H. R. 847 
One Hundred Eleventh Congress 
of the 
United States of America 
AT THE SECOND SESSION 
Begun and held at the City of Washington on Tuesday, 
the fifth day of January, two thousand and ten 
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. 
Be it enacted by the Senate and House of Representatives of 
the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the ‘‘James Zadroga 
9/11 Health and Compensation Act of 2010’’. 
(b) TABLE OF CONTENTS.—The table of contents of 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 con-
ditions. 
‘‘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 sur-
vivors 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 
‘‘Sec. 3341. Research regarding certain health conditions related to September 
11 terrorist attacks.
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‘‘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—REVENUE RELATED PROVISIONS 
Sec. 301. Excise tax on foreign procurement. 
Sec. 302. Renewal of fees for visa-dependent employers. 
TITLE IV—BUDGETARY EFFECTS 
Sec. 401. Compliance with Statutory Pay-As-You-Go Act of 2010. 
TITLE I—WORLD TRADE CENTER 
HEALTH PROGRAM 
SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 
The Public Health Service Act is amended by adding at the 
end the following new title: 
‘‘TITLE XXXIII—WORLD TRADE CENTER 
HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Program; 
Advisory Committee 
‘‘SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PRO-
GRAM. 
‘‘(a) IN GENERAL.—There is hereby established within the 
Department of Health and Human Services a program to be known 
as the World Trade Center Health Program, which shall be adminis-
tered by the WTC Program Administrator, to provide beginning 
on July 1, 2011— 
‘‘(1) medical monitoring and treatment benefits to eligible 
emergency responders and recovery and cleanup workers 
(including those who are Federal employees) who responded 
to the September 11, 2001, terrorist attacks; and 
‘‘(2) initial health evaluation, monitoring, and treatment 
benefits to residents and other building occupants and area 
workers in New York City who were directly impacted and 
adversely affected by such attacks. 
‘‘(b) COMPONENTS OF PROGRAM.—The WTC Program includes 
the following components: 
‘‘(1) MEDICAL MONITORING FOR RESPONDERS.—Medical mon-
itoring under section 3311, including clinical examinations and 
long-term health monitoring and analysis for enrolled WTC 
responders who were likely to have been exposed to airborne 
toxins that were released, or to other hazards, as a result 
of the September 11, 2001, terrorist attacks.
H. R. 847—3 
‘‘(2) INITIAL HEALTH EVALUATION FOR SURVIVORS.—An ini-
tial health evaluation under section 3321, including an evalua-
tion to determine eligibility for followup monitoring and treat-
ment. 
‘‘(3) FOLLOWUP
MONITORING
AND
TREATMENT
FOR
WTC- 
RELATED
HEALTH
CONDITIONS
FOR
RESPONDERS
AND
SUR-
VIVORS.—Provision under sections 3312, 3322, and 3323 of 
followup monitoring and treatment and payment, subject to 
the provisions of subsection (d), for all medically necessary 
health and mental health care expenses of an individual with 
respect to a WTC-related health condition (including necessary 
prescription drugs). 
‘‘(4) OUTREACH.—Establishment under section 3303 of an 
education and outreach program to potentially eligible individ-
uals concerning the benefits under this title. 
‘‘(5) CLINICAL DATA COLLECTION AND ANALYSIS.—Collection 
and analysis under section 3304 of health and mental health 
data relating to individuals receiving monitoring or treatment 
benefits in a uniform manner in collaboration with the collection 
of epidemiological data under section 3342. 
‘‘(6) RESEARCH
ON
HEALTH
CONDITIONS.—Establishment 
under subtitle C of a research program on health conditions 
resulting from the September 11, 2001, terrorist attacks. 
‘‘(c) NO COST SHARING.—Monitoring and treatment benefits 
and initial health evaluation benefits are provided under subtitle 
B without any deductibles, copayments, or other cost sharing to 
an enrolled WTC responder or certified-eligible WTC survivor. Ini-
tial health evaluation benefits are provided under subtitle B without 
any deductibles, copayments, or other cost sharing to a screening- 
eligible WTC survivor. 
‘‘(d) PREVENTING FRAUD AND UNREASONABLE ADMINISTRATIVE 
COSTS.— 
‘‘(1) FRAUD.—The Inspector General of the Department of 
Health and Human Services shall develop and implement a 
program to review the WTC Program’s health care expenditures 
to detect fraudulent or duplicate billing and payment for 
inappropriate services. This title is a Federal health care pro-
gram (as defined in section 1128B(f) of the Social Security 
Act) and is a health plan (as defined in section 1128C(c) of 
such Act) for purposes of applying sections 1128 through 1128E 
of such Act. 
‘‘(2) UNREASONABLE ADMINISTRATIVE COSTS.—The Inspector 
General of the Department of Health and Human Services 
shall develop and implement a program to review the WTC 
Program for unreasonable administrative costs, including with 
respect to infrastructure, administration, and claims processing. 
‘‘(e) QUALITY ASSURANCE.—The WTC Program Administrator 
working with the Clinical Centers of Excellence shall develop and 
implement a quality assurance program for the monitoring and 
treatment delivered by such Centers of Excellence and any other 
participating health care providers. Such program shall include— 
‘‘(1) adherence to monitoring and treatment protocols; 
‘‘(2) appropriate diagnostic and treatment referrals for 
participants; 
‘‘(3) prompt communication of test results to participants; 
and
H. R. 847—4 
‘‘(4) such other elements as the Administrator specifies 
in consultation with the Clinical Centers of Excellence. 
‘‘(f) ANNUAL PROGRAM REPORT.— 
‘‘(1) IN GENERAL.—Not later than 6 months after the end 
of each fiscal year in which the WTC Program is in operation, 
the WTC Program Administrator shall submit an annual report 
to the Congress on the operations of this title for such fiscal 
year and for the entire period of operation of the program. 
‘‘(2) CONTENTS INCLUDED IN REPORT.—Each annual report 
under paragraph (1) shall include at least the following: 
‘‘(A) ELIGIBLE INDIVIDUALS.—Information for each clin-
ical program described in paragraph (3)— 
‘‘(i) on the number of individuals who applied for 
certification under subtitle B and the number of such 
individuals who were so certified; 
‘‘(ii) of the individuals who were certified, on the 
number who received monitoring under the program 
and the number of such individuals who received med-
ical treatment under the program; 
‘‘(iii) with respect to individuals so certified who 
received such treatment, on the WTC-related health 
conditions for which they were treated; and 
‘‘(iv) on the projected number of individuals who 
will be certified under subtitle B in the succeeding 
fiscal year and the succeeding 10-year period. 
‘‘(B) MONITORING, INITIAL
HEALTH
EVALUATION, AND 
TREATMENT
COSTS.—For 
each 
clinical 
program 
so 
described— 
‘‘(i) information on the costs of monitoring and 
initial health evaluation and the costs of treatment 
and on the estimated costs of such monitoring, evalua-
tion, and treatment in the succeeding fiscal year; and 
‘‘(ii) an estimate of the cost of medical treatment 
for WTC-related health conditions that have been paid 
for or reimbursed by workers’ compensation, by public 
or private health plans, or by New York City under 
section 3331. 
‘‘(C) ADMINISTRATIVE COSTS.—Information on the cost 
of administering the program, including costs of program 
support, data collection and analysis, and research con-
ducted under the program. 
‘‘(D) ADMINISTRATIVE EXPERIENCE.—Information on the 
administrative performance of the program, including— 
‘‘(i) the performance of the program in providing 
timely evaluation of and treatment to eligible individ-
uals; and 
‘‘(ii) a list of the Clinical Centers of Excellence 
and other providers that are participating in the pro-
gram. 
‘‘(E) SCIENTIFIC REPORTS.—A summary of the findings 
of any new scientific reports or studies on the health effects 
associated with exposure described in section 3306(1), 
including the findings of research conducted under section 
3341(a). 
‘‘(F) ADVISORY COMMITTEE RECOMMENDATIONS.—A list 
of recommendations by the WTC Scientific/Technical 
Advisory Committee on additional WTC Program eligibility
H. R. 847—5 
criteria and on additional WTC-related health conditions 
and the action of the WTC Program Administrator con-
cerning each such recommendation. 
‘‘(3) SEPARATE CLINICAL PROGRAMS DESCRIBED.—In para-
graph (2), each of the following shall be treated as a separate 
clinical program of the WTC Program: 
‘‘(A) FIREFIGHTERS
AND
RELATED
PERSONNEL.—The 
benefits provided for enrolled WTC responders described 
in section 3311(a)(2)(A). 
‘‘(B) OTHER WTC RESPONDERS.—The benefits provided 
for enrolled WTC responders not described in subparagraph 
(A). 
‘‘(C) WTC 
SURVIVORS.—The benefits provided for 
screening-eligible WTC survivors and certified-eligible WTC 
survivors in section 3321(a). 
‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING 80 PERCENT 
OF ELIGIBILITY NUMERICAL LIMITS.—The Secretary shall promptly 
notify the Congress of each of the following: 
‘‘(1) When the number of enrollments of WTC responders 
subject to the limit established under section 3311(a)(4) has 
reached 80 percent of such limit. 
‘‘(2) When the number of certifications for certified-eligible 
WTC survivors subject to the limit established under section 
3321(a)(3) has reached 80 percent of such limit. 
‘‘(h) CONSULTATION.—The WTC Program Administrator shall 
engage in ongoing outreach and consultation with relevant stake-
holders, including the WTC Health Program Steering Committees 
and the Advisory Committee under section 3302, regarding the 
implementation and improvement of programs under this title. 
‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY 
COMMITTEE; WTC HEALTH PROGRAM STEERING COMMIT-
TEES. 
‘‘(a) ADVISORY COMMITTEE.— 
‘‘(1) ESTABLISHMENT.—The WTC Program Administrator 
shall establish an advisory committee to be known as the 
WTC Health Program Scientific/Technical Advisory Committee 
(in this subsection referred to as the ‘Advisory Committee’) 
to review scientific and medical evidence and to make rec-
ommendations to the Administrator on additional WTC Pro-
gram eligibility criteria and on additional WTC-related health 
conditions. 
‘‘(2) COMPOSITION.—The WTC Program Administrator shall 
appoint the members of the Advisory Committee and shall 
include at least— 
‘‘(A) 4 occupational physicians, at least 2 of whom 
have experience treating WTC rescue and recovery workers; 
‘‘(B) 1 physician with expertise in pulmonary medicine; 
‘‘(C) 2 environmental medicine or environmental health 
specialists; 
‘‘(D) 2 representatives of WTC responders; 
‘‘(E) 2 representatives of certified-eligible WTC sur-
vivors; 
‘‘(F) an industrial hygienist; 
‘‘(G) a toxicologist; 
‘‘(H) an epidemiologist; and 
‘‘(I) a mental health professional.
H. R. 847—6 
‘‘(3) MEETINGS.—The Advisory Committee shall meet at 
such frequency as may be required to carry out its duties. 
‘‘(4) REPORTS.—The WTC Program Administrator shall pro-
vide for publication of recommendations of the Advisory Com-
mittee on the public Web site established for the WTC Program. 
‘‘(5) DURATION.—Notwithstanding any other provision of 
law, the Advisory Committee shall continue in operation during 
the period in which the WTC Program is in operation. 
‘‘(6) APPLICATION OF FACA.—Except as otherwise specifically 
provided, the Advisory Committee shall be subject to the Fed-
eral Advisory Committee Act. 
‘‘(b) WTC HEALTH PROGRAM STEERING COMMITTEES.— 
‘‘(1) CONSULTATION.—The WTC Program Administrator 
shall consult with 2 steering committees (each in this section 
referred to as a ‘Steering Committee’) that are established 
as follows: 
‘‘(A) WTC RESPONDERS
STEERING
COMMITTEE.—One 
Steering Committee, to be known as the WTC Responders 
Steering Committee, for the purpose of receiving input 
from affected stakeholders and facilitating the coordination 
of monitoring and treatment programs for the enrolled 
WTC responders under part 1 of subtitle B. 
