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[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 4021 Introduced in Senate (IS)]

109th CONGRESS
  2d Session
                                S. 4021

    To amend title XVIII of the Social Security Act to provide for 
   comprehensive health benefits for the relief of individuals whose 
          health was adversely affected by the 9/11 disaster.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                           September 29, 2006

Mrs. Clinton (for herself, Mr. Schumer, and Mr. Kennedy) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL

 
    To amend title XVIII of the Social Security Act to provide for 
   comprehensive health benefits for the relief of individuals whose 
          health was adversely affected by the 9/11 disaster.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``9/11 Comprehensive Health Benefits 
Act of 2006''.

SEC. 2. MEDICARE-BASED ELIGIBILITY AND BENEFITS FOR INDIVIDUALS WITH A 
              9/11 DISASTER-CONNECTED HEALTH CONDITION.

    (a) In General.--Title XVIII of the Social Security Act is amended 
by inserting after section 1808 the following new section:

   ``benefits for individuals with a 9/11 disaster-connected health 
                               condition

    ``Sec. 1809.  (a) In General.--Every 9/11 impacted individual (as 
defined in subsection (b)(1)(A)) who has a 9/11 disaster-connected 
health condition (as defined in subsection (b)(2))--
            ``(1) is entitled to 9/11-related benefits (as defined in 
        subsection (c)(1)) under this title without payment of any 
        premium; and
            ``(2) if the individual is not otherwise entitled to 
        benefits under part A (or enrolled under part B), is eligible 
        to enroll under subsection (d) for benefits under parts A, B, 
        and D that are in addition to the 9/11-related benefits 
        provided under paragraph (1).
Paragraph (1) shall apply regardless of whether or not the individual 
is otherwise entitled to benefits under part A, B, or D. Paragraph (2) 
shall apply regardless of whether the individual is covered under a 
group health plan or otherwise has other health insurance or benefits 
coverage.
    ``(b) Eligibility.--
            ``(1) 9/11 impacted individual defined.--
                    ``(A) In general.--For purposes of this section, 
                the term `9/11 impacted individual' means any of the 
                following:
                            ``(i) Emergency services or rescue and 
                        recovery personnel.--Any emergency services or 
                        rescue and recovery personnel who responded to 
                        the 9/11 New York terrorist attacks at any time 
                        during the period beginning on September 11, 
                        2001, and ending on August 31, 2002.
                            ``(ii) Individuals exposed to hazardous 
                        substances, pollutants, or contaminants.--Any 
                        individual exposed in New York City to 
                        hazardous substances, pollutants, or 
                        contaminants released from the collapse of the 
                        World Trade Center that occurred in the 9/11 
                        New York terrorist attacks or from the fires 
                        that occurred, or from the handling of 
                        resulting debris, thereafter.
                            ``(iii) Other individuals.--Any other 
                        individual whom the Secretary determines to be 
                        appropriate.
                    ``(B) Emergency services or rescue and recovery 
                personnel included.--For purposes of this paragraph, 
                the term `emergency services personnel or rescue and 
                recovery personnel' includes any of the following:
                            ``(i) A Federal, State, or city employee 
                        who responded to the 9/11 New York terrorist 
                        attacks.
                            ``(ii) An individual who, as a worker or 
                        volunteer, was involved in clean-up, repair, or 
                        infrastructure restoration activities related 
                        to the 9/11 New York terrorist attacks.
                            ``(iii) An individual participating in a 
                        search and rescue team, or who assisted in the 
                        recovery of human remains, after the 9/11 New 
                        York terrorist attacks.
                            ``(iv) Any other relief or rescue worker 
                        who the Secretary determines to be appropriate.
                    ``(C) Presumption of exposure to hazardous 
                substances, pollutants, or contaminants.--
                            ``(i) In general.--An individual shall be 
                        treated as described in subparagraph (A)(ii) if 
                        the individual resided, owned a business, was 
                        employed, or attended school, child care, or 
                        adult day care in a building that was exposed 
                        to hazardous substances, pollutants, or 
                        contaminants released from the collapse of the 
                        World Trade Center that occurred during such 
                        attacks on or after September 11, 2001 or from 
                        the fires that occurred, or from the handling 
                        of resulting debris, thereafter.
                            ``(ii) Treatment of buildings.--For 
                        purposes of clause (i), any building in 
                        Manhattan, Brooklyn, Queens, Staten Island, or 
                        Northern New Jersey (as delineated by the 
                        Secretary) shall be treated as being described 
