II 

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. 

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

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘9/11 Comprehensive 

5 Health Benefits Act of 2006’’. 


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1 SEC. 2. MEDICARE-BASED ELIGIBILITY AND BENEFITS FOR 

2 INDIVIDUALS WITH A 9/11 DISASTER-CON3 NECTED HEALTH CONDITION. 

4 (a) IN GENERAL.—Title XVIII of the Social Security 

5 Act is amended by inserting after section 1808 the fol6 lowing new section: 

7 ‘‘BENEFITS FOR INDIVIDUALS WITH A 9/11 DISASTER8 CONNECTED HEALTH CONDITION

9 ‘‘SEC. 1809. (a) IN GENERAL.—Every 9/11 impacted 

10 individual (as defined in subsection (b)(1)(A)) who has a 

11 9/11 disaster-connected health condition (as defined in 

12 subsection (b)(2))— 

13 ‘‘(1) is entitled to 9/11-related benefits (as de14 fined in subsection (c)(1)) under this title without 

15 payment of any premium; and 

16 ‘‘(2) if the individual is not otherwise entitled 

17 to benefits under part A (or enrolled under part B), 

18 is eligible to enroll under subsection (d) for benefits 

19 under parts A, B, and D that are in addition to the 

20 9/11-related benefits provided under paragraph (1). 

21 Paragraph (1) shall apply regardless of whether or not 

22 the individual is otherwise entitled to benefits under part 

23 A, B, or D. Paragraph (2) shall apply regardless of wheth24 er the individual is covered under a group health plan or 

25 otherwise has other health insurance or benefits coverage. 

26 ‘‘(b) ELIGIBILITY.— 


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1 ‘‘(1) 9/11 IMPACTED INDIVIDUAL DEFINED.— 

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

3 section, the term ‘9/11 impacted individual’ 

4 means any of the following: 

5 ‘‘(i) EMERGENCY SERVICES OR RES6 CUE AND RECOVERY PERSONNEL.—Any 

7 emergency services or rescue and recovery 

8 personnel who responded to the 9/11 New 

9 York terrorist attacks at any time during 

10 the period beginning on September 11, 

11 2001, and ending on August 31, 2002. 

12 ‘‘(ii) INDIVIDUALS EXPOSED TO HAZ13 ARDOUS SUBSTANCES, POLLUTANTS, OR

14 CONTAMINANTS.—Any individual exposed 

15 in New York City to hazardous substances, 

16 pollutants, or contaminants released from 

17 the collapse of the World Trade Center 

18 that occurred in the 9/11 New York ter19 rorist attacks or from the fires that oc20 curred, or from the handling of resulting 

21 debris, thereafter. 

22 ‘‘(iii) OTHER INDIVIDUALS.—Any 

23 other individual whom the Secretary deter24 mines to be appropriate. 


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1 ‘‘(B) EMERGENCY SERVICES OR RESCUE

2 AND RECOVERY PERSONNEL INCLUDED.—For 

3 purposes of this paragraph, the term ‘emer4 gency services personnel or rescue and recovery 

5 personnel’ includes any of the following: 

6 ‘‘(i) A Federal, State, or city employee 

7 who responded to the 9/11 New York ter8 rorist attacks. 

9 ‘‘(ii) An individual who, as a worker 

10 or volunteer, was involved in clean-up, re11 pair, or infrastructure restoration activities 

12 related to the 9/11 New York terrorist at13 tacks. 

14 ‘‘(iii) An individual participating in a 

15 search and rescue team, or who assisted in 

16 the recovery of human remains, after the 

17 9/11 New York terrorist attacks. 

18 ‘‘(iv) Any other relief or rescue worker 

19 who the Secretary determines to be appro20 priate. 

