing to an eligible WTC re4 sponder or any eligible WTC community mem5 ber. 

6 ‘‘(d) PAYOR.— 

7 ‘‘(1) IN GENERAL.—Except as provided 

8 in paragraphs (2) and (3), the cost of 

9 monitoring and treatment benefits and 

10 initial health evaluation benefits pro11 vided under subtitle B shall be paid for 

12 by the WTC program. 

13 ‘‘(2) WORKERS’ COMPENSATION PAY14 MENT.— 

15 ‘‘(A) IN GENERAL.—Except as pro16 vided in subparagraph (B), payment 

17 for treatment under subtitle B of a 

18 WTC-related condition in an indi19 vidual that is work-related shall be 

20 reduced or recouped to the extent 

21 that the Secretary determines that 

22 payment has been made, or can rea23 sonably be expected to be made, 

24 under a workers’ compensation law 

25 or plan of the United States or a 


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1 State, or other work-related injury or 

2 illness benefit plan of the employer of 

3 such individual, for such treatment. 

4 The provisions of clauses (iii), (iv), 

5 (v), and (vi) of paragraph (2)(B) of 

6 section 1862(b) of the Social Security 

7 Act (42 U.S.C. 1395y(b)(2)) and para8 graph (3) of such section shall apply 

9 to the recoupment under this para10 graph of a payment to the WTC pro11 gram with respect to a workers’ com12 pensation law or plan, or other work13 related injury or illness plan of the 

14 employer involved, and such indi15 vidual in the same manner as such 

16 provisions apply to the reimburse17 ment of a payment under section 

18 1862(b)(2) of such Act to the Sec19 retary, with respect to such a law or 

20 plan and an individual entitled to 

21 benefits under title XVIII of such Act. 

22 ‘‘(B) EXCEPTION.—If the WTC Pro23 gram Administrator certifies that the 

24 City of New York has contributed the 

25 matching contribution required 


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1 under section 3006(a)(3) for a 12- 

2 month period (specified by the WTC 

3 Program Administrator), subpara4 graph (A) shall not apply for that 12- 

5 month period with respect to a work6 ers’ compensation law or plan, includ7 ing line of duty compensation, to 

8 which the City is obligated to make 

9 payments. 

10 ‘‘(3) HEALTH INSURANCE COVERAGE.— 

11 ‘‘(A) IN GENERAL.—In the case of 

12 an individual who has a WTC-related 

13 condition that is not work-related 

14 and has health coverage for such con15 dition through any public or private 

16 health plan, the provisions of section 

17 1862(b) of the Social Security Act (42 

18 U.S.C. 1395y(b)) shall apply to such a 

19 health plan and such individual in 

20 the same manner as they apply to a 

21 group health plan and an individual 

22 entitled to benefits under title XVIII 

23 of such Act pursuant to section 

24 226(a). Any costs for items and serv25 ices covered under such plan that are 


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1 not reimbursed by such health plan, 

2 due to the application of deductibles, 

3 copayments, coinsurance, other cost4 sharing, or otherwise, are reimburs5 able under this title to the extent that 

6 they are covered under the WTC pro7 gram. 

8 ‘‘(B) RECOVERY BY INDIVIDUAL PRO9 VIDERS.—Nothing in subparagraph (A) 

10 shall be construed as requiring an en11 tity providing monitoring and treat12 ment under this title to seek reim13 bursement under a health plan with 

14 which the entity has no contract for 

15 reimbursement. 

16 ‘‘(4) WORK-RELATED DESCRIBED.—For 

17 the purposes of this subsection, a WTC18 related condition shall be treated as a 

19 condition that is work-related if— 

20 ‘‘(A) the condition is diagnosed in 

21 an eligible WTC responder, or in an 

22 individual who qualifies as an eligible 

23 WTC community member on the basis 

24 of being a rescue, recovery, or clean25 up worker; or 


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1 ‘‘(B) with respect to the condition 

2 the individual has filed and had es3 tablished a claim under a workers’ 

4 compensation law or plan of the 

5 United States or a State, or other 

6 work-related injury or illness benefit 

7 plan of the employer of such indi8 vidual. 

9 ‘‘(e) QUALITY ASSURANCE AND MONITORING

10 OF CLINICAL EXPENDITURES.— 

11 ‘‘(1) QUALITY ASSURANCE.—The WTC 

12 Program Administrator working with the 

13 Clinical Centers of Excellence shall de14 velop and implement a quality assurance 

15 program for the medical monitoring and 

16 treatment delivered by such Centers of 

17 Excellence and any other participating 

18 health care providers. Such program 

19 shall include— 

20 ‘‘(A) adherence to medical moni21 toring and treatment protocols; 

22 ‘‘(B) appropriate diagnostic and 

23 treatment referrals for participants; 

24 ‘‘(C) prompt communication of 

25 test results to participants; and 


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1 ‘‘(D) such other elements as the 

2 Administrator specifies in consulta3 tion with the Clinical Centers of Ex4 cellence. 

5 ‘‘(2) FRAUD PREVENTION.—The WTC 

6 Program Administrator shall develop and 

7 implement a program to review the pro8 gram’s health care expenditures to detect 

9 fraudulent or duplicate billing and pay10 ment for inappropriate services. Such 

11 program shall be similar to current meth12 ods used in connection with the Medicare 

13 program under title XVIII of the Social 

14 Security Act. This title is a Federal health 

15 care program (as defined in section 

16 1128B(f) of such Act) and is a health plan 

17 (as defined in section 1128C(c) of such 

18 Act) for purposes of applying sections 

19 1128 through 1128E of such Act. 

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

21 WTC program shall be administered by the 

22 Director of the National Institute for Occupa23 tional Safety and Health, or a designee of 

24 such Director. 

25 ‘‘(g) ANNUAL PROGRAM REPORT.— 


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1 ‘‘(1) IN GENERAL.—Not later than 6 

2 months after the end of each fiscal year 

3 in which the WTC program is in oper4 ation, the WTC Program Administrator 

5 shall submit an annual report to the Con6 gress on the operations of this title for 

7 such fiscal year and for the entire period 

8 of operation of the program. 

9 ‘‘(2) CONTENTS OF REPORT.—Each an10 nual report under paragraph (1) shall in11 clude the following: 

12 ‘‘(A) ELIGIBLE INDIVIDUALS.—Infor13 mation for each clinical program de14 scribed in paragraph (3)— 

15 ‘‘(i) on the number of individ16 uals who applied for certification 

17 under subtitle B and the number 

18 of such individuals who were so 

19 certified; 

20 ‘‘(ii) of the individuals who 

21 were certified, on the number 

22 who received medical monitoring 

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1 ceived medical treatment under 

2 the program; 

3 ‘‘(iii) with respect to individ4 uals so certified who received 

5 such treatment, on the WTC-re6 lated health conditions for which 

7 they were treated; and 

8 ‘‘(iv) on the projected number 

9 of individuals who will be cer10 tified under subtitle B in the suc11 ceeding fiscal year. 

12 ‘‘(B) MONITORING, INITIAL HEALTH

13 EVALUATION, AND TREATMENT COSTS.— 

14 For each clinical program so de15 scribed— 

16 ‘‘(i) information on the costs 

17 of monitoring and initial health 

18 evaluation and the costs of treat19 ment and on the estimated costs 

20 of such monitoring, evaluation, 

21 and treatment in the succeeding 

22 fiscal year; and 

23 ‘‘(ii) an estimate of the cost of 

24 medical treatment for WTC-re25 lated conditions that have been 


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1 paid for or reimbursed by work2 ers’ compensation, by public or 

3 private health plans, or by the 

4 City of New York under section 

5 3012(c)(4). 

6 ‘‘(C) ADMINISTRATIVE COSTS.—Infor7 mation on the cost of administering 

8 the program, including costs of pro9 gram support, data collection and 

10 analysis, and research conducted 

11 under the program. 

12 ‘‘(D) ADMINISTRATIVE EXPERI13 ENCE.—Information on the adminis14 trative performance of the program, 

15 including— 

16 ‘‘(i) the performance of the 

17 program in providing timely eval18 uation of and treatment to eligi19 ble individuals; and 

20 ‘‘(ii) a list of the Clinical Cen21 ters of Excellence and other pro22 viders that are participating in 

23 the program. 

24 ‘‘(E) SCIENTIFIC REPORTS.—A sum25 mary of the findings of any new sciVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00131 Fmt 6652 Sfmt 6202 E:\BILLS\H847.RH H847

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1 entific reports or studies on the 

2 health effects associated with WTC 

3 center exposures, including the find4 ings of research conducted under sec5 tion 3041(a). 

6 ‘‘(F) ADVISORY COMMITTEE REC7 OMMENDATIONS.—A list of rec8 ommendations by the WTC Scientific/ 

9 Technical Advisory Committee on ad10 ditional WTC program eligibility cri11 teria and on additional WTC-related 

12 health conditions and the action of 

13 the WTC Program Administrator con14 cerning each such recommendation. 

15 ‘‘(3) SEPARATE CLINICAL PROGRAMS DE16 SCRIBED.—In paragraph (2), each of the 

17 following shall be treated as a separate 

18 clinical program of the WTC program: 

19 ‘‘(A) FDNY RESPONDERS.—The ben20 efits provided for eligible WTC re21 sponders described in section 

22 3006(b)(1)(A). 

23 ‘‘(B) OTHER ELIGIBLE WTC RESPOND24 ERS.—The benefits provided for eligiVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00132 Fmt 6652 Sfmt 6202 E:\BILLS\H847.RH H847

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1 ble WTC responders not described in 

2 subparagraph (A). 

3 ‘‘(C) ELIGIBLE WTC COMMUNITY

4 MEMBERS.—The benefits provided for 

5 eligible WTC community members in 

6 section 3006(b)(1)(C). 

7 ‘‘(h) NOTIFICATION TO CONGRESS WHEN

8 REACH 80 PERCENT OF ELIGIBILITY NUMERICAL

9 LIMITS.—The WTC Program Administrator 

10 shall promptly notify the Congress— 

11 ‘‘(1) when the number of certifi12 cations for eligible WTC responders sub13 ject to the limit established under section 

14 3011(a)(5) has reached 80 percent of such 

15 limit; and 

16 ‘‘(2) when the number of certifi17 cations for eligible WTC community mem18 bers subject to the limit established 

19 under section 3021(a)(5) has reached 80 

20 percent of such limit. 

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

22 after the date of the enactment of this Act, the 

23 Comptroller General of the United States 

24 shall submit to the Congress a report on the 


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1 costs of the monitoring and treatment pro2 grams provided under this title. 

3 ‘‘(j) NYC RECOMMENDATIONS.—The City of 

4 New York may make recommendations to the 

5 WTC Program Administrator on ways to im6 prove the monitoring and treatment pro7 grams under this title for both eligible WTC 

8 responders and eligible WTC community 

9 members. 

10 ‘‘SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECH11 NICAL ADVISORY COMMITTEE. 

12 ‘‘(a) ESTABLISHMENT.—The WTC Program 

13 Administrator shall establish an advisory 

14 committee to be known as the WTC Health 

15 Program Scientific/Technical Advisory Com16 mittee (in this section referred to as the ‘Advi17 sory Committee’) to review scientific and 

18 medical evidence and to make recommenda19 tions to the Administrator on additional WTC 

20 program eligibility criteria and on additional 

21 WTC-related health conditions. 

22 ‘‘(b) COMPOSITION.—The WTC Program Ad23 ministrator shall appoint the members of the 

24 Advisory Committee and shall include at 

25 least— 


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1 ‘‘(1) 4 occupational physicians, at 

2 least two of whom have experience treat3 ing WTC rescue and recovery workers; 

4 ‘‘(2) 1 physician with expertise in pul5 monary medicine; 

6 ‘‘(3) 2 environmental medicine or en7 vironmental health specialists; 

8 ‘‘(4) 2 representatives of eligible WTC 

9 responders; 

10 ‘‘(5) 2 representatives of WTC commu11 nity 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 

17 shall meet at such frequency as may be re18 quired to carry out its duties. 

19 ‘‘(d) REPORTS.—The WTC Program Admin20 istrator shall provide for publication of rec21 ommendations of the Advisory Committee on 

22 the public website established for the WTC 

23 program. 

24 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

25 For the purpose of carrying out this section, 


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1 there are authorized to be appropriated such 

2 sums as may be necessary, not to exceed 

3 $100,000, for each fiscal year beginning with 

4 fiscal year 2009. 

5 ‘‘(f) DURATION.—Notwithstanding any 

6 other provision of law, the Advisory Com7 mittee shall continue in operation during the 

8 period in which the WTC program is in oper9 ation. 

10 ‘‘(g) APPLICATION OF FACA.—Except as oth11 erwise specifically provided, the Advisory 

12 Committee shall be subject to the Federal Ad13 visory Committee Act. 

14 ‘‘SEC. 3003. WTC HEALTH PROGRAM STEERING COMMIT15 TEES. 

16 ‘‘(a) ESTABLISHMENT.—The WTC Program 

17 Administrator shall establish two steering 

18 committees (each in this section referred to as 

19 a ‘Steering Committee’) as follows: 

20 ‘‘(1) WTC RESPONDERS STEERING COM21 MITTEE.—One steering committee, to be 

22 known as the WTC Responders Steering 

23 Committee, for the purpose of facilitating 

24 the coordination of medical monitoring 

25 and treatment programs for the eligible 


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1 WTC responders under part 1 of subtitle 

2 B. 

3 ‘‘(2) WTC COMMUNITY PROGRAM STEER4 ING COMMITTEE.—One steering committee, 

5 to be known as the WTC Community Pro6 gram Steering Committee, for the pur7 pose of facilitating the coordination of 

8 initial health evaluations, monitoring, 

9 and treatment programs for eligible WTC 

10 community members under part 2 of sub11 title B. 

12 ‘‘(b) MEMBERSHIP.— 

13 ‘‘(1) INITIAL MEMBERSHIP OF WTC RE14 SPONDERS STEERING COMMITTEE.—The WTC 

15 Responders Steering Committee shall ini16 tially be composed of members of the 

17 WTC Monitoring and Treatment Program 

18 Steering Committee (as in existence on 

19 the day before the date of the enactment 

20 of this title). In addition, the committee 

21 membership shall include— 

22 ‘‘(A) a representative of the Police 

23 Commissioner of the City of New 

24 York; 


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1 ‘‘(B) a representative of the De2 partment of Health of the City of New 

3 York; 

4 ‘‘(C) a representative of another 

5 agency of the City of New York, se6 lected by the Mayor of New York 

7 City, which had a large number of 

8 non-uniformed City workers who re9 sponded to the WTC disaster; and 

10 ‘‘(D) three representatives of eligi11 ble WTC responders; 

12 in order that eligible WTC responders 

13 constitute half the members of the Steer14 ing Committee. 

