111TH CONGRESS 

2D SESSION H. R. 847 

AN ACT 

To amend the Public Health Service Act to extend and 

improve protections and services to individuals directly 

impacted by the terrorist attack in New York City on 

September 11, 2001, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
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1 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

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

4 2010’’. 

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

6 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 

Sec. 101. World Trade Center Health Program. 

‘‘TITLE XXXIII—WORLD TRADE CENTER HEALTH PROGRAM 

‘‘Subtitle A—Establishment of Program; Advisory Committee 

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

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

‘‘Sec. 3303. Education and outreach. 

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

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

‘‘Sec. 3306. Definitions. 

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

Treatment 

‘‘PART 1—WTC RESPONDERS

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

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

health conditions. 

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

‘‘PART 2—WTC SURVIVORS

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

and certified-eligible WTC survivors. 

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

survivors for WTC-related health conditions. 

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

WTC-related health conditions. 

‘‘PART 3—PAYOR PROVISIONS

‘‘Sec. 3331. Payment of claims. 

‘‘Sec. 3332. Administrative arrangement authority. 

‘‘Subtitle C—Research Into Conditions 
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‘‘Sec. 3341. Research regarding certain health conditions related to September 11 terrorist attacks. 

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

‘‘Subtitle D—Funding 

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

TITLE II—SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 

2001 

Sec. 201. Definitions. 

Sec. 202. Extended and expanded eligibility for compensation. 

Sec. 203. Requirement to update regulations. 

Sec. 204. Limited liability for certain claims. 

Sec. 205. Funding; attorney fees. 

TITLE III—LIMITATION ON TREATY BENEFITS FOR CERTAIN DEDUCTIBLE PAYMENTS; TIME FOR PAYMENT OF CORPORATE ESTIMATED TAXES 

Sec. 301. Limitation on treaty benefits for certain deductible payments. 

Sec. 302. Time for payment of corporate estimated taxes. 

TITLE IV—BUDGETARY EFFECTS 

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

1 TITLE I—WORLD TRADE CENTER 

2 HEALTH PROGRAM 

3 SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 

4 The Public Health Service Act is amended by adding 

5 at the end the following new title: 

6 ‘‘TITLE XXXIII—WORLD TRADE 

7 CENTER HEALTH PROGRAM 

8 ‘‘Subtitle A—Establishment of 

9 Program; Advisory Committee 

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

11 HEALTH PROGRAM. 

12 ‘‘(a) IN GENERAL.—There is hereby established with13 in the Department of Health and Human Services a pro14 gram to be known as the World Trade Center Health Pro-
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1 gram, which shall be administered by the WTC Program 

2 Administrator, to provide beginning on July 1, 2011— 

3 ‘‘(1) medical monitoring and treatment benefits 

4 to eligible emergency responders and recovery and 

5 cleanup workers (including those who are Federal 

6 employees) who responded to the September 11, 

7 2001, terrorist attacks; and 

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

9 treatment benefits to residents and other building 

10 occupants and area workers in New York City who 

11 were directly impacted and adversely affected by 

12 such attacks. 

13 ‘‘(b) COMPONENTS OF PROGRAM.—The WTC Pro14 gram includes the following components: 

15 ‘‘(1) MEDICAL MONITORING FOR RESPOND16 ERS.—Medical monitoring under section 3311, in17 cluding clinical examinations and long-term health 

18 monitoring and analysis for enrolled WTC respond19 ers who were likely to have been exposed to airborne 

20 toxins that were released, or to other hazards, as a 

21 result of the September 11, 2001, terrorist attacks. 

22 ‘‘(2) INITIAL HEALTH EVALUATION FOR SUR23 VIVORS.—An initial health evaluation under section 

24 3321, including an evaluation to determine eligibility 

25 for followup monitoring and treatment. 
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1 ‘‘(3) FOLLOWUP MONITORING AND TREATMENT

2 FOR WTC-RELATED HEALTH CONDITIONS FOR RE3 SPONDERS AND SURVIVORS.—Provision under sec4 tions 3312, 3322, and 3323 of followup monitoring 

5 and treatment and payment, subject to the provi6 sions of subsection (d), for all medically necessary 

7 health and mental health care expenses of an indi8 vidual with respect to a WTC-related health condi9 tion (including necessary prescription drugs). 

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

11 3303 of an education and outreach program to po12 tentially eligible individuals concerning the benefits 

13 under this title. 

14 ‘‘(5) CLINICAL DATA COLLECTION AND ANAL15 YSIS.—Collection and analysis under section 3304 of 

16 health and mental health data relating to individuals 

17 receiving monitoring or treatment benefits in a uni18 form manner in collaboration with the collection of 

19 epidemiological data under section 3342. 

20 ‘‘(6) RESEARCH ON HEALTH CONDITIONS.—Es21 tablishment under subtitle C of a research program 

22 on health conditions resulting from the September 

23 11, 2001, terrorist attacks. 

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

25 benefits and initial health evaluation benefits are provided 
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1 under subtitle B without any deductibles, copayments, or 

2 other cost sharing to an enrolled WTC responder or cer3 tified-eligible WTC survivor. Initial health evaluation ben4 efits are provided under subtitle B without any 

5 deductibles, copayments, or other cost sharing to a screen6 ing-eligible WTC survivor. 

7 ‘‘(d) PREVENTING FRAUD AND UNREASONABLE AD8 MINISTRATIVE COSTS.— 

9 ‘‘(1) FRAUD.—The Inspector General of the 

10 Department of Health and Human Services shall de11 velop and implement a program to review the WTC 

12 Program’s health care expenditures to detect fraudu13 lent or duplicate billing and payment for inappro14 priate services. This title is a Federal health care 

15 program (as defined in section 1128B(f) of the So16 cial Security Act) and is a health plan (as defined 

17 in section 1128C(c) of such Act) for purposes of ap18 plying sections 1128 through 1128E of such Act. 

19 ‘‘(2) UNREASONABLE ADMINISTRATIVE

20 COSTS.—The Inspector General of the Department 

21 of Health and Human Services shall develop and im22 plement a program to review the WTC Program for 

23 unreasonable administrative costs, including with re24 spect to infrastructure, administration, and claims 

25 processing. 
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1 ‘‘(e) QUALITY ASSURANCE.—The WTC Program Ad2 ministrator working with the Clinical Centers of Excel3 lence shall develop and implement a quality assurance pro4 gram for the monitoring and treatment delivered by such 

5 Centers of Excellence and any other participating health 

6 care providers. Such program shall include— 

7 ‘‘(1) adherence to monitoring and treatment 

8 protocols; 

9 ‘‘(2) appropriate diagnostic and treatment re10 ferrals for participants; 

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

12 participants; and 

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

14 specifies in consultation with the Clinical Centers of 

15 Excellence. 

16 ‘‘(f) ANNUAL PROGRAM REPORT.— 

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

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

19 Program is in operation, the WTC Program Admin20 istrator shall submit an annual report to the Con21 gress on the operations of this title for such fiscal 

22 year and for the entire period of operation of the 

23 program. 
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1 ‘‘(2) CONTENTS INCLUDED IN REPORT.—Each 

2 annual report under paragraph (1) shall include at 

3 least the following: 

4 ‘‘(A) ELIGIBLE INDIVIDUALS.—Informa5 tion for each clinical program described in para6 graph (3)— 

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

8 applied for certification under subtitle B 

9 and the number of such individuals who 

10 were so certified; 

11 ‘‘(ii) of the individuals who were cer12 tified, on the number who received moni13 toring under the program and the number 

14 of such individuals who received medical 

15 treatment under the program; 

16 ‘‘(iii) with respect to individuals so 

17 certified who received such treatment, on 

18 the WTC-related health conditions for 

19 which they were treated; and 

20 ‘‘(iv) on the projected number of indi21 viduals who will be certified under subtitle 

22 B in the succeeding fiscal year and the 

23 succeeding 10-year period. 
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1 ‘‘(B) MONITORING, INITIAL HEALTH EVAL2 UATION, AND TREATMENT COSTS.—For each 

3 clinical program so described— 

4 ‘‘(i) information on the costs of moni5 toring and initial health evaluation and the 

6 costs of treatment and on the estimated 

7 costs of such monitoring, evaluation, and 

8 treatment in the succeeding fiscal year; 

9 and 

10 ‘‘(ii) an estimate of the cost of med11 ical treatment for WTC-related health con12 ditions that have been paid for or reim13 bursed by workers’ compensation, by public 

14 or private health plans, or by New York 

15 City under section 3331. 

16 ‘‘(C) ADMINISTRATIVE COSTS.—Informa17 tion on the cost of administering the program, 

18 including costs of program support, data collec19 tion and analysis, and research conducted under 

20 the program. 

21 ‘‘(D) ADMINISTRATIVE EXPERIENCE.—In22 formation on the administrative performance of 

23 the program, including— 
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1 ‘‘(i) the performance of the program 

2 in providing timely evaluation of and treat3 ment to eligible individuals; and 

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

5 Excellence and other providers that are 

6 participating in the program. 

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

8 of the findings of any new scientific reports or 

9 studies on the health effects associated with ex10 posure described in section 3306(1), including 

11 the findings of research conducted under sec12 tion 3341(a). 

13 ‘‘(F) ADVISORY COMMITTEE REC14 OMMENDATIONS.—A list of recommendations by 

15 the WTC Scientific/Technical Advisory Com16 mittee on additional WTC Program eligibility 

17 criteria and on additional WTC-related health 

18 conditions and the action of the WTC Program 

19 Administrator concerning each such rec20 ommendation. 

21 ‘‘(3) SEPARATE CLINICAL PROGRAMS DE22 SCRIBED.—In paragraph (2), each of the following 

23 shall be treated as a separate clinical program of the 

24 WTC Program: 
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1 ‘‘(A) FIREFIGHTERS AND RELATED PER2 SONNEL.—The benefits provided for enrolled 

3 WTC responders described in section 

4 3311(a)(2)(A). 

5 ‘‘(B) OTHER WTC RESPONDERS.—The ben6 efits provided for enrolled WTC responders not 

7 described in subparagraph (A). 

8 ‘‘(C) WTC SURVIVORS.—The benefits pro9 vided for screening-eligible WTC survivors and 

10 certified-eligible WTC survivors in section 

11 3321(a). 

12 ‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING

13 80 PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The 

14 Secretary shall promptly notify the Congress of each of 

15 the following: 

16 ‘‘(1) When the number of enrollments of WTC 

17 responders subject to the limit established under sec18 tion 3311(a)(4) has reached 80 percent of such 

19 limit. 

20 ‘‘(2) When the number of certifications for cer21 tified-eligible WTC survivors subject to the limit es22 tablished under section 3321(a)(3) has reached 80 

23 percent of such limit. 

24 ‘‘(h) CONSULTATION.—The WTC Program Adminis25 trator shall engage in ongoing outreach and consultation 
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1 with relevant stakeholders, including the WTC Health 

2 Program Steering Committees and the Advisory Com3 mittee under section 3302, regarding the implementation 

4 and improvement of programs under this title. 

5 ‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECH6 NICAL ADVISORY COMMITTEE; WTC HEALTH 

7 PROGRAM STEERING COMMITTEES. 

8 ‘‘(a) ADVISORY COMMITTEE.— 

9 ‘‘(1) ESTABLISHMENT.—The WTC Program 

10 Administrator shall establish an advisory committee 

11 to be known as the WTC Health Program Scientific/ 

12 Technical Advisory Committee (in this subsection re13 ferred to as the ‘Advisory Committee’) to review sci14 entific and medical evidence and to make rec15 ommendations to the Administrator on additional 

16 WTC Program eligibility criteria and on additional 

17 WTC-related health conditions. 

18 ‘‘(2) COMPOSITION.—The WTC Program Ad19 ministrator shall appoint the members of the Advi20 sory Committee and shall include at least— 

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

22 of whom have experience treating WTC rescue 

23 and recovery workers; 

24 ‘‘(B) 1 physician with expertise in pul25 monary medicine; 
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1 ‘‘(C) 2 environmental medicine or environ2 mental health specialists; 

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

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

5 WTC survivors; 

6 ‘‘(F) an industrial hygienist; 

7 ‘‘(G) a toxicologist; 

8 ‘‘(H) an epidemiologist; and 

9 ‘‘(I) a mental health professional. 

10 ‘‘(3) MEETINGS.—The Advisory Committee 

11 shall meet at such frequency as may be required to 

12 carry out its duties. 

13 ‘‘(4) REPORTS.—The WTC Program Adminis14 trator shall provide for publication of recommenda15 tions of the Advisory Committee on the public Web 

16 site established for the WTC Program. 

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

18 provision of law, the Advisory Committee shall con19 tinue in operation during the period in which the 

20 WTC Program is in operation. 

21 ‘‘(6) APPLICATION OF FACA.—Except as other22 wise specifically provided, the Advisory Committee 

23 shall be subject to the Federal Advisory Committee 

24 Act. 
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1 ‘‘(b) WTC HEALTH PROGRAM STEERING COMMIT2 TEES.— 

3 ‘‘(1) CONSULTATION.—The WTC Program Ad4 ministrator shall consult with 2 steering committees 

5 (each in this section referred to as a ‘Steering Com6 mittee’) that are established as follows: 

7 ‘‘(A) WTC RESPONDERS STEERING COM8 MITTEE.—One Steering Committee, to be 

9 known as the WTC Responders Steering Com10 mittee, for the purpose of receiving input from 

11 affected stakeholders and facilitating the coordi12 nation of monitoring and treatment programs 

13 for the enrolled WTC responders under part 1 

14 of subtitle B. 

15 ‘‘(B) WTC SURVIVORS STEERING COM16 MITTEE.—One Steering Committee, to be 

17 known as the WTC Survivors Steering Com18 mittee, for the purpose of receiving input from 

19 affected stakeholders and facilitating the coordi20 nation of initial health evaluations, monitoring, 

21 and treatment programs for screening-eligible 

22 and certified-eligible WTC survivors under part 

23 2 of subtitle B. 

24 ‘‘(2) MEMBERSHIP.— 
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1 ‘‘(A) WTC RESPONDERS STEERING COM2 MITTEE.— 

3 ‘‘(i) REPRESENTATION.—The WTC 

4 Responders Steering Committee shall in5 clude— 

6 ‘‘(I) representatives of the Cen7 ters of Excellence providing services 

8 to WTC responders; 

9 ‘‘(II) representatives of labor or10 ganizations representing firefighters, 

11 police, other New York City employ12 ees, and recovery and cleanup workers 

13 who responded to the September 11, 

14 2001, terrorist attacks; and 

15 ‘‘(III) 3 representatives of New 

16 York City, 1 of whom will be selected 

17 by the police commissioner of New 

18 York City, 1 by the health commis19 sioner of New York City, and 1 by the 

20 mayor of New York City. 