21 ‘‘(C) PRESUMPTION OF EXPOSURE TO

22 HAZARDOUS SUBSTANCES, POLLUTANTS, OR

23 CONTAMINANTS.— 

24 ‘‘(i) IN GENERAL.—An individual 

25 shall be treated as described in subparaVerDate Aug 31 2005 02:41 Oct 06, 2006 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S4021.IS S4021

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1 graph (A)(ii) if the individual resided, 

2 owned a business, was employed, or at3 tended school, child care, or adult day care 

4 in a building that was exposed to haz5 ardous substances, pollutants, or contami6 nants released from the collapse of the 

7 World Trade Center that occurred during 

8 such attacks on or after September 11, 

9 2001 or from the fires that occurred, or 

10 from the handling of resulting debris, 

11 thereafter. 

12 ‘‘(ii) TREATMENT OF BUILDINGS.— 

13 For purposes of clause (i), any building in 

14 Manhattan, Brooklyn, Queens, Staten Is15 land, or Northern New Jersey (as delin16 eated by the Secretary) shall be treated as 

17 being described in such clause if there is 

18 evidence that the building was exposed to 

19 hazardous substances, pollutants, or con20 taminants released from the collapse of the 

21 World Trade Center or from the fires that 

22 occurred thereafter at any time during the 

23 period beginning on September 11, 2001, 

24 and ending on December 31, 2001. 


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1 ‘‘(2) 9/11 DISASTER-CONNECTED HEALTH CON2 DITION DEFINED.— 

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

4 section, the term ‘9/11 disaster-connected 

5 health condition’ means an adverse health con6 dition (including the exacerbation of a pre-exist7 ing health condition), which also may be an ad8 verse mental health condition, that, in the judg9 ment of a qualified medical practitioner (includ10 ing a therapist in the case of an adverse mental 

11 health condition), can reasonably be considered 

12 to be associated with exposure to the 9/11 New 

13 York terrorist attacks. 

14 ‘‘(B) 9/11 NEW YORK TERRORIST ATTACKS

15 DEFINED.—For purposes of this section, the 

16 term ‘9/11 New York terrorist attacks’ means 

17 the terrorist attacks that occurred on Sep18 tember 11, 2001, in New York City, New York. 

19 ‘‘(C) TREATMENT OF ADVERSE MENTAL

20 HEALTH CONDITION.—For purposes of sub21 paragraph (A), an individual shall be considered 

22 to have a 9/11 disaster-connected health condi23 tion if the individual has an adverse emotional 

24 or psychological health impact that— 


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1 ‘‘(i) has been formally diagnosed by a 

2 qualified medical practitioner or therapist; 

3 and 

4 ‘‘(ii) can be reasonably considered, in 

5 the judgment of such practitioner or thera6 pist, to be associated with exposure to the 

7 9/11 New York terrorist attacks. 

8 ‘‘(3) CRITERIA.—Not later than 30 days after 

9 the date of establishment of the Consortium estab10 lished under section 3 of the 9/11 Comprehensive 

11 Health Benefits Act of 2006, the Secretary, in con12 sultation with such Consortium, shall initially de13 velop standardized criteria for medical practitioners 

14 to consult with for assistance in their determination 

15 of whether an individual has a 9/11 disaster-con16 nected health condition consistent with this sub17 section. The Secretary shall periodically review such 

18 criteria and may, from time to time and in consulta19 tion with the Consortium, modify such criteria as 

20 the Secretary determines appropriate. 

21 ‘‘(4) APPEALS PROCESS.—The Secretary shall 

22 specify a process for the appeal of a determination 

23 that an individual is not eligible for benefits under 

24 this section. Such process shall be consistent with 

25 the process under section 1869 for the appeal of a 


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1 determination that an individual is entitled to bene2 fits under parts A and B. 

3 ‘‘(5) TREATMENT OF NONRESIDENTS AND UN4 DOCUMENTED ALIENS.—Nothing in this section 

5 shall be construed as making an individual ineligible 

6 for benefits under this section because the individual 

7 is not a resident of New York or the United States 

8 or because the individual is an alien or is not au9 thorized to reside in the United States. Nothing in 

10 this paragraph shall be construed to provide for any 

11 benefits under this title for items and services fur12 nished outside the United States, except as may oth13 erwise be authorized under this title. 