15 ‘‘(2) INITIAL MEMBERSHIP OF WTC COM16 MUNITY PROGRAM STEERING COMMITTEE.— 

17 ‘‘(A) IN GENERAL.—The WTC Com18 munity Program Steering Committee 

19 shall initially be composed of mem20 bers of the WTC Environmental 

21 Health Center Community Advisory 

22 Committee (as in existence on the day 

23 before the date of the enactment of 

24 this title) and shall initially have, as 

25 voting members, the following: 


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1 ‘‘(i) 11 representatives of the 

2 affected populations of residents, 

3 students, area workers, and other 

4 community members. 

5 ‘‘(ii) The Medical Director of 

6 the WTC Environmental Health 

7 Center. 

8 ‘‘(iii) The Executive Director 

9 of the WTC Environmental Health 

10 Center. 

11 ‘‘(iv) Three physicians, one 

12 each representing the three WTC 

13 Environmental Health Center 

14 treatment sites of Bellevue Hos15 pital Center, Gouverneur 

16 Healthcare Services, and Elm17 hurst Hospital Center. 

18 ‘‘(v) Five specialists with WTC 

19 related expertise or experience in 

20 treating non-responder WTC dis21 eases, such as a pediatrician, an 

22 epidemiologist, a psychiatrist or 

23 psychologist, an environmental/ 

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1 mental Health Center treatment 

2 site, or other relevant specialists. 

3 ‘‘(vi) A representative of the 

4 Department of Health and Mental 

5 Hygiene of the City of New York. 

6 ‘‘(B) APPOINTMENTS.— 

7 ‘‘(i) WTC EHC COMMUNITY ADVI8 SORY COMMITTEE.—The WTC Envi9 ronmental Health Center Commu10 nity Advisory Committee as in ex11 istence on the date of the enact12 ment of this title shall nominate 

13 members for positions described 

14 in subparagraph (A)(i). 

15 ‘‘(ii) NYC HEALTH AND HOS16 PITALS CORPORATION.—The New 

17 York City Health and Hospitals 

18 Corporation shall nominate mem19 bers for positions described in 

20 clauses (iv) and (v) of subpara21 graph (A). 

22 ‘‘(iii) TIMING.—Nominations 

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

24 recommended to the WTC Pro25 gram Administrator not later 


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1 than 60 days after the date of the 

2 enactment of this title. 

3 ‘‘(iv) APPOINTMENT.—The WTC 

4 Program Administrator shall ap5 point members of the WTC Com6 munity Program Steering Com7 mittee not later than 90 days after 

8 the date of the enactment of this 

9 title. 

10 ‘‘(v) GENERAL REPRESENTA11 TIVES.—Of the members appointed 

12 under subparagraph (A)(i)— 

13 ‘‘(I) the representation 

14 shall reflect the broad and di15 verse WTC-affected popu16 lations and constituencies and 

17 the diversity of impacted 

18 neighborhoods, including resi19 dents, hard-to-reach popu20 lations, students, area work21 ers, school parents, commu22 nity-based organizations, 

23 Community Boards, WTC En24 vironmental Health Center 

25 patients, labor unions, and 


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1 labor advocacy organizations; 

2 and 

3 ‘‘(II) no one individual or4 ganization can have more 

5 than one representative. 

6 ‘‘(3) ADDITIONAL APPOINTMENTS.—Each 

7 Steering Committee may appoint, if ap8 proved by a majority of voting members 

9 of the Committee, additional members to 

10 the Committee. 

11 ‘‘(4) VACANCIES.—A vacancy in a Steer12 ing Committee shall be filled by the 

13 Steering Committee, subject to the ap14 proval of the WTC Program Adminis15 trator, so long as— 

16 ‘‘(A) in the case of the WTC Re17 sponders Steering Committee, the 

18 composition of the Committee in19 cludes representatives of eligible 

20 WTC responders and representatives 

21 of each Clinical Center of Excellence 

22 and each Coordinating Center of Ex23 cellence that serves eligible WTC re24 sponders and such composition has 

25 eligible WTC responders constituting 


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1 half of the membership of the Steer2 ing Committee; or 

3 ‘‘(B) in the case of the WTC Com4 munity Program Steering Committee, 

5 the composition of the Committee in6 cludes representatives of eligible 

7 WTC community members and rep8 resentatives of each Clinical Center 

9 of Excellence and each Coordinating 

10 Center of Excellence that serves eligi11 ble WTC community members and the 

12 nominating process is consistent with 

13 paragraph (2)(B). 

14 ‘‘(5) CO-CHAIRS OF WTC COMMUNITY PRO15 GRAM STEERING COMMITTEE.—The WTC 

16 Community Program Steering Committee 

17 shall have two Co-Chairs as follows: 

18 ‘‘(A) COMMUNITY/LABOR CO-CHAIR.— 

19 A Community/Labor Co-Chair who 

20 shall be chosen by the community 

21 and labor-based members of the 

22 Steering Committee. 

23 ‘‘(B) ENVIRONMENTAL HEALTH CLIN24 IC CO-CHAIR.—A WTC Environmental 

25 Health Clinic Co-Chair who shall be 


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1 chosen by the WTC Environmental 

2 Health Center members on the Steer3 ing Committee. 

4 ‘‘(c) RELATION TO FACA.—Each Steering 

5 Committee shall not be subject to the Federal 

6 Advisory Committee Act. 

7 ‘‘(d) MEETINGS.—Each Steering Committee 

8 shall meet at such frequency necessary to 

9 carry out its duties, but not less than 4 times 

10 each calendar year and at least two such 

11 meetings each year shall be a joint meeting 

12 with the voting membership of the other 

13 Steering Committee for the purpose of ex14 changing information regarding the WTC pro15 gram. 

16 ‘‘(e) DURATION.—Notwithstanding any 

17 other provision of law, each Steering Com18 mittee shall continue in operation during the 

19 period in which the WTC program is in oper20 ation. 

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

22 ‘‘(a) IN GENERAL.—The WTC Program Ad23 ministrator shall institute a program that pro24 vides education and outreach on the exist25 ence and availability of services under the 


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1 WTC program. The outreach and education 

2 program— 

3 ‘‘(1) shall include— 

4 ‘‘(A) the establishment of a public 

5 website with information about the 

6 WTC program; 

7 ‘‘(B) meetings with potentially eli8 gible populations; 

9 ‘‘(C) development and dissemina10 tion of outreach materials informing 

11 people about the program; and 

12 ‘‘(D) the establishment of phone 

13 information services; and 

14 ‘‘(2) shall be conducted in a manner 

15 intended— 

16 ‘‘(A) to reach all affected popu17 lations; and 

18 ‘‘(B) to include materials for cul19 turally and linguistically diverse pop20 ulations. 

21 ‘‘(b) PARTNERSHIPS.—To the greatest ex22 tent possible, in carrying out this section, the 

23 WTC Program Administrator shall enter into 

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1 reach to the affected populations, including 

2 community and labor-based organizations. 

3 ‘‘SEC. 3005. UNIFORM DATA COLLECTION. 

4 ‘‘(a) IN GENERAL.—The WTC Program Ad5 ministrator shall provide for the uniform col6 lection of data (and analysis of data and reg7 ular reports to the Administrator) on the utili8 zation of monitoring and treatment benefits 

9 provided to eligible WTC responders and eli10 gible WTC community members, the preva11 lence of WTC-related health conditions, and 

12 the identification of new WTC-related medical 

13 conditions. Such data shall be collected for all 

14 individuals provided monitoring or treatment 

15 benefits under subtitle B and regardless of 

16 their place of residence or Clinical Center of 

17 Excellence through which the benefits are 

18 provided. 

19 ‘‘(b) COORDINATING THROUGH CENTERS OF

20 EXCELLENCE.—Each Clinical Center of Excel21 lence shall collect data described in sub22 section (a) and report such data to the cor23 responding Coordinating Center of Excel24 lence for analysis by such Coordinating Cen25 ter of Excellence. 


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

2 analysis under this section shall be conducted 

3 in a manner that protects the confidentiality 

4 of individually identifiable health informa5 tion consistent with applicable legal require6 ments. 

7 ‘‘SEC. 3006. CENTERS OF EXCELLENCE. 

8 ‘‘(a) IN GENERAL.— 

9 ‘‘(1) CONTRACTS WITH CLINICAL CENTERS

10 OF EXCELLENCE.—The WTC Program Ad11 ministrator shall enter into contracts 

12 with Clinical Centers of Excellence speci13 fied in subsection (b)(1)— 

14 ‘‘(A) for the provision of moni15 toring and treatment benefits and ini16 tial health evaluation benefits under 

17 subtitle B; 

18 ‘‘(B) for the provision of outreach 

19 activities to individuals eligible for 

20 such monitoring and treatment bene21 fits, for initial health evaluation bene22 fits, and for follow-up to individuals 

23 who are enrolled in the monitoring 

24 program; 


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1 ‘‘(C) for the provision of coun2 seling for benefits under subtitle B, 

3 with respect to WTC-related health 

4 conditions, for individuals eligible for 

5 such benefits; 

6 ‘‘(D) for the provision of coun7 seling for benefits for WTC-related 

8 health conditions that may be avail9 able under Workers’ Compensation or 

10 other benefit programs for work-re11 lated injuries or illnesses, health in12 surance, disability insurance, or 

13 other insurance plans or through 

14 public or private social service agen15 cies and assisting eligible individuals 

16 in applying for such benefits; 

17 ‘‘(E) for the provision of 

18 translational and interpretive serv19 ices as for program participants who 

20 are not English language proficient; 

21 and 

22 ‘‘(F) for the collection and report23 ing of data in accordance with sec24 tion 3005. 


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1 ‘‘(2) CONTRACTS WITH COORDINATING

2 CENTERS OF EXCELLENCE.—The WTC Pro3 gram Administrator shall enter into con4 tracts with Coordinating Centers of Ex5 cellence specified in subsection (b)(2)— 

6 ‘‘(A) for receiving, analyzing, and 

7 reporting to the WTC Program Ad8 ministrator on data, in accordance 

9 with section 3005, that has been col10 lected and reported to such Coordi11 nating Centers by the corresponding 

12 Clinical Centers of Excellence under 

13 subsection (d)(3); 

14 ‘‘(B) for the development of med15 ical monitoring, initial health evalua16 tion, and treatment protocols, with 

17 respect to WTC-related health condi18 tions; 

19 ‘‘(C) for coordinating the outreach 

20 activities conducted under paragraph 

21 (1)(B) by each corresponding Clinical 

22 Center of Excellence; 

23 ‘‘(D) for establishing criteria for 

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1 viders participating in the nation2 wide network under section 3031; 

3 ‘‘(E) for coordinating and admin4 istrating the activities of the WTC 

5 Health Program Steering Committees 

6 established under section 3003(a); 

7 and 

8 ‘‘(F) for meeting periodically with 

9 the corresponding Clinical Centers of 

10 Excellence to obtain input on the 

11 analysis and reporting of data col12 lected under subparagraph (A) and 

13 on the development of medical moni14 toring, initial health evaluation, and 

15 treatment protocols under subpara16 graph (B). 

17 The medical providers under subpara18 graph (D) shall be selected by the WTC 

19 Program Administrator on the basis of 

20 their experience treating or diagnosing 

21 the medical conditions included in the 

22 list of identified WTC-related conditions 

23 for responders and of identified WTC-re24 lated conditions for community members. 


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1 ‘‘(3) REQUIRED PARTICIPATION BY NEW

2 YORK CITY IN MONITORING AND TREATMENT

3 PROGRAM AND COSTS.— 

4 ‘‘(A) IN GENERAL.—In order for 

5 New York City, any agency or Depart6 ment thereof, or the New York City 

7 Health and Hospitals Corporation to 

8 qualify for a contract for the provi9 sion of monitoring and treatment 

10 benefits and other services under sec11 tion 3006, New York City is required 

12 to contribute a matching amount of 

13 10 percent of the amount of the cov14 ered monitoring and treatment pay15 ment (as defined in subparagraph 

16 (B)). 

17 ‘‘(B) COVERED MONITORING AND

18 TREATMENT PAYMENT DEFINED.—For 

19 the purposes of this paragraph, the 

20 term ‘covered monitoring and treat21 ment payment’ means payment under 

22 paragraphs (1) and (2), including 

23 under such paragraph as applied 

24 under section 3021(b), 3022(a), and 

25 3023, and reimbursement under 


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1 3006(c) for items and services fur2 nished by a Clinical Center of Excel3 lence or Coordinating Center of Ex4 cellence, and providers designated by 

5 the WTC Program under section 3031, 

6 after the application of paragraphs 

7 (2) and (3) of section 3001 (d). 

8 ‘‘(C) PAYMENT OF NEW YORK CITY

9 SHARE OF MONITORING AND TREATMENT

10 COSTS.—The WTC Program Adminis11 trator shall— 

12 ‘‘(i) bill the amount specified 

13 in subparagraph (A) directly to 

14 New York City; and 

15 ‘‘(ii) certify periodically, for 

16 purposes of section 3001(d)(2), 

17 whether or not New York City has 

18 paid the amount so billed. 

19 ‘‘(D) LIMITATION ON REQUIRED

20 AMOUNT.—In no case is New York City 

21 required under this paragraph to 

22 contribute more than a total of 

23 $500,000,000 over any 10-year period. 

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


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1 ‘‘(1) CLINICAL CENTER OF EXCEL2 LENCE.—In this title, the term ‘Clinical 

3 Center of Excellence’ means the fol4 lowing: 

5 ‘‘(A) FOR FDNY RESPONDERS.—With 

6 respect to an eligible WTC responder 

7 who responded to the 9/11 attacks as 

8 an employee of the Fire Department 

9 of the City of New York and who— 

10 ‘‘(i) is an active employee of 

11 such Department— 

12 ‘‘(I) with respect to moni13 toring, such Fire Department; 

14 and 

15 ‘‘(II) with respect to treat16 ment, such Fire Department 

17 (or such entity as has entered 

18 into a contract with the Fire 

19 Department for treatment of 

20 such responders) or any other 

21 Clinical Center of Excellence 

22 described in subparagraph 

23 (B), (C), or (D); or 

24 ‘‘(ii) is not an active employee 

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1 partment (or such entity as has 

2 entered into a contract with the 

3 Fire Department for monitoring 

4 or treatment of such responders) 

5 or any other or any other Clinical 

6 Center of Excellence described in 

7 subparagraph (B), (C), or (D). 