21 ‘‘(ii) INITIAL MEMBERSHIP.—The 

22 WTC Responders Steering Committee shall 

23 initially be composed of members of the 

24 WTC Monitoring and Treatment Program 

25 Steering Committee (as in existence on the 
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1 day before the date of the enactment of 

2 this title). 

3 ‘‘(B) WTC SURVIVORS STEERING COM4 MITTEE.— 

5 ‘‘(i) REPRESENTATION.—The WTC 

6 Survivors Steering Committee shall include 

7 representatives of— 

8 ‘‘(I) the Centers of Excellence 

9 providing services to screening-eligible 

10 and certified-eligible WTC survivors; 

11 ‘‘(II) the population of residents, 

12 students, and area and other workers 

13 affected by the September 11, 2001, 

14 terrorist attacks; 

15 ‘‘(III) screening-eligible and cer16 tified-eligible survivors receiving initial 

17 health evaluations, monitoring, or 

18 treatment under part 2 of subtitle B 

19 and organizations advocating on their 

20 behalf; and 

21 ‘‘(IV) New York City. 

22 ‘‘(ii) INITIAL MEMBERSHIP.—The 

23 WTC Survivors Steering Committee shall 

24 initially be composed of members of the 

25 WTC Environmental Health Center Sur-
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1 vivor Advisory Committee (as in existence 

2 on the day before the date of the enact3 ment of this title). 

4 ‘‘(C) ADDITIONAL APPOINTMENTS.—Each 

5 Steering Committee may recommend, if ap6 proved by a majority of voting members of the 

7 Committee, additional members to the Com8 mittee. 

9 ‘‘(D) VACANCIES.—A vacancy in a Steer10 ing Committee shall be filled by an individual 

11 recommended by the Steering Committee. 

12 ‘‘SEC. 3303. EDUCATION AND OUTREACH. 

13 ‘‘The WTC Program Administrator shall institute a 

14 program that provides education and outreach on the ex15 istence and availability of services under the WTC Pro16 gram. The outreach and education program— 

17 ‘‘(1) shall include— 

18 ‘‘(A) the establishment of a public Web 

19 site with information about the WTC Program; 

20 ‘‘(B) meetings with potentially eligible pop21 ulations; 

22 ‘‘(C) development and dissemination of 

23 outreach materials informing people about the 

24 program; and 
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1 ‘‘(D) the establishment of phone informa2 tion services; and 

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

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

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

6 linguistically diverse populations. 

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

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

10 analysis of data and regular reports to the Administrator) 

11 on the prevalence of WTC-related health conditions and 

12 the identification of new WTC-related health conditions. 

13 Such data shall be collected for all individuals provided 

14 monitoring or treatment benefits under subtitle B and re15 gardless of their place of residence or Clinical Center of 

16 Excellence through which the benefits are provided. The 

17 WTC Program Administrator shall provide, through the 

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

19 into the monitoring and treatment program activities 

20 under this title. 

21 ‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL22 LENCE.—Each Clinical Center of Excellence shall collect 

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

24 the corresponding Data Center for analysis by such Data 

25 Center. 
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1 ‘‘(c) COLLABORATION WITH WTC HEALTH REG2 ISTRY.—The WTC Program Administrator shall provide 

3 for collaboration between the Data Centers and the World 

4 Trade Center Health Registry described in section 3342. 

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

6 under this section shall be conducted and maintained in 

7 a manner that protects the confidentiality of individually 

8 identifiable health information consistent with applicable 

9 statutes and regulations, including, as applicable, HIPAA 

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

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

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

13 CENTERS. 

14 ‘‘(a) IN GENERAL.— 

15 ‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF

16 EXCELLENCE.—The WTC Program Administrator 

17 shall, subject to subsection (b)(1)(B), enter into con18 tracts with Clinical Centers of Excellence (as defined 

19 in subsection (b)(1)(A))— 

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

21 treatment benefits and initial health evaluation 

22 benefits under subtitle B; 

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

24 to individuals eligible for such monitoring and 

25 treatment benefits, for initial health evaluation 
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1 benefits, and for followup to individuals who are 

2 enrolled in the monitoring program; 

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

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

6 for such benefits; 

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

8 benefits for WTC-related health conditions that 

9 may be available under workers’ compensation 

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

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

15 benefits; 

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

17 interpretive services for program participants 

18 who are not English language proficient; and 

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

20 data in accordance with section 3304. 

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

22 ‘‘(A) IN GENERAL.—The WTC Program 

23 Administrator shall enter into contracts with 

24 Data Centers (as defined in subsection 

25 (b)(2))— 
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1 ‘‘(i) for receiving, analyzing, and re2 porting to the WTC Program Adminis3 trator on data, in accordance with section 

4 3304, that have been collected and re5 ported to such Data Centers by the cor6 responding Clinical Centers of Excellence 

7 under subsection (b)(1)(B)(iii); 

8 ‘‘(ii) for the development of moni9 toring, initial health evaluation, and treat10 ment protocols, with respect to WTC-re11 lated health conditions; 

12 ‘‘(iii) for coordinating the outreach ac13 tivities conducted under paragraph (1)(B) 

14 by each corresponding Clinical Center of 

15 Excellence; 

16 ‘‘(iv) for establishing criteria for the 

17 credentialing of medical providers partici18 pating in the nationwide network under 

19 section 3313; 

20 ‘‘(v) for coordinating and admin21 istering the activities of the WTC Health 

22 Program Steering Committees established 

23 under section 3002(b); and 

24 ‘‘(vi) for meeting periodically with the 

25 corresponding Clinical Centers of Excel-
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1 lence to obtain input on the analysis and 

2 reporting of data collected under clause (i) 

3 and on the development of monitoring, ini4 tial health evaluation, and treatment proto5 cols under clause (ii). 

6 ‘‘(B) MEDICAL PROVIDER SELECTION.— 

7 The medical providers under subparagraph 

8 (A)(iv) shall be selected by the WTC Program 

9 Administrator on the basis of their experience 

10 treating or diagnosing the health conditions in11 cluded in the list of WTC-related health condi12 tions. 

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

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

15 engage in clinical discussions across the WTC 

16 Program to guide treatment approaches for in17 dividuals with a WTC-related health condition. 

18 ‘‘(D) TRANSPARENCY OF DATA.—A con19 tract entered into under this subsection with a 

20 Data Center shall require the Data Center to 

21 make any data collected and reported to such 

22 Center under subsection (b)(1)(B)(iii) available 

23 to health researchers and others as provided in 

24 the CDC/ATSDR Policy on Releasing and 

25 Sharing Data. 
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1 ‘‘(3) AUTHORITY FOR CONTRACTS TO BE CLASS

2 SPECIFIC.—A contract entered into under this sub3 section with a Clinical Center of Excellence or a 

4 Data Center may be with respect to one or more 

5 class of enrolled WTC responders, screening-eligible 

6 WTC survivors, or certified-eligible WTC survivors. 

7 ‘‘(4) USE OF COOPERATIVE AGREEMENTS.— 

8 Any contract under this title between the WTC Pro9 gram Administrator and a Data Center or a Clinical 

10 Center of Excellence may be in the form of a cooper11 ative agreement. 

12 ‘‘(b) CENTERS OF EXCELLENCE.— 

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

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

15 title, the term ‘Clinical Center of Excellence’ 

16 means a Center that demonstrates to the satis17 faction of the Administrator that the Center— 

18 ‘‘(i) uses an integrated, centralized 

19 health care provider approach to create a 

20 comprehensive suite of health services 

21 under this title that are accessible to en22 rolled WTC responders, screening-eligible 

23 WTC survivors, or certified-eligible WTC 

24 survivors; 
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1 ‘‘(ii) has experience in caring for 

2 WTC responders and screening-eligible 

3 WTC survivors or includes health care pro4 viders who have been trained pursuant to 

5 section 3313(c); 

6 ‘‘(iii) employs health care provider 

7 staff with expertise that includes, at a min8 imum, occupational medicine, environ9 mental medicine, trauma-related psychiatry 

10 and psychology, and social services coun11 seling; and 

12 ‘‘(iv) meets such other requirements 

13 as specified by the Administrator. 

14 ‘‘(B) CONTRACT REQUIREMENTS.—The 

15 WTC Program Administrator shall not enter 

16 into a contract with a Clinical Center of Excel17 lence under subsection (a)(1) unless the Center 

18 agrees to do each of the following: 

19 ‘‘(i) Establish a formal mechanism for 

20 consulting with and receiving input from 

21 representatives of eligible populations re22 ceiving monitoring and treatment benefits 

23 under subtitle B from such Center. 

24 ‘‘(ii) Coordinate monitoring and treat25 ment benefits under subtitle B with rou-
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1 tine medical care provided for the treat2 ment of conditions other than WTC-related 

3 health conditions. 

4 ‘‘(iii) Collect and report to the cor5 responding Data Center data in accordance 

6 with section 3304(b). 

7 ‘‘(iv) Have in place safeguards against 

8 fraud that are satisfactory to the Adminis9 trator, in consultation with the Inspector 

10 General of the Department of Health and 

11 Human Services. 

12 ‘‘(v) Treat or refer for treatment all 

13 individuals who are enrolled WTC respond14 ers or certified-eligible WTC survivors with 

15 respect to such Center who present them16 selves for treatment of a WTC-related 

17 health condition. 

18 ‘‘(vi) Have in place safeguards, con19 sistent with section 3304(c), to ensure the 

20 confidentiality of an individual’s individ21 ually identifiable health information, in22 cluding requiring that such information 

23 not be disclosed to the individual’s em24 ployer without the authorization of the in25 dividual. 
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1 ‘‘(vii) Use amounts paid under sub2 section (c)(1) only for costs incurred in 

3 carrying out the activities described in sub4 section (a), other than those described in 

5 subsection (a)(1)(A). 

6 ‘‘(viii) Utilize health care providers 

7 with occupational and environmental medi8 cine expertise to conduct physical and 

9 mental health assessments, in accordance 

10 with protocols developed under subsection 

11 (a)(2)(A)(ii). 

12 ‘‘(ix) Communicate with WTC re13 sponders and screening-eligible and cer14 tified-eligible WTC survivors in appropriate 

15 languages and conduct outreach activities 

16 with relevant stakeholder worker or com17 munity associations. 

18 ‘‘(x) Meet all the other applicable re19 quirements of this title, including regula20 tions implementing such requirements. 

21 ‘‘(C) TRANSITION RULE TO ENSURE CON22 TINUITY OF CARE.—The WTC Program Admin23 istrator shall to the maximum extent feasible 

24 ensure continuity of care in any period of tran25 sition from monitoring and treatment of an en-
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1 rolled WTC responder or certified-eligible WTC 

2 survivor by a provider to a Clinical Center of 

3 Excellence or a health care provider partici4 pating in the nationwide network under section 

5 3313. 

6 ‘‘(2) DATA CENTERS.—For purposes of this 

7 title, the term ‘Data Center’ means a Center that 

8 the WTC Program Administrator determines has the 

9 capacity to carry out the responsibilities for a Data 

10 Center under subsection (a)(2). 

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

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

13 Data Center shall be treated as ‘corresponding’ to 

14 the extent that such Clinical Center and Data Cen15 ter serve the same population group. 

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

17 ‘‘(1) IN GENERAL.—The WTC Program Admin18 istrator shall reimburse a Clinical Center of Excel19 lence for the fixed infrastructure costs of such Cen20 ter in carrying out the activities described in subtitle 

21 B at a rate negotiated by the Administrator and 

22 such Centers. Such negotiated rate shall be fair and 

23 appropriate and take into account the number of en24 rolled WTC responders receiving services from such 

25 Center under this title. 
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1 ‘‘(2) FIXED INFRASTRUCTURE COSTS.—For 

2 purposes of paragraph (1), the term ‘fixed infra3 structure costs’ means, with respect to a Clinical 

4 Center of Excellence, the costs incurred by such 

5 Center that are not reimbursable by the WTC Pro6 gram Administrator under section 3312(c). 

7 ‘‘SEC. 3306. DEFINITIONS. 

8 ‘‘In this title: 

9 ‘‘(1) The term ‘aggravating’ means, with re10 spect to a health condition, a health condition that 

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

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

13 any other adverse condition resulting from the Sep14 tember 11, 2001, terrorist attacks, requires medical 

15 treatment that is (or will be) in addition to, more 

16 frequent than, or of longer duration than the med17 ical treatment that would have been required for 

18 such condition in the absence of such exposure. 

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

20 has the meaning given such term in section 

21 3321(a)(2). 

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

23 and ‘Data Center’ have the meanings given such 

24 terms in section 3305. 
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1 ‘‘(4) The term ‘enrolled WTC responder’ means 

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

3 ‘‘(5) The term ‘initial health evaluation’ in4 cludes, with respect to an individual, a medical and 

5 exposure history, a physical examination, and addi6 tional medical testing as needed to evaluate whether 

7 the individual has a WTC-related health condition 

8 and is eligible for treatment under the WTC Pro9 gram. 

10 ‘‘(6) The term ‘list of WTC-related health con11 ditions’ means— 

12 ‘‘(A) for WTC responders, the health con13 ditions listed in section 3312(a)(3); and 

14 ‘‘(B) for screening-eligible and certified-eli15 gible WTC survivors, the health conditions list16 ed in section 3322(b). 

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

18 means the area within New York City that is— 

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

20 of Houston Street; and 

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

22 or partially contained within a 1.5-mile radius 

23 of the former World Trade Center site. 

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

25 means an area, specified by the WTC Program Ad-
30 

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1 ministrator, within which WTC responders and eligi2 ble WTC screening-eligible survivors who reside in 

3 such area are reasonably able to access monitoring 

4 and treatment benefits and initial health evaluation 

5 benefits under this title through a Clinical Center of 

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

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

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

9 has the meaning given such term in section 

10 3321(a)(1). 

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

12 shall be deemed a reference to the period on such 

13 date subsequent to the terrorist attacks at the World 

14 Trade Center, Shanksville, Pennsylvania, or the 

15 Pentagon, as applicable, on such date. 

16 ‘‘(11) The term ‘September 11, 2001, terrorist 

17 attacks’ means the terrorist attacks that occurred on 

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

19 Shanksville, Pennsylvania, and at the Pentagon, and 

20 includes the aftermath of such attacks. 