‘‘(B) WTC 
SURVIVORS
STEERING
COMMITTEE.—One 
Steering Committee, to be known as the WTC Survivors 
Steering Committee, for the purpose of receiving input 
from affected stakeholders and facilitating the coordination 
of initial health evaluations, monitoring, and treatment 
programs for screening-eligible and certified-eligible WTC 
survivors under part 2 of subtitle B. 
‘‘(2) MEMBERSHIP.— 
‘‘(A) WTC RESPONDERS STEERING COMMITTEE.— 
‘‘(i) 
REPRESENTATION.—The 
WTC 
Responders 
Steering Committee shall include— 
‘‘(I) representatives of the Centers of Excel-
lence providing services to WTC responders; 
‘‘(II) representatives of labor organizations rep-
resenting firefighters, police, other New York City 
employees, and recovery and cleanup workers who 
responded to the September 11, 2001, terrorist 
attacks; and 
‘‘(III) 3 representatives of New York City, 1 
of whom will be selected by the police commis-
sioner of New York City, 1 by the health commis-
sioner of New York City, and 1 by the mayor 
of New York City. 
‘‘(ii) INITIAL MEMBERSHIP.—The WTC Responders 
Steering Committee shall initially be composed of 
members of the WTC Monitoring and Treatment Pro-
gram Steering Committee (as in existence on the day 
before the date of the enactment of this title). 
‘‘(B) WTC SURVIVORS STEERING COMMITTEE.— 
‘‘(i) 
REPRESENTATION.—The 
WTC 
Survivors 
Steering Committee shall include representatives of— 
‘‘(I) the Centers of Excellence providing serv-
ices to screening-eligible and certified-eligible WTC 
survivors;
H. R. 847—7 
‘‘(II) the population of residents, students, and 
area and other workers affected by the September 
11, 2001, terrorist attacks; 
‘‘(III) screening-eligible and certified-eligible 
survivors receiving initial health evaluations, mon-
itoring, or treatment under part 2 of subtitle B 
and organizations advocating on their behalf; and 
‘‘(IV) New York City. 
‘‘(ii) INITIAL
MEMBERSHIP.—The WTC Survivors 
Steering Committee shall initially be composed of 
members of the WTC Environmental Health Center 
Survivor Advisory Committee (as in existence on the 
day before the date of the enactment of this title). 
‘‘(C) ADDITIONAL APPOINTMENTS.—Each Steering Com-
mittee may recommend, if approved by a majority of voting 
members of the Committee, additional members to the 
Committee. 
‘‘(D) VACANCIES.—A vacancy in a Steering Committee 
shall be filled by an individual recommended by the 
Steering Committee. 
‘‘SEC. 3303. EDUCATION AND OUTREACH. 
‘‘The WTC Program Administrator shall institute a program 
that provides education and outreach on the existence and avail-
ability of services under the WTC Program. The outreach and 
education program— 
‘‘(1) shall include— 
‘‘(A) the establishment of a public Web site with 
information about the WTC Program; 
‘‘(B) meetings with potentially eligible populations; 
‘‘(C) development and dissemination of outreach mate-
rials informing people about the program; and 
‘‘(D) the establishment of phone information services; 
and 
‘‘(2) shall be conducted in a manner intended— 
‘‘(A) to reach all affected populations; and 
‘‘(B) to include materials for culturally and linguis-
tically diverse populations. 
‘‘SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS. 
‘‘(a) IN GENERAL.—The WTC Program Administrator shall pro-
vide for the uniform collection of data, including claims data (and 
analysis of data and regular reports to the Administrator) on the 
prevalence of WTC-related health conditions and the identification 
of new WTC-related health conditions. Such data shall be collected 
for all individuals provided monitoring or treatment benefits under 
subtitle B and regardless of their place of residence or Clinical 
Center of Excellence through which the benefits are provided. The 
WTC Program Administrator shall provide, through the Data Cen-
ters or otherwise, for the integration of such data into the moni-
toring and treatment program activities under this title. 
‘‘(b) COORDINATING THROUGH CENTERS OF EXCELLENCE.—Each 
Clinical Center of Excellence shall collect data described in sub-
section (a) and report such data to the corresponding Data Center 
for analysis by such Data Center. 
‘‘(c) COLLABORATION WITH WTC HEALTH REGISTRY.—The WTC 
Program Administrator shall provide for collaboration between the
H. R. 847—8 
Data Centers and the World Trade Center Health Registry 
described in section 3342. 
‘‘(d) PRIVACY.—The data collection and analysis under this sec-
tion shall be conducted and maintained in a manner that protects 
the confidentiality of individually identifiable health information 
consistent with applicable statutes and regulations, including, as 
applicable, HIPAA privacy and security law (as defined in section 
3009(a)(2)) and section 552a of title 5, United States Code. 
‘‘SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA CENTERS. 
‘‘(a) IN GENERAL.— 
‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF EXCELLENCE.— 
The WTC Program Administrator shall, subject to subsection 
(b)(1)(B), enter into contracts with Clinical Centers of Excel-
lence (as defined in subsection (b)(1)(A))— 
‘‘(A) for the provision of monitoring and treatment 
benefits and initial health evaluation benefits under sub-
title B; 
‘‘(B) for the provision of outreach activities to individ-
uals eligible for such monitoring and treatment benefits, 
for initial health evaluation benefits, and for followup to 
individuals who are enrolled in the monitoring program; 
‘‘(C) for the provision of counseling for benefits under 
subtitle B, with respect to WTC-related health conditions, 
for individuals eligible for such benefits; 
‘‘(D) for the provision of counseling for benefits for 
WTC-related health conditions that may be available under 
workers’ compensation or other benefit programs for work- 
related injuries or illnesses, health insurance, disability 
insurance, or other insurance plans or through public or 
private social service agencies and assisting eligible individ-
uals in applying for such benefits; 
‘‘(E) for the provision of translational and interpretive 
services for program participants who are not English lan-
guage proficient; and 
‘‘(F) for the collection and reporting of data, including 
claims data, in accordance with section 3304. 
‘‘(2) CONTRACTS WITH DATA CENTERS.— 
‘‘(A) IN GENERAL.—The WTC Program Administrator 
shall enter into contracts with one or more Data Centers 
(as defined in subsection (b)(2))— 
‘‘(i) for receiving, analyzing, and reporting to the 
WTC Program Administrator on data, in accordance 
with section 3304, that have been collected and 
reported to such Data Centers by the corresponding 
Clinical Centers of Excellence under subsection 
(b)(1)(B)(iii); 
‘‘(ii) for the development of monitoring, initial 
health evaluation, and treatment protocols, with 
respect to WTC-related health conditions; 
‘‘(iii) for coordinating the outreach activities con-
ducted under paragraph (1)(B) by each corresponding 
Clinical Center of Excellence; 
‘‘(iv) for establishing criteria for the credentialing 
of medical providers participating in the nationwide 
network under section 3313;
H. R. 847—9 
‘‘(v) for coordinating and administering the activi-
ties of the WTC Health Program Steering Committees 
established under section 3002(b); and 
‘‘(vi) for meeting periodically with the cor-
responding Clinical Centers of Excellence to obtain 
input on the analysis and reporting of data collected 
under clause (i) and on the development of monitoring, 
initial health evaluation, and treatment protocols 
under clause (ii). 
‘‘(B) MEDICAL PROVIDER SELECTION.—The medical pro-
viders under subparagraph (A)(iv) shall be selected by the 
WTC Program Administrator on the basis of their experi-
ence treating or diagnosing the health conditions included 
in the list of WTC-related health conditions. 
‘‘(C) CLINICAL DISCUSSIONS.—In carrying out subpara-
graph (A)(ii), a Data Center shall engage in clinical discus-
sions across the WTC Program to guide treatment 
approaches for individuals with a WTC-related health 
condition. 
‘‘(D) TRANSPARENCY OF DATA.—A contract entered into 
under this subsection with a Data Center shall require 
the Data Center to make any data collected and reported 
to such Center under subsection (b)(1)(B)(iii) available to 
health researchers and others as provided in the CDC/ 
ATSDR Policy on Releasing and Sharing Data. 
‘‘(3) AUTHORITY FOR CONTRACTS TO BE CLASS SPECIFIC.— 
A contract entered into under this subsection with a Clinical 
Center of Excellence or a Data Center may be with respect 
to one or more class of enrolled WTC responders, screening- 
eligible WTC survivors, or certified-eligible WTC survivors. 
‘‘(4) USE
OF
COOPERATIVE
AGREEMENTS.—Any contract 
under this title between the WTC Program Administrator and 
a Data Center or a Clinical Center of Excellence may be in 
the form of a cooperative agreement. 
‘‘(5) REVIEW ON FEASIBILITY OF CONSOLIDATING DATA CEN-
TERS.—Not later than July 1, 2011, the Comptroller General 
of the United States shall submit to the Committee on Energy 
and Commerce of the House of Representatives and the Com-
mittee on Health, Education, Labor, and Pensions of the Senate 
a report on the feasibility of consolidating Data Centers into 
a single Data Center. 
‘‘(b) CENTERS OF EXCELLENCE.— 
‘‘(1) CLINICAL CENTERS OF EXCELLENCE.— 
‘‘(A) DEFINITION.—For purposes of this title, the term 
‘Clinical Center of Excellence’ means a Center that dem-
onstrates to the satisfaction of the Administrator that the 
Center— 
‘‘(i) uses an integrated, centralized health care pro-
vider approach to create a comprehensive suite of 
health services under this title that are accessible to 
enrolled WTC responders, screening-eligible WTC sur-
vivors, or certified-eligible WTC survivors; 
‘‘(ii) has experience in caring for WTC responders 
and screening-eligible WTC survivors or includes 
health care providers who have been trained pursuant 
to section 3313(c);
H. R. 847—10 
‘‘(iii) employs health care provider staff with exper-
tise that includes, at a minimum, occupational medi-
cine, environmental medicine, trauma-related psychi-
atry and psychology, and social services counseling; 
and 
‘‘(iv) meets such other requirements as specified 
by the Administrator. 
‘‘(B) CONTRACT
REQUIREMENTS.—The WTC Program 
Administrator shall not enter into a contract with a Clinical 
Center of Excellence under subsection (a)(1) unless the 
Center agrees to do each of the following: 
‘‘(i) Establish a formal mechanism for consulting 
with and receiving input from representatives of 
eligible populations receiving monitoring and treat-
ment benefits under subtitle B from such Center. 
‘‘(ii) Coordinate monitoring and treatment benefits 
under subtitle B with routine medical care provided 
for the treatment of conditions other than WTC-related 
health conditions. 
‘‘(iii) Collect and report to the corresponding Data 
Center data, including claims data, in accordance with 
section 3304(b). 
‘‘(iv) Have in place safeguards against fraud that 
are satisfactory to the Administrator, in consultation 
with the Inspector General of the Department of 
Health and Human Services. 
‘‘(v) Treat or refer for treatment all individuals 
who are enrolled WTC responders or certified-eligible 
WTC survivors with respect to such Center who 
present themselves for treatment of a WTC-related 
health condition. 
‘‘(vi) Have in place safeguards, consistent with sec-
tion 3304(c), to ensure the confidentiality of an individ-
ual’s individually identifiable health information, 
including requiring that such information not be dis-
closed to the individual’s employer without the 
authorization of the individual. 
‘‘(vii) Use amounts paid under subsection (c)(1) 
only for costs incurred in carrying out the activities 
described in subsection (a), other than those described 
in subsection (a)(1)(A). 
‘‘(viii) Utilize health care providers with occupa-
tional and environmental medicine expertise to conduct 
physical and mental health assessments, in accordance 
with protocols developed under subsection (a)(2)(A)(ii). 
‘‘(ix) Communicate with WTC responders and 
screening-eligible and certified-eligible WTC survivors 
in appropriate languages and conduct outreach activi-
ties with relevant stakeholder worker or community 
associations. 