8 ‘‘(B) OTHER ELIGIBLE WTC RESPOND9 ERS.—With respect to other eligible 

10 WTC responders, whether or not they 

11 reside in the New York Metropolitan 

12 area, the Mt. Sinai coordinated con13 sortium, Queens College, State Uni14 versity of New York at Stony Brook, 

15 University of Medicine and Dentistry 

16 of New Jersey, and Bellevue Hospital. 

17 ‘‘(C) WTC COMMUNITY MEMBERS.— 

18 With respect to eligible WTC commu19 nity members, whether or not they 

20 reside in the New York Metropolitan 

21 area, the World Trade Center Envi22 ronmental Health Center at Bellevue 

23 Hospital and such hospitals or other 

24 facilities, including but not limited to 

25 those within the New York City 


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1 Health and Hospitals Corporation, as 

2 are identified by the WTC Program 

3 Administrator. 

4 ‘‘(D) ALL ELIGIBLE WTC RESPONDERS

5 AND ELIGIBLE WTC COMMUNITY MEM6 BERS.—With respect to all eligible 

7 WTC responders and eligible WTC 

8 community members, such other hos9 pitals or other facilities as are identi10 fied by the WTC Program Adminis11 trator. 

12 The WTC Program Administrator shall 

13 limit the number of additional Centers of 

14 Excellence identified under subpara15 graph (D) to ensure that the participating 

16 centers have adequate experience in the 

17 treatment and diagnosis of identified 

18 WTC-related medical conditions. 

19 ‘‘(2) COORDINATING CENTER OF EXCEL20 LENCE.—In this title, the term ‘Coordi21 nating Center of Excellence’ means the 

22 following: 

23 ‘‘(A) FOR FDNY RESPONDERS.—With 

24 respect to an eligible WTC responder 

25 who responded to the 9/11 attacks as 


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1 an employee of the Fire Department 

2 of the City of New York, such Fire De3 partment. 

4 ‘‘(B) OTHER WTC RESPONDERS.— 

5 With respect to other eligible WTC re6 sponders, the Mt. Sinai coordinated 

7 consortium. 

8 ‘‘(C) WTC COMMUNITY MEMBERS.— 

9 With respect to eligible WTC commu10 nity members, the World Trade Cen11 ter Environmental Health Center at 

12 Bellevue Hospital. 

13 ‘‘(3) CORRESPONDING CENTERS.—In this 

14 title, a Clinical Center of Excellence and 

15 a Coordinating Center of Excellence shall 

16 be treated as ‘corresponding’ to the ex17 tent that such Clinical Center and Co18 ordinating Center serve the same popu19 lation group. 

20 ‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, 

21 NON-MONITORING PROGRAM COSTS.—A Clinical 

22 or Coordinating Center of Excellence with a 

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1 section (a), other than those described in sub2 section (a)(1)(A), subject to the provisions of 

3 section 3001(d), as follows: 

4 ‘‘(1) CLINICAL CENTERS OF EXCEL5 LENCE.—For carrying out subparagraphs 

6 (B) through (F) of subsection (a)(1)— 

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

9 Center of Excellence for FDNY Re10 sponders in New York specified in 

11 subsection (b)(1)(A) shall be reim12 bursed— 

13 ‘‘(i) in the first year of the 

14 contract under this section, $600 

15 per certified eligible WTC re16 sponder in the medical treatment 

17 program, and $300 per certified 

18 eligible WTC responder in the 

19 monitoring program; and 

20 ‘‘(ii) in each subsequent con21 tract year, subject to paragraph 

22 (3), at the rates specified in this 

23 subparagraph for the previous 

24 contract year adjusted by the 

25 WTC Program Administrator to 


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1 reflect the rate of medical care in2 flation during the previous con3 tract year. 

4 ‘‘(B) CLINICAL CENTERS SERVING

5 OTHER ELIGIBLE WTC RESPONDERS IN

6 NEW YORK.—A Clinical Center of Ex7 cellence for other WTC responders in 

8 New York specified in subsection 

9 (b)(1)(B) shall be reimbursed the 

10 amounts specified in subparagraph 

11 (A). 

12 ‘‘(C) CLINICAL CENTERS SERVING

13 WTC COMMUNITY MEMBERS.—A Clinical 

14 Center of Excellence for eligible WTC 

15 community members in New York 

16 specified in subsection (b)(1)(C) shall 

17 be reimbursed— 

18 ‘‘(i) in the first year of the 

19 contract under this section, for 

20 each certified eligible WTC com21 munity member in a medical 

22 treatment program enrolled at a 

23 non-hospital-based facility, $600, 

24 and for each certified eligible 

25 WTC community member in a 


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1 medical treatment program en2 rolled at a hospital-based facility, 

3 $300; and 

4 ‘‘(ii) in each subsequent con5 tract year, subject to paragraph 

6 (3), at the rates specified in this 

7 subparagraph for the previous 

8 contract year adjusted by the 

9 WTC Program Administrator to 

10 reflect the rate of medical care in11 flation during the previous con12 tract year. 

13 ‘‘(D) OTHER CLINICAL CENTERS.—A 

14 Clinical Center of Excellence or other 

15 providers not described in a previous 

16 subparagraph shall be reimbursed at 

17 a rate set by the WTC Program Ad18 ministrator. 

19 ‘‘(E) REIMBURSEMENT RULES.—The 

20 reimbursement provided under sub21 paragraphs (A), (B) and (C) shall be 

22 made for each certified eligible WTC 

23 responder and for each WTC commu24 nity member in the WTC program per 

25 year that the member receives such 


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1 services, regardless of the volume or 

2 cost of services required. 

3 ‘‘(2) COORDINATING CENTERS OF EXCEL4 LENCE.—A Coordinating Centers of Excel5 lence specified in section (a)(2) shall be 

6 reimbursed for the provision of services 

7 set forth in this section at such levels as 

8 are established by the WTC Program Ad9 ministrator. 

10 ‘‘(3) REVIEW OF RATES.— 

11 ‘‘(A) INITIAL REVIEW.—Before the 

12 end of the third contract year of the 

13 WTC program, the WTC Program Ad14 ministrator shall conduct a review to 

15 determine whether the reimburse16 ment rates set forth in this subsection 

17 provide fair and appropriate reim18 bursement for such program services. 

19 Based on such review, the Adminis20 trator may, by rule beginning with 

21 the fourth contract year, may modify 

22 such rates, taking into account a rea23 sonable and fair rate for the services 

24 being provided. 


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1 ‘‘(B) SUBSEQUENT REVIEWS.—After 

2 the fourth contract year, the WTC 

3 Program Administrator shall conduct 

4 periodic reviews to determine wheth5 er the reimbursement rates in effect 

6 under this subsection provide fair 

7 and appropriate reimbursement for 

8 such program services. Based upon 

9 such a review, the Administrator may 

10 by rule modify such rates, taking into 

11 account a reasonable and fair rate for 

12 the services being provided. 

13 ‘‘(C) GAO REVIEW.—The Comp14 troller General of the United States 

15 shall review the WTC Program Ad16 ministrator’s determinations regard17 ing fair and appropriate reimburse18 ment for program services under this 

19 paragraph. 

20 ‘‘(d) REQUIREMENTS.—The WTC Program 

21 Administrator shall not enter into a contract 

22 with a Clinical Center of Excellence under 

23 subsection (a)(1) unless— 

24 ‘‘(1) the Center establishes a formal 

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1 ceiving input from representatives of eli2 gible populations receiving monitoring 

3 and treatment benefits under subtitle B 

4 from such Center; 

5 ‘‘(2) the Center provides for the co6 ordination of monitoring and treatment 

7 benefits under subtitle B with routine 

8 medical care provided for the treatment 

9 of conditions other than WTC-related 

10 health conditions; 

11 ‘‘(3) the Center collects and reports to 

12 the corresponding Coordinating Center 

13 of Excellence data in accordance with 

14 section 3005; 

15 ‘‘(4) the Center has in place safe16 guards against fraud that are satisfactory 

17 to the Administrator; 

18 ‘‘(5) the Center agrees to treat or 

19 refer for treatment all individuals who 

20 are eligible WTC responders or eligible 

21 WTC community members with respect to 

22 such Center who present themselves for 

23 treatment of a WTC-related health condi24 tion; 


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1 ‘‘(6) the Center has in place safe2 guards to ensure the confidentiality of an 

3 individual’s individually identifiable 

4 health information, including requiring 

5 that such information not be disclosed to 

6 the individual’s employer without the au7 thorization of the individual; 

8 ‘‘(7) the Center provides assurances 

9 that the amounts paid under subsection 

10 (c)(1) are used only for costs incurred in 

11 carrying out the activities described in 

12 subsection (a), other than those described 

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

14 ‘‘(8) the Center agrees to meet all the 

15 other applicable requirements of this 

16 title, including regulations implementing 

17 such requirements. 

18 ‘‘SEC. 3007. ENTITLEMENT AUTHORITIES. 

19 ‘‘Subject to subsections (b)(4)(C) and (c)(5) 

20 of section 3012, subtitle B constitutes budget 

21 authority in advance of appropriations Acts 

22 and represents the obligation of the Federal 

23 Government to provide for the payment for 

24 monitoring, initial health evaluations, and 

25 treatment in accordance with such subtitle 


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1 and section 3006(c) constitutes such budget 

2 authority and represents the obligation of the 

3 Federal Government to provide for the pay4 ment described in such section. 

5 ‘‘SEC. 3008. DEFINITIONS. 

6 ‘‘In this title: 

7 ‘‘(1) The term ‘aggravating’ means, 

8 with respect to a health condition, a 

9 health condition that existed on Sep10 tember 11, 2001, and that, as a result of 

11 exposure to airborne toxins, any other 

12 hazard, or any other adverse condition 

13 resulting from the September 11, 2001, 

14 terrorist attacks on the World Trade Cen15 ter requires medical treatment that is (or 

16 will be) in addition to, more frequent 

17 than, or of longer duration than the med18 ical treatment that would have been re19 quired for such condition in the absence 

20 of such exposure. 

21 ‘‘(2) The terms ‘certified eligible WTC 

22 responder’ and ‘certified eligible WTC 

23 community member’ mean an individual 

24 who has been certified as an eligible WTC 

25 responder under section 3011(a)(4) or an 


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1 eligible WTC community member under 

2 section 3021(a)(4), respectively. 

3 ‘‘(3) The terms ‘Clinical Center of Ex4 cellence’ and ‘Coordinating Center of Ex5 cellence’ have the meanings given such 

6 terms in section 3006(b). 

7 ‘‘(4) The term ‘current consortium ar8 rangements’ means the arrangements as 

9 in effect on the date of the enactment of 

10 this title between the National Institute 

11 for Occupational Safety and Health and 

12 the Mt. Sinai-coordinated consortium and 

13 the Fire Department of the City of New 

14 York. 

15 ‘‘(5) The terms ‘eligible WTC re16 sponder’ and ‘eligible WTC community 

17 member’ are defined in sections 3011(a) 

18 and 3021(a), respectively. 

19 ‘‘(6) The term ‘initial health evalua20 tion’ includes, with respect to an indi21 vidual, a medical and exposure history, a 

22 physical examination, and additional 

23 medical testing as needed to evaluate 

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1 lated health condition and is eligible for 

2 treatment under the WTC program. 

3 ‘‘(7) The term ‘list of identified WTC4 related health conditions’ means— 

5 ‘‘(A) for eligible WTC responders, 

6 the identified WTC-related health 

7 condition for eligible WTC responders 

8 under section 3012(a)(3) or 3012(a)(4); 

9 or 

10 ‘‘(B) for eligible WTC community 

11 members, the identified WTC-related 

12 health condition for WTC community 

13 members under section 3022(b)(1) or 

14 3022(b)(2). 

15 ‘‘(8) The term ‘Mt.-Sinai-coordinated 

16 consortium’ means the consortium co17 ordinated by Mt. Sinai hospital in New 

18 York City that coordinates the moni19 toring and treatment under the current 

20 consortium arrangements for eligible 

21 WTC responders other than with respect 

22 to those covered under the arrangement 

23 with the Fire Department of the City of 

24 New York. 


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1 ‘‘(9) The term ‘New York City disaster 

2 area’ means the area within New York 

3 City that is— 

4 ‘‘(A) the area of Manhattan that is 

5 south of Houston Street; and 

6 ‘‘(B) any block in Brooklyn that is 

7 wholly or partially contained within 

8 a 1.5-mile radius of the former World 

9 Trade Center site. 

10 ‘‘(10) The term ‘New York metropoli11 tan area’ means an area, specified by the 

12 WTC Program Administrator, within 

13 which eligible WTC responders and eligi14 ble WTC community members who reside 

15 in such area are reasonably able to ac16 cess monitoring and treatment benefits 

17 and initial health evaluation benefits 

18 under this title through a Clinical Cen19 ters of Excellence described in subpara20 graphs (A), (B), or (C) of section 

21 3006(b)(1). 

22 ‘‘(11) Any reference to ‘September 11, 

23 2001’ shall be deemed a reference to the 

24 period on such date subsequent to the 


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1 terrorist attacks on the World Trade Cen2 ter on such date. 

3 ‘‘(12) The term ‘September 11, 2001, 

4 terrorist attacks on the World Trade Cen5 ter’ means the terrorist attacks that oc6 curred on September 11, 2001, in New 

7 York City and includes the aftermath of 

8 such attacks. 

9 ‘‘(13) The term ‘WTC Health Program 

10 Steering Committee’ means such a Steer11 ing Committee established under section 

12 3003. 

13 ‘‘(14) The term ‘WTC Program Admin14 istrator’ means the individual responsible 

15 under section 3001(f) for the administra16 tion of the WTC program. 

17 ‘‘(15) The term ‘WTC-related health 

18 condition’ is defined in section 3012(a). 

19 ‘‘(16) The term ‘WTC Scientific/Tech20 nical Advisory Committee’ means such 

21 Committee established under section 

22 3002. 


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1 ‘‘Subtitle B—Program of Moni2 toring, Initial Health Evalua3 tions, and Treatment 

4 ‘‘PART 1—FOR WTC RESPONDERS 

5 ‘‘SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPOND6 ERS AND PROVISION OF WTC-RELATED MONI7 TORING SERVICES. 

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

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

10 title, the term ‘eligible WTC responder’ 

11 means any of the following individuals, 

12 subject to paragraph (5): 

13 ‘‘(A) CURRENTLY IDENTIFIED RE14 SPONDER.—An individual who has 

15 been identified as eligible for medical 

16 monitoring under the current consor17 tium arrangements (as defined in sec18 tion 3008(4)). 

19 ‘‘(B) RESPONDER WHO MEETS CUR20 RENT ELIGIBILITY CRITERIA.—An indi21 vidual who meets the current eligi22 bility criteria described in paragraph 

23 (2). 