21 ‘‘(12) The term ‘WTC Health Program Steer22 ing Committee’ means such a Steering Committee 

23 established under section 3302(b). 
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1 ‘‘(13) The term ‘WTC Program’ means the 

2 Word Trade Center Health Program established 

3 under section 3301(a). 

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

5 means— 

6 ‘‘(A) with respect to paragraphs (3) and 

7 (4) of section 3311(a) (relating to enrollment of 

8 WTC responders), section 3312(c) and the cor9 responding provisions of section 3322 (relating 

10 to payment for initial health evaluation, moni11 toring, and treatment), paragraphs (1)(C), 

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

13 determination or certification of screening-eligi14 ble or certified-eligible WTC responders), and 

15 part 3 of subtitle B (relating to payor provi16 sions), an official in the Department of Health 

17 and Human Services, to be designated by the 

18 Secretary; and 

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

20 this title, the Director of the National Institute 

21 for Occupational Safety and Health, or a des22 ignee of such Director. 

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

24 is defined in section 3312(a). 
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1 ‘‘(16) The term ‘WTC responder’ is defined in 

2 section 3311(a). 

3 ‘‘(17) The term ‘WTC Scientific/Technical Ad4 visory Committee’ means such Committee estab5 lished under section 3302(a). 

6 ‘‘Subtitle B—Program of Moni7 toring, Initial Health Evalua8 tions, and Treatment 

9 ‘‘PART 1—WTC RESPONDERS 

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

11 PROVISION OF WTC-RELATED MONITORING 

12 SERVICES. 

13 ‘‘(a) WTC RESPONDER DEFINED.— 

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

15 the term ‘WTC responder’ means any of the fol16 lowing individuals, subject to paragraph (4): 

17 ‘‘(A) CURRENTLY IDENTIFIED RE18 SPONDER.—An individual who has been identi19 fied as eligible for monitoring under the ar20 rangements as in effect on the date of the en21 actment of this title between the National Insti22 tute for Occupational Safety and Health and— 

23 ‘‘(i) the consortium coordinated by 

24 Mt. Sinai Hospital in New York City that 

25 coordinates the monitoring and treatment 
33 

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1 for enrolled WTC responders other than 

2 with respect to those covered under the ar3 rangement with the Fire Department of 

4 New York City; or 

5 ‘‘(ii) the Fire Department of New 

6 York City. 

7 ‘‘(B) RESPONDER WHO MEETS CURRENT

8 ELIGIBILITY CRITERIA.—An individual who 

9 meets the current eligibility criteria described in 

10 paragraph (2). 

11 ‘‘(C) RESPONDER WHO MEETS MODIFIED

12 ELIGIBILITY CRITERIA.—An individual who— 

13 ‘‘(i) performed rescue, recovery, demo14 lition, debris cleanup, or other related serv15 ices in the New York City disaster area in 

16 response to the September 11, 2001, ter17 rorist attacks, regardless of whether such 

18 services were performed by a State or Fed19 eral employee or member of the National 

20 Guard or otherwise; and 

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

23 hazards, or adverse conditions resulting 

24 from the September 11, 2001, terrorist at25 tacks as the WTC Program Administrator, 
34 

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1 after consultation with the WTC Scientific/ 

2 Technical Advisory Committee, determines 

3 appropriate. 

4 The WTC Program Administrator shall not 

5 modify such eligibility criteria on or after the 

6 date that the number of enrollments of WTC 

7 responders has reached 80 percent of the limit 

8 described in paragraph (4) or on or after the 

9 date that the number of certifications for cer10 tified-eligible WTC survivors under section 

11 3321(a)(2)(B) has reached 80 percent of the 

12 limit described in section 3321(a)(3). 

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

14 eligibility criteria described in this paragraph for an 

15 individual is that the individual is described in any 

16 of the following categories: 

17 ‘‘(A) FIREFIGHTERS AND RELATED PER18 SONNEL.—The individual— 

19 ‘‘(i) was a member of the Fire De20 partment of New York City (whether fire 

21 or emergency personnel, active or retired) 

22 who participated at least one day in the 

23 rescue and recovery effort at any of the 

24 former World Trade Center sites (includ25 ing Ground Zero, Staten Island Landfill, 
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1 and the New York City Chief Medical Ex2 aminer’s Office) for any time during the 

3 period beginning on September 11, 2001, 

4 and ending on July 31, 2002; or 

5 ‘‘(ii)(I) is a surviving immediate fam6 ily member of an individual who was a 

7 member of the Fire Department of New 

8 York City (whether fire or emergency per9 sonnel, active or retired) and was killed at 

10 the World Trade site on September 11, 

11 2001; and 

12 ‘‘(II) received any treatment for a 

13 WTC-related health condition described in 

14 section 3312(a)(1)(A)(ii) (relating to men15 tal health conditions) on or before Sep16 tember 1, 2008. 

17 ‘‘(B) LAW ENFORCEMENT OFFICERS AND

18 WTC RESCUE, RECOVERY, AND CLEANUP WORK19 ERS.—The individual— 

20 ‘‘(i) worked or volunteered onsite in 

21 rescue, recovery, debris cleanup, or related 

22 support services in lower Manhattan (south 

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

24 or the barge loading piers, for at least 4 

25 hours during the period beginning on Sep-
36 

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1 tember 11, 2001, and ending on Sep2 tember 14, 2001, for at least 24 hours 

3 during the period beginning on September 

4 11, 2001, and ending on September 30, 

5 2001, or for at least 80 hours during the 

6 period beginning on September 11, 2001, 

7 and ending on July 31, 2002; 

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

9 Department of New York City (whether 

10 active or retired) or a member of the Port 

11 Authority Police of the Port Authority of 

12 New York and New Jersey (whether active 

13 or retired) who participated onsite in res14 cue, recovery, debris cleanup, or related 

15 services in lower Manhattan (south of 

16 Canal St.), including Ground Zero, the 

17 Staten Island Landfill, or the barge load18 ing piers, for at least 4 hours during the 

19 period beginning September 11, 2001, and 

20 ending on September 14, 2001; 

21 ‘‘(II) participated onsite in rescue, re22 covery, debris cleanup, or related services 

23 in at Ground Zero, the Staten Island 

24 Landfill, or the barge loading piers, for at 

25 least one day during the period beginning 
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1 on September 11, 2001, and ending on 

2 July 31, 2002; 

3 ‘‘(III) participated onsite in rescue, 

4 recovery, debris cleanup, or related services 

5 in lower Manhattan (south of Canal St.) 

6 for at least 24 hours during the period be7 ginning on September 11, 2001, and end8 ing on September 30, 2001; or 

9 ‘‘(IV) participated onsite in rescue, re10 covery, debris cleanup, or related services 

11 in lower Manhattan (south of Canal St.) 

12 for at least 80 hours during the period be13 ginning on September 11, 2001, and end14 ing on July 31, 2002; 

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

16 the Chief Medical Examiner of New York 

17 City involved in the examination and han18 dling of human remains from the World 

19 Trade Center attacks, or other morgue 

20 worker who performed similar post-Sep21 tember 11 functions for such Office staff, 

22 during the period beginning on September 

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

24 ‘‘(iv) was a worker in the Port Au25 thority Trans-Hudson Corporation Tunnel 
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1 for at least 24 hours during the period be2 ginning on February 1, 2002, and ending 

3 on July 1, 2002; or 

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

5 who was exposed to debris from the former 

6 World Trade Center while retrieving, driv7 ing, cleaning, repairing, and maintaining 

8 vehicles contaminated by airborne toxins 

9 from the September 11, 2001, terrorist at10 tacks during a duration and period de11 scribed in subparagraph (A). 

12 ‘‘(C) RESPONDERS TO THE SEPTEMBER 11

13 ATTACKS AT THE PENTAGON AND

14 SHANKSVILLE, PENNSYLVANIA.—The indi15 vidual— 

16 ‘‘(i)(I) was a member of a fire or po17 lice department (whether fire or emergency 

18 personnel, active or retired), worked for a 

19 recovery or cleanup contractor, or was a 

20 volunteer; and performed rescue, recovery, 

21 demolition, debris cleanup, or other related 

22 services at the Pentagon site of the ter23 rorist-related aircraft crash of September 

24 11, 2001, during the period beginning on 

25 September 11, 2001, and ending on the 
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1 date on which the cleanup of the site was 

2 concluded, as determined by the WTC Pro3 gram Administrator; or 

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

5 department (whether fire or emergency 

6 personnel, active or retired), worked for a 

7 recovery or cleanup contractor, or was a 

8 volunteer; and performed rescue, recovery, 

9 demolition, debris cleanup, or other related 

10 services at the Shanksville, Pennsylvania, 

11 site of the terrorist-related aircraft crash 

12 of September 11, 2001, during the period 

13 beginning on September 11, 2001, and 

14 ending on the date on which the cleanup of 

15 the site was concluded, as determined by 

16 the WTC Program Administrator; and 

17 ‘‘(ii) is determined by the WTC Pro18 gram Administrator to be at an increased 

19 risk of developing a WTC-related health 

20 condition as a result of exposure to air21 borne toxins, other hazards, or adverse 

22 conditions resulting from the September 

23 11, 2001, terrorist attacks, and meets such 

24 eligibility criteria related to such expo25 sures, as the WTC Program Administrator 
40 

•HR 847 EH

1 determines are appropriate, after consulta2 tion with the WTC Scientific/Technical Ad3 visory Committee. 

4 ‘‘(3) ENROLLMENT PROCESS.— 

5 ‘‘(A) IN GENERAL.—The WTC Program 

6 Administrator shall establish a process for en7 rolling WTC responders in the WTC Program. 

8 Under such process— 

9 ‘‘(i) WTC responders described in 

10 paragraph (1)(A) shall be deemed to be en11 rolled in such Program; 

12 ‘‘(ii) subject to clause (iii), the Admin13 istrator shall enroll in such program indi14 viduals who are determined to be WTC re15 sponders; 

16 ‘‘(iii) the Administrator shall deny 

17 such enrollment to an individual if the Ad18 ministrator determines that the numerical 

19 limitation in paragraph (4) on enrollment 

20 of WTC responders has been met; 

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

22 the applicant for making an application for 

23 such enrollment; 

24 ‘‘(v) the Administrator shall make a 

25 determination on such an application not 
41 

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1 later than 60 days after the date of filing 

2 the application; and 

3 ‘‘(vi) an individual who is denied en4 rollment in such Program shall have an op5 portunity to appeal such determination in 

6 a manner established under such process. 

7 ‘‘(B) TIMING.— 

8 ‘‘(i) CURRENTLY IDENTIFIED RE9 SPONDERS.—In accordance with subpara10 graph (A)(i), the WTC Program Adminis11 trator shall enroll an individual described 

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

13 not later than July 1, 2011. 

14 ‘‘(ii) OTHER RESPONDERS.—In ac15 cordance with subparagraph (A)(ii) and 

16 consistent with paragraph (4), the WTC 

17 Program Administrator shall enroll any 

18 other individual who is determined to be a 

19 WTC responder in the WTC Program at 

20 the time of such determination. 

21 ‘‘(4) NUMERICAL LIMITATION ON ELIGIBLE

22 WTC RESPONDERS.— 

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

24 individuals not described in paragraph (1)(A) or 

25 (2)(A)(ii) who may be enrolled under paragraph 
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1 (3)(A)(ii) shall not exceed 25,000 at any time, 

2 of which no more than 2,500 may be individ3 uals enrolled based on modified eligibility cri4 teria established under paragraph (1)(C). 

5 ‘‘(B) PROCESS.—In implementing subpara6 graph (A), the WTC Program Administrator 

7 shall— 

8 ‘‘(i) limit the number of enrollments 

9 made under paragraph (3)— 

10 ‘‘(I) in accordance with such sub11 paragraph; and 

12 ‘‘(II) to such number, as deter13 mined by the Administrator based on 

14 the best available information and 

15 subject to amounts available under 

16 section 3351, that will ensure suffi17 cient funds will be available to provide 

18 treatment and monitoring benefits 

19 under this title, with respect to all in20 dividuals who are enrolled through the 

21 end of fiscal year 2020; and 

22 ‘‘(ii) provide priority (subject to para23 graph (3)(A)(i)) in such enrollments in the 

24 order in which individuals apply for enroll25 ment under paragraph (3). 
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1 ‘‘(5) DISQUALIFICATION OF INDIVIDUALS ON

2 TERRORIST WATCH LIST.—No individual who is on 

3 the terrorist watch list maintained by the Depart4 ment of Homeland Security shall qualify as an eligi5 ble WTC responder. Before enrolling any individual 

6 as a WTC responder in the WTC Program under 

7 paragraph (3), the Administrator, in consultation 

8 with the Secretary of Homeland Security, shall de9 termine whether the individual is on such list. 

10 ‘‘(b) MONITORING BENEFITS.— 

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

12 WTC responder (other than one described in sub13 section (a)(2)(A)(ii)), the WTC Program shall pro14 vide for monitoring benefits that include monitoring 

15 consistent with protocols approved by the WTC Pro16 gram Administrator and including clinical examina17 tions and long-term health monitoring and analysis. 

18 In the case of an enrolled WTC responder who is an 

19 active member of the Fire Department of New York 

20 City, the responder shall receive such benefits as 

21 part of the individual’s periodic company medical 

22 exams. 

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

24 The monitoring benefits under paragraph (1) shall 

25 be provided through the Clinical Center of Excel-
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1 lence for the type of individual involved or, in the 

2 case of an individual residing outside the New York 

3 metropolitan area, under an arrangement under sec4 tion 3313. 

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

6 FOR WTC-RELATED HEALTH CONDITIONS. 

7 ‘‘(a) WTC-RELATED HEALTH CONDITION DE8 FINED.— 

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

10 the term ‘WTC-related health condition’ means a 

11 condition that— 

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

13 which exposure to airborne toxins, any other 

14 hazard, or any other adverse condition resulting 

15 from the September 11, 2001, terrorist attacks, 

16 based on an examination by a medical profes17 sional with experience in treating or diagnosing 

18 the health conditions included in the applicable 

19 list of WTC-related health conditions, is sub20 stantially likely to be a significant factor in ag21 gravating, contributing to, or causing the illness 

22 or health condition, as determined under para23 graph (2); or 

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

25 such attacks, based on an examination by a 
45 

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1 medical professional with experience in treating 

2 or diagnosing the health conditions included in 

3 the applicable list of WTC-related health condi4 tions, is substantially likely to be a significant 

5 factor in aggravating, contributing to, or caus6 ing the condition, as determined under para7 graph (2); and 

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

9 WTC-related health conditions or— 

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

11 is provided certification of coverage under 

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

13 ‘‘(ii) with respect to a screening-eligi14 ble WTC survivor or certified-eligible WTC 

15 survivor, is provided certification of cov16 erage under subsection (b)(2)(B)(iii), as 

17 applied under section 3322(a). 