                        in such clause if there is evidence that the 
                        building was exposed to hazardous substances, 
                        pollutants, or contaminants released from the 
                        collapse of the World Trade Center or from the 
                        fires that occurred thereafter at any time 
                        during the period beginning on September 11, 
                        2001, and ending on December 31, 2001.
            ``(2) 9/11 disaster-connected health condition defined.--
                    ``(A) In general.--For purposes of this section, 
                the term `9/11 disaster-connected health condition' 
                means an adverse health condition (including the 
                exacerbation of a pre-existing health condition), which 
                also may be an adverse mental health condition, that, 
                in the judgment of a qualified medical practitioner 
                (including a therapist in the case of an adverse mental 
                health condition), can reasonably be considered to be 
                associated with exposure to the 9/11 New York terrorist 
                attacks.
                    ``(B) 9/11 new york terrorist attacks defined.--For 
                purposes of this section, the term `9/11 New York 
                terrorist attacks' means the terrorist attacks that 
                occurred on September 11, 2001, in New York City, New 
                York.
                    ``(C) Treatment of adverse mental health 
                condition.--For purposes of subparagraph (A), an 
                individual shall be considered to have a 9/11 disaster-
                connected health condition if the individual has an 
                adverse emotional or psychological health impact that--
                            ``(i) has been formally diagnosed by a 
                        qualified medical practitioner or therapist; 
                        and
                            ``(ii) can be reasonably considered, in the 
                        judgment of such practitioner or therapist, to 
                        be associated with exposure to the 9/11 New 
                        York terrorist attacks.
            ``(3) Criteria.--Not later than 30 days after the date of 
        establishment of the Consortium established under section 3 of 
        the 9/11 Comprehensive Health Benefits Act of 2006, the 
        Secretary, in consultation with such Consortium, shall 
        initially develop standardized criteria for medical 
        practitioners to consult with for assistance in their 
        determination of whether an individual has a 9/11 disaster-
        connected health condition consistent with this subsection. The 
        Secretary shall periodically review such criteria and may, from 
        time to time and in consultation with the Consortium, modify 
        such criteria as the Secretary determines appropriate.
            ``(4) Appeals process.--The Secretary shall specify a 
        process for the appeal of a determination that an individual is 
        not eligible for benefits under this section. Such process 
        shall be consistent with the process under section 1869 for the 
        appeal of a determination that an individual is entitled to 
        benefits under parts A and B.
            ``(5) Treatment of nonresidents and undocumented aliens.--
        Nothing in this section shall be construed as making an 
        individual ineligible for benefits under this section because 
        the individual is not a resident of New York or the United 
        States or because the individual is an alien or is not 
        authorized to reside in the United States. Nothing in this 
        paragraph shall be construed to provide for any benefits under 
        this title for items and services furnished outside the United 
        States, except as may otherwise be authorized under this title.
    ``(c) 9/11-Related Benefits Defined.--
            ``(1) In general.--For purposes of this section, the term 
        `9/11-related benefits' means benefits under parts A, B, and D 
        for the treatment of any 9/11 disaster-related health 
        condition, subject to the following modifications with respect 
        to such treatment:
                    ``(A) No cost-sharing.--No deductibles, 
                coinsurance, copayments, or other cost-sharing shall be 
                applicable.
                    ``(B) Elimination of day or dollar limitations.--
                Any day or dollar limitations on coverage with respect 
                to such treatment, including such limitations under 
                sections 1812, 1833(g), and 1860D-2(b)(3), shall not be 
                applicable.
            ``(2) Entitlement without premiums.--An individual entitled 
        to 9/11-related benefits under this section is deemed to be 
        entitled to benefits under parts A, B, and D with respect to 
        such 9/11-related benefits without requirement for payment for 
        any premium. The entitlement to such benefits shall begin on 
        the date that the individual is determined to be eligible for 
        such benefits, but in no case before the date of the enactment 
        of this section.
            ``(3) Relation to part c.--Except in the case of an 
        individual enrolled under part A or B under subsection (d) or 
        otherwise, 9/11-related benefits are not available through 
        enrollment in a Medicare Advantage plan under part C.
    ``(d) Enrollment Option for Additional Medicare Benefits.--
            ``(1) In general.--With respect to the enrollment option 
        described in subsection (a)(2), an eligible individual may 
        enroll under part A or B (or both), and under part D, in a 
        manner and form prescribed in regulations. Such regulations 