‘‘(x) Meet all the other applicable requirements 
of this title, including regulations implementing such 
requirements. 
‘‘(C) TRANSITION
RULE
TO
ENSURE
CONTINUITY
OF 
CARE.—The WTC Program Administrator shall to the max-
imum extent feasible ensure continuity of care in any period 
of transition from monitoring and treatment of an enrolled
H. R. 847—11 
WTC responder or certified-eligible WTC survivor by a 
provider to a Clinical Center of Excellence or a health 
care provider participating in the nationwide network 
under section 3313. 
‘‘(2) DATA CENTERS.—For purposes of this title, the term 
‘Data Center’ means a Center that the WTC Program Adminis-
trator determines has the capacity to carry out the responsibil-
ities for a Data Center under subsection (a)(2). 
‘‘(3) CORRESPONDING CENTERS.—For purposes of this title, 
a Clinical Center of Excellence and a Data Center shall be 
treated as ‘corresponding’ to the extent that such Clinical 
Center and Data Center serve the same population group. 
‘‘(c) PAYMENT FOR INFRASTRUCTURE COSTS.— 
‘‘(1) IN GENERAL.—The WTC Program Administrator shall 
reimburse a Clinical Center of Excellence for the fixed infra-
structure costs of such Center in carrying out the activities 
described in subtitle B at a rate negotiated by the Administrator 
and such Centers. Such negotiated rate shall be fair and appro-
priate and take into account the number of enrolled WTC 
responders receiving services from such Center under this title. 
‘‘(2) FIXED INFRASTRUCTURE COSTS.—For purposes of para-
graph (1), the term ‘fixed infrastructure costs’ means, with 
respect to a Clinical Center of Excellence, the costs incurred 
by such Center that are not otherwise reimbursable by the 
WTC Program Administrator under section 3312(c) for patient 
evaluation, monitoring, or treatment but which are needed 
to operate the WTC program such as the costs involved in 
outreach to participants or recruiting participants, data collec-
tion and analysis, social services for counseling patients on 
other available assistance outside the WTC program, and the 
development of treatment protocols. Such term does not include 
costs for new construction or other capital costs. 
‘‘(d) GAO ANALYSIS.—Not later than July 1, 2011, the Comp-
troller General shall submit to the Committee on Energy and Com-
merce of the House of Representatives and the Committee on 
Health, Education, Labor, and Pensions of the Senate an analysis 
on whether Clinical Centers of Excellence with which the WTC 
Program Administrator enters into a contract under this section 
have financial systems that will allow for the timely submission 
of claims data for purposes of section 3304 and subsections (a)(1)(F) 
and (b)(1)(B)(iii). 
‘‘SEC. 3306. DEFINITIONS. 
‘‘In this title: 
‘‘(1) The term ‘aggravating’ means, with respect to a health 
condition, a health condition that existed on September 11, 
2001, and that, as a result of exposure to airborne toxins, 
any other hazard, or any other adverse condition resulting 
from the September 11, 2001, terrorist attacks, requires medical 
treatment that is (or will be) in addition to, more frequent 
than, or of longer duration than the medical treatment that 
would have been required for such condition in the absence 
of such exposure. 
‘‘(2) The term ‘certified-eligible WTC survivor’ has the 
meaning given such term in section 3321(a)(2). 
‘‘(3) The terms ‘Clinical Center of Excellence’ and ‘Data 
Center’ have the meanings given such terms in section 3305.
H. R. 847—12 
‘‘(4) The term ‘enrolled WTC responder’ means a WTC 
responder enrolled under section 3311(a)(3). 
‘‘(5) The term ‘initial health evaluation’ includes, with 
respect to an individual, a medical and exposure history, a 
physical examination, and additional medical testing as needed 
to evaluate whether the individual has a WTC-related health 
condition and is eligible for treatment under the WTC Program. 
‘‘(6) The term ‘list of WTC-related health conditions’ 
means— 
‘‘(A) for WTC responders, the health conditions listed 
in section 3312(a)(3); and 
‘‘(B) for screening-eligible and certified-eligible WTC 
survivors, the health conditions listed in section 3322(b). 
‘‘(7) The term ‘New York City disaster area’ means the 
area within New York City that is— 
‘‘(A) the area of Manhattan that is south of Houston 
Street; and 
‘‘(B) any block in Brooklyn that is wholly or partially 
contained within a 1.5-mile radius of the former World 
Trade Center site. 
‘‘(8) The term ‘New York metropolitan area’ means an 
area, specified by the WTC Program Administrator, within 
which WTC responders and eligible WTC screening-eligible sur-
vivors who reside in such area are reasonably able to access 
monitoring and treatment benefits and initial health evaluation 
benefits under this title through a Clinical Center of Excellence 
described in subparagraphs (A), (B), or (C) of section 3305(b)(1). 
‘‘(9) The term ‘screening-eligible WTC survivor’ has the 
meaning given such term in section 3321(a)(1). 
‘‘(10) Any reference to ‘September 11, 2001’ shall be deemed 
a reference to the period on such date subsequent to the ter-
rorist attacks at the World Trade Center, Shanksville, Pennsyl-
vania, or the Pentagon, as applicable, on such date. 
‘‘(11) The term ‘September 11, 2001, terrorist attacks’ 
means the terrorist attacks that occurred on September 11, 
2001, in New York City, in Shanksville, Pennsylvania, and 
at the Pentagon, and includes the aftermath of such attacks. 
‘‘(12) The term ‘WTC Health Program Steering Committee’ 
means such a Steering Committee established under section 
3302(b). 
‘‘(13) The term ‘WTC Program’ means the Word Trade 
Center Health Program established under section 3301(a). 
‘‘(14)(A) The term ‘WTC Program Administrator’ means— 
‘‘(i) subject to subparagraph (B), with respect to para-
graphs (3) and (4) of section 3311(a) (relating to enrollment 
of WTC responders), section 3312(c) and the corresponding 
provisions of section 3322 (relating to payment for initial 
health evaluation, monitoring, and treatment, paragraphs 
(1)(C), (2)(B), and (3) of section 3321(a) (relating to deter-
mination or certification of screening-eligible or certified- 
eligible WTC responders), and part 3 of subtitle B (relating 
to payor provisions), an official in the Department of Health 
and Human Services, to be designated by the Secretary; 
and 
‘‘(ii) with respect to any other provision of this title, 
the Director of the National Institute for Occupational 
Safety and Health, or a designee of such Director.
H. R. 847—13 
‘‘(B) In no case may the Secretary designate under subpara-
graph (A)(i) the Director of the National Institute for Occupa-
tional Safety and Health or a designee of such Director with 
respect to section 3322 (relating to payment for initial health 
evaluation, monitoring, and treatment). 
‘‘(15) The term ‘WTC-related health condition’ is defined 
in section 3312(a). 
‘‘(16) The term ‘WTC responder’ is defined in section 
3311(a). 
‘‘(17) The term ‘WTC Scientific/Technical Advisory Com-
mittee’ means such Committee established under section 
3302(a). 
‘‘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. 
‘‘(a) WTC RESPONDER DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this title, the term ‘WTC 
responder’ means any of the following individuals, subject to 
paragraph (4): 
‘‘(A) CURRENTLY
IDENTIFIED
RESPONDER.—An indi-
vidual who has been identified as eligible for monitoring 
under the arrangements as in effect on the date of the 
enactment of this title between the National Institute for 
Occupational Safety and Health and— 
‘‘(i) the consortium coordinated by Mt. Sinai Hos-
pital in New York City that coordinates the monitoring 
and treatment for enrolled WTC responders other than 
with respect to those covered under the arrangement 
with the Fire Department of New York City; or 
‘‘(ii) the Fire Department of New York City. 
‘‘(B) RESPONDER WHO MEETS CURRENT ELIGIBILITY CRI-
TERIA.—An individual who meets the current eligibility 
criteria described in paragraph (2). 
‘‘(C) RESPONDER WHO MEETS MODIFIED ELIGIBILITY CRI-
TERIA.—An individual who— 
‘‘(i) performed rescue, recovery, demolition, debris 
cleanup, or other related services in the New York 
City disaster area in response to the September 11, 
2001, terrorist attacks, regardless of whether such 
services were performed by a State or Federal employee 
or member of the National Guard or otherwise; and 
‘‘(ii) meets such eligibility criteria relating to expo-
sure to airborne toxins, other hazards, or adverse 
conditions resulting from the September 11, 2001, ter-
rorist attacks as the WTC Program Administrator, 
after consultation with the WTC Scientific/Technical 
Advisory Committee, determines appropriate. 
The WTC Program Administrator shall not modify such 
eligibility criteria on or after the date that the number 
of enrollments of WTC responders has reached 80 percent 
of the limit described in paragraph (4) or on or after the
H. R. 847—14 
date that the number of certifications for certified-eligible 
WTC survivors under section 3321(a)(2)(B) has reached 
80 percent of the limit described in section 3321(a)(3). 
‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria 
described in this paragraph for an individual is that the indi-
vidual is described in any of the following categories: 
‘‘(A) FIREFIGHTERS
AND
RELATED
PERSONNEL.—The 
individual— 
‘‘(i) was a member of the Fire Department of New 
York City (whether fire or emergency personnel, active 
or retired) who participated at least one day in the 
rescue and recovery effort at any of the former World 
Trade Center sites (including Ground Zero, Staten 
Island Landfill, and the New York City Chief Medical 
Examiner’s Office) for any time during the period 
beginning on September 11, 2001, and ending on July 
31, 2002; or 
‘‘(ii)(I) is a surviving immediate family member 
of an individual who was a member of the Fire Depart-
ment of New York City (whether fire or emergency 
personnel, active or retired) and was killed at the 
World Trade site on September 11, 2001; and 
‘‘(II) received any treatment for a WTC-related 
health condition described in section 3312(a)(1)(A)(ii) 
(relating to mental health conditions) on or before Sep-
tember 1, 2008. 
‘‘(B) LAW ENFORCEMENT OFFICERS AND WTC RESCUE, 
RECOVERY, AND CLEANUP WORKERS.—The individual— 
‘‘(i) worked or volunteered onsite in rescue, 
recovery, debris cleanup, or related support services 
in lower Manhattan (south of Canal St.), the Staten 
Island Landfill, or the barge loading piers, for at least 
4 hours during the period beginning on September 
11, 2001, and ending on September 14, 2001, for at 
least 24 hours during the period beginning on Sep-
tember 11, 2001, and ending on September 30, 2001, 
or for at least 80 hours during the period beginning 
on September 11, 2001, and ending on July 31, 2002; 
‘‘(ii)(I) was a member of the Police Department 
of New York City (whether active or retired) or a 
member of the Port Authority Police of the Port 
Authority of New York and New Jersey (whether active 
or retired) who participated onsite in rescue, recovery, 
debris cleanup, or related services in lower Manhattan 
(south of Canal St.), including Ground Zero, the Staten 
Island Landfill, or the barge loading piers, for at least 
4 hours during the period beginning September 11, 
2001, and ending on September 14, 2001; 
‘‘(II) participated onsite in rescue, recovery, debris 
cleanup, or related services at Ground Zero, the Staten 
Island Landfill, or the barge loading piers, for at least 
one day during the period beginning on September 
11, 2001, and ending on July 31, 2002; 
‘‘(III) participated onsite in rescue, recovery, debris 
cleanup, or related services in lower Manhattan (south 
of Canal St.) for at least 24 hours during the period
H. R. 847—15 
beginning on September 11, 2001, and ending on Sep-
tember 30, 2001; or 
‘‘(IV) participated onsite in rescue, recovery, debris 
cleanup, or related services in lower Manhattan (south 
of Canal St.) for at least 80 hours during the period 
beginning on September 11, 2001, and ending on July 
31, 2002; 
‘‘(iii) was an employee of the Office of the Chief 
Medical Examiner of New York City involved in the 
examination and handling of human remains from the 
World Trade Center attacks, or other morgue worker 
who performed similar post-September 11 functions 
for such Office staff, during the period beginning on 
September 11, 2001, and ending on July 31, 2002; 
‘‘(iv) was a worker in the Port Authority Trans- 
Hudson Corporation Tunnel for at least 24 hours 
during the period beginning on February 1, 2002, and 
ending on July 1, 2002; or 
‘‘(v) was a vehicle-maintenance worker who was 
exposed to debris from the former World Trade Center 
while retrieving, driving, cleaning, repairing, and 
maintaining vehicles contaminated by airborne toxins 
from the September 11, 2001, terrorist attacks during 
a duration and period described in subparagraph (A). 