18 In the case of a WTC responder described in section 

19 3311(a)(2)(A)(ii) (relating to a surviving immediate 

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

21 include an illness or health condition described in 

22 subparagraph (A)(i). 

23 ‘‘(2) DETERMINATION.—The determination 

24 under paragraph (1) or subsection (b) of whether 

25 the September 11, 2001, terrorist attacks were sub-
46 

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1 stantially likely to be a significant factor in aggra2 vating, contributing to, or causing an individual’s ill3 ness or health condition shall be made based on an 

4 assessment of the following: 

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

6 toxins, any other hazard, or any other adverse 

7 condition resulting from the terrorist attacks. 

8 Such exposure shall be— 

9 ‘‘(i) evaluated and characterized 

10 through the use of a standardized, popu11 lation-appropriate questionnaire approved 

12 by the Director of the National Institute 

13 for Occupational Safety and Health; and 

14 ‘‘(ii) assessed and documented by a 

15 medical professional with experience in 

16 treating or diagnosing health conditions in17 cluded on the list of WTC-related health 

18 conditions. 

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

20 sequence of symptoms. Such symptoms shall 

21 be— 

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

23 standardized, population-appropriate med24 ical questionnaire approved by the Director 

25 of the National Institute for Occupational 
47 

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1 Safety and Health and a medical examina2 tion; and 

3 ‘‘(ii) diagnosed and documented by a 

4 medical professional described in subpara5 graph (A)(ii). 

6 ‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC

7 RESPONDERS.—The list of health conditions for 

8 WTC responders consists of the following: 

9 ‘‘(A) AERODIGESTIVE DISORDERS.— 

10 ‘‘(i) Interstitial lung diseases. 

11 ‘‘(ii) Chronic respiratory disorder— 

12 fumes/vapors. 

13 ‘‘(iii) Asthma. 

14 ‘‘(iv) Reactive airways dysfunction 

15 syndrome (RADS). 

16 ‘‘(v) WTC-exacerbated chronic ob17 structive pulmonary disease (COPD). 

18 ‘‘(vi) Chronic cough syndrome. 

19 ‘‘(vii) Upper airway hyperreactivity. 

20 ‘‘(viii) Chronic rhinosinusitis. 

21 ‘‘(ix) Chronic nasopharyngitis. 

22 ‘‘(x) Chronic laryngitis. 

23 ‘‘(xi) Gastroesophageal reflux disorder 

24 (GERD). 
48 

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1 ‘‘(xii) Sleep apnea exacerbated by or 

2 related to a condition described in a pre3 vious clause. 

4 ‘‘(B) MENTAL HEALTH CONDITIONS.— 

5 ‘‘(i) Posttraumatic stress disorder 

6 (PTSD). 

7 ‘‘(ii) Major depressive disorder. 

8 ‘‘(iii) Panic disorder. 

9 ‘‘(iv) Generalized anxiety disorder. 

10 ‘‘(v) Anxiety disorder (not otherwise 

11 specified). 

12 ‘‘(vi) Depression (not otherwise speci13 fied). 

14 ‘‘(vii) Acute stress disorder. 

15 ‘‘(viii) Dysthymic disorder. 

16 ‘‘(ix) Adjustment disorder. 

17 ‘‘(x) Substance abuse. 

18 ‘‘(C) MUSCULOSKELETAL DISORDERS FOR

19 CERTAIN WTC RESPONDERS.—In the case of a 

20 WTC responder described in paragraph (4), a 

21 condition described in such paragraph. 

22 ‘‘(D) ADDITIONAL CONDITIONS.—Any can23 cer (or type of cancer) or other condition added, 

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

25 under this paragraph. 
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1 ‘‘(4) MUSCULOSKELETAL DISORDERS.— 

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

3 title, in the case of a WTC responder who re4 ceived any treatment for a WTC-related mus5 culoskeletal disorder on or before September 11, 

6 2003, the list of health conditions in paragraph 

7 (3) shall include: 

8 ‘‘(i) Low back pain. 

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

10 ‘‘(iii) Other musculoskeletal disorders. 

11 ‘‘(B) DEFINITION.—The term ‘WTC-re12 lated musculoskeletal disorder’ means a chronic 

13 or recurrent disorder of the musculoskeletal 

14 system caused by heavy lifting or repetitive 

15 strain on the joints or musculoskeletal system 

16 occurring during rescue or recovery efforts in 

17 the New York City disaster area in the after18 math of the September 11, 2001, terrorist at19 tacks. 

20 ‘‘(5) CANCER.— 

21 ‘‘(A) IN GENERAL.—The WTC Program 

22 Administrator shall periodically conduct a re23 view of all available scientific and medical evi24 dence, including findings and recommendations 

25 of Clinical Centers of Excellence, published in 
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1 peer-reviewed journals to determine if, based on 

2 such evidence, cancer or a certain type of can3 cer should be added to the applicable list of 

4 WTC-related health conditions. The WTC Pro5 gram Administrator shall conduct the first re6 view under this subparagraph not later than 

7 180 days after the date of the enactment of this 

8 title. 

9 ‘‘(B) PROPOSED REGULATIONS AND RULE10 MAKING.—Based on the periodic reviews under 

11 subparagraph (A), if the WTC Program Admin12 istrator determines that cancer or a certain 

13 type of cancer should be added to such list of 

14 WTC-related health conditions, the WTC Pro15 gram Administrator shall propose regulations, 

16 through rulemaking, to add cancer or the cer17 tain type of cancer to such list. 

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

19 the available evidence in the rulemaking record, 

20 the WTC Program Administrator shall make a 

21 final determination of whether cancer or a cer22 tain type of cancer should be added to such list 

23 of WTC-related health conditions. If such a de24 termination is made to make such an addition, 

25 the WTC Program Administrator shall by regu-
51 

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1 lation add cancer or the certain type of cancer 

2 to such list. 

3 ‘‘(D) DETERMINATIONS NOT TO ADD CAN4 CER OR CERTAIN TYPES OF CANCER.—In the 

5 case that the WTC Program Administrator de6 termines under subparagraph (B) or (C) that 

7 cancer or a certain type of cancer should not be 

8 added to such list of WTC-related health condi9 tions, the WTC Program Administrator shall 

10 publish an explanation for such determination 

11 in the Federal Register. Any such determina12 tion to not make such an addition shall not pre13 clude the addition of cancer or the certain type 

14 of cancer to such list at a later date. 

15 ‘‘(6) ADDITION OF HEALTH CONDITIONS TO

16 LIST FOR WTC RESPONDERS.— 

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

18 Program Administrator determines that a pro19 posed rule should be promulgated to add a 

20 health condition to the list of health conditions 

21 in paragraph (3), the Administrator may re22 quest a recommendation of the Advisory Com23 mittee or may publish such a proposed rule in 

24 the Federal Register in accordance with sub25 paragraph (D). 
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1 ‘‘(B) ADMINISTRATOR’S OPTIONS AFTER

2 RECEIPT OF PETITION.—In the case that the 

3 WTC Program Administrator receives a written 

4 petition by an interested party to add a health 

5 condition to the list of health conditions in 

6 paragraph (3), not later than 60 days after the 

7 date of receipt of such petition the Adminis8 trator shall— 

9 ‘‘(i) request a recommendation of the 

10 Advisory Committee; 

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

12 Federal Register to add such health condi13 tion, in accordance with subparagraph (D); 

14 ‘‘(iii) publish in the Federal Register 

15 the Administrator’s determination not to 

16 publish such a proposed rule and the basis 

17 for such determination; or 

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

19 determination that insufficient evidence ex20 ists to take action under clauses (i) 

21 through (iii). 

22 ‘‘(C) ACTION BY ADVISORY COMMITTEE.— 

23 In the case that the Administrator requests a 

24 recommendation of the Advisory Committee 

25 under this paragraph, with respect to adding a 
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1 health condition to the list in paragraph (3), 

2 the Advisory Committee shall submit to the Ad3 ministrator such recommendation not later than 

4 60 days after the date of such request or by 

5 such date (not to exceed 180 days after such 

6 date of request) as specified by the Adminis7 trator. Not later than 60 days after the date of 

8 receipt of such recommendation, the Adminis9 trator shall, in accordance with subparagraph 

10 (D), publish in the Federal Register a proposed 

11 rule with respect to such recommendation or a 

12 determination not to propose such a proposed 

13 rule and the basis for such determination. 

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

15 Administrator shall, with respect to any pro16 posed rule under this paragraph— 

17 ‘‘(i) publish such proposed rule in ac18 cordance with section 553 of title 5, 

19 United States Code; and 

20 ‘‘(ii) provide interested parties a pe21 riod of 30 days after such publication to 

22 submit written comments on the proposed 

23 rule. 

24 The WTC Program Administrator may extend 

25 the period described in clause (ii) upon a find-
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1 ing of good cause. In the case of such an exten2 sion, the Administrator shall publish such ex3 tension in the Federal Register. 

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

5 purposes of this paragraph, the term ‘interested 

6 party’ includes a representative of any organi7 zation representing WTC responders, a nation8 ally recognized medical association, a Clinical or 

9 Data Center, a State or political subdivision, or 

10 any other interested person. 

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

12 HEALTH CONDITIONS.— 

13 ‘‘(1) DETERMINATION FOR ENROLLED WTC RE14 SPONDERS BASED ON A WTC-RELATED HEALTH CON15 DITION.— 

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

17 Clinical Center of Excellence that is providing 

18 monitoring benefits under section 3311 for an 

19 enrolled WTC responder makes a determination 

20 that the responder has a WTC-related health 

21 condition that is in the list in subsection (a)(3) 

22 and that exposure to airborne toxins, other haz23 ards, or adverse conditions resulting from the 

24 September 1, 2001, terrorist attacks is substan25 tially likely to be a significant factor in aggra-
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1 vating, contributing to, or causing the condi2 tion— 

3 ‘‘(i) the physician shall promptly 

4 transmit such determination to the WTC 

5 Program Administrator and provide the 

6 Administrator with the medical facts sup7 porting such determination; and 

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

9 transmittal and subject to subparagraph 

10 (B), the WTC Program shall provide for 

11 payment under subsection (c) for medically 

12 necessary treatment for such condition. 

13 ‘‘(B) REVIEW; CERTIFICATION; AP14 PEALS.— 

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 de24 termines that the responder’s condition is 

25 not a WTC-related health condition in the 
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1 list in subsection (a)(3) or that exposure to 

2 airborne toxins, other hazards, or adverse 

3 conditions 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 

10 for the appeal of determinations under 

11 clause (ii). 

12 ‘‘(2) DETERMINATION BASED ON MEDICALLY

13 ASSOCIATED 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 

10 rule 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 subpara18 graph (A)(i), a determination by the WTC 

19 Program Administrator on whether or not 

20 the condition involved is described in sub21 section (a)(1)(A) and is medically associ22 ated with 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 CON7 DITIONS.—If the WTC Program Administrator 

8 provides certification under subparagraph 

9 (B)(iii) for coverage of a condition, the Admin10 istrator may, pursuant to subsection (a)(6), add 

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

12 ‘‘(D) CONDITIONS ALREADY DECLINED

13 FOR INCLUSION IN LIST.—If the WTC Program 

14 Administrator 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 

22 of the publication of such determination the 

23 previous sentence shall not apply. 

24 ‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 
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1 ‘‘(A) IN GENERAL.—In providing treat2 ment for a WTC-related health condition, a 

3 physician or other provider shall provide treat4 ment that is medically necessary and in accord5 ance with medical treatment protocols estab6 lished under subsection (d). 

7 ‘‘(B) REGULATIONS RELATING TO MED8 ICAL NECESSITY.—For the purpose of this title, 

9 the WTC Program Administrator shall issue 

10 regulations specifying a standard for deter11 mining medical necessity with respect to health 

12 care services and prescription pharmaceuticals, 

13 a process for determining whether treatment 

14 furnished and pharmaceuticals prescribed under 

15 this title meet such standard (including any 

16 prior authorization requirement), and a process 

17 for appeal of a determination under subsection 

18 (c)(3). 

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

20 ‘‘(A) IN GENERAL.—The scope of treat21 ment covered under this subsection includes 

22 services of physicians and other health care pro23 viders, diagnostic and laboratory tests, prescrip24 tion drugs, inpatient and outpatient hospital 
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1 services, and other medically necessary treat2 ment. 

3 ‘‘(B) PHARMACEUTICAL COVERAGE.—With 

4 respect to ensuring coverage of medically nec5 essary outpatient prescription drugs, such drugs 

6 shall be provided, under arrangements made by 

7 the WTC Program Administrator, directly 

8 through participating Clinical Centers of Excel9 lence or through one or more outside vendors. 

10 ‘‘(C) TRANSPORTATION EXPENSES FOR

11 NATIONWIDE NETWORK.—The WTC Program 

12 Administrator may provide for necessary and 

13 reasonable transportation and expenses incident 

14 to the securing of medically necessary treat15 ment through the nationwide network under 

16 section 3313 involving travel of more than 250 

17 miles and for which payment is made under this 

18 section in the same manner in which individuals 

19 may be furnished necessary and reasonable 

20 transportation and expenses incident to services 

21 involving travel of more than 250 miles under 

22 regulations implementing section 3629(c) of the 

23 Energy Employees Occupational Illness Com24 pensation Program Act of 2000 (title XXXVI 

25 of Public Law 106–398; 42 U.S.C. 7384t(c)). 
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1 ‘‘(5) PROVISION OF TREATMENT PENDING CER2 TIFICATION.—With respect to an enrolled WTC re3 sponder for whom a determination is made by an ex4 amining physician under paragraph (1) or (2), but 

5 for whom the WTC Program Administrator has not 

6 yet determined whether to certify the determination, 

7 the WTC Program Administrator may establish by 

8 rule a process through which the Administrator may 

9 approve the provision of medical treatment under 

10 this subsection (and payment under subsection (c)) 

11 with respect to such responder and such responder’s 

12 WTC-related health condition (under such terms and 

13 conditions as the Administrator may provide) until 

14 the Administrator makes a decision on whether to 

15 certify the determination. 