14 ‘‘(c) 9/11-RELATED BENEFITS DEFINED.— 

15 ‘‘(1) IN GENERAL.—For purposes of this sec16 tion, the term ‘9/11-related benefits’ means benefits 

17 under parts A, B, and D for the treatment of any 

18 9/11 disaster-related health condition, subject to the 

19 following modifications with respect to such treat20 ment: 

21 ‘‘(A) NO COST-SHARING.—No deductibles, 

22 coinsurance, copayments, or other cost-sharing 

23 shall be applicable. 

24 ‘‘(B) ELIMINATION OF DAY OR DOLLAR

25 LIMITATIONS.—Any day or dollar limitations on 


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1 coverage with respect to such treatment, includ2 ing such limitations under sections 1812, 

3 1833(g), and 1860D–2(b)(3), shall not be ap4 plicable. 

5 ‘‘(2) ENTITLEMENT WITHOUT PREMIUMS.—An 

6 individual entitled to 9/11-related benefits under this 

7 section is deemed to be entitled to benefits under 

8 parts A, B, and D with respect to such 9/11-related 

9 benefits without requirement for payment for any 

10 premium. The entitlement to such benefits shall 

11 begin on the date that the individual is determined 

12 to be eligible for such benefits, but in no case before 

13 the date of the enactment of this section. 

14 ‘‘(3) RELATION TO PART C.—Except in the case 

15 of an individual enrolled under part A or B under 

16 subsection (d) or otherwise, 9/11-related benefits are 

17 not available through enrollment in a Medicare Ad18 vantage plan under part C. 

19 ‘‘(d) ENROLLMENT OPTION FOR ADDITIONAL MEDI20 CARE BENEFITS.— 

21 ‘‘(1) IN GENERAL.—With respect to the enroll22 ment option described in subsection (a)(2), an eligi23 ble individual may enroll under part A or B (or 

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1 scribed in regulations. Such regulations shall provide 

2 for continuous open enrollment for such individuals. 

3 ‘‘(2) PREMIUMS.— 

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

5 this paragraph, the premium for enrollment 

6 under part A under this subsection shall be the 

7 same as the premium established under sub8 section (d) of section 1818 for enrollment under 

9 such section, subject to any reduction provided 

10 under such subsection. 

11 ‘‘(B) ELIMINATION OF PREMIUM BASED

12 ON QUARTERS OF COVERAGE.—No premium 

13 shall be imposed under subparagraph (A) in the 

14 case of an individual if the individual would be 

15 entitled, based solely on the number of quarters 

16 of coverage under title II, to benefits under 

17 part A under section 226(a), 226(b), or 226A. 

18 ‘‘(C) NO LATE ENROLLMENT PENALTY.— 

19 An individual enrolling under part A, B, or D 

20 under this subsection shall not be subject to 

21 any late enrollment penalty, including under 

22 sections 1839(b) and 1860D–13(b). 

23 ‘‘(3) ENROLLMENT UNDER PARTS B AND D.— 

24 For purposes of parts B and D, in the case of an 

25 individual eligible to enroll under this subsection, the 


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1 individual’s initial enrollment period under such 

2 parts shall be treated as beginning on the date of 

3 such eligibility and having no end date. 

4 ‘‘(4) COVERAGE.— 

5 ‘‘(A) IN GENERAL.—The period (in this 

6 subsection referred to as a ‘coverage period’) 

7 during which an individual enrolled under this 

8 subsection is entitled to benefits under the re9 spective part shall begin on the first day of the 

10 first month that begins at least 15 days after 

11 the date of the individual’s enrollment under 

12 such part. 