‘‘(C) RESPONDERS TO THE SEPTEMBER 11 ATTACKS AT 
THE
PENTAGON
AND
SHANKSVILLE, PENNSYLVANIA.—The 
individual— 
‘‘(i)(I) was a member of a fire or police department 
(whether fire or emergency personnel, active or 
retired), worked for a recovery or cleanup contractor, 
or was a volunteer; and performed rescue, recovery, 
demolition, debris cleanup, or other related services 
at the Pentagon site of the terrorist-related aircraft 
crash of September 11, 2001, during the period begin-
ning on September 11, 2001, and ending on the date 
on which the cleanup of the site was concluded, as 
determined by the WTC Program Administrator; or 
‘‘(II) was a member of a fire or police department 
(whether fire or emergency personnel, active or 
retired), worked for a recovery or cleanup contractor, 
or was a volunteer; and performed rescue, recovery, 
demolition, debris cleanup, or other related services 
at the Shanksville, Pennsylvania, site of the terrorist- 
related aircraft crash of September 11, 2001, during 
the period beginning on September 11, 2001, and 
ending on the date on which the cleanup of the site 
was concluded, as determined by the WTC Program 
Administrator; and 
‘‘(ii) is determined by the WTC Program Adminis-
trator to be at an increased risk of developing a WTC- 
related health condition as a result of exposure to 
airborne toxins, other hazards, or adverse conditions 
resulting from the September 11, 2001, terrorist 
attacks, and meets such eligibility criteria related to 
such exposures, as the WTC Program Administrator 
determines are appropriate, after consultation with the 
WTC Scientific/Technical Advisory Committee.
H. R. 847—16 
‘‘(3) ENROLLMENT PROCESS.— 
‘‘(A) IN GENERAL.—The WTC Program Administrator 
shall establish a process for enrolling WTC responders 
in the WTC Program. Under such process— 
‘‘(i) WTC responders described in paragraph (1)(A) 
shall be deemed to be enrolled in such Program; 
‘‘(ii) subject to clause (iii), the Administrator shall 
enroll in such program individuals who are determined 
to be WTC responders; 
‘‘(iii) the Administrator shall deny such enrollment 
to an individual if the Administrator determines that 
the numerical limitation in paragraph (4) on enroll-
ment of WTC responders has been met; 
‘‘(iv) there shall be no fee charged to the applicant 
for making an application for such enrollment; 
‘‘(v) the Administrator shall make a determination 
on such an application not later than 60 days after 
the date of filing the application; and 
‘‘(vi) an individual who is denied enrollment in 
such Program shall have an opportunity to appeal 
such determination in a manner established under 
such process. 
‘‘(B) TIMING.— 
‘‘(i) 
CURRENTLY
IDENTIFIED
RESPONDERS.—In 
accordance with subparagraph (A)(i), the WTC Pro-
gram 
Administrator 
shall 
enroll 
an 
individual 
described in paragraph (1)(A) in the WTC Program 
not later than July 1, 2011. 
‘‘(ii) OTHER
RESPONDERS.—In accordance with 
subparagraph (A)(ii) and consistent with paragraph 
(4), the WTC Program Administrator shall enroll any 
other individual who is determined to be a WTC 
responder in the WTC Program at the time of such 
determination. 
‘‘(4) 
NUMERICAL
LIMITATION
ON
ELIGIBLE
WTC 
RESPONDERS.— 
‘‘(A) IN GENERAL.—The total number of individuals not 
described in paragraph (1)(A) or (2)(A)(ii) who may be 
enrolled under paragraph (3)(A)(ii) shall not exceed 25,000 
at any time, of which no more than 2,500 may be individ-
uals enrolled based on modified eligibility criteria estab-
lished under paragraph (1)(C). 
‘‘(B) PROCESS.—In implementing subparagraph (A), the 
WTC Program Administrator shall— 
‘‘(i) limit the number of enrollments made under 
paragraph (3)— 
‘‘(I) in accordance with such subparagraph; 
and 
‘‘(II) to such number, as determined by the 
Administrator based on the best available informa-
tion and subject to amounts available under sec-
tion 3351, that will ensure sufficient funds will 
be available to provide treatment and monitoring 
benefits under this title, with respect to all individ-
uals who are enrolled through the end of fiscal 
year 2020; and
H. R. 847—17 
‘‘(ii) provide priority (subject to paragraph (3)(A)(i)) 
in such enrollments in the order in which individuals 
apply for enrollment under paragraph (3). 
‘‘(5) DISQUALIFICATION
OF
INDIVIDUALS
ON
TERRORIST 
WATCH LIST.—No individual who is on the terrorist watch list 
maintained by the Department of Homeland Security shall 
qualify as an eligible WTC responder. Before enrolling any 
individual as a WTC responder in the WTC Program under 
paragraph (3), the Administrator, in consultation with the Sec-
retary of Homeland Security, shall determine whether the indi-
vidual is on such list. 
‘‘(b) MONITORING BENEFITS.— 
‘‘(1) IN GENERAL.—In the case of an enrolled WTC responder 
(other than one described in subsection (a)(2)(A)(ii)), the WTC 
Program shall provide for monitoring benefits that include mon-
itoring consistent with protocols approved by the WTC Program 
Administrator and including clinical examinations and long- 
term health monitoring and analysis. In the case of an enrolled 
WTC responder who is an active member of the Fire Depart-
ment of New York City, the responder shall receive such bene-
fits as part of the individual’s periodic company medical exams. 
‘‘(2) PROVISION OF MONITORING BENEFITS.—The monitoring 
benefits under paragraph (1) shall be provided through the 
Clinical Center of Excellence for the type of individual involved 
or, in the case of an individual residing outside the New York 
metropolitan area, under an arrangement under section 3313. 
‘‘SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS FOR WTC- 
RELATED HEALTH CONDITIONS. 
‘‘(a) WTC-RELATED HEALTH CONDITION DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this title, the term ‘WTC- 
related health condition’ means a condition that— 
‘‘(A)(i) is an illness or health condition for which expo-
sure to airborne toxins, any other hazard, or any other 
adverse condition resulting from the September 11, 2001, 
terrorist attacks, based on an examination by a medical 
professional with experience in treating or diagnosing the 
health conditions included in the applicable list of WTC- 
related health conditions, is substantially likely to be a 
significant factor in aggravating, contributing to, or causing 
the illness or health condition, as determined under para-
graph (2); or 
‘‘(ii) is a mental health condition for which such 
attacks, based on an examination by a medical professional 
with experience in treating or diagnosing the health condi-
tions included in the applicable list of WTC-related health 
conditions, is substantially likely to be a significant factor 
in aggravating, contributing to, or causing the condition, 
as determined under paragraph (2); and 
‘‘(B) is included in the applicable list of WTC-related 
health conditions or— 
‘‘(i) with respect to a WTC responder, is provided 
certification of coverage under subsection (b)(2)(B)(iii); 
or 
‘‘(ii) with respect to a screening-eligible WTC sur-
vivor or certified-eligible WTC survivor, is provided
H. R. 847—18 
certification of coverage under subsection (b)(2)(B)(iii), 
as applied under section 3322(a). 
In the case of a WTC responder described in section 
3311(a)(2)(A)(ii) (relating to a surviving immediate family 
member of a firefighter), such term does not include an illness 
or health condition described in subparagraph (A)(i). 
‘‘(2) DETERMINATION.—The determination under paragraph 
(1) or subsection (b) of whether the September 11, 2001, ter-
rorist attacks were substantially likely to be a significant factor 
in aggravating, contributing to, or causing an individual’s ill-
ness or health condition shall be made based on an assessment 
of the following: 
‘‘(A) The individual’s exposure to airborne toxins, any 
other hazard, or any other adverse condition resulting from 
the terrorist attacks. Such exposure shall be— 
‘‘(i) evaluated and characterized through the use 
of a standardized, population-appropriate question-
naire approved by the Director of the National Institute 
for Occupational Safety and Health; and 
‘‘(ii) assessed and documented by a medical profes-
sional with experience in treating or diagnosing health 
conditions included on the list of WTC-related health 
conditions. 
‘‘(B) The type of symptoms and temporal sequence 
of symptoms. Such symptoms shall be— 
‘‘(i) assessed through the use of a standardized, 
population-appropriate medical questionnaire approved 
by the Director of the National Institute for Occupa-
tional Safety and Health and a medical examination; 
and 
‘‘(ii) diagnosed and documented by a medical 
professional described in subparagraph (A)(ii). 
‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC RESPONDERS.— 
The list of health conditions for WTC responders consists of 
the following: 
‘‘(A) AERODIGESTIVE DISORDERS.— 
‘‘(i) Interstitial lung diseases. 
‘‘(ii) Chronic respiratory disorder—fumes/vapors. 
‘‘(iii) Asthma. 
‘‘(iv) 
Reactive 
airways 
dysfunction 
syndrome 
(RADS). 
‘‘(v) WTC-exacerbated chronic obstructive pul-
monary disease (COPD). 
‘‘(vi) Chronic cough syndrome. 
‘‘(vii) Upper airway hyperreactivity. 
‘‘(viii) Chronic rhinosinusitis. 
‘‘(ix) Chronic nasopharyngitis. 
‘‘(x) Chronic laryngitis. 
‘‘(xi) Gastroesophageal reflux disorder (GERD). 
‘‘(xii) Sleep apnea exacerbated by or related to 
a condition described in a previous clause. 
‘‘(B) MENTAL HEALTH CONDITIONS.— 
‘‘(i) Posttraumatic stress disorder (PTSD). 
‘‘(ii) Major depressive disorder. 
‘‘(iii) Panic disorder. 
‘‘(iv) Generalized anxiety disorder. 
‘‘(v) Anxiety disorder (not otherwise specified).
H. R. 847—19 
‘‘(vi) Depression (not otherwise specified). 
‘‘(vii) Acute stress disorder. 
‘‘(viii) Dysthymic disorder. 
‘‘(ix) Adjustment disorder. 
‘‘(x) Substance abuse. 
‘‘(C) MUSCULOSKELETAL DISORDERS FOR CERTAIN WTC 
RESPONDERS.—In the case of a WTC responder described 
in paragraph (4), a condition described in such paragraph. 
‘‘(D) ADDITIONAL CONDITIONS.—Any cancer (or type of 
cancer) or other condition added, pursuant to paragraph 
(5) or (6), to the list under this paragraph. 
‘‘(4) MUSCULOSKELETAL DISORDERS.— 
‘‘(A) IN GENERAL.—For purposes of this title, in the 
case of a WTC responder who received any treatment for 
a WTC-related musculoskeletal disorder on or before Sep-
tember 11, 2003, the list of health conditions in paragraph 
(3) shall include: 
‘‘(i) Low back pain. 
‘‘(ii) Carpal tunnel syndrome (CTS). 
‘‘(iii) Other musculoskeletal disorders. 
‘‘(B) DEFINITION.—The term ‘WTC-related musculo-
skeletal disorder’ means a chronic or recurrent disorder 
of the musculoskeletal system caused by heavy lifting or 
repetitive strain on the joints or musculoskeletal system 
occurring during rescue or recovery efforts in the New 
York City disaster area in the aftermath of the September 
11, 2001, terrorist attacks. 