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

17 MONITORING, AND TREATMENT OF WTC-RELATED

18 HEALTH CONDITIONS.— 

19 ‘‘(1) MEDICAL TREATMENT.— 

20 ‘‘(A) USE OF FECA PAYMENT RATES.— 

21 Subject to subparagraphs (B) and (C), the 

22 WTC Program Administrator shall reimburse 

23 costs for medically necessary treatment under 

24 this title for WTC-related health conditions ac25 cording to the payment rates that would apply 
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1 to the provision of such treatment and services 

2 by the facility under the Federal Employees 

3 Compensation Act. For treatment not covered 

4 under the previous sentence or subparagraph 

5 (B), the WTC Program Administrator shall es6 tablish by regulation a reimbursement rate for 

7 such treatment. 

8 ‘‘(B) PHARMACEUTICALS.— 

9 ‘‘(i) IN GENERAL.—The WTC Pro10 gram Administrator shall establish a pro11 gram for paying for the medically nec12 essary outpatient prescription pharma13 ceuticals prescribed under this title for 

14 WTC-related health conditions through one 

15 or more contracts with outside vendors. 

16 ‘‘(ii) COMPETITIVE BIDDING.—Under 

17 such program the Administrator shall— 

18 ‘‘(I) select one or more appro19 priate vendors through a Federal com20 petitive bid process; and 

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

22 bidders) meeting the requirements for 

23 providing pharmaceutical benefits for 

24 participants in the WTC Program. 
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1 ‘‘(iii) TREATMENT OF FDNY PARTICI2 PANTS.—Under such program the Admin3 istrator may enter into an agreement with 

4 a separate vendor to provide pharma5 ceutical benefits to enrolled WTC respond6 ers for whom the Clinical Center of Excel7 lence is described in section 3305 if such 

8 an arrangement is deemed necessary and 

9 beneficial to the program by the WTC Pro10 gram Administrator. 

11 ‘‘(C) IMPROVING QUALITY AND EFFI12 CIENCY THROUGH MODIFICATION OF PAYMENT

13 AMOUNTS AND METHODOLOGIES.—The WTC 

14 Program Administrator may modify the 

15 amounts and methodologies for making pay16 ments for initial health evaluations, monitoring, 

17 or treatment, if, taking into account utilization 

18 and quality data furnished by the Clinical Cen19 ters of Excellence under section 

20 3305(b)(1)(B)(iii), the Administrator deter21 mines that a bundling, capitation, pay for per22 formance, or other payment methodology would 

23 better ensure high quality and efficient delivery 

24 of initial health evaluations, monitoring, or 

25 treatment to an enrolled WTC responder, 
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1 screening-eligible WTC survivor, or certified-eli2 gible WTC survivor. 

3 ‘‘(2) MONITORING AND INITIAL HEALTH EVAL4 UATION.—The WTC Program Administrator shall 

5 reimburse the costs of monitoring and the costs of 

6 an initial health evaluation provided under this title 

7 at a rate set by the Administrator by regulation. 

8 ‘‘(3) DETERMINATION OF MEDICAL NECES9 SITY.— 

10 ‘‘(A) REVIEW OF MEDICAL NECESSITY AND

11 PROTOCOLS.—As part of the process for reim12 bursement or payment under this subsection, 

13 the WTC Program Administrator shall provide 

14 for the review of claims for reimbursement or 

15 payment for the provision of medical treatment 

16 to determine if such treatment is medically nec17 essary and in accordance with medical treat18 ment protocols established under subsection (d). 

19 ‘‘(B) WITHHOLDING OF PAYMENT FOR

20 MEDICALLY UNNECESSARY TREATMENT.—The 

21 Administrator shall withhold such reimburse22 ment or payment for treatment that the Admin23 istrator determines is not medically necessary 

24 or is not in accordance with such medical treat25 ment protocols. 
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1 ‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 

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

3 develop medical treatment protocols for the treat4 ment of enrolled WTC responders and certified-eligi5 ble WTC survivors for health conditions included in 

6 the applicable list of WTC-related health conditions. 

7 ‘‘(2) APPROVAL.—The medical treatment proto8 cols developed under paragraph (1) shall be subject 

9 to approval by the WTC Program Administrator. 

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

11 ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 

12 ‘‘(a) IN GENERAL.—In order to ensure reasonable ac13 cess to benefits under this subtitle for individuals who are 

14 enrolled WTC responders, screening-eligible WTC sur15 vivors, or certified-eligible WTC survivors and who reside 

16 in any State, as defined in section 2(f), outside the New 

17 York metropolitan area, the WTC Program Administrator 

18 shall establish a nationwide network of health care pro19 viders to provide monitoring and treatment benefits and 

20 initial health evaluations near such individuals’ areas of 

21 residence in such States. Nothing in this subsection shall 

22 be construed as preventing such individuals from being 

23 provided such monitoring and treatment benefits or initial 

24 health evaluation through any Clinical Center of Excel25 lence. 
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1 ‘‘(b) NETWORK REQUIREMENTS.—Any health care 

2 provider participating in the network under subsection (a) 

3 shall— 

4 ‘‘(1) meet criteria for credentialing established 

5 by the Data Centers; 

6 ‘‘(2) follow the monitoring, initial health evalua7 tion, and treatment protocols developed under sec8 tion 3305(a)(2)(A)(ii); 

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

10 section 3304; and 

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

12 other requirements as the WTC Program Adminis13 trator establishes, including sections 1128 through 

14 1128E of the Social Security Act, as applied by sec15 tion 3301(d). 

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

17 WTC Program Administer may provide, including through 

18 contract, for the provision of training and technical assist19 ance to health care providers participating in the network 

20 under subsection (a). 
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1 ‘‘PART 2—WTC SURVIVORS 

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

5 ‘‘(a) IDENTIFICATION OF SCREENING-ELIGIBLE

6 WTC SURVIVORS AND CERTIFIED-ELIGIBLE WTC SUR7 VIVORS.— 

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

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

10 ‘screening-eligible WTC survivor’ means, sub11 ject to subparagraph (C) and paragraph (3), an 

12 individual who is described in any of the fol13 lowing clauses: 

14 ‘‘(i) CURRENTLY IDENTIFIED SUR15 VIVOR.—An individual, including a WTC 

16 responder, who has been identified as eligi17 ble for medical treatment and monitoring 

18 by the WTC Environmental Health Center 

19 as of the date of enactment of this title. 

20 ‘‘(ii) SURVIVOR WHO MEETS CURRENT

21 ELIGIBILITY CRITERIA.—An individual who 

22 is not a WTC responder, for purposes of 

23 the initial health evaluation under sub24 section (b), claims symptoms of a WTC-re25 lated health condition and meets any of the 
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1 current eligibility criteria described in sub2 paragraph (B). 

3 ‘‘(iii) SURVIVOR WHO MEETS MODI4 FIED ELIGIBILITY CRITERIA.—An indi5 vidual who is not a WTC responder, for 

6 purposes of the initial health evaluation 

7 under subsection (b), claims symptoms of a 

8 WTC-related health condition and meets 

9 such eligibility criteria relating to exposure 

10 to airborne toxins, other hazards, or ad11 verse conditions resulting from the Sep12 tember 11, 2001, terrorist attacks as the 

13 WTC Administrator determines, after con14 sultation with the Data Centers described 

15 in section 3305 and the WTC Scientific/ 

16 Technical Advisory Committee and WTC 

17 Health Program Steering Committees 

18 under section 3302. 

19 The Administrator shall not modify such cri20 teria under clause (iii) on or after the date that 

21 the number of certifications for certified-eligible 

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

23 reached 80 percent of the limit described in 

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

25 number of enrollments of WTC responders has 
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1 reached 80 percent of the limit described in sec2 tion 3311(a)(4). 

3 ‘‘(B) CURRENT ELIGIBILITY CRITERIA.— 

4 The eligibility criteria described in this subpara5 graph for an individual are that the individual 

6 is described in any of the following clauses: 

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

8 New York City disaster area in the dust or 

9 dust cloud on September 11, 2001. 

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

11 attended school, childcare, or adult daycare 

12 in the New York City disaster area for— 

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

14 month period beginning on September 

15 11, 2001, and ending on January 10, 

16 2002; or 

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

18 period beginning on September 11, 

19 2001, and ending on July 31, 2002. 

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

21 cleanup worker or performed maintenance 

22 work in the New York City disaster area 

23 during the 4-month period described in 

24 subparagraph (B)(i) and had extensive ex-
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1 posure to WTC dust as a result of such 

2 work. 

3 ‘‘(iv) A person who was deemed eligi4 ble to receive a grant from the Lower 

5 Manhattan Development Corporation Resi6 dential Grant Program, who possessed a 

7 lease for a residence or purchased a resi8 dence in the New York City disaster area, 

9 and who resided in such residence during 

10 the period beginning on September 11, 

11 2001, and ending on May 31, 2003. 

12 ‘‘(v) A person whose place of employ13 ment— 

14 ‘‘(I) at any time during the pe15 riod beginning on September 11, 

16 2001, and ending on May 31, 2003, 

17 was in the New York City disaster 

18 area; and 

19 ‘‘(II) was deemed eligible to re20 ceive a grant from the Lower Manhat21 tan Development Corporation WTC 

22 Small Firms Attraction and Retention 

23 Act program or other government in24 centive program designed to revitalize 

25 the lower Manhattan economy after 
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1 the September 11, 2001, terrorist at2 tacks. 

3 ‘‘(C) APPLICATION AND DETERMINATION

4 PROCESS FOR SCREENING ELIGIBILITY.— 

5 ‘‘(i) IN GENERAL.—The WTC Pro6 gram Administrator in consultation with 

7 the Data Centers shall establish a process 

8 for individuals, other than individuals de9 scribed in subparagraph (A)(i), to be de10 termined to be screening-eligible WTC sur11 vivors. Under such process— 

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

13 to the applicant for making an appli14 cation for such determination; 

15 ‘‘(II) the Administrator shall 

16 make a determination on such an ap17 plication not later than 60 days after 

18 the date of filing the application; 

19 ‘‘(III) the Administrator shall 

20 make such a determination relating to 

21 an applicant’s compliance with this 

22 title and shall not determine that an 

23 individual is not so eligible or deny 

24 written documentation under clause 
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1 (ii) to such individual unless the Ad2 ministrator determines that— 

3 ‘‘(aa) based on the applica4 tion submitted, the individual 

5 does not meet the eligibility cri6 teria; or 

7 ‘‘(bb) the numerical limita8 tion on certifications of certified9 eligible WTC survivors set forth 

10 in paragraph (3) has been met; 

11 and 

12 ‘‘(IV) an individual who is deter13 mined not to be a screening-eligible 

14 WTC survivor shall have an oppor15 tunity to appeal such determination in 

16 a manner established under such 

17 process. 

18 ‘‘(ii) WRITTEN DOCUMENTATION OF

19 SCREENING-ELIGIBILITY.— 

20 ‘‘(I) IN GENERAL.—In the case 

21 of an individual who is described in 

22 subparagraph (A)(i) or who is deter23 mined under clause (i) (consistent 

24 with paragraph (3)) to be a screening25 eligible WTC survivor, the WTC Pro-
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1 gram Administrator shall provide an 

2 appropriate written documentation of 

3 such fact. 

4 ‘‘(II) TIMING.— 

5 ‘‘(aa) CURRENTLY IDENTI6 FIED SURVIVORS.—In the case of 

7 an individual who is described in 

8 subparagraph (A)(i), the WTC 

9 Program Administrator shall pro10 vide the written documentation 

11 under subclause (I) not later 

12 than July 1, 2011. 

13 ‘‘(bb) OTHER MEMBERS.— 

14 In the case of another individual 

15 who is determined under clause 

16 (i) and consistent with paragraph 

17 (3) to be a screening-eligible 

18 WTC survivor, the WTC Pro19 gram Administrator shall provide 

20 the written documentation under 

21 subclause (I) at the time of such 

22 determination. 

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

24 ‘‘(A) DEFINITION.—The term ‘certified-eli25 gible WTC survivor’ means, subject to para-
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1 graph (3), a screening-eligible WTC survivor 

2 who the WTC Program Administrator certifies 

3 under subparagraph (B) to be eligible for fol4 lowup monitoring and treatment under this 

5 part. 

6 ‘‘(B) CERTIFICATION OF ELIGIBILITY FOR

7 MONITORING AND TREATMENT.— 

8 ‘‘(i) IN GENERAL.—The WTC Pro9 gram Administrator shall establish a cer10 tification process under which the Adminis11 trator shall provide appropriate certifi12 cation to screening-eligible WTC survivors 

13 who, pursuant to the initial health evalua14 tion under subsection (b), are determined 

15 to be eligible for followup monitoring and 

16 treatment under this part. 

17 ‘‘(ii) TIMING.— 

18 ‘‘(I) CURRENTLY IDENTIFIED

19 SURVIVORS.—In the case of an indi20 vidual who is described in paragraph 

21 (1)(A)(i), the WTC Program Adminis22 trator shall provide the certification 

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

24 2011. 
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1 ‘‘(II) OTHER MEMBERS.—In the 

2 case of another individual who is de3 termined under clause (i) to be eligi4 ble for followup monitoring and treat5 ment, the WTC Program Adminis6 trator shall provide the certification 

7 under such clause at the time of such 

8 determination. 

9 ‘‘(3) NUMERICAL LIMITATION ON CERTIFIED10 ELIGIBLE WTC SURVIVORS.— 

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

12 individuals not described in paragraph (1)(A)(i) 

13 who may be certified as certified-eligible WTC 

14 survivors under paragraph (2)(B) shall not ex15 ceed 25,000 at any time. 

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

18 shall— 

19 ‘‘(i) limit the number of certifications 

20 provided under paragraph (2)(B)— 

21 ‘‘(I) in accordance with such sub22 paragraph; and 

23 ‘‘(II) to such number, as deter24 mined by the Administrator based on 

25 the best available information and 
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1 subject to amounts made available 

2 under section 3351, that will ensure 

3 sufficient funds will be available to 

4 provide treatment and monitoring 

5 benefits under this title, with respect 

6 to all individuals receiving such cer7 tifications through the end of fiscal 

8 year 2020; and 

9 ‘‘(ii) provide priority in such certifi10 cations in the order in which individuals 

11 apply for a determination under paragraph 

12 (2)(B). 