13 ‘‘(B) TERMINATION.—An individual’s cov14 erage period under this subsection under a part 

15 shall continue until the individual’s enrollment 

16 under such part is terminated as follows: 

17 ‘‘(i) As of the month following the 

18 month in which the individual files notice 

19 that the individual no longer wishes to be 

20 enrolled in the part under this subsection. 

21 ‘‘(ii) For nonpayment of any applica22 ble premiums under such part. 

23 ‘‘(iii) With respect to coverage under 

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1 vidual is neither enrolled in part A nor en2 rolled in part B. 

3 The termination of a coverage period under 

4 clause (ii) shall take effect on a date deter5 mined under regulations, which may be deter6 mined so as to provide a grace period in which 

7 overdue premiums may be paid and coverage 

8 continued. The grace period determined under 

9 the preceding sentence shall not exceed 90 days; 

10 except that it may be extended to not to exceed 

11 180 days in any case where the Secretary deter12 mines that there was good cause for failure to 

13 pay the overdue premiums within such 90-day 

14 period. 

15 ‘‘(e) PAYMENT-RELATED PROVISIONS.— 

16 ‘‘(1) AUTHORIZATION OF APPROPRIATIONS TO

17 COVER ADDITIONAL BENEFITS.—There are author18 ized to be appropriated to the Federal Hospital In19 surance Trust Fund and the Federal Supplementary 

20 Medical Insurance Trust Fund, and the Medicare 

21 Prescription Drug Account in such Trust Fund, 

22 such sums as may be necessary to cover the costs 

23 under such Trust Funds and Account of providing 

24 benefits under this section, net of any premiums 


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1 paid with respect to such benefits under subsection 

2 (d). 

3 ‘‘(2) REIMBURSEMENT OF PRESCRIPTION DRUG

4 PLANS AND MA PLANS FOR 9/11-RELATED BENE5 FITS.—With respect to benefits under a prescription 

6 drug plan under part D or under a Medicare Advan7 tage plan under part C, the Secretary shall provide 

8 for reimbursement to the plan from the appropriate 

9 Trust Funds and Accounts under this title for the 

10 cost of 9/11-related benefits provided under the plan 

11 under this section, including costs related to the ap12 plication of the benefit modifications described in 

13 subsection (c)(1).’’. 

14 (b) MEDICARE SECONDARY PAYOR FOR 9/11-RE15 LATED COVERAGE; NO DISCRIMINATION AGAINST INDI16 VIDUALS IN EMPLOYMENT-BASED HEALTH INSUR17 ANCE.—Section 1862(b) of such Act (42 U.S.C. 1395y(b)) 

18 is amended— 

19 (1) by redesignating subparagraph (D) of para20 graph (1) as subparagraph (G) and by moving it to 

21 the end of such paragraph; 

22 (2) by inserting after subparagraph (C) of 

23 paragraph (1) the following new subparagraph: 

24 ‘‘(D) INDIVIDUALS WITH A 9/11-DISASTER

25 CONNECTED HEALTH CONDITION.— 


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1 ‘‘(i) IN GENERAL.—A group health 

2 plan, individual health insurance coverage, 

3 or any other form of health benefits cov4 erage— 

5 ‘‘(I) may not take into account 

6 that an individual who is covered 

7 under the plan or coverage is entitled 

8 to 9/11-related benefits under this 

9 title under section 1809; and 

10 ‘‘(II) shall provide that any cov11 ered individual shall be entitled to the 

12 same benefits under the plan with re13 spect to treatment of a 9/11 disaster14 related health condition (as defined in 

15 section 1809(b)(2)(A)) under the 

16 same conditions as any similarly situ17 ated individual who is not so entitled. 

18 ‘‘(ii) ENFORCEMENT.— 

19 ‘‘(I) CIVIL MONEY PENALTIES.— 

20 Any plan or coverage that violates 

21 clause (i) is subject to a civil money 

22 penalty of not to exceed $25,000 for 

23 each such violation. The provisions of 

24 section 1128A (other than subsections 

25 (a) and (b)) shall apply to a civil 


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1 money penalty under the previous sen2 tence in the same manner as such 

3 provisions apply to a penalty or pro4 ceeding under section 1128A(a). 