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1 ‘‘(C) RESPONDER WHO MEETS MODI2 FIED ELIGIBILITY CRITERIA.—An indi3 vidual who— 

4 ‘‘(i) performed rescue, recov5 ery, demolition, debris cleanup, 

6 or other related services in the 

7 New York City disaster area in re8 sponse to the September 11, 2001, 

9 terrorist attacks on the World 

10 Trade Center, regardless of 

11 whether such services were per12 formed by a State or Federal em13 ployee or member of the National 

14 Guard or otherwise; and 

15 ‘‘(ii) meets such eligibility cri16 teria relating to exposure to air17 borne toxins, other hazards, or 

18 adverse conditions resulting from 

19 the September 11, 2001, terrorist 

20 attacks on the World Trade Cen21 ter as the WTC Program Adminis22 trator, after consultation with the 

23 WTC Responders Steering Com24 mittee and the WTC Scientific/ 


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1 Technical Advisory Committee, 

2 determines appropriate. 

3 The WTC Program Administrator 

4 shall not modify such eligibility cri5 teria on or after the date that the 

6 number of certifications for eligible 

7 responders has reached 80 percent of 

8 the limit described in paragraph (5) 

9 or on or after the date that the num10 ber of certifications for eligible com11 munity members has reached 80 per12 cent of the limit described in section 

13 3021(a)(5). 

14 ‘‘(2) CURRENT ELIGIBILITY CRITERIA.— 

15 The eligibility criteria described in this 

16 paragraph for an individual is that the 

17 individual is described in either of the 

18 following categories: 

19 ‘‘(A) FIRE FIGHTERS AND RELATED

20 PERSONNEL.—The individual— 

21 ‘‘(i) was a member of the Fire 

22 Department of the City of New 

23 York (whether fire or emergency 

24 personnel, active or retired) who 

25 participated at least one day in 


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1 the rescue and recovery effort at 

2 any of the former World Trade 

3 sites (including Ground Zero, 

4 Staten Island land fill, and the 

5 NYC Chief Medical Examiner’s of6 fice) for any time during the pe7 riod beginning on September 11, 

8 2001, and ending on July 31, 2002; 

9 or 

10 ‘‘(ii)(I) is a surviving imme11 diate family member of an indi12 vidual who was a member of the 

13 Fire Department of the City of 

14 New York (whether fire or emer15 gency personnel, active or re16 tired) and was killed at the World 

17 Trade site on September 11, 2001; 

18 and 

19 ‘‘(II) received any treatment 

20 for a WTC-related mental health 

21 condition described in section 

22 3012(a)(1)(B) on or before Sep23 tember 1, 2008. 


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1 ‘‘(B) LAW ENFORCEMENT OFFICERS

2 AND WTC RESCUE, RECOVERY, AND

3 CLEAN-UP WORKERS.—The individual— 

4 ‘‘(i) worked or volunteered on5 site in rescue, recovery, debris6 cleanup or related support serv7 ices in lower Manhattan (south of 

8 Canal St.), the Staten Island 

9 Landfill, or the barge loading 

10 piers, for at least 4 hours during 

11 the period beginning on Sep12 tember 11, 2001, and ending on 

13 September 14, 2001, for at least 24 

14 hours during the period begin15 ning on September 11, 2001, and 

16 ending on September 30, 2001, or 

17 for at least 80 hours during the 

18 period beginning on September 

19 11, 2001, and ending on July 31, 

20 2002; 

21 ‘‘(ii)(I) was a member of the 

22 Police Department of the City of 

23 New York (whether active or re24 tired) or a member of the Port 

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1 thority of New York and New Jer2 sey (whether active or retired) 

3 who participated on-site in res4 cue, recovery, debris clean-up, or 

5 related services in lower Manhat6 tan (south of Canal St.), including 

7 Ground Zero, the Staten Island 

8 Landfill or the barge loading 

9 piers, for at least 4 hours during 

10 the period beginning September 

11 11, 2001, and ending on Sep12 tember 14, 2001; 

13 ‘‘(II) participated on-site in 

14 rescue, recovery, debris clean-up, 

15 or related services in at Ground 

16 Zero, the Staten Island Landfill or 

17 the barge loading piers, for at 

18 least one day during the period 

19 beginning on September 11, 2001, 

20 and ending on July 31, 2002; 

21 ‘‘(III) participated on-site in 

22 rescue, recovery, debris clean-up, 

23 or related services in lower Man24 hattan (south of Canal St.) for at 

25 least 24 hours during the period 


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1 beginning on September 11, 2001, 

2 and ending on September 30, 

3 2001; or 

4 ‘‘(IV) participated on-site in 

5 rescue, recovery, debris clean-up, 

6 or related services in lower Man7 hattan (south of Canal St.) for at 

8 least 80 hours during the period 

9 beginning on September 11, 2001, 

10 and ending on July 31, 2002; 

11 ‘‘(iii) was an employee of the 

12 Office of the Chief Medical Exam13 iner of the City of New York in14 volved in the examination and 

15 handling of human remains from 

16 the World Trade Center attacks, 

17 or other morgue worker who per18 formed similar post-September 11 

19 functions for such Office staff, 

20 during the period beginning on 

21 September 11, 2001 and ending on 

22 July 31, 2002; 

23 ‘‘(iv) was a worker in the Port 

24 Authority Trans-Hudson Corpora25 tion tunnel for at least 24 hours 


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1 during the period beginning on 

2 February 1, 2002, and ending on 

3 July 1, 2002; or 

4 ‘‘(v) was a vehicle-mainte5 nance worker who was exposed to 

6 debris from the former World 

7 Trade Center while retrieving, 

8 driving, cleaning, repairing, and 

9 maintaining vehicles contami10 nated by airborne toxins from the 

11 September 11, 2001, terrorist at12 tacks on the World Trade Center 

13 during a duration and period de14 scribed in subparagraph (A). 

15 ‘‘(3) APPLICATION PROCESS.—The WTC 

16 Program Administrator in consultation 

17 with the Coordinating Centers of Excel18 lence shall establish a process for indi19 viduals, other than eligible WTC respond20 ers described in paragraph (1)(A), to 

21 apply to be determined to be eligible 

22 WTC responders. Under such process— 

23 ‘‘(A) there shall be no fee charged 

24 to the applicant for making an appli25 cation for such determination; 


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1 ‘‘(B) the Administrator shall make 

2 a determination on such an applica3 tion not later than 60 days after the 

4 date of filing the application; and 

5 ‘‘(C) an individual who is deter6 mined not to be an eligible WTC re7 sponder shall have an opportunity to 

8 appeal such determination before an 

9 administrative law judge in a manner 

10 established under such process. 

11 ‘‘(4) CERTIFICATION.— 

12 ‘‘(A) IN GENERAL.—In the case of 

13 an individual who is described in 

14 paragraph (1)(A) or who is deter15 mined under paragraph (3) (con16 sistent with paragraph (5)) to be an 

17 eligible WTC responder, the WTC Pro18 gram Administrator shall provide an 

19 appropriate certification of such fact 

20 and of eligibility for monitoring and 

21 treatment benefits under this part. 

22 The Administrator shall make deter23 minations of eligibility relating to an 

24 applicant’s compliance with this title, 

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1 tion submitted in support of the ap2 plication, and shall not deny such a 

3 certification to an individual unless 

4 the Administrator determines that— 

5 ‘‘(i) based on the application 

6 submitted, the individual does not 

7 meet the eligibility criteria; or 

8 ‘‘(ii) the numerical limitation 

9 on eligible WTC responders set 

10 forth in paragraph (5) has been 

11 met. 

12 ‘‘(B) TIMING.— 

13 ‘‘(i) CURRENTLY IDENTIFIED RE14 SPONDERS.—In the case of an indi15 vidual who is described in para16 graph (1)(A), the WTC Program 

17 Administrator shall provide the 

18 certification under subparagraph 

19 (A) not later than 60 days after 

20 the date of the enactment of this 

21 title. 

22 ‘‘(ii) OTHER RESPONDERS.—In 

23 the case of another individual 

24 who is determined under para25 graph (3) and consistent with 


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1 paragraph (5) to be an eligible 

2 WTC responder, the WTC Pro3 gram Administrator shall provide 

4 the certification under subpara5 graph (A) at the time of the deter6 mination. 

7 ‘‘(5) NUMERICAL LIMITATION ON ELIGI8 BLE WTC RESPONDERS.— 

9 ‘‘(A) IN GENERAL.—The total num10 ber of individuals not described in 

11 subparagraph (C) who may qualify as 

12 eligible WTC responders for purposes 

13 of this title, and be certified as eligi14 ble WTC responders under paragraph 

15 (4), shall not exceed 15,000, subject to 

16 adjustment under paragraph (6), of 

17 which no more than 2,500 may be in18 dividuals certified based on modified 

19 eligibility criteria established under 

20 paragraph (1)(C). In applying the pre21 vious sentence, any individual who at 

22 any time so qualifies as an eligible 

23 WTC responder shall be counted 

24 against such numerical limitation. 


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1 ‘‘(B) PROCESS.—In implementing 

2 subparagraph (A), the WTC Program 

3 Administrator shall— 

4 ‘‘(i) limit the number of cer5 tifications provided under para6 graph (4) in accordance with such 

7 subparagraph; and 

8 ‘‘(ii) provide priority in such 

9 certifications in the order in 

10 which individuals apply for a de11 termination under paragraph (3). 

12 ‘‘(C) CURRENTLY IDENTIFIED RE13 SPONDERS NOT COUNTED.—Individuals 

14 described in this subparagraph are 

15 individuals who are described in 

16 paragraph (1)(A). 

17 ‘‘(6) POTENTIAL ADJUSTMENT IN NUMER18 ICAL LIMITATIONS DEPENDENT UPON ACTUAL

19 SPENDING RELATIVE TO ESTIMATED SPEND20 ING.— 

21 ‘‘(A) INITIAL CALCULATION FOR FIS22 CAL YEARS 2009 THROUGH 2011.—If the 

23 WTC Program Administrator deter24 mines as of December 1, 2011, that 

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1 mate percentage (as defined in sub2 paragraph (D)(iii)) for fiscal years 

3 2009 through 2011 does not exceed 90 

4 percent, then, effective January 1, 

5 2012, the WTC Program Adminis6 trator may increase the numerical 

7 limitation under paragraph (5)(A), the 

8 numerical limitation under section 

9 3021(a)(5), or both, by a number of 

10 percentage points not to exceed the 

11 number of percentage points speci12 fied in subparagraph (C) for such pe13 riod of fiscal years. 

14 ‘‘(B) SUBSEQUENT CALCULATION FOR

15 FISCAL YEARS 2009 THROUGH 2015.—If the 

16 Secretary determines as of December 

17 1, 2015, that the WTC expenditure-to18 CBO-estimate percentages for fiscal 

19 years 2009 through 2015 and for fiscal 

20 years 2012 through 2015 do not ex21 ceed 90 percent, then, effective Janu22 ary 1, 2015, the WTC Program Admin23 istrator may increase the numerical 

24 limitation under paragraph (5)(A), the 

25 numerical limitation under section 


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1 3021(a)(5), or both, as in effect after 

2 the application of subparagraph (A), 

3 by a number of percentage points not 

4 to exceed twice the lesser of— 

5 ‘‘(i) the number of percentage 

6 points specified in subparagraph 

7 (C) for fiscal years 2009 through 

8 2012, or 

9 ‘‘(ii) the number of percentage 

10 points specified in subparagraph 

11 (C) for fiscal years 2012 through 

12 2015. 

13 ‘‘(C) MAXIMUM PERCENTAGE IN14 CREASE IN NUMERICAL LIMITATIONS FOR

15 PERIOD OF FISCAL YEARS.—The number 

16 of percentage points specified in this 

17 clause for a period of fiscal years is— 

18 ‘‘(i) 100 percentage points, 

19 multiplied by 

20 ‘‘(ii) one minus a fraction the 

21 numerator of which is the net 

22 Federal WTC spending for such 

23 period, and the denominator of 

24 which is the CBO WTC spending 


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1 estimate under this title for such 

2 period. 

3 ‘‘(D) DEFINITIONS.—For purposes 

4 of this paragraph: 

5 ‘‘(i) NET FEDERAL SPENDING.— 

6 The term ‘net Federal WTC spend7 ing’ means, with respect to a pe8 riod of fiscal years, the net Fed9 eral spending under this title for 

10 such fiscal years. 

11 ‘‘(ii) CBO WTC SPENDING ESTI12 MATE UNDER THIS TITLE.—The term 

13 ‘CBO WTC medical spending esti14 mate under this title’ means, with 

15 respect to— 

16 ‘‘(I) fiscal years 2009 

17 through 2011, $900,000,000; 

18 ‘‘(II) fiscal years 2012 

19 through 2015, $1,890,000,000; 

20 and 

21 ‘‘(III) fiscal years 2009 

22 through 2015, the sum of the 

23 amounts specified in sub24 clauses (I) and (II). 


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1 ‘‘(iii) WTC EXPENDITURE-TO2 CBO-ESTIMATE PERCENTAGE.—The 

3 term ‘WTC expenditure-to-esti4 mate percentage’ means, with re5 spect to a period of fiscal years, 

6 the ratio (expressed as a percent7 age) of— 

8 ‘‘(I) the net Federal WTC 

9 spending for such period, to 

10 ‘‘(II) the CBO WTC spend11 ing estimate under this title 

12 for such period. 

13 ‘‘(b) MONITORING BENEFITS.— 

14 ‘‘(1) IN GENERAL.—In the case of an eli15 gible WTC responder under section 

16 3011(a)(4) (other than one described in 

17 subsection (a)(2)(A)(ii)), the WTC pro18 gram shall provide for monitoring bene19 fits that include medical monitoring con20 sistent with protocols approved by the 

21 WTC Program Administrator and includ22 ing clinical examinations and long-term 

23 health monitoring and analysis. In the 

24 case of an eligible WTC responder who is 

25 an active member of the Fire Department 


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1 of the City of New York, the responder 

2 shall receive such benefits as part of the 

3 individual’s periodic company medical 

4 exams. 

5 ‘‘(2) PROVISION OF MONITORING BENE6 FITS.—The monitoring benefits under 

7 paragraph (1) shall be provided through 

8 the Clinical Center of Excellence for the 

9 type of individual involved or, in the case 

10 of an individual residing outside the New 

11 York metropolitan area, under an ar12 rangement under section 3031. 

13 ‘‘SEC. 3012. TREATMENT OF CERTIFIED ELIGIBLE WTC RE14 SPONDERS FOR WTC-RELATED HEALTH CON15 DITIONS. 