        shall provide for continuous open enrollment for such 
        individuals.
            ``(2) Premiums.--
                    ``(A) In general.--Except as provided in this 
                paragraph, the premium for enrollment under part A 
                under this subsection shall be the same as the premium 
                established under subsection (d) of section 1818 for 
                enrollment under such section, subject to any reduction 
                provided under such subsection.
                    ``(B) Elimination of premium based on quarters of 
                coverage.--No premium shall be imposed under 
                subparagraph (A) in the case of an individual if the 
                individual would be entitled, based solely on the 
                number of quarters of coverage under title II, to 
                benefits under part A under section 226(a), 226(b), or 
                226A.
                    ``(C) No late enrollment penalty.--An individual 
                enrolling under part A, B, or D under this subsection 
                shall not be subject to any late enrollment penalty, 
                including under sections 1839(b) and 1860D-13(b).
            ``(3) Enrollment under parts b and d.--For purposes of 
        parts B and D, in the case of an individual eligible to enroll 
        under this subsection, the individual's initial enrollment 
        period under such parts shall be treated as beginning on the 
        date of such eligibility and having no end date.
            ``(4) Coverage.--
                    ``(A) In general.--The period (in this subsection 
                referred to as a `coverage period') during which an 
                individual enrolled under this subsection is entitled 
                to benefits under the respective part shall begin on 
                the first day of the first month that begins at least 
                15 days after the date of the individual's enrollment 
                under such part.
                    ``(B) Termination.--An individual's coverage period 
                under this subsection under a part shall continue until 
                the individual's enrollment under such part is 
                terminated as follows:
                            ``(i) As of the month following the month 
                        in which the individual files notice that the 
                        individual no longer wishes to be enrolled in 
                        the part under this subsection.
                            ``(ii) For nonpayment of any applicable 
                        premiums under such part.
                            ``(iii) With respect to coverage under part 
                        D, as of the month in which the individual is 
                        neither enrolled in part A nor enrolled in part 
                        B.
                The termination of a coverage period under clause (ii) 
                shall take effect on a date determined under 
                regulations, which may be determined so as to provide a 
                grace period in which overdue premiums may be paid and 
                coverage continued. The grace period determined under 
                the preceding sentence shall not exceed 90 days; except 
                that it may be extended to not to exceed 180 days in 
                any case where the Secretary determines that there was 
                good cause for failure to pay the overdue premiums 
                within such 90-day period.
    ``(e) Payment-Related Provisions.--
            ``(1) Authorization of appropriations to cover additional 
        benefits.--There are authorized to be appropriated to the 
        Federal Hospital Insurance Trust Fund and the Federal 
        Supplementary Medical Insurance Trust Fund, and the Medicare 
        Prescription Drug Account in such Trust Fund, such sums as may 
        be necessary to cover the costs under such Trust Funds and 
        Account of providing benefits under this section, net of any 
        premiums paid with respect to such benefits under subsection 
        (d).
            ``(2) Reimbursement of prescription drug plans and ma plans 
        for 9/11-related benefits.--With respect to benefits under a 
        prescription drug plan under part D or under a Medicare 
        Advantage plan under part C, the Secretary shall provide for 
        reimbursement to the plan from the appropriate Trust Funds and 
        Accounts under this title for the cost of 9/11-related benefits 
        provided under the plan under this section, including costs 
        related to the application of the benefit modifications 
        described in subsection (c)(1).''.
    (b) Medicare Secondary Payor for 9/11-Related Coverage; No 
Discrimination Against Individuals in Employment-Based Health 
Insurance.--Section 1862(b) of such Act (42 U.S.C. 1395y(b)) is 
amended--
            (1) by redesignating subparagraph (D) of paragraph (1) as 
        subparagraph (G) and by moving it to the end of such paragraph;
            (2) by inserting after subparagraph (C) of paragraph (1) 
        the following new subparagraph:
                    ``(D) Individuals with a 9/11-disaster connected 
                health condition.--
                            ``(i) In general.--A group health plan, 
                        individual health insurance coverage, or any 
                        other form of health benefits coverage--
                                    ``(I) may not take into account 
                                that an individual who is covered under 
                                the plan or coverage is entitled to 9/
                                11-related benefits under this title 
                                under section 1809; and
                                    ``(II) shall provide that any 
                                covered individual shall be entitled to 