13 ‘‘(4) DISQUALIFICATION OF INDIVIDUALS ON

14 TERRORIST WATCH LIST.—No individual who is on 

15 the terrorist watch list maintained by the Depart16 ment of Homeland Security shall qualify as a screen17 ing-eligible WTC survivor or a certified-eligible WTC 

18 survivor. Before determining any individual to be a 

19 screening-eligible WTC survivor under paragraph (1) 

20 or certifying any individual as a certified eligible 

21 WTC survivor under paragraph (2), the Adminis22 trator, in consultation with the Secretary of Home23 land Security, shall determine whether the individual 

24 is on such list. 
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1 ‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE

2 ELIGIBILITY FOR FOLLOWUP MONITORING OR TREAT3 MENT.— 

4 ‘‘(1) IN GENERAL.—In the case of a screening5 eligible WTC survivor, the WTC Program shall pro6 vide for an initial health evaluation to determine if 

7 the survivor has a WTC-related health condition and 

8 is eligible for followup monitoring and treatment 

9 benefits under the WTC Program. Initial health 

10 evaluation protocols under section 3305(a)(2)(A)(ii) 

11 shall be subject to approval by the WTC Program 

12 Administrator. 

13 ‘‘(2) INITIAL HEALTH EVALUATION PRO14 VIDERS.—The initial health evaluation described in 

15 paragraph (1) shall be provided through a Clinical 

16 Center of Excellence with respect to the individual 

17 involved. 

18 ‘‘(3) LIMITATION ON INITIAL HEALTH EVALUA19 TION BENEFITS.—Benefits for an initial health eval20 uation under this part for a screening-eligible WTC 

21 survivor shall consist only of a single medical initial 

22 health evaluation consistent with initial health eval23 uation protocols described in paragraph (1). Nothing 

24 in this paragraph shall be construed as preventing 

25 such an individual from seeking additional medical 
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1 initial health evaluations at the expense of the indi2 vidual. 

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

4 CERTIFIED-ELIGIBLE WTC SURVIVORS FOR 

5 WTC-RELATED HEALTH CONDITIONS. 

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

7 provisions of sections 3311 and 3312 shall apply to fol8 lowup monitoring and treatment of WTC-related health 

9 conditions for certified-eligible WTC survivors in the same 

10 manner as such provisions apply to the monitoring and 

11 treatment of WTC-related health conditions for enrolled 

12 WTC responders. 

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

14 FOR SURVIVORS.—The list of health conditions for screen15 ing-eligible WTC survivors and certified-eligible WTC sur16 vivors consists of the following: 

17 ‘‘(1) AERODIGESTIVE DISORDERS.— 

18 ‘‘(A) Interstitial lung diseases. 

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

20 vapors. 

21 ‘‘(C) Asthma. 

22 ‘‘(D) Reactive airways dysfunction syn23 drome (RADS). 

24 ‘‘(E) WTC-exacerbated chronic obstructive 

25 pulmonary disease (COPD). 
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1 ‘‘(F) Chronic cough syndrome. 

2 ‘‘(G) Upper airway hyperreactivity. 

3 ‘‘(H) Chronic rhinosinusitis. 

4 ‘‘(I) Chronic nasopharyngitis. 

5 ‘‘(J) Chronic laryngitis. 

6 ‘‘(K) Gastroesophageal reflux disorder 

7 (GERD). 

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

9 to a condition described in a previous clause. 

10 ‘‘(2) MENTAL HEALTH CONDITIONS.— 

11 ‘‘(A) Posttraumatic stress disorder 

12 (PTSD). 

13 ‘‘(B) Major depressive disorder. 

14 ‘‘(C) Panic disorder. 

15 ‘‘(D) Generalized anxiety disorder. 

16 ‘‘(E) Anxiety disorder (not otherwise speci17 fied). 

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

19 ‘‘(G) Acute stress disorder. 

20 ‘‘(H) Dysthymic disorder. 

21 ‘‘(I) Adjustment disorder. 

22 ‘‘(J) Substance abuse. 

23 ‘‘(3) ADDITIONAL CONDITIONS.—Any cancer 

24 (or type of cancer) or other condition added to the 

25 list in section 3312(a)(3) pursuant to paragraph (5) 
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1 or (6) of section 3312(a), as such provisions are ap2 plied under subsection (a) with respect to certified3 eligible WTC survivors. 

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

5 OTHER INDIVIDUALS WITH WTC-RELATED 

6 HEALTH CONDITIONS. 

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

8 provisions of section 3322 shall apply to the followup mon9 itoring and treatment of WTC-related health conditions 

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

11 the same manner as such provisions apply to the followup 

12 monitoring and treatment of WTC-related health condi13 tions for certified-eligible WTC survivors. 

14 ‘‘(b) INDIVIDUALS DESCRIBED.—An individual de15 scribed in this subsection is an individual who, regardless 

16 of location of residence— 

17 ‘‘(1) is not an enrolled WTC responder or a cer18 tified-eligible WTC survivor; and 

19 ‘‘(2) is diagnosed at a Clinical Center of Excel20 lence with a WTC-related health condition for cer21 tified-eligible WTC survivors. 

22 ‘‘(c) LIMITATION.— 

23 ‘‘(1) IN GENERAL.—The WTC Program Admin24 istrator shall limit benefits for any fiscal year under 

25 subsection (a) in a manner so that payments under 
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1 this section for such fiscal year do not exceed the 

2 amount specified in paragraph (2) for such fiscal 

3 year. 

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

5 this paragraph for— 

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

7 year 2011 is $5,000,000; 

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

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

10 specified in this paragraph for the previous fis11 cal year increased by the annual percentage in12 crease in the medical care component of the 

13 consumer price index for all urban consumers. 

14 ‘‘PART 3—PAYOR PROVISIONS 

15 ‘‘SEC. 3331. PAYMENT OF CLAIMS. 

16 ‘‘(a) IN GENERAL.—Except as provided in sub17 sections (b) and (c), the cost of monitoring and treatment 

18 benefits and initial health evaluation benefits provided 

19 under parts 1 and 2 of this subtitle shall be paid for by 

20 the WTC Program from the World Trade Center Health 

21 Program Fund. 

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

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

24 payment for treatment under parts 1 and 2 of this 

25 subtitle of a WTC-related health condition of an in-
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1 dividual that is work-related shall be reduced or re2 couped to the extent that the WTC Program Admin3 istrator determines that payment has been made, or 

4 can reasonably be expected to be made, under a 

5 workers’ compensation law or plan of the United 

6 States, a State, or a locality, or other work-related 

7 injury or illness benefit plan of the employer of such 

8 individual, for such treatment. The provisions of 

9 clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) 

10 of section 1862(b) of the Social Security Act and 

11 paragraphs (3) and (4) of such section shall apply 

12 to the recoupment under this subsection of a pay13 ment to the WTC Program (with respect to a work14 ers’ compensation law or plan, or other work-related 

15 injury or illness plan of the employer involved, and 

16 such individual) in the same manner as such provi17 sions apply to the reimbursement of a payment 

18 under section 1862(b)(2) of such Act to the Sec19 retary (with respect to such a law or plan and an 

20 individual entitled to benefits under title XVIII of 

21 such Act) except that any reference in such para22 graph (4) to payment rates under title XVIII of the 

23 Social Security Act shall be deemed a reference to 

24 payment rates under this title. 
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1 ‘‘(2) EXCEPTION.—Paragraph (1) shall not 

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

3 compensation law or plan, including line of duty 

4 compensation, to which New York City is obligated 

5 to make payments, if, in accordance with terms 

6 specified under the contract under subsection 

7 (d)(1)(A), New York City has made the full payment 

8 required under such contract for such quarter. 

9 ‘‘(3) RULES OF CONSTRUCTION.—Nothing in 

10 this title shall be construed to affect, modify, or re11 lieve any obligations under a worker’s compensation 

12 law or plan, other work-related injury or illness ben13 efit plan of an employer, or any health insurance 

14 plan. 

15 ‘‘(c) HEALTH INSURANCE COVERAGE.— 

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

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

18 work-related and has health coverage for such condi19 tion through any public or private health plan (in20 cluding health benefits under title XVIII, XIX, or 

21 XXI of the Social Security Act) the provisions of 

22 section 1862(b) of the Social Security Act shall 

23 apply to such a health plan and such individual in 

24 the same manner as they apply to group health plan 

25 and an individual entitled to benefits under title 
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1 XVIII of such Act pursuant to section 226(a) of 

2 such Act. Any costs for items and services covered 

3 under such plan that are not reimbursed by such 

4 health plan, due to the application of deductibles, co5 payments, coinsurance, other cost sharing, or other6 wise, are reimbursable under this title to the extent 

7 that they are covered under the WTC Program. The 

8 program under this title shall not be treated as a le9 gally liable party for purposes of applying section 

10 1902(a)(25) of the Social Security Act. 

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

12 Nothing in paragraph (1) shall be construed as re13 quiring an entity providing monitoring and treat14 ment under this title to seek reimbursement under 

15 a health plan with which the entity has no contract 

16 for reimbursement. 

17 ‘‘(3) MAINTENANCE OF REQUIRED MINIMUM

18 ESSENTIAL COVERAGE.—No payment may be made 

19 for monitoring and treatment under this title for an 

20 individual for a month (beginning with July 2014) 

21 if with respect to such month the individual— 

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

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

24 Revenue Code of 1986) for whom the exemption 
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1 under subsection (e) of such section does not 

2 apply; and 

3 ‘‘(B) is not covered under minimum essen4 tial coverage, as required under subsection (a) 

5 of such section. 

6 ‘‘(d) REQUIRED CONTRIBUTION BY NEW YORK CITY

7 IN PROGRAM COSTS.— 

8 ‘‘(1) CONTRACT REQUIREMENT.— 

9 ‘‘(A) IN GENERAL.—No funds may be dis10 bursed from the World Trade Center Health 

11 Program Fund under section 3351 unless New 

12 York City has entered into a contract with the 

13 WTC Program Administrator under which New 

14 York City agrees, in a form and manner speci15 fied by the Administrator, to pay the full con16 tribution described in subparagraph (B) in ac17 cordance with this subsection on a timely basis, 

18 plus any interest owed pursuant to subpara19 graph (E)(i). Such contract shall specify the 

20 terms under which New York City shall be con21 sidered to have made the full payment required 

22 for a quarter for purposes of subsection (b)(2). 

23 ‘‘(B) FULL CONTRIBUTION AMOUNT.— 

24 Under such contract, with respect to the last 

25 calendar quarter of fiscal year 2011 and each 
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1 calendar quarter in fiscal years 2012 through 

2 2018 the full contribution amount under this 

3 subparagraph shall be equal to 10 percent of 

4 the expenditures in carrying out this title for 

5 the respective quarter and with respect to cal6 endar quarters in fiscal years 2019 and 2020, 

7 such full contribution amount shall be equal to 

1 8 ⁄9 of the Federal expenditures in carrying out 

9 this title for the respective quarter. 

10 ‘‘(C) SATISFACTION OF PAYMENT OBLIGA11 TION.—The payment obligation under such con12 tract may not be satisfied through any of the 

13 following: 

14 ‘‘(i) An amount derived from Federal 

15 sources. 

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

17 of the enactment of this title. 

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

19 judgment or as part of a settlement related 

20 to injuries or illnesses arising out of the 

21 September 11, 2001, terrorist attacks. 

22 ‘‘(D) TIMING OF CONTRIBUTION.—The 

23 payment obligation under such contract for a 

24 calendar quarter in a fiscal year shall be paid 
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1 not later than the last day of the second suc2 ceeding calendar quarter. 

3 ‘‘(E) COMPLIANCE.— 

4 ‘‘(i) INTEREST FOR LATE PAYMENT.— 

5 If New York City fails to pay to the WTC 

6 Program Administrator pursuant to such 

7 contract the amount required for any cal8 endar quarter by the day specified in sub9 paragraph (D), interest shall accrue on the 

10 amount not so paid at the rate (deter11 mined by the Administrator) based on the 

12 average yield to maturity, plus 1 percent13 age point, on outstanding municipal bonds 

14 issued by New York City with a remaining 

15 maturity of at least 1 year. 

16 ‘‘(ii) RECOVERY OF AMOUNTS

17 OWED.— The amounts owed to the WTC 

18 Program Administrator under such con19 tract shall be recoverable by the United 

20 States in an action in the same manner as 

21 payments made under title XVIII of the 

22 Social Security Act may be recoverable in 

23 an action brought under section 

24 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 Cen4 ter 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 contribu13 tion at the beginning of such quarter and with 

14 an updated estimate of such amount at the be15 ginning of each of the subsequent 2 quarters; 

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

17 York 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 

22 WTC Program Administrator and shall be subject to 

23 adjustment and reconciliation based upon actual ex24 penditures in carrying out this title. 
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1 ‘‘(3) RULE OF CONSTRUCTION.—Nothing in 

2 this subsection shall be construed as authorizing the 

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

4 reduce the numerical limitation under section 

5 3311(a)(4) or 3321(a)(3) for such fiscal year if New 

6 York City fails to comply with paragraph (1) for a 

7 calendar quarter in such fiscal year. 

8 ‘‘(e) WORK-RELATED DESCRIBED.—For the pur9 poses of this section, a WTC-related health condition shall 

10 be 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 

14 being 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 

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

19 benefit plan of the employer of such individual. 

20 ‘‘SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY. 

21 ‘‘The WTC Program Administrator may enter into 

22 arrangements with other government agencies, insurance 

23 companies, or other third-party administrators to provide 

24 for timely and accurate processing of claims under sec25 tions 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 

8 WTC survivors, receiving monitoring or treatment under 

9 subtitle B, the WTC Program Administrator shall conduct 

10 or support— 

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

12 conditions that may be related to the September 11, 

13 2001, terrorist attacks; 

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

15 health conditions of such individuals, in the case of 

16 conditions for which there has been diagnostic un17 certainty; 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 uncer21 tainty. 

22 The Administrator may provide such support through con23 tinuation and expansion of research that was initiated be24 fore the date of the enactment of this title and through 

25 the World Trade Center Health Registry (referred to in 
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1 section 3342), through a Clinical Center of Excellence, or 

2 through a Data Center. 