5 ‘‘(II) PRIVATE CAUSE OF AC6 TION.—An individual adversely af7 fected by a violation of clause (i) may 

8 bring a private cause of action to en9 join the violation and to obtain dam10 ages (which shall be in an amount 

11 double the amount otherwise provided 

12 and may include reasonable attorney’s 

13 fees) resulting from such a violation.’’; 

14 and 

15 (3) in the second sentence of paragraph (2)(A), 

16 by inserting after ‘‘large group health plan’’ the fol17 lowing: ‘‘or other coverage described in paragraph 

18 (1)(D)(i)’’; 

19 (4) in paragraph (2)(B)(vi), by inserting ‘‘or 

20 other coverage described in paragraph (1)(D)(i)’’ 

21 after ‘‘employer group health plan’’; and 

22 (5) in paragraph (3)(C)— 

23 (A) in the heading by inserting ‘‘OR OTHER

24 COVERAGE’’ after ‘‘LARGE GROUP HEALTH

25 PLAN’’; and 


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1 (B) by inserting ‘‘or other coverage de2 scribed in paragraph (1)(D)(i)’’ after ‘‘large 

3 group health plan’’. 

4 (c) PROHIBITION OF DISCRIMINATION IN WORKERS’ 

5 COMPENSATION AND EMPLOYMENT.— 

6 (1) WORKERS’ COMPENSATION.— 

7 (A) DISCRIMINATION PROHIBITED.—A 

8 workers’ compensation law or plan may not dis9 criminate against an individual by virtue of the 

10 individual’s entitlement to benefits under title 

11 XVIII of the Social Security Act under section 

12 1809 of such Act, as inserted by subsection (a). 

13 (B) PRIVATE CAUSE OF ACTION.—An indi14 vidual adversely affected by a violation of sub15 paragraph (A) may bring a private cause of ac16 tion to enjoin the violation and to obtain dam17 ages (which shall be in an amount double the 

18 amount such individual was otherwise entitled 

19 to under such law or plan and may include rea20 sonable attorney’s fees) resulting from such a 

21 violation. 

22 (2) EMPLOYMENT.— 

23 (A) DISCRIMINATION PROHIBITED.—An 

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1 pensation, or other terms, conditions, and privi2 leges of employment by virtue of the individ3 ual’s entitlement to benefits under title XVIII 

4 of the Social Security Act under section 1809 

5 of such Act, as inserted by subsection (a). 

6 (B) ENFORCEMENT.—The powers, rem7 edies, and procedures provided in sections 705, 

8 706, 707, 709, 710, and 711 of the Civil Rights 

9 Act of 1964 (42 U.S.C. 2000e–4 et seq.) to the 

10 Equal Employment Opportunity Commission, 

11 the Attorney General, or any person, alleging a 

12 violation of title VII of that Act (42 U.S.C. 

13 2000e et seq.) shall be the powers, remedies, 

14 and procedures this subsection provides to the 

15 Equal Employment Opportunity Commission, 

16 the Attorney General, or any person, respec17 tively, alleging discrimination in violation of 

18 subparagraph (A), except that any employer 

19 found by a court to have intentionally engaged 

20 in discrimination in violation of subparagraph 

21 (A) shall be additionally subject to a civil pen22 alty of not to exceed $25,000 for each such vio23 lation. 

24 (C) EMPLOYER DEFINED.—As used in this 

25 paragraph, the term ‘‘employer’’ has the same 


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1 meaning given that term in section 101(5) of 

2 the Americans with Disabilities Act of 1990 (42 

3 U.S.C. 12112(5)). 

4 (d) CONFORMING AMENDMENTS.— 

5 (1) APPLICATION OF ENROLLMENT CORREC6 TION PROVISIONS.—Section 1837(h) of the Social 

7 Security Act (42 U.S.C. 1395p(h)) is amended by 

8 inserting ‘‘or section 1809(d)’’ after ‘‘1818’’. 