‘‘(5) CANCER.— 
‘‘(A) IN GENERAL.—The WTC Program Administrator 
shall periodically conduct a review of all available scientific 
and medical evidence, including findings and recommenda-
tions of Clinical Centers of Excellence, published in peer- 
reviewed journals to determine if, based on such evidence, 
cancer or a certain type of cancer should be added to 
the applicable list of WTC-related health conditions. The 
WTC Program Administrator shall conduct the first review 
under this subparagraph not later than 180 days after 
the date of the enactment of this title. 
‘‘(B) PROPOSED REGULATIONS AND RULEMAKING.—Based 
on the periodic reviews under subparagraph (A), if the 
WTC Program Administrator determines that cancer or 
a certain type of cancer should be added to such list of 
WTC-related health conditions, the WTC Program Adminis-
trator shall propose regulations, through rulemaking, to 
add cancer or the certain type of cancer to such list. 
‘‘(C) FINAL REGULATIONS.—Based on all the available 
evidence in the rulemaking record, the WTC Program 
Administrator shall make a final determination of whether 
cancer or a certain type of cancer should be added to 
such list of WTC-related health conditions. If such a deter-
mination is made to make such an addition, the WTC 
Program Administrator shall by regulation add cancer or 
the certain type of cancer to such list. 
‘‘(D) DETERMINATIONS NOT TO ADD CANCER OR CERTAIN 
TYPES OF CANCER.—In the case that the WTC Program 
Administrator determines under subparagraph (B) or (C) 
that cancer or a certain type of cancer should not be added
H. R. 847—20 
to such list of WTC-related health conditions, the WTC 
Program Administrator shall publish an explanation for 
such determination in the Federal Register. Any such deter-
mination to not make such an addition shall not preclude 
the addition of cancer or the certain type of cancer to 
such list at a later date. 
‘‘(6) ADDITION OF HEALTH CONDITIONS TO LIST FOR WTC 
RESPONDERS.— 
‘‘(A) IN
GENERAL.—Whenever the WTC Program 
Administrator determines that a proposed rule should be 
promulgated to add a health condition to the list of health 
conditions in paragraph (3), the Administrator may request 
a recommendation of the Advisory Committee or may pub-
lish such a proposed rule in the Federal Register in accord-
ance with subparagraph (D). 
‘‘(B) ADMINISTRATOR’S OPTIONS AFTER RECEIPT OF PETI-
TION.—In the case that the WTC Program Administrator 
receives a written petition by an interested party to add 
a health condition to the list of health conditions in para-
graph (3), not later than 60 days after the date of receipt 
of such petition the Administrator shall— 
‘‘(i) request a recommendation of the Advisory 
Committee; 
‘‘(ii) publish a proposed rule in the Federal Register 
to add such health condition, in accordance with 
subparagraph (D); 
‘‘(iii) publish in the Federal Register the Adminis-
trator’s determination not to publish such a proposed 
rule and the basis for such determination; or 
‘‘(iv) publish in the Federal Register a determina-
tion that insufficient evidence exists to take action 
under clauses (i) through (iii). 
‘‘(C) ACTION BY ADVISORY COMMITTEE.—In the case that 
the Administrator requests a recommendation of the 
Advisory Committee under this paragraph, with respect 
to adding a health condition to the list in paragraph (3), 
the Advisory Committee shall submit to the Administrator 
such recommendation not later than 60 days after the 
date of such request or by such date (not to exceed 180 
days after such date of request) as specified by the Adminis-
trator. Not later than 60 days after the date of receipt 
of such recommendation, the Administrator shall, in accord-
ance with subparagraph (D), publish in the Federal Reg-
ister a proposed rule with respect to such recommendation 
or a determination not to propose such a proposed rule 
and the basis for such determination. 
‘‘(D) PUBLICATION.—The WTC Program Administrator 
shall, with respect to any proposed rule under this para-
graph— 
‘‘(i) publish such proposed rule in accordance with 
section 553 of title 5, United States Code; and 
‘‘(ii) provide interested parties a period of 30 days 
after such publication to submit written comments on 
the proposed rule. 
The WTC Program Administrator may extend the period 
described in clause (ii) upon a finding of good cause. In
H. R. 847—21 
the case of such an extension, the Administrator shall 
publish such extension in the Federal Register. 
‘‘(E) INTERESTED PARTY DEFINED.—For purposes of this 
paragraph, the term ‘interested party’ includes a represent-
ative of any organization representing WTC responders, 
a nationally recognized medical association, a Clinical or 
Data Center, a State or political subdivision, or any other 
interested person. 
‘‘(b) COVERAGE
OF TREATMENT
FOR WTC-RELATED HEALTH 
CONDITIONS.— 
‘‘(1) DETERMINATION FOR ENROLLED WTC RESPONDERS BASED 
ON A WTC-RELATED HEALTH CONDITION.— 
‘‘(A) IN GENERAL.—If a physician at a Clinical Center 
of Excellence that is providing monitoring benefits under 
section 3311 for an enrolled WTC responder makes a deter-
mination that the responder has a WTC-related health 
condition that is in the list in subsection (a)(3) and that 
exposure to airborne toxins, other hazards, or adverse 
conditions resulting from the September 1, 2001, terrorist 
attacks is substantially likely to be a significant factor 
in aggravating, contributing to, or causing the condition— 
‘‘(i) the physician shall promptly transmit such 
determination to the WTC Program Administrator and 
provide the Administrator with the medical facts sup-
porting such determination; and 
‘‘(ii) on and after the date of such transmittal 
and subject to subparagraph (B), the WTC Program 
shall provide for payment under subsection (c) for 
medically necessary treatment for such condition. 
‘‘(B) REVIEW; CERTIFICATION; APPEALS.— 
‘‘(i) REVIEW.—A Federal employee designated by 
the WTC Program Administrator shall review deter-
minations made under subparagraph (A). 
‘‘(ii) CERTIFICATION.—The Administrator shall pro-
vide a certification of such condition based upon 
reviews conducted under clause (i). Such a certification 
shall be provided unless the Administrator determines 
that the responder’s condition is not a WTC-related 
health condition in the list in subsection (a)(3) or that 
exposure to airborne toxins, other hazards, or adverse 
conditions resulting from the September 1, 2001, ter-
rorist attacks is not substantially likely to be a signifi-
cant factor in aggravating, contributing to, or causing 
the condition. 
‘‘(iii) APPEAL PROCESS.—The Administrator shall 
establish, by rule, a process for the appeal of deter-
minations under clause (ii). 
‘‘(2) DETERMINATION BASED ON MEDICALLY ASSOCIATED WTC- 
RELATED HEALTH CONDITIONS.— 
‘‘(A) IN GENERAL.—If a physician at a Clinical Center 
of Excellence determines pursuant to subsection (a) that 
the enrolled WTC responder has a health condition 
described in subsection (a)(1)(A) that is not in the list 
in subsection (a)(3) but which is medically associated with 
a WTC-related health condition— 
‘‘(i) the physician shall promptly transmit such 
determination to the WTC Program Administrator and
H. R. 847—22 
provide the Administrator with the facts supporting 
such determination; and 
‘‘(ii) the Administrator shall make a determination 
under subparagraph (B) with respect to such physi-
cian’s determination. 
‘‘(B) PROCEDURES
FOR
REVIEW, CERTIFICATION, AND 
APPEAL.—The WTC Program Administrator shall, by rule, 
establish procedures for the review and certification of 
physician determinations under subparagraph (A). Such 
rule shall provide for— 
‘‘(i) the timely review of such a determination by 
a physician panel with appropriate expertise for the 
condition and recommendations to the WTC Program 
Administrator; 
‘‘(ii) not later than 60 days after the date of the 
transmittal under subparagraph (A)(i), a determination 
by the WTC Program Administrator on whether or 
not the condition involved is described in subsection 
(a)(1)(A) and is medically associated with a WTC- 
related health condition; 
‘‘(iii) certification in accordance with paragraph 
(1)(B)(ii) of coverage of such condition if determined 
to be described in subsection (a)(1)(A) and medically 
associated with a WTC-related health condition; and 
‘‘(iv) a process for appeals of determinations 
relating to such conditions. 
‘‘(C) INCLUSION IN LIST OF HEALTH CONDITIONS.—If the 
WTC Program Administrator provides certification under 
subparagraph (B)(iii) for coverage of a condition, the 
Administrator may, pursuant to subsection (a)(6), add the 
condition to the list in subsection (a)(3). 
‘‘(D) CONDITIONS
ALREADY
DECLINED
FOR
INCLUSION 
IN LIST.—If the WTC Program Administrator publishes a 
determination under subsection (a)(6)(B) not to include a 
condition in the list in subsection (a)(3), the WTC Program 
Administrator 
shall 
not 
provide 
certification 
under 
subparagraph (B)(iii) for coverage of the condition. In the 
case of an individual who is certified under subparagraph 
(B)(iii) with respect to such condition before the date of 
the publication of such determination the previous sentence 
shall not apply. 
‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 
‘‘(A) IN GENERAL.—In providing treatment for a WTC- 
related health condition, a physician or other provider shall 
provide treatment that is medically necessary and in 
accordance with medical treatment protocols established 
under subsection (d). 
‘‘(B) REGULATIONS RELATING TO MEDICAL NECESSITY.— 
For the purpose of this title, the WTC Program Adminis-
trator shall issue regulations specifying a standard for 
determining medical necessity with respect to health care 
services and prescription pharmaceuticals, a process for 
determining whether treatment furnished and pharma-
ceuticals prescribed under this title meet such standard 
(including any prior authorization requirement), and a 
process for appeal of a determination under subsection 
(c)(3).
H. R. 847—23 
‘‘(4) SCOPE OF TREATMENT COVERED.— 
‘‘(A) IN
GENERAL.—The scope of treatment covered 
under this subsection includes services of physicians and 
other health care providers, diagnostic and laboratory tests, 
prescription drugs, inpatient and outpatient hospital serv-
ices, and other medically necessary treatment. 
‘‘(B) PHARMACEUTICAL
COVERAGE.—With respect to 
ensuring coverage of medically necessary outpatient 
prescription drugs, such drugs shall be provided, under 
arrangements made by the WTC Program Administrator, 
directly through participating Clinical Centers of Excel-
lence or through one or more outside vendors. 
‘‘(C) TRANSPORTATION EXPENSES FOR NATIONWIDE NET-
WORK.—The WTC Program Administrator may provide for 
necessary and reasonable transportation and expenses 
incident to the securing of medically necessary treatment 
through the nationwide network under section 3313 
involving travel of more than 250 miles and for which 
payment is made under this section in the same manner 
in which individuals may be furnished necessary and 
reasonable transportation and expenses incident to services 
involving travel of more than 250 miles under regulations 
implementing section 3629(c) of the Energy Employees 
Occupational Illness Compensation Program Act of 2000 
(title XXXVI of Public Law 106–398; 42 U.S.C. 7384t(c)). 
‘‘(5) PROVISION OF TREATMENT PENDING CERTIFICATION.— 
With respect to an enrolled WTC responder for whom a deter-
mination is made by an examining physician under paragraph 
(1) or (2), but for whom the WTC Program Administrator has 
not yet determined whether to certify the determination, the 
WTC Program Administrator may establish by rule a process 
through which the Administrator may approve the provision 
of medical treatment under this subsection (and payment under 
subsection (c)) with respect to such responder and such 
responder’s WTC-related health condition (under such terms 
and conditions as the Administrator may provide) until the 
Administrator makes a decision on whether to certify the deter-
mination. 
‘‘(c) PAYMENT FOR INITIAL HEALTH EVALUATION, MONITORING, 
AND TREATMENT OF WTC-RELATED HEALTH CONDITIONS.— 
‘‘(1) MEDICAL TREATMENT.— 
‘‘(A) USE OF FECA PAYMENT RATES.— 
‘‘(i) IN GENERAL.—Subject to clause (ii): 
‘‘(I) Subject to subparagraphs (B) and (C), the 
WTC Program Administrator shall reimburse costs 
for medically necessary treatment under this title 
for WTC-related health conditions according to the 
payment rates that would apply to the provision 
of such treatment and services by the facility under 
the Federal Employees Compensation Act. 