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

4 subsection (a)(1) shall include epidemiologic and other re5 search studies on WTC-related health conditions or 

6 emerging conditions— 

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 

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

12 populations, to identify potential for long-term ad13 verse 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 SUB18 JECT PROTECTIONS.—The privacy and human subject 

19 protections applicable to research conducted under this 

20 section shall not be less than such protections applicable 

21 to research conducted or funded by the Department of 

22 Health and Human Services. 

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

24 ‘‘For the purpose of ensuring ongoing data collection 

25 relating to victims of the September 11, 2001, terrorist 
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1 attacks, the WTC Program Administrator shall ensure 

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

3 least as comprehensive as the World Trade Center Health 

4 Registry maintained under the arrangements in effect as 

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

6 of 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 

14 ‘Fund’). 

15 ‘‘(2) FUNDING.—Out of any money in the 

16 Treasury not otherwise appropriated, there shall be 

17 deposited into the Fund for each of fiscal years 

18 2012 through 2020 (and the last calendar quarter of 

19 fiscal year 2011)— 

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

21 amount equal to the lesser of— 

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

23 carrying out this title for the respective fis24 cal year (initially based on estimates, sub-
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1 ject to subsequent reconciliation based on 

2 actual expenditures); or 

3 ‘‘(ii)(I) $71,000,000 for the last cal4 endar quarter of fiscal year 2011, 

5 $318,000,000 for fiscal year 2012, 

6 $354,000,000 for fiscal year 2013, 

7 $382,000,000 for fiscal year 2014, 

8 $431,000,000 for fiscal year 2015, 

9 $481,000,000 for fiscal year 2016, 

10 $537,000,000 for fiscal year 2017, 

11 $601,000,000 for fiscal year 2018, and 

12 $173,000,000 for fiscal year 2019; and 

13 ‘‘(II) subject to paragraph (4), an ad14 ditional $499,000,000 for fiscal year 2019 

15 and $743,000,000 for fiscal year 2020; 

16 plus 

17 ‘‘(B) the New York City share, consisting 

18 of the amount contributed under the contract 

19 under section 3331(d). 

20 ‘‘(3) CONTRACT REQUIREMENT.— 

21 ‘‘(A) IN GENERAL.—No funds may be dis22 bursed from the Fund unless New York City 

23 has entered into a contract with the WTC Pro24 gram Administrator under section 3331(d)(1). 
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1 ‘‘(B) BREACH OF CONTRACT.— In the case 

2 of a failure to pay the amount so required 

3 under the contract— 

4 ‘‘(i) the amount is recoverable under 

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

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

7 disbursement of amounts from the Fund; 

8 and 

9 ‘‘(iii) the Federal share described in 

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

11 the amount so unpaid. 

12 ‘‘(4) AGGREGATE LIMITATION ON FUNDING BE13 GINNING WITH FISCAL YEAR 2019.—Beginning with 

14 fiscal year 2019, in no case shall the share of Fed15 eral funds deposited into the Fund under paragraph 

16 (2) for such fiscal year and previous fiscal years and 

17 quarters exceed the sum of the amounts specified in 

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

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

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

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

23 into the Fund under subsection (a)(2) shall be avail24 able, without further appropriation, consistent with 

25 paragraph (2) and subsection (c), to carry out sub-
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1 title B and sections 3302(a), 3303, 3304, 

2 3305(a)(2), 3305(c), 3341, and 3342. 

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

4 This title does not establish any Federal obligation 

5 for payment of amounts in excess of the amounts 

6 available from the Fund for such purpose. 

7 ‘‘(3) LIMITATION ON AUTHORIZATION FOR FUR8 THER APPROPRIATIONS.—This title does not estab9 lish any authorization for appropriation of amounts 

10 in excess of the amounts available from the Fund 

11 under paragraph (1). 

12 ‘‘(c) LIMITS ON SPENDING FOR CERTAIN PUR13 POSES.—Of the amounts made available under subsection 

14 (b)(1), not more than each of the following amounts may 

15 be available for each of the following purposes: 

16 ‘‘(1) SURVIVING IMMEDIATE FAMILY MEMBERS

17 OF FIREFIGHTERS.—For the purposes of carrying 

18 out subtitle B with respect to WTC responders de19 scribed in section 3311(a)(2)(A)(ii)— 

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

21 year 2011, $100,000; 

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

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

24 amount specified under this paragraph for the 

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

2 urban consumers (all items; United States city 

3 average) as estimated by the Secretary for the 

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

6 ‘‘(2) WTC HEALTH PROGRAM SCIENTIFIC/ 

7 TECHNICAL ADVISORY COMMITTEE.—For the pur8 pose of carrying out section 3302(a)— 

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

10 year 2011, $25,000; 

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

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

13 amount specified under this paragraph for the 

14 previous fiscal year increased by the percentage 

15 increase in the consumer price index for all 

16 urban consumers (all items; United States city 

17 average) as estimated by the Secretary for the 

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

20 ‘‘(3) EDUCATION AND OUTREACH.—For the 

21 purpose of carrying out section 3303— 

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

23 year 2011, $500,000; 

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

2 amount specified under this paragraph for the 

3 previous fiscal year increased by the percentage 

4 increase in the consumer price index for all 

5 urban consumers (all items; United States city 

6 average) as estimated by the Secretary for the 

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

9 ‘‘(4) UNIFORM DATA COLLECTION.—For the 

10 purpose of carrying out section 3304 and for reim11 bursing Data Centers (as defined in section 

12 3305(b)(2)) for the costs incurred by such Centers 

13 in carrying out activities under contracts entered 

14 into under section 3305(a)(2)— 

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

16 year 2011, $2,500,000; 

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

18 and 

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

20 amount specified under this paragraph for the 

21 previous fiscal year increased by the percentage 

22 increase in the consumer price index for all 

23 urban consumers (all items; United States city 

24 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 ‘‘(5) RESEARCH REGARDING CERTAIN HEALTH

4 CONDITIONS.—For the purpose of carrying out sec5 tion 3341— 

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

7 year 2011, $3,750,000; 

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

9 and 

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

11 amount specified under this paragraph for the 

12 previous fiscal year increased by the percentage 

13 increase in the consumer price index for all 

14 urban consumers (all items; United States city 

15 average) as estimated by the Secretary for the 

16 12-month period ending with March of the pre17 vious year. 

18 ‘‘(6) WORLD TRADE CENTER HEALTH REG19 ISTRY.—For the purpose of carrying out section 

20 3342— 

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

22 year 2011, $1,750,000; 

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

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

25 amount specified under this paragraph for the 
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1 previous fiscal year increased by the percentage 

2 increase in the consumer price index for all 

3 urban consumers (all items; United States city 

4 average) as estimated by the Secretary for the 

5 12-month period ending with March of the pre6 vious year.’’. 

7 TITLE II—SEPTEMBER 11TH VIC8 TIM COMPENSATION FUND OF 

9 2001 

10 SEC. 201. DEFINITIONS. 

11 Section 402 of the Air Transportation Safety and 

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

13 amended— 

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

15 removal, including under the World Trade Center 

16 Health Program established under section 3001 of 

17 the Public Health Service Act, and payments made 

18 pursuant to the settlement of a civil action described 

19 in section 405(c)(3)(C)(iii)’’ after ‘‘September 11, 

20 2001’’; 

21 (2) by inserting after paragraph (6) the fol22 lowing new paragraphs and redesignating subse23 quent paragraphs accordingly: 

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

25 term ‘contractor and subcontractor’ means any con-
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1 tractor or subcontractor (at any tier of a subcon2 tracting relationship), including any general con3 tractor, construction manager, prime contractor, 

4 consultant, or any parent, subsidiary, associated or 

5 allied company, affiliated company, corporation, 

6 firm, organization, or joint venture thereof that par7 ticipated in debris removal at any 9/11 crash site. 

8 Such term shall not include any entity, including the 

9 Port Authority of New York and New Jersey, with 

10 a property interest in the World Trade Center, on 

11 September 11, 2001, whether fee simple, leasehold 

12 or easement, direct or indirect. 

13 ‘‘(8) DEBRIS REMOVAL.—The term ‘debris re14 moval’ means rescue and recovery efforts, removal of 

15 debris, cleanup, remediation, and response during 

16 the immediate aftermath of the terrorist-related air17 craft crashes of September 11, 2001, with respect to 

18 a 9/11 crash site.’’; 

19 (3) by inserting after paragraph (10), as so re20 designated, the following new paragraph and redes21 ignating the subsequent paragraphs accordingly: 

22 ‘‘(11) IMMEDIATE AFTERMATH.—The term ‘im23 mediate aftermath’ means any period beginning with 

24 the terrorist-related aircraft crashes of September 

25 11, 2001, and ending on August 30, 2002.’’; and 
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1 (4) by adding at the end the following new 

2 paragraph: 

3 ‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash 

4 site’ means— 

5 ‘‘(A) the World Trade Center site, Pen6 tagon site, and Shanksville, Pennsylvania site; 

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

8 that were destroyed as a result of the terrorist9 related aircraft crashes of September 11, 2001; 

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

11 crashes that the Special Master determines was 

12 sufficiently close to the site that there was a de13 monstrable risk of physical harm resulting from 

14 the impact of the aircraft or any subsequent 

15 fire, explosions, or building collapses (including 

16 the immediate area in which the impact oc17 curred, fire occurred, portions of buildings fell, 

18 or debris fell upon and injured individuals); and 

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

20 of debris removal, such as barges and Fresh 

21 Kills.’’. 

22 SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 

23 COMPENSATION. 

24 (a) INFORMATION ON LOSSES RESULTING FROM DE25 BRIS REMOVAL INCLUDED IN CONTENTS OF CLAIM
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1 FORM.—Section 405(a)(2)(B) of the Air Transportation 

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

3 note) is amended— 

4 (1) in clause (i), by inserting ‘‘, or debris re5 moval during the immediate aftermath’’ after ‘‘Sep6 tember 11, 2001’’; 

7 (2) in clause (ii), by inserting ‘‘or debris re8 moval during the immediate aftermath’’ after 

9 ‘‘crashes’’; and 

10 (3) in clause (iii), by inserting ‘‘or debris re11 moval during the immediate aftermath’’ after 

12 ‘‘crashes’’. 

13 (b) EXTENSION OF DEADLINE FOR CLAIMS UNDER

14 SEPTEMBER 11TH VICTIM COMPENSATION FUND OF

15 2001.—Section 405(a)(3) of such Act is amended to read 

16 as follows: 

17 ‘‘(3) LIMITATION.— 

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

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

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

21 after the date on which regulations are promul22 gated under section 407(a). 

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

24 under paragraph (1), in accordance with sub25 section (c)(3)(A)(i), by an individual (or by a 
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1 personal representative on behalf of a deceased 

2 individual) during the period beginning on the 

3 date on which the regulations are updated 

4 under section 407(b) and ending on December 

5 22, 2031.’’. 

6 (c) REQUIREMENTS FOR FILING CLAIMS DURING

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

8 Act is amended— 

9 (1) by redesignating subparagraphs (A) and 

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

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

12 redesignated, the following new subparagraph: 

13 ‘‘(A) REQUIREMENTS FOR FILING CLAIMS

14 DURING EXTENDED FILING PERIOD.— 

15 ‘‘(i) TIMING REQUIREMENTS FOR FIL16 ING CLAIMS.—An individual (or a personal 

17 representative on behalf of a deceased indi18 vidual) may file a claim during the period 

19 described in subsection (a)(3)(B) as fol20 lows: 

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

22 Master determines the individual 

23 knew (or reasonably should have 

24 known) before the date specified in 

25 clause (iii) that the individual suffered 
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1 a physical harm at a 9/11 crash site 

2 as a result of the terrorist-related air3 craft crashes of September 11, 2001, 

4 or as a result of debris removal, and 

5 that the individual knew (or should 

6 have known) before such specified 

7 date that the individual was eligible to 

8 file a claim under this title, the indi9 vidual may file a claim not later than 

10 the date that is 2 years after such 

11 specified date. 

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

13 Master determines the individual first 

14 knew (or reasonably should have 

15 known) on or after the date specified 

16 in clause (iii) that the individual suf17 fered such a physical harm or that the 

18 individual first knew (or should have 

19 known) on or after such specified date 

20 that the individual was eligible to file 

21 a claim under this title, the individual 

22 may file a claim not later than the 

23 last day of the 2-year period begin24 ning on the date the Special Master 

25 determines the individual first knew 
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1 (or should have known) that the indi2 vidual both suffered from such harm 

3 and was eligible to file a claim under 

4 this title. 

5 ‘‘(ii) OTHER ELIGIBILITY REQUIRE6 MENTS FOR FILING CLAIMS.—An indi7 vidual may file a claim during the period 

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

9 ‘‘(I) the individual was treated by 

10 a medical professional for suffering 

11 from a physical harm described in 

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

13 from the date of discovering such 

14 harm; and 

15 ‘‘(II) the individual’s physical 

16 harm is verified by contemporaneous 

17 medical records created by or at the 

18 direction of the medical professional 

19 who provided the medical care. 

20 ‘‘(iii) DATE SPECIFIED.—The date 

21 specified in this clause is the date on which 

22 the regulations are updated under section 

23 407(a).’’. 

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

25 SITES.—Section 405(c)(2)(A)(i) of such Act is amended 
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1 by striking ‘‘or the site of the aircraft crash at Shanksville, 

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

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

4 site’’. 

5 (e) INCLUSION OF PHYSICAL HARM RESULTING

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

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

8 removal’’ after ‘‘air crash’’. 

9 (f) LIMITATIONS ON CIVIL ACTIONS.— 

10 (1) APPLICATION TO DAMAGES RELATED TO

11 DEBRIS REMOVAL.—Clause (i) of section 

12 405(c)(3)(C) of such Act, as redesignated by sub13 section (c), is amended by inserting ‘‘, or for dam14 ages arising from or related to debris removal’’ after 

15 ‘‘September 11, 2001’’. 

16 (2) PENDING ACTIONS.—Clause (ii) of such sec17 tion, as so redesignated, is amended to read as fol18 lows: 

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

20 of an individual who is a party to a civil 

21 action described in clause (i), such indi22 vidual may not submit a claim under this 

23 title— 

24 ‘‘(I) during the period described 

25 in subsection (a)(3)(A) unless such in-
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1 dividual withdraws from such action 

2 by the date that is 90 days after the 

3 date on which regulations are promul4 gated under section 407(a); and 

5 ‘‘(II) during the period described 

6 in subsection (a)(3)(B) unless such in7 dividual withdraws from such action 

8 by the date that is 90 days after the 

9 date on which the regulations are up10 dated under section 407(b).’’. 