16 ‘‘(a) WTC-RELATED HEALTH CONDITION DE17 FINED.— 

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

19 title, the term ‘WTC-related health condi20 tion’ means— 

21 ‘‘(A) an illness or health condition 

22 for which exposure to airborne tox23 ins, any other hazard, or any other 

24 adverse condition resulting from the 

25 September 11, 2001, terrorist attacks 


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1 on the World Trade Center, based on 

2 an examination by a medical profes3 sional with experience in treating or 

4 diagnosing the medical conditions in5 cluded in the applicable list of identi6 fied WTC-related conditions, is sub7 stantially likely to be a significant 

8 factor in aggravating, contributing to, 

9 or causing the illness or health condi10 tion, as determined under paragraph 

11 (2); or 

12 ‘‘(B) a mental health condition for 

13 which such attacks, based on an ex14 amination by a medical professional 

15 with experience in treating or diag16 nosing the medical conditions in17 cluded in the applicable list of identi18 fied WTC-related conditions, is sub19 stantially likely be a significant fac20 tor in aggravating, contributing to, or 

21 causing the condition, as determined 

22 under paragraph (2). 

23 In the case of an eligible WTC responder 

24 described in section 3011(a)(2)(A)(ii), such 


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1 term only includes the mental health con2 dition described in subparagraph (B). 

3 ‘‘(2) DETERMINATION.—The determina4 tion of whether the September 11, 2001, 

5 terrorist attacks on the World Trade Cen6 ter were substantially likely to be a sig7 nificant factor in aggravating, contrib8 uting to, or causing an individual’s illness 

9 or health condition shall be made based 

10 on an assessment of the following: 

11 ‘‘(A) The individual’s exposure to 

12 airborne toxins, any other hazard, or 

13 any other adverse condition resulting 

14 from the terrorist attacks. Such expo15 sure shall be— 

16 ‘‘(i) evaluated and character17 ized through the use of a stand18 ardized, population appropriate 

19 questionnaire approved by the Di20 rector of the National Institute 

21 for Occupational Safety and 

22 Health; and 

23 ‘‘(ii) assessed and documented 

24 by a medical professional with ex25 perience in treating or diagnosing 


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1 medical conditions included on 

2 the list of identified WTC-related 

3 conditions. 

4 ‘‘(B) The type of symptoms and 

5 temporal sequence of symptoms. Such 

6 symptoms shall be— 

7 ‘‘(i) assessed through the use 

8 of a standardized, population ap9 propriate medical questionnaire 

10 approved by Director of the Na11 tional Institute for Occupational 

12 Safety and Health and a medical 

13 examination; and 

14 ‘‘(ii) diagnosed and docu15 mented by a medical professional 

16 described in subparagraph (A)(ii). 

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

18 HEALTH CONDITIONS FOR CERTIFIED ELIGI19 BLE WTC RESPONDERS.—For purposes of 

20 this title, the term ‘identified WTC-re21 lated health condition for eligible WTC 

22 responders’ means any of the following 

23 health conditions: 

24 ‘‘(A) AERODIGESTIVE DISORDERS.— 

25 ‘‘(i) Interstitial lung diseases. 


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1 ‘‘(ii) Chronic respiratory dis2 order-fumes/vapors. 

3 ‘‘(iii) Asthma. 

4 ‘‘(iv) Reactive airways dys5 function syndrome (RADS). 

6 ‘‘(v) WTC-exacerbated chronic 

7 obstructive pulmonary disease 

8 (COPD). 

9 ‘‘(vi) Chronic cough syndrome. 

10 ‘‘(vii) Upper airway 

11 hyperreactivity. 

12 ‘‘(viii) Chronic rhinosinusitis. 

13 ‘‘(ix) Chronic nasopharyngitis. 

14 ‘‘(x) Chronic laryngitis. 

15 ‘‘(xi) Gastro-esophageal reflux 

16 disorder (GERD). 

17 ‘‘(xii) Sleep apnea exacerbated 

18 by or related to a condition de19 scribed in a previous clause. 

20 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

21 ‘‘(i) Post traumatic stress dis22 order (PTSD). 

23 ‘‘(ii) Major depressive dis24 order. 

25 ‘‘(iii) Panic disorder. 


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1 ‘‘(iv) Generalized anxiety dis2 order. 

3 ‘‘(v) Anxiety disorder (not oth4 erwise specified). 

5 ‘‘(vi) Depression (not other6 wise specified). 

7 ‘‘(vii) Acute stress disorder. 

8 ‘‘(viii) Dysthymic disorder. 

9 ‘‘(ix) Adjustment disorder. 

10 ‘‘(x) Substance abuse. 

11 ‘‘(xi) V codes (treatments not 

12 specifically related to psychiatric 

13 disorders, such as marital prob14 lems, parenting problems etc.), 

15 secondary to another identified 

16 WTC-related health condition for 

17 WTC eligible responders. 

18 ‘‘(C) MUSCULOSKELETAL DIS19 ORDERS.— 

20 ‘‘(i) Low back pain. 

21 ‘‘(ii) Carpal tunnel syndrome 

22 (CTS). 

23 ‘‘(iii) Other musculoskeletal 

24 disorders. 


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1 ‘‘(4) ADDITION OF IDENTIFIED WTC-RE2 LATED HEALTH CONDITIONS FOR ELIGIBLE

3 WTC RESPONDERS.— 

4 ‘‘(A) IN GENERAL.—The WTC Pro5 gram Administrator may promulgate 

6 regulations to add an illness or health 

7 condition not described in paragraph 

8 (3) to be added to the list of identified 

9 WTC-related conditions for eligible 

10 WTC responders. In promulgating 

11 such regulations, the Secretary shall 

12 provide for notice and opportunity 

13 for a public hearing and at least 90 

14 days of public comment. In promul15 gating such regulations, the WTC Pro16 gram Administrator shall take into 

17 account the findings and rec18 ommendations of Clinical Centers of 

19 Excellence published in peer re20 viewed journals in the determination 

21 of whether an additional illness or 

22 health condition, such as cancer, 

23 should be added to the list of identi24 fied WTC-related health conditions 

25 for eligible WTC responders. 


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1 ‘‘(B) PETITIONS.—Any person (in2 cluding the WTC Health Program Sci3 entific/Technical Advisory Com4 mittee) may petition the WTC Pro5 gram Administrator to propose regu6 lations described in subparagraph 

7 (A). Unless clearly frivolous, or initi8 ated by such Committee, any such pe9 tition shall be referred to such Com10 mittee for its recommendations. Fol11 lowing— 

12 ‘‘(i) receipt of any rec13 ommendation of the Committee; 

14 or 

15 ‘‘(ii) 180 days after the date of 

16 the referral to the Committee, 

17 whichever occurs first, the WTC Pro18 gram Administrator shall conduct a 

19 rulemaking proceeding on the mat20 ters proposed in the petition or pub21 lish in the Federal Register a state22 ment of reasons for not conducting 

23 such proceeding. 

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1 ness or health condition shall apply 

2 only with respect to applications for 

3 benefits under this title which are 

4 filed after the effective date of such 

5 regulation. 

6 ‘‘(D) ROLE OF ADVISORY COM7 MITTEE.—Except with respect to a reg8 ulation recommended by the WTC 

9 Health Program Scientific/Technical 

10 Advisory Committee), the WTC Pro11 gram Administrator may not propose 

12 a regulation under this paragraph, 

13 unless the Administrator has first 

14 provided to the Committee a copy of 

15 the proposed regulation, requested 

16 recommendations and comments by 

17 the Committee, and afforded the 

18 Committee at least 90 days to make 

19 such recommendations. 

20 ‘‘(b) COVERAGE OF TREATMENT FOR WTC-RE21 LATED HEALTH CONDITIONS.— 

22 ‘‘(1) DETERMINATION BASED ON AN IDEN23 TIFIED WTC-RELATED HEALTH CONDITION FOR

24 CERTIFIED ELIGIBLE WTC RESPONDERS.— 


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

2 a Clinical Center of Excellence that is 

3 providing monitoring benefits under 

4 section 3011 for a certified eligible 

5 WTC responder determines that the 

6 responder has an identified WTC-re7 lated health condition, and the physi8 cian makes a clinical determination 

9 that exposure to airborne toxins, 

10 other hazards, or adverse conditions 

11 resulting from the 9/11 terrorist at12 tacks is substantially likely to be a 

13 significant factor in aggravating, con14 tributing to, or causing the condi15 tion— 

16 ‘‘(i) the physician shall 

17 promptly transmit such deter18 mination to the WTC Program Ad19 ministrator and provide the Ad20 ministrator with the medical facts 

21 supporting such determination; 

22 and 

23 ‘‘(ii) on and after the date of 

24 such transmittal and subject to 

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1 gram shall provide for payment 

2 under subsection (c) for medically 

3 necessary treatment for such con4 dition. 

5 ‘‘(B) REVIEW; CERTIFICATION; AP6 PEALS.— 

7 ‘‘(i) REVIEW.—A Federal em8 ployee designated by the WTC 

9 Program Administrator shall re10 view determinations made under 

11 subparagraph (A) of a WTC-re12 lated health condition. 

13 ‘‘(ii) CERTIFICATION.—The Ad14 ministrator shall provide a certifi15 cation of such condition based 

16 upon reviews conducted under 

17 clause (i). Such a certification 

18 shall be provided unless the Ad19 ministrator determines that the 

20 responder’s condition is not an 

21 identified WTC-related health 

22 condition or that exposure to air23 borne toxins, other hazards, or 

24 adverse conditions resulting from 

25 the 9/11 terrorist attacks is not 


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1 substantially likely to be a signifi2 cant factor in significantly aggra3 vating, contributing to, or causing 

4 the condition. 

5 ‘‘(iii) APPEAL PROCESS.—The 

6 Administrator shall provide a 

7 process for the appeal of deter8 minations under clause (ii) before 

9 an administrative law judge. 

10 ‘‘(2) DETERMINATION BASED ON OTHER

11 WTC-RELATED HEALTH CONDITION.— 

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

13 a Clinical Center of Excellence deter14 mines pursuant to subsection (a) that 

15 the certified eligible WTC responder 

16 has a WTC-related health condition 

17 that is not an identified WTC-related 

18 health condition for eligible WTC re19 sponders— 

20 ‘‘(i) the physician shall 

21 promptly transmit such deter22 mination to the WTC Program Ad23 ministrator and provide the Ad24 ministrator with the facts sup25 porting such determination; and 


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1 ‘‘(ii) the Administrator shall 

2 make a determination under sub3 paragraph (B) with respect to 

4 such physician’s determination. 

5 ‘‘(B) REVIEW; CERTIFICATION.— 

6 ‘‘(i) USE OF PHYSICIAN PANEL.— 

7 With respect to each determina8 tion relating to a WTC-related 

9 health condition transmitted 

10 under subparagraph (A)(i), the 

11 WTC Program Administrator shall 

12 provide for the review of the con13 dition to be made by a physician 

14 panel with appropriate expertise 

15 appointed by the WTC Program 

16 Administrator. Such a panel shall 

17 make recommendations to the Ad18 ministrator on the evidence sup19 porting such determination. 

20 ‘‘(ii) REVIEW OF RECOMMENDA21 TIONS OF PANEL; CERTIFICATION.— 

22 The Administrator, based on such 

23 recommendations shall deter24 mine, within 60 days after the 

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1 paragraph (A)(i), whether or not 

2 the condition is a WTC-related 

3 health condition and, if it is, pro4 vide for a certification under 

5 paragraph (1)(B)(ii) of coverage of 

6 such condition. The Adminis7 trator shall provide a process for 

8 the appeal of determinations that 

9 the responder’s condition is not a 

10 WTC-related health condition be11 fore an administrative law judge. 

12 ‘‘(3) REQUIREMENT OF MEDICAL NECES13 SITY.— 

14 ‘‘(A) IN GENERAL.—In providing 

15 treatment for a WTC-health condi16 tion, a physician shall provide treat17 ment that is medically necessary and 

18 in accordance with medical protocols 

19 established under subsection (d). 

20 ‘‘(B) MEDICALLY NECESSARY STAND21 ARD.—For the purpose of this title, 

22 health care services shall be treated 

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1 sider the services to be medically nec2 essary for the individual for the pur3 pose of evaluating, diagnosing, or 

4 treating an illness, injury, disease or 

5 its symptoms, and that are— 

6 ‘‘(i) in accordance with the 

7 generally accepted standards of 

8 medical practice; 

9 ‘‘(ii) clinically appropriate, in 

10 terms of type, frequency, extent, 

11 site, and duration, and considered 

12 effective for the individual’s ill13 ness, injury, or disease; and 

14 ‘‘(iii) not primarily for the 

15 convenience of the patient or phy16 sician, or another physician, and 

17 not more costly than an alter18 native service or sequence of 

19 services at least as likely to 

20 produce equivalent therapeutic 

21 or diagnostic results as to the di22 agnosis or treatment of the indi23 vidual’s illness, injury, or disease. 

24 ‘‘(C) DETERMINATION OF MEDICAL

25 NECESSITY.— 


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1 ‘‘(i) REVIEW OF MEDICAL NECES2 SITY.—As part of the reimburse3 ment payment process under sub4 section (c), the WTC Program Ad5 ministrator shall review claims 

6 for reimbursement for the provi7 sion of medical treatment to de8 termine if such treatment is medi9 cally necessary. 

10 ‘‘(ii) WITHHOLDING OF PAYMENT

11 FOR MEDICALLY UNNECESSARY

12 TREATMENT.—The Administrator 

13 may withhold such payment for 

14 treatment that the Administrator 

15 determines is not medically nec16 essary. 

17 ‘‘(iii) REVIEW OF DETERMINA18 TIONS OF MEDICAL NECESSITY.—The 

19 Administrator shall provide a 

20 process for providers to appeal a 

21 determination under clause (ii) 

22 that medical treatment is not 

23 medically necessary. Such ap24 peals shall be reviewed through 


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1 the use of a physician panel with 

2 appropriate expertise. 

3 ‘‘(4) SCOPE OF TREATMENT COVERED.— 

4 ‘‘(A) IN GENERAL.—The scope of 

5 treatment covered under such para6 graphs includes services of physi7 cians and other health care pro8 viders, diagnostic and laboratory 

9 tests, prescription drugs, inpatient 

10 and outpatient hospital services, and 

11 other medically necessary treatment. 

12 ‘‘(B) PHARMACEUTICAL COVERAGE.— 

13 With respect to ensuring coverage of 

14 medically necessary outpatient pre15 scription drugs, such drugs shall be 

16 provided, under arrangements made 

17 by the WTC Program Administrator, 

18 directly through participating Clin19 ical Centers of Excellence or through 

20 one or more outside vendors. 