                                the same benefits under the plan with 
                                respect to treatment of a 9/11 
                                disaster-related health condition (as 
                                defined in section 1809(b)(2)(A)) under 
                                the same conditions as any similarly 
                                situated individual who is not so 
                                entitled.
                            ``(ii) Enforcement.--
                                    ``(I) Civil money penalties.--Any 
                                plan or coverage that violates clause 
                                (i) is subject to a civil money penalty 
                                of not to exceed $25,000 for each such 
                                violation. The provisions of section 
                                1128A (other than subsections (a) and 
                                (b)) shall apply to a civil money 
                                penalty under the previous sentence in 
                                the same manner as such provisions 
                                apply to a penalty or proceeding under 
                                section 1128A(a).
                                    ``(II) Private cause of action.--An 
                                individual adversely affected by a 
                                violation of clause (i) may bring a 
                                private cause of action to enjoin the 
                                violation and to obtain damages (which 
                                shall be in an amount double the amount 
                                otherwise provided and may include 
                                reasonable attorney's fees) resulting 
                                from such a violation.''; and
            (3) in the second sentence of paragraph (2)(A), by 
        inserting after ``large group health plan'' the following: ``or 
        other coverage described in paragraph (1)(D)(i)'';
            (4) in paragraph (2)(B)(vi), by inserting ``or other 
        coverage described in paragraph (1)(D)(i)'' after ``employer 
        group health plan''; and
            (5) in paragraph (3)(C)--
                    (A) in the heading by inserting ``or other 
                coverage'' after ``large group health plan''; and
                    (B) by inserting ``or other coverage described in 
                paragraph (1)(D)(i)'' after ``large group health 
                plan''.
    (c) Prohibition of Discrimination in Workers' Compensation and 
Employment.--
            (1) Workers' compensation.--
                    (A) Discrimination prohibited.--A workers' 
                compensation law or plan may not discriminate against 
                an individual by virtue of the individual's entitlement 
                to benefits under title XVIII of the Social Security 
                Act under section 1809 of such Act, as inserted by 
                subsection (a).
                    (B) Private cause of action.--An individual 
                adversely affected by a violation of subparagraph (A) 
                may bring a private cause of action to enjoin the 
                violation and to obtain damages (which shall be in an 
                amount double the amount such individual was otherwise 
                entitled to under such law or plan and may include 
                reasonable attorney's fees) resulting from such a 
                violation.
            (2) Employment.--
                    (A) Discrimination prohibited.--An employer may not 
                discriminate against an individual in regards to 
                hiring, advancement, compensation, or other terms, 
                conditions, and privileges of employment by virtue of 
                the individual's entitlement to benefits under title 
                XVIII of the Social Security Act under section 1809 of 
                such Act, as inserted by subsection (a).
                    (B) Enforcement.--The powers, remedies, and 
                procedures provided in sections 705, 706, 707, 709, 
                710, and 711 of the Civil Rights Act of 1964 (42 U.S.C. 
                2000e-4 et seq.) to the Equal Employment Opportunity 
                Commission, the Attorney General, or any person, 
                alleging a violation of title VII of that Act (42 
                U.S.C. 2000e et seq.) shall be the powers, remedies, 
                and procedures this subsection provides to the Equal 
                Employment Opportunity Commission, the Attorney 
                General, or any person, respectively, alleging 
                discrimination in violation of subparagraph (A), except 
                that any employer found by a court to have 
                intentionally engaged in discrimination in violation of 
                subparagraph (A) shall be additionally subject to a 
                civil penalty of not to exceed $25,000 for each such 
                violation.
                    (C) Employer defined.--As used in this paragraph, 
                the term ``employer'' has the same meaning given that 
                term in section 101(5) of the Americans with 
                Disabilities Act of 1990 (42 U.S.C. 12112(5)).
    (d) Conforming Amendments.--
            (1) Application of enrollment correction provisions.--
        Section 1837(h) of the Social Security Act (42 U.S.C. 1395p(h)) 
        is amended by inserting ``or section 1809(d)'' after ``1818''.
            (2) Conforming reference.--The second sentence of section 
        1818(a) of such Act (42 U.S.C. 1395i-2(a)) is amended by 
        inserting ``or 1809(d)'' after ``1818A'' .
            (3) Application of qmb provisions.--Section 1905(p)(1)(A) 
        of such Act (42 U.S.C. 1396d(p)(1)(A)) is amended by inserting 
        ``or 1809(d)'' after ``1818''.