11 (3) SETTLED ACTIONS; AUTHORITY TO RE12 INSTITUTE CERTAIN LAWSUITS.—Such section, as so 

13 redesignated, is further amended by adding at the 

14 end the following new clauses: 

15 ‘‘(iii) SETTLED ACTIONS.—In the case 

16 of an individual who settled a civil action 

17 described in clause (i), such individual may 

18 not submit a claim under this title unless 

19 such action was commenced after Decem20 ber 22, 2003, and a release of all claims in 

21 such action was tendered prior to the date 

22 on which the James Zadroga 9/11 Health 

23 and Compensation Act of 2010 was en24 acted. 
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1 ‘‘(iv) AUTHORITY TO REINSTITUTE

2 CERTAIN LAWSUITS.—In the case of a 

3 claimant who was a party to a civil action 

4 described in clause (i), who withdrew from 

5 such action pursuant to clause (ii), and 

6 who is subsequently determined to not be 

7 an eligible individual for purposes of this 

8 subsection, such claimant may reinstitute 

9 such action without prejudice during the 

10 90-day period beginning after the date of 

11 such ineligibility determination.’’. 

12 SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 

13 Section 407 of the Air Transportation Safety and 

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

15 amended— 

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

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

18 (2) by adding at the end the following new sub19 section: 

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

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

22 9/11 Health and Compensation Act of 2010, the Special 

23 Master shall update the regulations promulgated under 

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

25 provisions of title II of such Act.’’. 
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1 SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 

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

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

4 amended by adding at the end the following new para5 graphs: 

6 ‘‘(4) LIABILITY FOR CERTAIN CLAIMS.—Not7 withstanding any other provision of law, liability for 

8 all claims and actions (including claims or actions 

9 that have been previously resolved, that are cur10 rently pending, and that may be filed through De11 cember 22, 2031) for compensatory damages, con12 tribution or indemnity, or any other form or type of 

13 relief, arising from or related to debris removal, 

14 against the City of New York, any entity (including 

15 the Port Authority of New York and New Jersey) 

16 with a property interest in the World Trade Center 

17 on September 11, 2001 (whether fee simple, lease18 hold or easement, or direct or indirect) and any con19 tractors and subcontractors, shall not be in an 

20 amount that exceeds the sum of the following, as 

21 may be applicable: 

22 ‘‘(A) The amount of funds of the WTC 

23 Captive Insurance Company, including the cu24 mulative interest. 
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1 ‘‘(B) The amount of all available insurance 

2 identified in schedule 2 of the WTC Captive In3 surance Company insurance policy. 

4 ‘‘(C) As it relates to the limitation of li5 ability of the City of New York, the amount 

6 that is the greater of the City of New York’s 

7 insurance coverage or $350,000,000. In deter8 mining the amount of the City’s insurance cov9 erage for purposes of the previous sentence, any 

10 amount described in clauses (i) and (ii) shall 

11 not be included. 

12 ‘‘(D) As it relates to the limitation of li13 ability of any entity, including the Port Author14 ity of New York and New Jersey, with a prop15 erty interest in the World Trade Center on Sep16 tember 11, 2001 (whether fee simple, leasehold 

17 or easement, or direct or indirect), the amount 

18 of all available liability insurance coverage 

19 maintained by any such entity. 

20 ‘‘(E) As it relates to the limitation of li21 ability of any individual contractor or subcon22 tractor, the amount of all available liability in23 surance coverage maintained by such contractor 

24 or subcontractor on September 11, 2001. 
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1 ‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Pay2 ments to plaintiffs who obtain a settlement or judg3 ment with respect to a claim or action to which 

4 paragraph (4)(A) applies, shall be paid solely from 

5 the following funds in the following order, as may be 

6 applicable: 

7 ‘‘(A) The funds described in clause (i) or 

8 (ii) of paragraph (4)(A). 

9 ‘‘(B) If there are no funds available as de10 scribed in clause (i) or (ii) of paragraph (4)(A), 

11 the funds described in clause (iii) of such para12 graph. 

13 ‘‘(C) If there are no funds available as de14 scribed in clause (i), (ii), or (iii) of paragraph 

15 (4)(A), the funds described in clause (iv) of 

16 such paragraph. 

17 ‘‘(D) If there are no funds available as de18 scribed in clause (i), (ii), (iii), or (iv) of para19 graph (4)(A), the funds described in clause (v) 

20 of such paragraph. 

21 ‘‘(6) DECLARATORY JUDGMENT ACTIONS AND

22 DIRECT ACTION.—Any party to a claim or action to 

23 which paragraph (4)(A) applies may, with respect to 

24 such claim or action, either file an action for a de25 claratory judgment for insurance coverage or bring 
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1 a direct action against the insurance company in2 volved.’’. 

3 SEC. 205. FUNDING; ATTORNEY FEES. 

4 Section 406 of the Air Transportation Safety and 

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

6 amended— 

7 (1) in subsection (a), by striking ‘‘Not later 

8 than’’ and inserting ‘‘Subject to the limitations 

9 under subsection (d), not later than’’; 

10 (2) in subsection (b)— 

11 (A) by inserting ‘‘in the amounts provided 

12 under subsection (d)(1)’’ after ‘‘appropriations 

13 Acts’’; and 

14 (B) by inserting ‘‘subject to the limitations 

15 under subsection (d)’’ before the period; and 

16 (3) by adding at the end the following new sub17 sections: 

18 ‘‘(d) LIMITATION.— 

19 ‘‘(1) IN GENERAL.—The total amount of Fed20 eral funds paid for compensation under this title, 

21 with respect to claims filed on or after the date on 

22 which the regulations are updated under section 

23 407(b), shall not exceed $8,400,000,000. Of such 

24 amounts, $4,200,000,000 shall be available to pay 

25 such claims during the 10-year period beginning on 
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1 such date and $4,200,000,000 shall be available to 

2 pay such claims after such period. 

3 ‘‘(2) PRO-RATION AND PAYMENT OF REMAINING

4 CLAIMS.— 

5 ‘‘(A) IN GENERAL.—With respect to the 

6 one-year period beginning on the date on which 

7 the first payment is made under this title for 

8 claims filed pursuant to the regulations updated 

9 under section 407(b), the Special Master shall 

10 examine the total number of such claims paid 

11 during such period and the amounts of the pay12 ments made for such claims to project the total 

13 number and amount of claims expected to be 

14 paid under this title during the 10-year period 

15 described in paragraph (1). If, based on such 

16 projection, the Special Master determines that 

17 there will be insufficient funds available under 

18 paragraph (1) to pay such claims during such 

19 10-year period, beginning on the first day fol20 lowing such one-year period, the Special Master 

21 shall ratably reduce the amount of compensa22 tion due claimants under this title in a manner 

23 to ensure, to the extent possible, that— 

24 ‘‘(i) all claimants who, before applica25 tion of the limitation under the second sen-
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1 tence of paragraph (1), would have been 

2 determined to be entitled to a payment 

3 under this title during such 10-year period, 

4 receive a payment during such period; and 

5 ‘‘(ii) the total amount of all such pay6 ments made during such 10-year period do 

7 not exceed the amount available under the 

8 second sentence of paragraph (1) to pay 

9 claims during such period. 

10 ‘‘(B) PAYMENT OF REMAINDER OF CLAIM

11 AMOUNTS.—In any case in which the amount of 

12 a claim is ratably reduced pursuant to subpara13 graph (A), on or after the first day after the 

14 10-year period described in paragraph (1), the 

15 Special Master shall pay to the claimant the 

16 amount that is equal to the difference be17 tween— 

18 ‘‘(i) the amount that the claimant 

19 would have been paid under this title dur20 ing such period without regard to the limi21 tation under the second sentence of para22 graph (1) applicable to such period; and 

23 ‘‘(ii) the amount the claimant was 

24 paid under this title during such period. 

25 ‘‘(e) ATTORNEY FEES.— 
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1 ‘‘(1) IN GENERAL.—Notwithstanding any con2 tract, and except as provided in paragraphs (2) and 

3 (3), the representative of an individual may not 

4 charge, for services rendered in connection with the 

5 claim of an individual under this title, more than 10 

6 percent of an award made under this title on such 

7 claim. 

8 ‘‘(2) LIMITATION.— 

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

10 subparagraph (B), in the case of an individual 

11 who was charged a legal fee in connection with 

12 the settlement of a civil action described in sec13 tion 405(c)(3)(C)(iii), the representative of 

14 the individual may not charge any amount for 

15 compensation for services rendered in connec16 tion with a claim filed under this title. 

17 ‘‘(B) EXCEPTION.—If the legal fee charged 

18 in connection with the settlement of a civil ac19 tion described in section 405(c)(3)(C)(iii) of an 

20 individual is less than 10 percent of the aggre21 gate amount of compensation awarded to such 

22 individual through such settlement and the 

23 claim of the individual under this title, the rep24 resentative of such individual may charge an 

25 amount for compensation for services rendered 
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1 in connection with such claim under this title to 

2 the extent that such amount charged is not 

3 more than— 

4 ‘‘(i) 10 percent of such aggregate 

5 amount, minus 

6 ‘‘(ii) the total amount of all legal fees 

7 charged for services rendered in connection 

8 with such settlement. 

9 ‘‘(3) EXCEPTION.—With respect to a claim 

10 made on behalf of an individual for whom a lawsuit 

11 was filed in the Southern District of New York prior 

12 to January 1, 2009, in the event that the represent13 ative believes in good faith that the fee limit set by 

14 paragraph (1) or (2) will not provide adequate com15 pensation for services rendered in connection with 

16 such claim because of the substantial amount of 

17 legal work provided on behalf of the claimant (in18 cluding work performed before the enactment of this 

19 legislation), application for greater compensation 

20 may be made to the Special Master. Upon such ap21 plication, the Special Master may, in his or her dis22 cretion, award as reasonable compensation for serv23 ices rendered an amount greater than that allowed 

24 for in paragraph (1). Such fee award will be final, 

25 binding, and non-appealable.’’. 
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1 TITLE III—LIMITATION ON TREA2 TY BENEFITS FOR CERTAIN 

3 DEDUCTIBLE PAYMENTS; 

4 TIME FOR PAYMENT OF COR5 PORATE ESTIMATED TAXES 

6 SEC. 301. LIMITATION ON TREATY BENEFITS FOR CERTAIN 

7 DEDUCTIBLE PAYMENTS. 

8 (a) IN GENERAL.—Section 894 of the Internal Rev9 enue Code of 1986 (relating to income affected by treaty) 

10 is amended by adding at the end the following new sub11 section: 

12 ‘‘(d) LIMITATION ON TREATY BENEFITS FOR CER13 TAIN DEDUCTIBLE PAYMENTS.— 

14 ‘‘(1) IN GENERAL.—In the case of any deduct15 ible related-party payment, any withholding tax im16 posed under chapter 3 (and any tax imposed under 

17 subpart A or B of this part) with respect to such 

18 payment may not be reduced under any treaty of the 

19 United States unless any such withholding tax would 

20 be reduced under a treaty of the United States if 

21 such payment were made directly to the foreign par22 ent corporation. 

23 ‘‘(2) DEDUCTIBLE RELATED-PARTY PAY24 MENT.—For purposes of this subsection, the term 

25 ‘deductible related-party payment’ means any pay-
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1 ment made, directly or indirectly, by any person to 

2 any other person if the payment is allowable as a de3 duction under this chapter and both persons are 

4 members of the same foreign controlled group of en5 tities. 

6 ‘‘(3) FOREIGN CONTROLLED GROUP OF ENTI7 TIES.—For purposes of this subsection— 

8 ‘‘(A) IN GENERAL.—The term ‘foreign 

9 controlled group of entities’ means a controlled 

10 group of entities the common parent of which 

11 is a foreign corporation. 

12 ‘‘(B) CONTROLLED GROUP OF ENTITIES.— 

13 The term ‘controlled group of entities’ means a 

14 controlled group of corporations as defined in 

15 section 1563(a)(1), except that— 

16 ‘‘(i) ‘more than 50 percent’ shall be 

17 substituted for ‘at least 80 percent’ each 

18 place it appears therein, and 

19 ‘‘(ii) the determination shall be made 

20 without regard to subsections (a)(4) and 

21 (b)(2) of section 1563. 

22 A partnership or any other entity (other than a 

23 corporation) shall be treated as a member of a 

24 controlled group of entities if such entity is con25 trolled (within the meaning of section 
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1 954(d)(3)) by members of such group (includ2 ing any entity treated as a member of such 

3 group by reason of this sentence). 

4 ‘‘(4) FOREIGN PARENT CORPORATION.—For 

5 purposes of this subsection, the term ‘foreign parent 

6 corporation’ means, with respect to any deductible 

7 related-party payment, the common parent of the 

8 foreign controlled group of entities referred to in 

9 paragraph (3)(A). 

10 ‘‘(5) REGULATIONS.—The Secretary may pre11 scribe such regulations or other guidance as are nec12 essary or appropriate to carry out the purposes of 

13 this subsection, including regulations or other guid14 ance which provide for— 

15 ‘‘(A) the treatment of two or more persons 

16 as members of a foreign controlled group of en17 tities if such persons would be the common par18 ent of such group if treated as one corporation, 

19 and 

20 ‘‘(B) the treatment of any member of a 

21 foreign controlled group of entities as the com22 mon parent of such group if such treatment is 

23 appropriate taking into account the economic 

24 relationships among such entities.’’. 
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1 (b) EFFECTIVE DATE.—The amendment made by 

2 this section shall apply to payments made after the date 

3 of the enactment of this Act. 

4 SEC. 302. TIME FOR PAYMENT OF CORPORATE ESTIMATED 

5 TAXES. 

6 The percentage under paragraph (2) of section 561 

7 of the Hiring Incentives to Restore Employment Act in 

8 effect on the date of the enactment of this Act is increased 

9 by 3 percentage points. 

10 TITLE IV—BUDGETARY EFFECTS 

11 SEC. 401. COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO 

12 ACT OF 2010. 

13 The budgetary effects of this Act, for the purpose of 

14 complying with the Statutory Pay-As-You-Go Act of 2010, 

15 shall be determined by reference to the latest statement 

16 titled ‘‘Budgetary Effects of PAYGO Legislation’’ for this 

17 Act, submitted for printing in the Congressional Record 

18 by the Chairman of the House Budget Committee, pro19 vided that such statement has been submitted prior to the 

20 vote on passage. 

Passed the House of Representatives September 29, 

2010. 

Attest: 

Clerk. 

111TH CONGRESS 

2D SESSION H. R. 847 

AN ACT 

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 individ-