21 ‘‘(C) TRANSPORTATION EXPENSES.— 

22 To the extent provided in advance in 

23 appropriations Acts, the WTC Pro24 gram Administrator may provide for 

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1 tation and expenses incident to the 

2 securing of medically necessary treat3 ment involving travel of more than 

4 250 miles and for which payment is 

5 made under this section in the same 

6 manner in which individuals may be 

7 furnished necessary and reasonable 

8 transportation and expenses incident 

9 to services involving travel of more 

10 than 250 miles under regulations im11 plementing section 3629(c) of the En12 ergy Employees Occupational Illness 

13 Compensation Program Act of 2000 

14 (title XXXVI of Public Law 106–398; 42 

15 U.S.C. 7384t(c)). 

16 ‘‘(5) PROVISION OF TREATMENT PENDING

17 CERTIFICATION.—In the case of a certified 

18 eligible WTC responder who has been de19 termined by an examining physician 

20 under subsection (b)(1) to have an identi21 fied WTC-related health condition, but 

22 for whom a certification of the deter23 mination has not yet been made by the 

24 WTC Program Administrator, medical 

25 treatment may be provided under this 


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1 subsection, subject to paragraph (6), until 

2 the Administrator makes a decision on 

3 such certification. Medical treatment pro4 vided under this paragraph shall be con5 sidered to be medical treatment for 

6 which payment may be made under sub7 section (c). 

8 ‘‘(6) PRIOR APPROVAL PROCESS FOR NON9 CERTIFIED NON-EMERGENCY INPATIENT HOS10 PITAL SERVICES.—Non-emergency inpa11 tient hospital services for a WTC-related 

12 health condition identified by an exam13 ining physician under paragraph (b)(1) 

14 that is not certified under paragraph 

15 (1)(B)(ii) is not covered unless the serv16 ices have been determined to be medi17 cally necessary and approved through a 

18 process established by the WTC Program 

19 Administrator. Such process shall pro20 vide for a decision on a request for such 

21 services within 15 days of the date of re22 ceipt of the request. The WTC Adminis23 trator shall provide a process for the ap24 peal of a decision that the services are 

25 not medically necessary. 


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1 ‘‘(c) PAYMENT FOR INITIAL HEALTH EVALUA2 TION, MEDICAL MONITORING, AND TREATMENT OF

3 WTC-RELATED HEALTH CONDITIONS.— 

4 ‘‘(1) MEDICAL TREATMENT.— 

5 ‘‘(A) USE OF FECA PAYMENT RATES.— 

6 Subject to subparagraph (B), the WTC 

7 Program Administrator shall reim8 burse costs for medically necessary 

9 treatment under this title for WTC-re10 lated health conditions according to 

11 the payment rates that would apply 

12 to the provision of such treatment 

13 and services by the facility under the 

14 Federal Employees Compensation 

15 Act. 

16 ‘‘(B) PHARMACEUTICALS.— 

17 ‘‘(i) IN GENERAL.—The WTC 

18 Program Administrator shall es19 tablish a program for paying for 

20 the medically necessary out21 patient prescription pharma22 ceuticals prescribed under this 

23 title for WTC-related conditions 

24 through one or more contracts 

25 with outside vendors. 


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1 ‘‘(ii) COMPETITIVE BIDDING.— 

2 Under such program the Adminis3 trator shall— 

4 ‘‘(I) select one or more ap5 propriate vendors through a 

6 Federal competitive bid proc7 ess; and 

8 ‘‘(II) select the lowest bid9 der (or bidders) meeting the 

10 requirements for providing 

11 pharmaceutical benefits for 

12 participants in the WTC pro13 gram. 

14 ‘‘(iii) TREATMENT OF FDNY PAR15 TICIPANTS.—Under such program 

16 the Administrator may enter se17 lect a separate vendor to provide 

18 pharmaceutical benefits to cer19 tified eligible WTC responders for 

20 whom the Clinical Center of Ex21 cellence is described in section 

22 3006(b)(1)(A) if such an arrange23 ment is deemed necessary and 

24 beneficial to the program by the 

25 WTC Program Administrator. 


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1 ‘‘(C) OTHER TREATMENT.—For 

2 treatment not covered under a pre3 ceding subparagraph, the WTC Pro4 gram Administrator shall designate a 

5 reimbursement rate for each such 

6 service. 

7 ‘‘(2) MEDICAL MONITORING AND INITIAL

8 HEALTH EVALUATION.—The WTC Program 

9 Administrator shall reimburse the costs 

10 of medical monitoring and the costs of an 

11 initial health evaluation provided under 

12 this title at a rate set by the Adminis13 trator. 

14 ‘‘(3) ADMINISTRATIVE ARRANGEMENT AU15 THORITY.—The WTC Program Adminis16 trator may enter into arrangements with 

17 other government agencies, insurance 

18 companies, or other third-party adminis19 trators to provide for timely and accurate 

20 processing of claims under this section. 

21 ‘‘(4) CLAIMS PROCESSING SUBJECT TO AP22 PROPRIATIONS.—The payment by the WTC 

23 Program Administrator for the proc24 essing of claims under this title is limited 


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1 to the amounts provided in advance in 

2 appropriations Acts. 

3 ‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

4 ‘‘(1) DEVELOPMENT.—The Coordinating 

5 Centers of Excellence shall develop med6 ical treatment protocols for the treatment 

7 of certified eligible WTC responders and 

8 certified eligible WTC community mem9 bers for identified WTC-related health 

10 conditions. 

11 ‘‘(2) APPROVAL.—The WTC Program 

12 Administrator shall approve the medical 

13 treatment protocols, in consultation with 

14 the WTC Health Program Steering Com15 mittees. 

16 ‘‘PART 2—COMMUNITY PROGRAM 

17 ‘‘SEC. 3021. IDENTIFICATION AND INITIAL HEALTH EVALUA18 TION OF ELIGIBLE WTC COMMUNITY MEM19 BERS. 

20 ‘‘(a) ELIGIBLE WTC COMMUNITY MEMBER

21 DEFINED.— 

22 ‘‘(1) IN GENERAL.—In this title, the 

23 term ‘eligible WTC community member’ 

24 means, subject to paragraphs (3) and (5), 

25 an individual who claims symptoms of a 


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1 WTC-related health condition and is de2 scribed in any of the following subpara3 graphs: 

4 ‘‘(A) CURRENTLY IDENTIFIED COM5 MUNITY MEMBER.—An individual, in6 cluding an eligible WTC responder, 

7 who has been identified as eligible 

8 for medical treatment or monitoring 

9 by the WTC Environmental Health 

10 Center as of the date of enactment of 

11 this title. 

12 ‘‘(B) COMMUNITY MEMBER WHO

13 MEETS CURRENT ELIGIBILITY CRITERIA.— 

14 An individual who is not an eligible 

15 WTC responder and meets any of the 

16 current eligibility criteria described 

17 in a subparagraph of paragraph (2). 

18 ‘‘(C) COMMUNITY MEMBER WHO

19 MEETS MODIFIED ELIGIBILITY CRI20 TERIA.—An individual who is not an 

21 eligible WTC responder and meets 

22 such eligibility criteria relating to ex23 posure to airborne toxins, other haz24 ards, or adverse conditions resulting 

25 from the September 11, 2001, terrorist 


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1 attacks on the World Trade Center as 

2 the WTC Administrator determines 

3 eligible, after consultation with the 

4 WTC Community Program Steering 

5 Committee, Coordinating Centers of 

6 Excellence described in section 

7 3006(b)(1)(C), and the WTC Scientific/ 

8 Technical Advisory Committee. 

9 The Administrator shall not modify such 

10 criteria under subparagraph (C) on or 

11 after the date that the number of certifi12 cations for eligible community members 

13 has reached 80 percent of the limit de14 scribed in paragraph (5) or on or after 

15 the date that the number of certifications 

16 for eligible responders has reached 80 

17 percent of the limit described in section 

18 3021(a)(5). 

19 ‘‘(2) CURRENT ELIGIBILITY CRITERIA.— 

20 The eligibility criteria described in this 

21 paragraph for an individual are that the 

22 individual is described in any of the fol23 lowing subparagraphs: 

24 ‘‘(A) A person who was present in 

25 the New York City disaster area in 


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1 the dust or dust cloud on September 

2 11, 2001. 

3 ‘‘(B) A person who worked, re4 sided or attended school, child care 

5 or adult day care in the New York 

6 City disaster area for— 

7 ‘‘(i) at least four days during 

8 the 4-month period beginning on 

9 September 11, 2001, and ending 

10 on January 10, 2002; or 

11 ‘‘(ii) at least 30 days during 

12 the period beginning on Sep13 tember 11, 2001, and ending on 

14 July 31, 2002. 

15 ‘‘(C) Any person who worked as a 

16 clean-up worker or performed main17 tenance work in the New York City 

18 disaster area during the 4-month pe19 riod described in subparagraph (B)(i) 

20 and had extensive exposure to WTC 

21 dust as a result of such work. 

22 ‘‘(D) A person who was deemed el23 igible to receive a grant from the 

24 Lower Manhattan Development Cor25 poration Residential Grant Program, 


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1 who possessed a lease for a residence 

2 or purchased a residence in the New 

3 York City disaster area, and who re4 sided in such residence during the 

5 period beginning on September 11, 

6 2001, and ending on May 31, 2003. 

7 ‘‘(E) A person whose place of em8 ployment— 

9 ‘‘(i) at any time during the pe10 riod beginning on September 11, 

11 2001, and ending on May 31, 2003, 

12 was in the New York City disaster 

13 area; and 

14 ‘‘(ii) was deemed eligible to re15 ceive a grant from the Lower 

16 Manhattan Development Corpora17 tion WTC Small Firms Attraction 

18 and Retention Act program or 

19 other government incentive pro20 gram designed to revitalize the 

21 Lower Manhattan economy after 

22 the September 11, 2001, terrorist 

23 attacks on the World Trade Cen24 ter. 


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1 ‘‘(3) APPLICATION PROCESS.—The WTC 

2 Program Administrator in consultation 

3 with the Coordinating Centers of Excel4 lence shall establish a process for indi5 viduals, other than individuals described 

6 in paragraph (1)(A), to be determined eli7 gible WTC community member. Under 

8 such process— 

9 ‘‘(A) there shall be no fee charged 

10 to the applicant for making an appli11 cation for such determination; 

12 ‘‘(B) the Administrator shall make 

13 a determination on such an applica14 tion not later than 60 days after the 

15 date of filing the application; and 

16 ‘‘(C) an individual who is deter17 mined not to be an eligible WTC com18 munity member shall have an oppor19 tunity to appeal such determination 

20 before an administrative law judge in 

21 a manner established under such 

22 process. 

23 ‘‘(4) CERTIFICATION.— 

24 ‘‘(A) IN GENERAL.—In the case of 

25 an individual who is described in 


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1 paragraph (1)(A) or who is deter2 mined under paragraph (3) (con3 sistent with paragraph (5)) to be an 

4 eligible WTC community member, the 

5 WTC Program Administrator shall 

6 provide an appropriate certification 

7 of such fact and of eligibility for fol8 lowup monitoring and treatment ben9 efits under this part. The Adminis10 trator shall make determinations of 

11 eligibility relating to an applicant’s 

12 compliance with this title, including 

13 the verification of information sub14 mitted in support of the application 

15 and shall not deny such a certifi16 cation to an individual unless the Ad17 ministrator determines that— 

18 ‘‘(i) based on the application 

19 submitted, the individual does not 

20 meet the eligibility criteria; or 

21 ‘‘(ii) the numerical limitation 

22 on certification of eligible WTC 

23 community members set forth in 

24 paragraph (5) has been met. 

25 ‘‘(B) TIMING.— 


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1 ‘‘(i) CURRENTLY IDENTIFIED

2 COMMUNITY MEMBERS.—In the case 

3 of an individual who is described 

4 in paragraph (1)(A), the WTC Pro5 gram Administrator shall provide 

6 the certification under subpara7 graph (A) not later than 60 days 

8 after the date of the enactment of 

9 this title. 

10 ‘‘(ii) OTHER MEMBERS.—In the 

11 case of another individual who is 

12 determined under paragraph (3) 

13 and consistent with paragraph (5) 

14 to be an eligible WTC community 

15 member, the WTC Program Ad16 ministrator shall provide the cer17 tification under subparagraph (A) 

18 at the time of such determination. 

19 ‘‘(5) NUMERICAL LIMITATION ON CERTIFI20 CATION OF ELIGIBLE WTC COMMUNITY MEM21 BERS.— 

22 ‘‘(A) IN GENERAL.—The total num23 ber of individuals not described in 

24 subparagraph (C) who may be cer25 tified as eligible WTC community 


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1 members under paragraph (4) shall 

2 not exceed 15,000. In applying the 

3 previous sentence, any individual 

4 who at any time so qualifies as an eli5 gible WTC community member shall 

6 be counted against such numerical 

7 limitation. 

8 ‘‘(B) PROCESS.—In implementing 

9 subparagraph (A), the WTC Program 

10 Administrator shall— 

11 ‘‘(i) limit the number of cer12 tifications provided under para13 graph (4) in accordance with such 

14 subparagraph; and 

15 ‘‘(ii) provide priority in such 

16 certifications in the order in 

17 which individuals apply for a de18 termination under paragraph (4). 

19 ‘‘(C) INDIVIDUALS CURRENTLY RE20 CEIVING TREATMENT NOT COUNTED.—In21 dividuals described in this subpara22 graph are individuals who— 

23 ‘‘(i) are described in para24 graph (1)(A); or 


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1 ‘‘(ii) before the date of the en2 actment of this title, have re3 ceived monitoring or treatment at 

4 the World Trade Center Environ5 mental Health Center at Bellevue 

6 Hospital Center, Gouverneur 

7 Health Care Services, or Elmhurst 

8 Hospital Center. 

9 The New York City Health and Hos10 pitals Corporation shall, not later 

11 than 6 months after the date of enact12 ment of this title, enter into arrange13 ments with the Mt. Sinai Data and 

14 Clinical Coordination Center for the 

15 reporting of medical data concerning 

16 eligible WTC responders described in 

17 paragraph (1)(A), as determined by 

18 the WTC Program Administrator and 

19 consistent with applicable Federal 

20 and State laws and regulations relat21 ing to confidentiality of individually 

22 identifiable health information. 