SEC. 3. CONSORTIUM TO CONDUCT SCREENING, MONITORING, TREATMENT, AND 
              RESEARCH REGARDING 9/11 DISASTER-CONNECTED HEALTH 
              CONDITIONS.

    (a) Establishment of Consortium.--
            (1) In general.--Not later than 90 days after the date of 
        the enactment of this Act, the Secretary of Health and Human 
        Services, in consultation with the Director of the Centers for 
        Disease Control and Prevention and the Director of the National 
        Institutes of Health, shall establish a consortium (in this 
        section referred to as the ``Consortium'').
            (2) Composition.--
                    (A) In general.--The Consortium shall consist of 
                institutions, programs, and practitioners that have 
                provided, or are qualified to provide, screening, 
                clinical examinations, or long-term health monitoring 
                and analysis and treatment regarding 9/11 disaster-
                connected health conditions. The Consortium shall also 
                include community-based organizations with expertise in 
                providing outreach to hard-to-reach affected 
                communities.
                    (B) Director.--The Consortium shall have a 
                director, appointed by the Secretary, who shall be a 
                Federal official responsible for the administration of 
                the Consortium, including its governance and 
                management. The director also shall be the primary 
                Federal official responsible for general health issues 
                relating to the 9/11 New York terrorist attacks.
                    (C) Public participation in governance.--The 
                Secretary shall provide for public participation, 
                including representatives of affected communities or 
                members of affected populations, in the governance of 
                the Consortium.
            (3) Duties.--
                    (A) In general.--The Consortium shall conduct and 
                coordinate screening, monitoring, treatment, and 
                diagnostic research on the 9/11 disaster-connected 
                health conditions.
                    (B) Specific duties.--Specifically, the Consortium 
                shall--
                            (i) conduct outreach to hard-to-reach 
                        affected communities;
                            (ii) develop diagnostic criteria for the 
                        purposes of identifying latent and late-onset 
                        9/11 disaster-connected health conditions;
                            (iii) develop treatments for 9/11 disaster-
                        connected health conditions; and
                            (iv) track the adverse health and mental 
                        health conditions on historically underserved 
                        populations, including children, the elderly, 
                        and minority populations.
            (4) Clinical facility.--The Consortium shall have a 
        clinical facility located in Lower Manhattan, New York City.
    (b) Annual Report by NIH.--The Director of the National Institutes 
of Health shall submit to Congress an annual report describing the 
findings of research conducted under this section.
    (c) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be required to carry out this section.
    (d) 9/11 Disaster-Connected Health Condition.--The term ``9/11 
disaster-connected health condition'' has the meaning given such term 
in section 1809(b)(2)(A) of the Social Security Act, as inserted by the 
amendment made by section 2(a).
                                 <all>
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