‘‘(II) For treatment not covered under sub-
clause (i) or subparagraph (B), the WTC Program 
Administrator shall establish by regulation a 
reimbursement rate for such treatment. 
‘‘(ii) EXCEPTION.—In no case shall payments for 
products or services under clause (i) be made at a 
rate higher than the Office of Worker’s Compensation
H. R. 847—24 
Programs in the Department Labor would pay for such 
products or services rendered at the time such products 
or services were provided. 
‘‘(B) PHARMACEUTICALS.— 
‘‘(i) IN
GENERAL.—The WTC Program Adminis-
trator shall establish a program for paying for the 
medically necessary outpatient prescription pharma-
ceuticals prescribed under this title for WTC-related 
health conditions through one or more contracts with 
outside vendors. 
‘‘(ii) COMPETITIVE BIDDING.—Under such program 
the Administrator shall— 
‘‘(I) select one or more appropriate vendors 
through a Federal competitive bid process; and 
‘‘(II) select the lowest bidder (or bidders) 
meeting the requirements for providing pharma-
ceutical benefits for participants in the WTC Pro-
gram. 
‘‘(iii) TREATMENT OF FDNY PARTICIPANTS.—Under 
such program the Administrator may enter into an 
agreement with a separate vendor to provide pharma-
ceutical benefits to enrolled WTC responders for whom 
the Clinical Center of Excellence is described in section 
3305 if such an arrangement is deemed necessary and 
beneficial to the program by the WTC Program 
Administrator. 
‘‘(iv) PHARMACEUTICALS.—Not later than July 1, 
2011, the Comptroller General of the United States 
shall submit to the Committee on Energy and Com-
merce of the House of Representatives and the Com-
mittee on Health, Education, Labor, and Pensions of 
the Senate a report on whether existing Federal 
pharmaceutical purchasing programs can provide 
pharmaceutical benefits more efficiently and effectively 
than through the WTC program. 
‘‘(C) IMPROVING
QUALITY
AND
EFFICIENCY
THROUGH 
MODIFICATION
OF
PAYMENT
AMOUNTS
AND
METHODOLO-
GIES.—The WTC Program Administrator may modify the 
amounts and methodologies for making payments for initial 
health evaluations, monitoring, or treatment, if, taking into 
account utilization and quality data furnished by the Clin-
ical Centers of Excellence under section 3305(b)(1)(B)(iii), 
the Administrator determines that a bundling, capitation, 
pay for performance, or other payment methodology would 
better ensure high quality and efficient delivery of initial 
health evaluations, monitoring, or treatment to an enrolled 
WTC responder, screening-eligible WTC survivor, or cer-
tified-eligible WTC survivor. 
‘‘(2) MONITORING AND INITIAL HEALTH EVALUATION.—The 
WTC Program Administrator shall reimburse the costs of moni-
toring and the costs of an initial health evaluation provided 
under this title at a rate set by the Administrator by regulation. 
‘‘(3) DETERMINATION OF MEDICAL NECESSITY.— 
‘‘(A) REVIEW OF MEDICAL NECESSITY AND PROTOCOLS.— 
As part of the process for reimbursement or payment under 
this subsection, the WTC Program Administrator shall pro-
vide for the review of claims for reimbursement or payment
H. R. 847—25 
for the provision of medical treatment to determine if such 
treatment is medically necessary and in accordance with 
medical treatment protocols established under subsection 
(d). 
‘‘(B) WITHHOLDING
OF
PAYMENT
FOR
MEDICALLY 
UNNECESSARY TREATMENT.—The Administrator shall with-
hold such reimbursement or payment for treatment that 
the Administrator determines is not medically necessary 
or is not in accordance with such medical treatment proto-
cols. 
‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 
‘‘(1) DEVELOPMENT.—The Data Centers shall develop med-
ical treatment protocols for the treatment of enrolled WTC 
responders and certified-eligible WTC survivors for health 
conditions included in the applicable list of WTC-related health 
conditions. 
‘‘(2) APPROVAL.—The medical treatment protocols developed 
under paragraph (1) shall be subject to approval by the WTC 
Program Administrator. 
‘‘SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE 
INDIVIDUALS OUTSIDE NEW YORK. 
‘‘(a) IN GENERAL.—In order to ensure reasonable access to bene-
fits under this subtitle for individuals who are enrolled WTC 
responders, screening-eligible WTC survivors, or certified-eligible 
WTC survivors and who reside in any State, as defined in section 
2(f), outside the New York metropolitan area, the WTC Program 
Administrator shall establish a nationwide network of health care 
providers to provide monitoring and treatment benefits and initial 
health evaluations near such individuals’ areas of residence in 
such States. Nothing in this subsection shall be construed as pre-
venting such individuals from being provided such monitoring and 
treatment benefits or initial health evaluation through any Clinical 
Center of Excellence. 
‘‘(b) NETWORK
REQUIREMENTS.—Any health care provider 
participating in the network under subsection (a) shall— 
‘‘(1) meet criteria for credentialing established by the Data 
Centers; 
‘‘(2) follow the monitoring, initial health evaluation, and 
treatment protocols developed under section 3305(a)(2)(A)(ii); 
‘‘(3) collect and report data in accordance with section 3304; 
and 
‘‘(4) meet such fraud, quality assurance, and other require-
ments as the WTC Program Administrator establishes, 
including sections 1128 through 1128E of the Social Security 
Act, as applied by section 3301(d). 
‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.—The WTC Program 
Administer may provide, including through contract, for the provi-
sion of training and technical assistance to health care providers 
participating in the network under subsection (a). 
‘‘(d) PROVISION OF SERVICES THROUGH THE VA.— 
‘‘(1) IN GENERAL.—The WTC Program Administrator may 
enter into an agreement with the Secretary of Veterans Affairs 
for the Secretary to provide services under this section through 
facilities of the Department of Veterans Affairs. 
‘‘(2) NATIONAL
PROGRAM.—Not later than July 1, 2011, 
the Comptroller General of the United States shall submit
H. R. 847—26 
to the Committee on Energy and Commerce of the House of 
Representatives and the Committee on Health, Education, 
Labor, and Pensions of the Senate a report on whether the 
Department of Veterans Affairs can provide monitoring and 
treatment services to individuals under this section more effi-
ciently and effectively than through the nationwide network 
to be established under subsection (a). 
‘‘PART 2—WTC SURVIVORS 
‘‘SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF 
SCREENING-ELIGIBLE 
AND 
CERTIFIED-ELIGIBLE 
WTC 
SURVIVORS. 
‘‘(a) IDENTIFICATION OF SCREENING-ELIGIBLE WTC SURVIVORS 
AND CERTIFIED-ELIGIBLE WTC SURVIVORS.— 
‘‘(1) SCREENING-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—In this title, the term ‘screening- 
eligible WTC survivor’ means, subject to subparagraph (C) 
and paragraph (3), an individual who is described in any 
of the following clauses: 
‘‘(i) CURRENTLY
IDENTIFIED
SURVIVOR.—An indi-
vidual, including a WTC responder, who has been 
identified as eligible for medical treatment and moni-
toring by the WTC Environmental Health Center as 
of the date of enactment of this title. 
‘‘(ii) SURVIVOR
WHO
MEETS
CURRENT
ELIGIBILITY 
CRITERIA.—An individual who is not a WTC responder, 
for purposes of the initial health evaluation under sub-
section (b), claims symptoms of a WTC-related health 
condition and meets any of the current eligibility cri-
teria described in subparagraph (B). 
‘‘(iii) SURVIVOR WHO MEETS MODIFIED ELIGIBILITY 
CRITERIA.—An individual who is not a WTC responder, 
for purposes of the initial health evaluation under sub-
section (b), claims symptoms of a WTC-related health 
condition and meets such eligibility criteria relating 
to exposure to airborne toxins, other hazards, or 
adverse conditions resulting from the September 11, 
2001, terrorist attacks as the WTC Administrator 
determines, after consultation with the Data Centers 
described in section 3305 and the WTC Scientific/Tech-
nical Advisory Committee and WTC Health Program 
Steering Committees under section 3302. 
The Administrator shall not modify such criteria under 
clause (iii) on or after the date that the number of certifi-
cations for certified-eligible WTC survivors under para-
graph (2)(B) has reached 80 percent of the limit described 
in paragraph (3) or on or after the date that the number 
of enrollments of WTC responders has reached 80 percent 
of the limit described in section 3311(a)(4). 
‘‘(B) CURRENT ELIGIBILITY CRITERIA.—The eligibility cri-
teria described in this subparagraph for an individual are 
that the individual is described in any of the following 
clauses: 
‘‘(i) A person who was present in the New York 
City disaster area in the dust or dust cloud on Sep-
tember 11, 2001.
H. R. 847—27 
‘‘(ii) A person who worked, resided, or attended 
school, childcare, or adult daycare in the New York 
City disaster area for— 
‘‘(I) at least 4 days during the 4-month period 
beginning on September 11, 2001, and ending on 
January 10, 2002; or 
‘‘(II) at least 30 days during the period begin-
ning on September 11, 2001, and ending on July 
31, 2002. 
‘‘(iii) Any person who worked as a cleanup worker 
or performed maintenance work in the New York City 
disaster area during the 4-month period described in 
subparagraph (B)(i) and had extensive exposure to 
WTC dust as a result of such work. 
‘‘(iv) A person who was deemed eligible to receive 
a grant from the Lower Manhattan Development Cor-
poration Residential Grant Program, who possessed 
a lease for a residence or purchased a residence in 
the New York City disaster area, and who resided 
in such residence during the period beginning on Sep-
tember 11, 2001, and ending on May 31, 2003. 
‘‘(v) A person whose place of employment— 
‘‘(I) at any time during the period beginning 
on September 11, 2001, and ending on May 31, 
2003, was in the New York City disaster area; 
and 
‘‘(II) was deemed eligible to receive a grant 
from the Lower Manhattan Development Corpora-
tion WTC Small Firms Attraction and Retention 
Act program or other government incentive pro-
gram designed to revitalize the lower Manhattan 
economy after the September 11, 2001, terrorist 
attacks. 
‘‘(C) APPLICATION
AND
DETERMINATION
PROCESS
FOR 
SCREENING ELIGIBILITY.— 
‘‘(i) IN
GENERAL.—The WTC Program Adminis-
trator in consultation with the Data Centers shall 
establish a process for individuals, other than individ-
uals described in subparagraph (A)(i), to be determined 
to be screening-eligible WTC survivors. Under such 
process— 
‘‘(I) there shall be no fee charged to the 
applicant for making an application for such deter-
mination; 
‘‘(II) the Administrator shall make a deter-
mination on such an application not later than 
60 days after the date of filing the application; 
‘‘(III) the Administrator shall make such a 
determination relating to an applicant’s compli-
ance with this title and shall not determine that 
an individual is not so eligible or deny written 
documentation under clause (ii) to such individual 
unless the Administrator determines that— 
‘‘(aa) based on the application submitted, 
the individual does not meet the eligibility 
criteria; or
H. R. 847—28 
‘‘(bb) the numerical limitation on certifi-
cations of certified-eligible WTC survivors set 
forth in paragraph (3) has been met; and 
‘‘(IV) an individual who is determined not to 
be a screening-eligible WTC survivor shall have 
an opportunity to appeal such determination in 
a manner established under such process. 
‘‘(ii) WRITTEN
DOCUMENTATION
OF
SCREENING- 
ELIGIBILITY.— 
‘‘(I) IN GENERAL.—In the case of an individual 
who is described in subparagraph (A)(i) or who 
is determined under clause (i) (consistent with 
paragraph (3)) to be a screening-eligible WTC sur-
vivor, the WTC Program Administrator shall pro-
vide an appropriate written documentation of such 
fact. 