23 ‘‘(D) REPORT TO CONGRESS IF NU24 MERICAL LIMITATION TO BE REACHED.— 

25 If the WTC Program Administrator 


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1 determines that the number of indi2 viduals subject to the numerical limi3 tation of subparagraph (A) is likely to 

4 exceed such numerical limitation, the 

5 Administrator shall submit to Con6 gress a report on such determination. 

7 Such report shall include an estimate 

8 of the number of such individuals in 

9 excess of such numerical limitation 

10 and of the additional expenditures 

11 that would result under this title if 

12 such numerical limitation were re13 moved. 

14 ‘‘(b) INITIAL HEALTH EVALUATION TO DETER15 MINE ELIGIBILITY FOR FOLLOWUP MONITORING

16 OR TREATMENT.— 

17 ‘‘(1) IN GENERAL.—In the case of a cer18 tified eligible WTC community member, 

19 the WTC program shall provide for an 

20 initial health evaluation to determine if 

21 the member has a WTC-related health 

22 condition and is eligible for followup 

23 monitoring and treatment benefits under 

24 the WTC program. Initial health evalua25 tion protocols shall be approved by the 


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1 WTC Program Administrator, in consulta2 tion with the World Trade Center Envi3 ronmental Health Center at Bellevue Hos4 pital and the WTC Community Program 

5 Steering Committee. 

6 ‘‘(2) INITIAL HEALTH EVALUATION PRO7 VIDERS.—The initial health evaluation de8 scribed in paragraph (1) shall be pro9 vided through a Clinical Center of Excel10 lence with respect to the individual in11 volved. 

12 ‘‘(3) LIMITATION ON INITIAL HEALTH

13 EVALUATION BENEFITS.—Benefits for initial 

14 health evaluation under this part for an 

15 eligible WTC community member shall 

16 consist only of a single medical initial 

17 health evaluation consistent with initial 

18 health evaluation protocols described in 

19 paragraph (1). Nothing in this paragraph 

20 shall be construed as preventing such an 

21 individual from seeking additional med22 ical initial health evaluations at the ex23 pense of the individual. 


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

2 CERTIFIED ELIGIBLE WTC COMMUNITY MEM3 BERS FOR WTC-RELATED HEALTH CONDI4 TIONS. 

5 ‘‘(a) IN GENERAL.—Subject to subsection 

6 (b), the provisions of sections 3011 and 3012 

7 shall apply to followup monitoring and treat8 ment of WTC-related health conditions for 

9 certified eligible WTC community members in 

10 the same manner as such provisions apply to 

11 the monitoring and treatment of identified 

12 WTC-related health conditions for certified el13 igible WTC responders, except that such mon14 itoring shall only be available to those cer15 tified as eligible for treatment under this title. 

16 Under section 3006(a)(3), the City of New York 

17 is required to contribute a share of the costs 

18 of such treatment. 

19 ‘‘(b) LIST OF IDENTIFIED WTC-RELATED

20 HEALTH CONDITIONS FOR WTC COMMUNITY

21 MEMBERS.— 

22 ‘‘(1) IDENTIFIED WTC-RELATED HEALTH

23 CONDITIONS FOR WTC COMMUNITY MEM24 BERS.—For purposes of this title, the term 

25 ‘identified WTC-related health conditions 


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1 for WTC community members’ means any 

2 of the following health conditions: 

3 ‘‘(A) AERODIGESTIVE DISORDERS.— 

4 ‘‘(i) Interstitial lung diseases. 

5 ‘‘(ii) Chronic respiratory dis6 order—fumes/vapors. 

7 ‘‘(iii) Asthma. 

8 ‘‘(iv) Reactive airways dys9 function syndrome (RADS). 

10 ‘‘(v) WTC-exacerbated chronic 

11 obstructive pulmonary disease 

12 (COPD). 

13 ‘‘(vi) Chronic cough syndrome. 

14 ‘‘(vii) Upper airway 

15 hyperreactivity. 

16 ‘‘(viii) Chronic rhinosinusitis. 

17 ‘‘(ix) Chronic nasopharyngitis. 

18 ‘‘(x) Chronic laryngitis. 

19 ‘‘(xi) Gastro-esophageal reflux 

20 disorder (GERD). 

21 ‘‘(xii) Sleep apnea exacerbated 

22 by or related to a condition de23 scribed in a previous clause. 

24 ‘‘(B) MENTAL HEALTH CONDITIONS.— 


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1 ‘‘(i) Post traumatic stress dis2 order (PTSD). 

3 ‘‘(ii) Major depressive dis4 order. 

5 ‘‘(iii) Panic disorder. 

6 ‘‘(iv) Generalized anxiety dis7 order. 

8 ‘‘(v) Anxiety disorder (not oth9 erwise specified). 

10 ‘‘(vi) Depression (not other11 wise specified). 

12 ‘‘(vii) Acute stress disorder. 

13 ‘‘(viii) Dysthymic disorder. 

14 ‘‘(ix) Adjustment disorder. 

15 ‘‘(x) Substance abuse. 

16 ‘‘(xi) V codes (treatments not 

17 specifically related to psychiatric 

18 disorders, such as marital prob19 lems, parenting problems etc.), 

20 secondary to another identified 

21 WTC-related health condition for 

22 WTC community members. 

23 ‘‘(2) ADDITIONS TO IDENTIFIED WTC-RE24 LATED HEALTH CONDITIONS FOR WTC COMMU25 NITY MEMBERS.—The provisions of paraVerDate Mar 15 2010 00:52 Jul 23, 2010 Jkt 089200 PO 00000 Frm 00221 Fmt 6652 Sfmt 6202 E:\BILLS\H847.RH H847

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1 graph (4) of section 3012(a) shall apply 

2 with respect to an addition to the list of 

3 identified WTC-related conditions for eli4 gible WTC community members under 

5 paragraph (1) in the same manner as 

6 such provisions apply to an addition to 

7 the list of identified WTC-related condi8 tions for eligible WTC responders under 

9 section 3012(a)(3). 

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

11 OTHER INDIVIDUALS WITH WTC-RELATED 

12 HEALTH CONDITIONS. 

13 ‘‘(a) IN GENERAL.—Subject to subsection 

14 (c), the provisions of section 3022 shall apply 

15 to the followup monitoring and treatment of 

16 WTC-related health conditions for eligible 

17 WTC community members in the case of indi18 viduals described in subsection (b) in the 

19 same manner as such provisions apply to the 

20 followup monitoring and treatment of WTC21 related health conditions for WTC community 

22 members. Under section 3006(a)(3), the City of 

23 New York is required to contribute a share of 

24 the costs of such monitoring and treatment. 


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1 ‘‘(b) INDIVIDUALS DESCRIBED.—An indi2 vidual described in this subsection is an indi3 vidual who, regardless of location of resi4 dence— 

5 ‘‘(1) is not a eligible WTC responder 

6 or an eligible WTC community member; 

7 and 

8 ‘‘(2) is diagnosed at a Clinical Center 

9 of Excellence (with respect to an eligible 

10 WTC community member) with an identi11 fied WTC-related health condition for 

12 WTC community members. 

13 ‘‘(c) LIMITATION.— 

14 ‘‘(1) IN GENERAL.—The WTC Program 

15 Administrator shall limit benefits for any 

16 fiscal year under subsection (a) in a man17 ner so that payments under this section 

18 for such fiscal year do not exceed the 

19 amount specified in paragraph (2) for 

20 such fiscal year. 

21 ‘‘(2) LIMITATION.—The amount speci22 fied in this paragraph for— 

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

24 or 


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1 ‘‘(B) a succeeding fiscal year is 

2 the amount specified in this para3 graph for the previous fiscal year in4 creased by the annual percentage in5 crease in the medical care component 

6 of the consumer price index for all 

7 urban consumers. 

8 ‘‘PART 3—NATIONAL ARRANGEMENT FOR BENE9 FITS FOR ELIGIBLE INDIVIDUALS OUTSIDE 

10 NEW YORK 

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

12 ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 

13 ‘‘(a) IN GENERAL.—In order to ensure rea14 sonable access to benefits under this subtitle 

15 for individuals who are eligible WTC respond16 ers or eligible WTC community members and 

17 who reside in any State, as defined in section 

18 2(f), outside the New York metropolitan area, 

19 the WTC Program Administrator shall estab20 lish a nationwide network of health care pro21 viders to provide monitoring and treatment 

22 benefits and initial health evaluations near 

23 such individuals’ areas of residence in such 

24 States. Nothing in this subsection shall be 

25 construed as preventing such individuals 


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1 from being provided such monitoring and 

2 treatment benefits or initial health evaluation 

3 through any Clinical Center of Excellence. 

4 ‘‘(b) NETWORK REQUIREMENTS.—Any health 

5 care provider participating in the network 

6 under subsection (a) shall— 

7 ‘‘(1) meet criteria for credentialing es8 tablished by the Coordinating Centers of 

9 Excellence; 

10 ‘‘(2) follow the monitoring, initial 

11 health evaluation, and treatment proto12 cols developed under section 

13 3006(a)(2)(B); 

14 ‘‘(3) collect and report data in accord15 ance with section 3005; and 

16 ‘‘(4) meet such fraud, quality assur17 ance, and other requirements as the WTC 

18 Program Administrator establishes. 

19 ‘‘Subtitle C—Research Into 

20 Conditions 

21 ‘‘SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CON22 DITIONS RELATED TO SEPTEMBER 11 TER23 RORIST ATTACKS IN NEW YORK CITY. 

24 ‘‘(a) IN GENERAL.—With respect to individ25 uals, including eligible WTC responders and 


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1 eligible WTC community members, receiving 

2 monitoring or treatment under subtitle B, the 

3 WTC Program Administrator shall conduct or 

4 support— 

5 ‘‘(1) research on physical and mental 

6 health conditions that may be related to 

7 the September 11, 2001, terrorist attacks; 

8 ‘‘(2) research on diagnosing WTC-re9 lated health conditions of such individ10 uals, in the case of conditions for which 

11 there has been diagnostic uncertainty; 

12 and 

13 ‘‘(3) research on treating WTC-related 

14 health conditions of such individuals, in 

15 the case of conditions for which there has 

16 been treatment uncertainty. 

17 The Administrator may provide such support 

18 through continuation and expansion of re19 search that was initiated before the date of 

20 the enactment of this title and through the 

21 World Trade Center Health Registry (referred 

22 to in section 3051), through a Clinical Center 

23 of Excellence, or through a Coordinating Cen24 ter of Excellence. 


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1 ‘‘(b) TYPES OF RESEARCH.—The research 

2 under subsection (a)(1) shall include epi3 demiologic and other research studies on 

4 WTC-related conditions or emerging condi5 tions— 

6 ‘‘(1) among WTC responders and com7 munity members under treatment; and 

8 ‘‘(2) in sampled populations outside 

9 the New York City disaster area in Man10 hattan as far north as 14th Street and in 

11 Brooklyn, along with control populations, 

12 to identify potential for long-term ad13 verse health effects in less exposed popu14 lations. 

15 ‘‘(c) CONSULTATION.—The WTC Program 

16 Administrator shall carry out this section in 

17 consultation with the WTC Health Program 

18 Steering Committees and the WTC Scientific/ 

19 Technical Advisory Committee. 

20 ‘‘(d) APPLICATION OF PRIVACY AND HUMAN

21 SUBJECT PROTECTIONS.—The privacy and 

22 human subject protections applicable to re23 search conducted under this section shall not 

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1 search otherwise conducted by the National 

2 Institutes of Health. 

3 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

4 For the purpose of carrying out this section, 

5 there are authorized to be appropriated 

6 $15,000,000 for each fiscal year, in addition to 

7 any other authorizations of appropriations 

8 that are available for such purpose. 

9 ‘‘Subtitle D—Programs of the New 

10 York City Department of Health 

11 and Mental Hygiene 

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

13 ‘‘(a) PROGRAM EXTENSION.—For the pur14 pose of ensuring on-going data collection for 

15 victims of the September 11, 2001, terrorist at16 tacks on the World Trade Center, the WTC 

17 Program Administrator, shall extend and ex18 pand the arrangements in effect as of January 

19 1, 2008, with the New York City Department 

20 of Health and Mental Hygiene that provide 

21 for the World Trade Center Health Registry. 

22 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.— 

23 There are authorized to be appropriated 

24 $7,000,000 for each fiscal year to carry out this 

25 section. 


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1 ‘‘SEC. 3052. MENTAL HEALTH SERVICES. 

2 ‘‘(a) IN GENERAL.—The WTC Program Ad3 ministrator may make grants to the New York 

4 City Department of Health and Mental Hy5 giene to provide mental health services to ad6 dress mental health needs relating to the Sep7 tember 11, 2001, terrorist attacks on the World 

8 Trade Center. 

9 ‘‘(b) AUTHORIZATION OF APPROPRIATIONS.— 

10 There are authorized to be appropriated 

11 $8,500,000 for each fiscal year to carry out this 

12 section.’’. 

13 TITLE II—SEPTEMBER 11TH VIC14 TIM COMPENSATION FUND OF 

15 2001 

16 SEC. 201. DEFINITIONS. 

17 Section 402 of the Air Transportation 

18 Safety and System Stabilization Act (49 U.S.C. 

19 40101 note) is amended— 

20 (1) in paragraph (6) by inserting ‘‘, or 

21 debris removal, including under the 

22 World Trade Center Health Program es23 tablished under section 3001 of the Pub24 lic Health Service Act’’ after ‘‘September 

25 11, 2001’’; 


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1 (2) by inserting after paragraph (6) 

2 the following new paragraphs and redes3 ignating subsequent paragraphs accord4 ingly: 

5 ‘‘(7) CONTRACTOR AND SUBCON6 TRACTOR.—The term ‘contractor and sub7 contractor’ means any contractor or sub8 contractor (at any tier of a subcon9 tracting relationship), including any gen10 eral contractor, construction manager, 

11 prime contractor, consultant, or any par12 ent, subsidiary, associated or allied com13 pany, affiliated company, corporation, 

14 firm, organization, or joint venture there15 of that participated in debris removal at 

16 any 9/11 crash site. Such term shall not 

17 include any entity, including the Port Au18 thority of New York and New Jersey, 

19 with a property interest in the World 

20 Trade Center, on September 11, 2001, 

21 whether fee simple, leasehold or ease22 ment, direct or indirect. 