9 (2) CONFORMING REFERENCE.—The second 

10 sentence of section 1818(a) of such Act (42 U.S.C. 

11 1395i–2(a)) is amended by inserting ‘‘or 1809(d)’’ 

12 after ‘‘1818A’’ . 

13 (3) APPLICATION OF QMB PROVISIONS.—Sec14 tion 1905(p)(1)(A) of such Act (42 U.S.C. 

15 1396d(p)(1)(A)) is amended by inserting ‘‘or 

16 1809(d)’’ after ‘‘1818’’. 

17 SEC. 3. CONSORTIUM TO CONDUCT SCREENING, MONI18 TORING, TREATMENT, AND RESEARCH RE19 GARDING 9/11 DISASTER-CONNECTED 

20 HEALTH CONDITIONS. 

21 (a) ESTABLISHMENT OF CONSORTIUM.— 

22 (1) IN GENERAL.—Not later than 90 days after 

23 the date of the enactment of this Act, the Secretary 

24 of Health and Human Services, in consultation with 

25 the Director of the Centers for Disease Control and 


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1 Prevention and the Director of the National Insti2 tutes of Health, shall establish a consortium (in this 

3 section referred to as the ‘‘Consortium’’). 

4 (2) COMPOSITION.— 

5 (A) IN GENERAL.—The Consortium shall 

6 consist of institutions, programs, and practi7 tioners that have provided, or are qualified to 

8 provide, screening, clinical examinations, or 

9 long-term health monitoring and analysis and 

10 treatment regarding 9/11 disaster-connected 

11 health conditions. The Consortium shall also in12 clude community-based organizations with ex13 pertise in providing outreach to hard-to-reach 

14 affected communities. 

15 (B) DIRECTOR.—The Consortium shall 

16 have a director, appointed by the Secretary, 

17 who shall be a Federal official responsible for 

18 the administration of the Consortium, including 

19 its governance and management. The director 

20 also shall be the primary Federal official re21 sponsible for general health issues relating to 

22 the 9/11 New York terrorist attacks. 

23 (C) PUBLIC PARTICIPATION IN GOVERN24 ANCE.—The Secretary shall provide for public 

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1 fected communities or members of affected pop2 ulations, in the governance of the Consortium. 

3 (3) DUTIES.— 

4 (A) IN GENERAL.—The Consortium shall 

5 conduct and coordinate screening, monitoring, 

6 treatment, and diagnostic research on the 9/11 

7 disaster-connected health conditions. 

8 (B) SPECIFIC DUTIES.—Specifically, the 

9 Consortium shall— 

10 (i) conduct outreach to hard-to-reach 

11 affected communities; 

12 (ii) develop diagnostic criteria for the 

13 purposes of identifying latent and late14 onset 9/11 disaster-connected health condi15 tions; 

16 (iii) develop treatments for 9/11 dis17 aster-connected health conditions; and 

18 (iv) track the adverse health and men19 tal health conditions on historically under20 served populations, including children, the 

21 elderly, and minority populations. 

22 (4) CLINICAL FACILITY.—The Consortium shall 

23 have a clinical facility located in Lower Manhattan, 

24 New York City. 


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1 (b) ANNUAL REPORT BY NIH.—The Director of the 

2 National Institutes of Health shall submit to Congress an 

3 annual report describing the findings of research con4 ducted under this section. 

5 (c) AUTHORIZATION OF APPROPRIATIONS.—There 

6 are authorized to be appropriated such sums as may be 

7 required to carry out this section. 

8 (d) 9/11 DISASTER-CONNECTED HEALTH CONDI9 TION.—The term ‘‘9/11 disaster-connected health condi10 tion’’ has the meaning given such term in section 

11 1809(b)(2)(A) of the Social Security Act, as inserted by 

12 the amendment made by section 2(a). 

Æ 


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