‘‘(II) TIMING.— 
‘‘(aa) CURRENTLY IDENTIFIED SURVIVORS.— 
In the case of an individual who is described 
in subparagraph (A)(i), the WTC Program 
Administrator shall provide the written docu-
mentation under subclause (I) not later than 
July 1, 2011. 
‘‘(bb) OTHER
MEMBERS.—In the case of 
another individual who is determined under 
clause (i) and consistent with paragraph (3) 
to be a screening-eligible WTC survivor, the 
WTC Program Administrator shall provide the 
written documentation under subclause (I) at 
the time of such determination. 
‘‘(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—The term ‘certified-eligible WTC sur-
vivor’ means, subject to paragraph (3), a screening-eligible 
WTC survivor who the WTC Program Administrator cer-
tifies under subparagraph (B) to be eligible for followup 
monitoring and treatment under this part. 
‘‘(B) CERTIFICATION
OF
ELIGIBILITY
FOR
MONITORING 
AND TREATMENT.— 
‘‘(i) IN
GENERAL.—The WTC Program Adminis-
trator shall establish a certification process under 
which the Administrator shall provide appropriate cer-
tification to screening-eligible WTC survivors who, 
pursuant to the initial health evaluation under sub-
section (b), are determined to be eligible for followup 
monitoring and treatment under this part. 
‘‘(ii) TIMING.— 
‘‘(I) CURRENTLY IDENTIFIED SURVIVORS.—In the 
case of an individual who is described in paragraph 
(1)(A)(i), the WTC Program Administrator shall 
provide the certification under clause (i) not later 
than July 1, 2011. 
‘‘(II) OTHER MEMBERS.—In the case of another 
individual who is determined under clause (i) to 
be eligible for followup monitoring and treatment, 
the WTC Program Administrator shall provide the 
certification under such clause at the time of such 
determination.
H. R. 847—29 
‘‘(3) NUMERICAL
LIMITATION
ON
CERTIFIED-ELIGIBLE
WTC 
SURVIVORS.— 
‘‘(A) IN GENERAL.—The total number of individuals not 
described in paragraph (1)(A)(i) who may be certified as 
certified-eligible WTC survivors under paragraph (2)(B) 
shall not exceed 25,000 at any time. 
‘‘(B) PROCESS.—In implementing subparagraph (A), the 
WTC Program Administrator shall— 
‘‘(i) limit the number of certifications provided 
under paragraph (2)(B)— 
‘‘(I) in accordance with such subparagraph; 
and 
‘‘(II) to such number, as determined by the 
Administrator based on the best available informa-
tion and subject to amounts made available under 
section 3351, that will ensure sufficient funds will 
be available to provide treatment and monitoring 
benefits under this title, with respect to all individ-
uals receiving such certifications through the end 
of fiscal year 2020; and 
‘‘(ii) provide priority in such certifications in the 
order in which individuals apply for a determination 
under paragraph (2)(B). 
‘‘(4) DISQUALIFICATION
OF
INDIVIDUALS
ON
TERRORIST 
WATCH LIST.—No individual who is on the terrorist watch list 
maintained by the Department of Homeland Security shall 
qualify as a screening-eligible WTC survivor or a certified- 
eligible WTC survivor. Before determining any individual to 
be a screening-eligible WTC survivor under paragraph (1) or 
certifying any individual as a certified eligible WTC survivor 
under paragraph (2), the Administrator, in consultation with 
the Secretary of Homeland Security, shall determine whether 
the individual is on such list. 
‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE ELIGIBILITY 
FOR FOLLOWUP MONITORING OR TREATMENT.— 
‘‘(1) IN GENERAL.—In the case of a screening-eligible WTC 
survivor, the WTC Program shall provide for an initial health 
evaluation to determine if the survivor has a WTC-related 
health condition and is eligible for followup monitoring and 
treatment benefits under the WTC Program. Initial health 
evaluation protocols under section 3305(a)(2)(A)(ii) shall be sub-
ject to approval by the WTC Program Administrator. 
‘‘(2) INITIAL HEALTH EVALUATION PROVIDERS.—The initial 
health evaluation described in paragraph (1) shall be provided 
through a Clinical Center of Excellence with respect to the 
individual involved. 
‘‘(3) LIMITATION
ON
INITIAL
HEALTH
EVALUATION
BENE-
FITS.—Benefits for an initial health evaluation under this part 
for a screening-eligible WTC survivor shall consist only of a 
single medical initial health evaluation consistent with initial 
health evaluation protocols described in paragraph (1). Nothing 
in this paragraph shall be construed as preventing such an 
individual from seeking additional medical initial health 
evaluations at the expense of the individual.
H. R. 847—30 
‘‘SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED- 
ELIGIBLE WTC SURVIVORS FOR WTC-RELATED HEALTH 
CONDITIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), the provisions of 
sections 3311 and 3312 shall apply to followup monitoring and 
treatment of WTC-related health conditions for certified-eligible 
WTC survivors in the same manner as such provisions apply to 
the monitoring and treatment of WTC-related health conditions 
for enrolled WTC responders. 
‘‘(b) LIST
OF WTC-RELATED HEALTH CONDITIONS
FOR SUR-
VIVORS.—The list of health conditions for screening-eligible WTC 
survivors and certified-eligible WTC survivors consists of the fol-
lowing: 
‘‘(1) AERODIGESTIVE DISORDERS.— 
‘‘(A) Interstitial lung diseases. 
‘‘(B) Chronic respiratory disorder—fumes/vapors. 
‘‘(C) Asthma. 
‘‘(D) Reactive airways dysfunction syndrome (RADS). 
‘‘(E) WTC-exacerbated chronic obstructive pulmonary 
disease (COPD). 
‘‘(F) Chronic cough syndrome. 
‘‘(G) Upper airway hyperreactivity. 
‘‘(H) Chronic rhinosinusitis. 
‘‘(I) Chronic nasopharyngitis. 
‘‘(J) Chronic laryngitis. 
‘‘(K) Gastroesophageal reflux disorder (GERD). 
‘‘(L) Sleep apnea exacerbated by or related to a condi-
tion described in a previous clause. 
‘‘(2) MENTAL HEALTH CONDITIONS.— 
‘‘(A) Posttraumatic stress disorder (PTSD). 
‘‘(B) Major depressive disorder. 
‘‘(C) Panic disorder. 
‘‘(D) Generalized anxiety disorder. 
‘‘(E) Anxiety disorder (not otherwise specified). 
‘‘(F) Depression (not otherwise specified). 
‘‘(G) Acute stress disorder. 
‘‘(H) Dysthymic disorder. 
‘‘(I) Adjustment disorder. 
‘‘(J) Substance abuse. 
‘‘(3) ADDITIONAL
CONDITIONS.—Any cancer (or type of 
cancer) or other condition added to the list in section 3312(a)(3) 
pursuant to paragraph (5) or (6) of section 3312(a), as such 
provisions are applied under subsection (a) with respect to 
certified-eligible WTC survivors. 
‘‘SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF OTHER 
INDIVIDUALS WITH WTC-RELATED HEALTH CONDITIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (c), the provisions of 
section 3322 shall apply to the followup monitoring and treatment 
of WTC-related health conditions in the case of individuals described 
in subsection (b) in the same manner as such provisions apply 
to the followup monitoring and treatment of WTC-related health 
conditions for certified-eligible WTC survivors. 
‘‘(b) INDIVIDUALS DESCRIBED.—An individual described in this 
subsection is an individual who, regardless of location of residence— 
‘‘(1) is not an enrolled WTC responder or a certified-eligible 
WTC survivor; and
H. R. 847—31 
‘‘(2) is diagnosed at a Clinical Center of Excellence with 
a WTC-related health condition for certified-eligible WTC sur-
vivors. 
‘‘(c) LIMITATION.— 
‘‘(1) IN GENERAL.—The WTC Program Administrator shall 
limit benefits for any fiscal year under subsection (a) in a 
manner so that payments under this section for such fiscal 
year do not exceed the amount specified in paragraph (2) for 
such fiscal year. 
‘‘(2) LIMITATION.—The amount specified in this paragraph 
for— 
‘‘(A) the last calendar quarter of fiscal year 2011 is 
$5,000,000; 
‘‘(B) fiscal year 2012 is $20,000,000; or 
‘‘(C) a succeeding fiscal year is the amount specified 
in this paragraph for the previous fiscal year increased 
by the annual percentage increase in the medical care 
component of the consumer price index for all urban con-
sumers. 
‘‘PART 3—PAYOR PROVISIONS 
‘‘SEC. 3331. PAYMENT OF CLAIMS. 
‘‘(a) IN GENERAL.—Except as provided in subsections (b) and 
(c), the cost of monitoring and treatment benefits and initial health 
evaluation benefits provided under parts 1 and 2 of this subtitle 
shall be paid for by the WTC Program from the World Trade 
Center Health Program Fund. 
‘‘(b) WORKERS’ COMPENSATION PAYMENT.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), payment for 
treatment under parts 1 and 2 of this subtitle of a WTC- 
related health condition of an individual that is work-related 
shall be reduced or recouped to the extent that the WTC Pro-
gram Administrator determines that payment has been made, 
or can reasonably be expected to be made, under a workers’ 
compensation law or plan of the United States, a State, or 
a locality, or other work-related injury or illness benefit plan 
of the employer of such individual, for such treatment. The 
provisions of clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) 
of section 1862(b) of the Social Security Act and paragraphs 
(3) and (4) of such section shall apply to the recoupment under 
this subsection of a payment to the WTC Program (with respect 
to a workers’ compensation law or plan, or other work-related 
injury or illness plan of the employer involved, and such indi-
vidual) in the same manner as such provisions apply to the 
reimbursement of a payment under section 1862(b)(2) of such 
Act to the Secretary (with respect to such a law or plan and 
an individual entitled to benefits under title XVIII of such 
Act) except that any reference in such paragraph (4) to payment 
rates under title XVIII of the Social Security Act shall be 
deemed a reference to payment rates under this title. 
‘‘(2) EXCEPTION.—Paragraph (1) shall not apply for any 
quarter, with respect to any workers’ compensation law or 
plan, including line of duty compensation, to which New York 
City is obligated to make payments, if, in accordance with 
terms specified under the contract under subsection (d)(1)(A),
H. R. 847—32 
New York City has made the full payment required under 
such contract for such quarter. 
‘‘(3) RULES OF CONSTRUCTION.—Nothing in this title shall 
be construed to affect, modify, or relieve any obligations under 
a worker’s compensation law or plan, other work-related injury 
or illness benefit plan of an employer, or any health insurance 
plan. 
‘‘(c) HEALTH INSURANCE COVERAGE.— 
‘‘(1) IN GENERAL.—In the case of an individual who has 
a WTC-related health condition that is not work-related and 
has health coverage for such condition through any public or 
private health plan (including health benefits under title XVIII, 
XIX, or XXI of the Social Security Act) the provisions of section 
1862(b) of the Social Security Act shall apply to such a health 
plan and such individual in the same manner as they apply 
to group health plan and an individual entitled to benefits 
under title XVIII of such Act pursuant to section 226(a) of 
such Act. Any costs for items and services covered under such 
plan that are not reimbursed by such health plan, due to 
the application of deductibles, copayments, coinsurance, other 
cost sharing, or otherwise, are reimbursable under this title 
to the extent that they are covered under the WTC Program. 
The program under this title shall not be treated as a legally 
liable party for purposes of applying section 1902(a)(25) of 
the Social Security Act. 
‘‘(2) RECOVERY BY INDIVIDUAL PROVIDERS.—Nothing in para-
graph (1) shall be construed as requiring an entity providing 
monitoring and treatment under this title to seek reimburse-
ment under a health plan with which the entity has no contract 
for reimbursement. 