23 ‘‘(8) DEBRIS REMOVAL.—The term ‘de24 bris removal’ means rescue and recovery 

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1 diation, and response during the imme2 diate aftermath of the terrorist-related 

3 aircraft crashes of September 11, 2001, 

4 with respect to a 9/11 crash site.’’; 

5 (3) by inserting after paragraph (10), 

6 as so redesignated, the following new 

7 paragraph and redesignating the subse8 quent paragraphs accordingly: 

9 ‘‘(11) IMMEDIATE AFTERMATH.—The 

10 term ‘immediate aftermath’ means any 

11 period beginning with the terrorist-re12 lated aircraft crashes of September 11, 

13 2001, and ending on August 30, 2002.’’; 

14 and 

15 (4) by adding at the end the following 

16 new paragraph: 

17 ‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 

18 crash site’ means— 

19 ‘‘(A) the World Trade Center site, 

20 Pentagon site, and Shanksville, Penn21 sylvania site; 

22 ‘‘(B) the buildings or portions of 

23 buildings that were destroyed as a re24 sult of the terrorist-related aircraft 

25 crashes of September 11, 2001; 


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1 ‘‘(C) any area contiguous to a site 

2 of such crashes that the Special Mas3 ter determines was sufficiently close 

4 to the site that there was a demon5 strable risk of physical harm result6 ing from the impact of the aircraft or 

7 any subsequent fire, explosions, or 

8 building collapses (including the im9 mediate area in which the impact oc10 curred, fire occurred, portions of 

11 buildings fell, or debris fell upon and 

12 injured individuals); and 

13 ‘‘(D) any area related to, or along, 

14 routes of debris removal, such as 

15 barges and Fresh Kills.’’. 

16 SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 

17 COMPENSATION. 

18 (a) INFORMATION ON LOSSES RESULTING

19 FROM DEBRIS REMOVAL INCLUDED IN CONTENTS

20 OF CLAIM FORM.—Section 405(a)(2)(B) of the 

21 Air Transportation Safety and System Sta22 bilization Act (49 U.S.C. 40101 note) is amend23 ed— 


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1 (1) in clause (i), by inserting ‘‘, or de2 bris removal during the immediate after3 math’’ after ‘‘September 11, 2001’’; 

4 (2) in clause (ii), by inserting ‘‘or de5 bris removal during the immediate after6 math’’ after ‘‘crashes’’; and 

7 (3) in clause (iii), by inserting ‘‘or de8 bris removal during the immediate after9 math’’ after ‘‘crashes’’. 

10 (b) EXTENSION OF DEADLINE FOR CLAIMS

11 UNDER SEPTEMBER 11TH VICTIM COMPENSATION

12 FUND OF 2001.—Section 405(a)(3) of such Act 

13 is amended to read as follows: 

14 ‘‘(3) LIMITATION.— 

15 ‘‘(A) IN GENERAL.—Except as pro16 vided by subparagraph (B), no claim 

17 may be filed under paragraph (1) 

18 after the date that is 2 years after the 

19 date on which regulations are pro20 mulgated under section 407(a). 

21 ‘‘(B) EXCEPTION.—A claim may be 

22 filed under paragraph (1), in accord23 ance with subsection (c)(3)(A)(i), by 

24 an individual (or by a personal rep25 resentative on behalf of a deceased 


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1 individual) during the period begin2 ning on the date on which the regula3 tions are updated under section 

4 407(b) and ending on December 22, 

5 2031.’’. 

6 (c) REQUIREMENTS FOR FILING CLAIMS DUR7 ING EXTENDED FILING PERIOD.—Section 

8 405(c)(3) of such Act is amended— 

9 (1) by redesignating subparagraphs 

10 (A) and (B) as subparagraphs (B) and (C), 

11 respectively; and 

12 (2) by inserting before subparagraph 

13 (B), as so redesignated, the following new 

14 subparagraph: 

15 ‘‘(A) REQUIREMENTS FOR FILING

16 CLAIMS DURING EXTENDED FILING PE17 RIOD.— 

18 ‘‘(i) TIMING REQUIREMENTS FOR

19 FILING CLAIMS.—An individual (or 

20 a personal representative on be21 half of a deceased individual) may 

22 file a claim during the period de23 scribed in subsection (a)(3)(B) as 

24 follows: 


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1 ‘‘(I) In the case that the 

2 Special Master determines the 

3 individual knew (or reason4 ably should have known) be5 fore the date specified in 

6 clause (iii) that the individual 

7 suffered a physical harm at a 

8 9/11 crash site as a result of 

9 the terrorist-related aircraft 

10 crashes of September 11, 2001, 

11 or as a result of debris re12 moval, and that the individual 

13 knew (or should have known) 

14 before such specified date 

15 that the individual was eligi16 ble to file a claim under this 

17 title, the individual may file a 

18 claim not later than the date 

19 that is 2 years after such spec20 ified date. 

21 ‘‘(II) In the case that the 

22 Special Master determines the 

23 individual first knew (or rea24 sonably should have known) 

25 on or after the date specified 


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1 in clause (iii) that the indi2 vidual suffered such a phys3 ical harm or that the indi4 vidual first knew (or should 

5 have known) on or after such 

6 specified date that the indi7 vidual was eligible to file a 

8 claim under this title, the in9 dividual may file a claim not 

10 later than the last day of the 

11 2-year period beginning on 

12 the date the Special Master 

13 determines the individual 

14 first knew (or should have 

15 known) that the individual 

16 both suffered from such harm 

17 and was eligible to file a claim 

18 under this title. 

19 ‘‘(ii) OTHER ELIGIBILITY RE20 QUIREMENTS FOR FILING CLAIMS.— 

21 An individual may file a claim 

22 during the period described in 

23 subsection (a)(3)(B) only if— 

24 ‘‘(I) the individual was 

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1 sional for suffering from a 

2 physical harm described in 

3 clause (i)(I) within a reason4 able time from the date of dis5 covering such harm; and 

6 ‘‘(II) the individual’s phys7 ical harm is verified by con8 temporaneous medical 

9 records created by or at the 

10 direction of the medical pro11 fessional who provided the 

12 medical care. 

13 ‘‘(iii) DATE SPECIFIED.—The 

14 date specified in this clause is the 

15 date on which the regulations are 

16 updated under section 407(a).’’. 

17 (d) CLARIFYING APPLICABILITY TO ALL 9/11 

18 CRASH SITES.—Section 405(c)(2)(A)(i) of such 

19 Act is amended by striking ‘‘or the site of the 

20 aircraft crash at Shanksville, Pennsylvania’’ 

21 and inserting ‘‘the site of the aircraft crash at 

22 Shanksville, Pennsylvania, or any other 9/11 

23 crash site’’. 

24 (e) INCLUSION OF PHYSICAL HARM RESULT25 ING FROM DEBRIS REMOVAL.—Section 405(c) of 


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1 such Act is amended in paragraph (2)(A)(ii), 

2 by inserting ‘‘or debris removal’’ after ‘‘air 

3 crash’’. 

4 (f) LIMITATIONS ON CIVIL ACTIONS.— 

5 (1) APPLICATION TO DAMAGES RELATED

6 TO DEBRIS REMOVAL.—Clause (i) of section 

7 405(c)(3)(C) of such Act, as redesignated 

8 by subsection (c), is amended by insert9 ing ‘‘, or for damages arising from or re10 lated to debris removal’’ after ‘‘September 

11 11, 2001’’. 

12 (2) PENDING ACTIONS.—Clause (ii) of 

13 such section, as so redesignated, is 

14 amended to read as follows: 

15 ‘‘(ii) PENDING ACTIONS.—In the 

16 case of an individual who is a 

17 party to a civil action described 

18 in clause (i), such individual may 

19 not submit a claim under this 

20 title— 

21 ‘‘(I) during the period de22 scribed in subsection (a)(3)(A) 

23 unless such individual with24 draws from such action by the 

25 date that is 90 days after the 


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1 date on which regulations are 

2 promulgated under section 

3 407(a); and 

4 ‘‘(II) during the period de5 scribed in subsection (a)(3)(B) 

6 unless such individual with7 draws from such action by the 

8 date that is 90 days after the 

9 date on which the regulations 

10 are updated under section 

11 407(b).’’. 

12 (3) AUTHORITY TO REINSTITUTE CERTAIN

13 LAWSUITS.—Such section, as so redesig14 nated, is further amended by adding at 

15 the end the following new clause: 

16 ‘‘(iii) AUTHORITY TO RE17 INSTITUTE CERTAIN LAWSUITS.—In 

18 the case of a claimant who was a 

19 party to a civil action described 

20 in clause (i), who withdrew from 

21 such action pursuant to clause 

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1 institute such action without 

2 prejudice during the 90-day pe3 riod beginning after the date of 

4 such ineligibility determination.’’. 

5 SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

6 Section 407 of the Air Transportation 

7 Safety and System Stabilization Act (49 U.S.C. 

8 40101 note) is amended— 

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

10 inserting ‘‘(a) IN GENERAL.—Not later 

11 than’’; and 

12 (2) by adding at the end the following 

13 new subsection: 

14 ‘‘(b) UPDATED REGULATIONS.—Not later 

15 than 90 days after the date of the enactment 

16 of the James Zadroga 9/11 Health and Com17 pensation Act of 2010, the Special Master shall 

18 update the regulations promulgated under 

19 subsection (a) to the extent necessary to com20 ply with the provisions of title II of such Act.’’. 

21 SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 

22 Section 408(a) of the Air Transportation 

23 Safety and System Stabilization Act (49 U.S.C. 

24 40101 note) is amended by adding at the end 

25 the following new paragraphs: 


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1 ‘‘(4) LIABILITY FOR CERTAIN CLAIMS.— 

2 Notwithstanding any other provision of 

3 law, liability for all claims and actions 

4 (including claims or actions that have 

5 been previously resolved, that are cur6 rently pending, and that may be filed 

7 through December 22, 2031) for compen8 satory damages, contribution or indem9 nity, or any other form or type of relief, 

10 arising from or related to debris removal, 

11 against the City of New York, any entity 

12 (including the Port Authority of New 

13 York and New Jersey) with a property in14 terest in the World Trade Center on Sep15 tember 11, 2001 (whether fee simple, 

16 leasehold or easement, or direct or indi17 rect) and any contractors and sub18 contractors, shall not be in an amount 

19 that exceeds the sum of the following, as 

20 may be applicable: 

21 ‘‘(A) The amount of funds of the 

22 WTC Captive Insurance Company, in23 cluding the cumulative interest. 

24 ‘‘(B) The amount of all available 

25 insurance identified in schedule 2 of 


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1 the WTC Captive Insurance Company 

2 insurance policy. 

3 ‘‘(C) As it relates to the limitation 

4 of liability of the City of New York, 

5 the amount that is the greater of the 

6 City of New York’s insurance cov7 erage or $350,000,000. In determining 

8 the amount of the City’s insurance 

9 coverage for purposes of the previous 

10 sentence, any amount described in 

11 clauses (i) and (ii) shall not be in12 cluded. 

13 ‘‘(D) As it relates to the limitation 

14 of liability of any entity, including 

15 the Port Authority of New York and 

16 New Jersey, with a property interest 

17 in the World Trade Center on Sep18 tember 11, 2001 (whether fee simple, 

19 leasehold or easement, or direct or in20 direct), the amount of all available li21 ability insurance coverage main22 tained by any such entity. 

23 ‘‘(E) As it relates to the limitation 

24 of liability of any individual con25 tractor or subcontractor, the amount 


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1 of all available liability insurance 

2 coverage maintained by such con3 tractor or subcontractor on Sep4 tember 11, 2001. 

5 ‘‘(5) PRIORITY OF CLAIMS PAYMENTS.— 

6 Payments to plaintiffs who obtain a set7 tlement or judgment with respect to a 

8 claim or action to which paragraph (4)(A) 

9 applies, shall be paid solely from the fol10 lowing funds in the following order, as 

11 may be applicable: 

12 ‘‘(A) The funds described in clause 

13 (i) or (ii) of paragraph (4)(A). 

14 ‘‘(B) If there are no funds avail15 able as described in clause (i) or (ii) 

16 of paragraph (4)(A), the funds de17 scribed in clause (iii) of such para18 graph. 

19 ‘‘(C) If there are no funds avail20 able as described in clause (i), (ii), or 

21 (iii) of paragraph (4)(A), the funds de22 scribed in clause (iv) of such para23 graph. 

24 ‘‘(D) If there are no funds avail25 able as described in clause (i), (ii), 


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1 (iii), or (iv) of paragraph (4)(A), the 

2 funds described in clause (v) of such 

3 paragraph. 

4 ‘‘(6) DECLARATORY JUDGMENT ACTIONS

5 AND DIRECT ACTION.—Any party to a claim 

6 or action to which paragraph (4)(A) ap7 plies may, with respect to such claim or 

8 action, either file an action for a declara9 tory judgment for insurance coverage or 

10 bring a direct action against the insur11 ance company involved.’’. 

12 SEC. 205. FUNDING; ATTORNEY FEES. 

13 Section 406 of the Air Transportation 

14 Safety and System Stabilization Act (49 U.S.C. 

15 40101 note) is amended— 

16 (1) in subsection (a), by striking ‘‘Not 

17 later than’’ and inserting ‘‘Subject to sub18 section (d), not later than’’; 

19 (2) in subsection (b), by striking ‘‘This 

20 title’’ and inserting ‘‘Subject to subsection 

21 (d), this title’’; and 

22 (3) by adding at the end the following 

23 new subsections: 

24 ‘‘(d) LIMITATION.—The total payment of 

25 amounts for compensation under this title, 


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1 with respect to claims filed on or after the 

2 date on which the regulations are updated 

3 under section 407(b), shall not exceed 

4 $8,400,000,000. 

5 ‘‘(e) ATTORNEY FEES.— 

6 ‘‘(1) IN GENERAL.—Notwithstanding 

7 any contract, and except as provided in 

8 paragraph (2), the representative of an 

9 individual may not charge, for services 

10 rendered in connection with the claim of 

11 an individual under this title, more than 

12 10 percent of an award made under this 

13 title on such claim. 

14 ‘‘(2) EXCEPTION.—With respect to a 

15 claim made on behalf of an individual for 

16 whom a lawsuit was filed in the Southern 

17 District of New York prior to January 1, 

18 2009, in the event that the representative 

19 believes in good faith that the fee limit 

20 set by paragraph (1) will not provide ade21 quate compensation for services ren22 dered in connection with such claim be23 cause of the substantial amount of legal 

24 work provided on behalf of the claimant 

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1 actment of this legislation), application 

2 for greater compensation may be made to 

3 the Special Master. Upon such applica4 tion, the Special Master may, in his or 

5 her discretion, award as reasonable com6 pensation for services rendered an 

7 amount greater than that allowed for in 

8 paragraph (1). Such fee award will be 

9 final, binding, and non-appealable.’’. 


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Union Calendar No. 321 

111TH CONGRESS 

2D SESSION H. R. 847 

[Report No. 111–560, Parts I and II] 

A BILL 

To amend the Public Health Service Act to extend 

other purposes. New York City on September 11, 2001, and for uals directly impacted by the terrorist attack in and improve protections and services to individJULY 22, 2010 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


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