‘‘(3) MAINTENANCE OF REQUIRED MINIMUM ESSENTIAL COV-
ERAGE.—No payment may be made for monitoring and treat-
ment under this title for an individual for a month (beginning 
with July 2014) if with respect to such month the individual— 
‘‘(A) is an applicable individual (as defined in sub-
section (d) of section 5000A of Internal Revenue Code of 
1986) for whom the exemption under subsection (e) of such 
section does not apply; and 
‘‘(B) is not covered under minimum essential coverage, 
as required under subsection (a) of such section. 
‘‘(d) REQUIRED CONTRIBUTION BY NEW YORK CITY IN PROGRAM 
COSTS.— 
‘‘(1) CONTRACT REQUIREMENT.— 
‘‘(A) IN GENERAL.—No funds may be disbursed from 
the World Trade Center Health Program Fund under sec-
tion 3351 unless New York City has entered into a contract 
with the WTC Program Administrator under which New 
York City agrees, in a form and manner specified by the 
Administrator, to pay the full contribution described in 
subparagraph (B) in accordance with this subsection on 
a timely basis, plus any interest owed pursuant to subpara-
graph (E)(i). Such contract shall specify the terms under 
which New York City shall be considered to have made 
the full payment required for a quarter for purposes of 
subsection (b)(2). 
‘‘(B) FULL CONTRIBUTION AMOUNT.—Under such con-
tract, with respect to the last calendar quarter of fiscal
H. R. 847—33 
year 2011 and each calendar quarter in fiscal years 2012 
through 2015 the full contribution amount under this 
subparagraph shall be equal to 10 percent of the expendi-
tures in carrying out this title for the respective quarter 
and with respect to calendar quarters in fiscal year 2016, 
such full contribution amount shall be equal to 1⁄9 of the 
Federal expenditures in carrying out this title for the 
respective quarter. 
‘‘(C) SATISFACTION OF PAYMENT OBLIGATION.—The pay-
ment obligation under such contract may not be satisfied 
through any of the following: 
‘‘(i) An amount derived from Federal sources. 
‘‘(ii) An amount paid before the date of the enact-
ment of this title. 
‘‘(iii) An amount paid to satisfy a judgment or 
as part of a settlement related to injuries or illnesses 
arising out of the September 11, 2001, terrorist attacks. 
‘‘(D) TIMING OF CONTRIBUTION.—The payment obliga-
tion under such contract for a calendar quarter in a fiscal 
year shall be paid not later than the last day of the second 
succeeding calendar quarter. 
‘‘(E) COMPLIANCE.— 
‘‘(i) INTEREST FOR LATE PAYMENT.—If New York 
City fails to pay to the WTC Program Administrator 
pursuant to such contract the amount required for 
any calendar quarter by the day specified in subpara-
graph (D), interest shall accrue on the amount not 
so paid at the rate (determined by the Administrator) 
based on the average yield to maturity, plus 1 percent-
age point, on outstanding municipal bonds issued by 
New York City with a remaining maturity of at least 
1 year. 
‘‘(ii) RECOVERY OF AMOUNTS OWED.—The amounts 
owed to the WTC Program Administrator under such 
contract shall be recoverable by the United States in 
an action in the same manner as payments made under 
title XVIII of the Social Security Act may be recover-
able 
in 
an 
action 
brought 
under 
section 
1862(b)(2)(B)(iii) of such Act. 
‘‘(F) DEPOSIT IN FUND.—The WTC Program Administer 
shall deposit amounts paid under such contract into the 
World Trade Center Health Program Fund under section 
3351. 
‘‘(2) PAYMENT OF NEW YORK CITY SHARE OF MONITORING 
AND TREATMENT COSTS.—With respect to each calendar quarter 
for which a contribution is required by New York City under 
the contract under paragraph (1), the WTC Program Adminis-
trator shall— 
‘‘(A) provide New York City with an estimate of such 
amount of the required contribution at the beginning of 
such quarter and with an updated estimate of such amount 
at the beginning of each of the subsequent 2 quarters; 
‘‘(B) bill such amount directly to New York City; and 
‘‘(C) certify periodically, for purposes of this subsection, 
whether or not New York City has paid the amount so 
billed.
H. R. 847—34 
Such amount shall initially be estimated by the WTC Program 
Administrator and shall be subject to adjustment and reconcili-
ation based upon actual expenditures in carrying out this title. 
‘‘(3) RULE OF CONSTRUCTION.—Nothing in this subsection 
shall be construed as authorizing the WTC Administrator, with 
respect to a fiscal year, to reduce the numerical limitation 
under section 3311(a)(4) or 3321(a)(3) for such fiscal year if 
New York City fails to comply with paragraph (1) for a calendar 
quarter in such fiscal year. 
‘‘(e) WORK-RELATED DESCRIBED.—For the purposes of this sec-
tion, a WTC-related health condition shall be treated as a condition 
that is work-related if— 
‘‘(1) the condition is diagnosed in an enrolled WTC 
responder, or in an individual who qualifies as a certified- 
eligible WTC survivor on the basis of being a rescue, recovery, 
or cleanup worker; or 
‘‘(2) with respect to the condition the individual has filed 
and had established a claim under a workers’ compensation 
law or plan of the United States or a State, or other work- 
related injury or illness benefit plan of the employer of such 
individual. 
‘‘SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY. 
‘‘The WTC Program Administrator may enter into arrange-
ments with other government agencies, insurance companies, or 
other third-party administrators to provide for timely and accurate 
processing of claims under sections 3312, 3313, 3322, and 3323. 
‘‘Subtitle C—Research Into Conditions 
‘‘SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS 
RELATED TO SEPTEMBER 11 TERRORIST ATTACKS. 
‘‘(a) IN
GENERAL.—With respect to individuals, including 
enrolled WTC responders and certified-eligible WTC survivors, 
receiving monitoring or treatment under subtitle B, the WTC Pro-
gram Administrator shall conduct or support— 
‘‘(1) research on physical and mental health conditions 
that may be related to the September 11, 2001, terrorist 
attacks; 
‘‘(2) research on diagnosing WTC-related health conditions 
of such individuals, in the case of conditions for which there 
has been diagnostic uncertainty; and 
‘‘(3) research on treating WTC-related health conditions 
of such individuals, in the case of conditions for which there 
has been treatment uncertainty. 
The Administrator may provide such support through continuation 
and expansion of research that was initiated before the date of 
the enactment of this title and through the World Trade Center 
Health Registry (referred to in section 3342), through a Clinical 
Center of Excellence, or through a Data Center. 
‘‘(b) TYPES OF RESEARCH.—The research under subsection (a)(1) 
shall include epidemiologic and other research studies on WTC- 
related health conditions or emerging conditions— 
‘‘(1) among enrolled WTC responders and certified-eligible 
WTC survivors under treatment; and
H. R. 847—35 
‘‘(2) in sampled populations outside the New York City 
disaster area in Manhattan as far north as 14th Street and 
in Brooklyn, along with control populations, to identify potential 
for long-term adverse health effects in less exposed populations. 
‘‘(c) CONSULTATION.—The WTC Program Administrator shall 
carry out this section in consultation with the WTC Scientific/ 
Technical Advisory Committee. 
‘‘(d) APPLICATION OF PRIVACY AND HUMAN SUBJECT PROTEC-
TIONS.—The privacy and human subject protections applicable to 
research conducted under this section shall not be less than such 
protections applicable to research conducted or funded by the 
Department of Health and Human Services. 
‘‘SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY. 
‘‘For the purpose of ensuring ongoing data collection relating 
to victims of the September 11, 2001, terrorist attacks, the WTC 
Program Administrator shall ensure that a registry of such victims 
is maintained that is at least as comprehensive as the World 
Trade Center Health Registry maintained under the arrangements 
in effect as of April 20, 2009, with the New York City Department 
of Health and Mental Hygiene. 
‘‘Subtitle D—Funding 
‘‘SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM FUND. 
‘‘(a) ESTABLISHMENT OF FUND.— 
‘‘(1) IN GENERAL.—There is established a fund to be known 
as the World Trade Center Health Program Fund (referred 
to in this section as the ‘Fund’). 
‘‘(2) FUNDING.—Out of any money in the Treasury not 
otherwise appropriated, there shall be deposited into the Fund 
for each of fiscal years 2012 through 2016 (and the last calendar 
quarter of fiscal year 2011)— 
‘‘(A) the Federal share, consisting of an amount equal 
to the lesser of— 
‘‘(i) 90 percent of the expenditures in carrying out 
this title for the respective fiscal year (initially based 
on estimates, subject to subsequent reconciliation 
based on actual expenditures); or 
‘‘(ii)(I) $71,000,000 for the last calendar quarter 
of fiscal year 2011, $318,000,000 for fiscal year 2012, 
$354,000,000 for fiscal year 2013, $382,000,000 for 
fiscal year 2014, and $431,000,000 for fiscal year 2015; 
and 
‘‘(II) subject to paragraph (4), an additional amount 
for fiscal year 2016 from unexpended amounts for pre-
vious fiscal years; plus 
‘‘(B) the New York City share, consisting of the amount 
contributed under the contract under section 3331(d). 
‘‘(3) CONTRACT REQUIREMENT.— 
‘‘(A) IN GENERAL.—No funds may be disbursed from 
the Fund unless New York City has entered into a contract 
with the WTC Program Administrator under section 
3331(d)(1). 
‘‘(B) BREACH OF CONTRACT.—In the case of a failure 
to pay the amount so required under the contract—
H. R. 847—36 
‘‘(i) the amount is recoverable under subparagraph 
(E)(ii) of such section; 
‘‘(ii) such failure shall not affect the disbursement 
of amounts from the Fund; and 
‘‘(iii) the Federal share described in paragraph 
(2)(A) shall not be increased by the amount so unpaid. 
‘‘(4) AGGREGATE LIMITATION ON FUNDING BEGINNING WITH 
FISCAL YEAR 2016.—Beginning with fiscal year 2016, in no case 
shall the share of Federal funds deposited into the Fund under 
paragraph (2) for such fiscal year and previous fiscal years 
and quarters exceed the sum of the amounts specified in para-
graph (2)(A)(ii)(I). 
‘‘(b) MANDATORY FUNDS
FOR MONITORING, INITIAL HEALTH 
EVALUATIONS, TREATMENT, AND CLAIMS PROCESSING.— 
‘‘(1) IN GENERAL.—The amounts deposited into the Fund 
under subsection (a)(2) shall be available, without further 
appropriation, consistent with paragraph (2) and subsection 
(c), to carry out subtitle B and sections 3302(a), 3303, 3304, 
3305(a)(2), 3305(c), 3341, and 3342. 
‘‘(2) LIMITATION ON MANDATORY FUNDING.—This title does 
not establish any Federal obligation for payment of amounts 
in excess of the amounts available from the Fund for such 
purpose. 
‘‘(3) LIMITATION ON AUTHORIZATION FOR FURTHER APPRO-
PRIATIONS.—This title does not establish any authorization for 
appropriation of amounts in excess of the amounts available 
from the Fund under paragraph (1). 
‘‘(c) LIMITS
ON SPENDING
FOR CERTAIN PURPOSES.—Of the 
amounts made available under subsection (b)(1), not more than 
each of the following amounts may be available for each of the 
following purposes: 
‘‘(1) SURVIVING
IMMEDIATE
FAMILY
MEMBERS
OF
FIRE-
FIGHTERS.—For the purposes of carrying out subtitle B with 
respect 
to 
WTC 
responders 
described 
in 
section 
3311(a)(2)(A)(ii)— 
‘‘(A) for the last calendar quarter of fiscal year 2011, 
$100,000; 
‘‘(B) for fiscal year 2012, $400,000; and 
‘‘(C) for each subsequent fiscal year, the amount speci-
fied under this paragraph for the previous fiscal year 
increased by the percentage increase in the consumer price 
index for all urban consumers (all items; United States 
city average) as estimated by the Secretary for the 12- 
month period ending with March of the previous year. 
‘‘(2) WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY 
COMMITTEE.—For the purpose of carrying out section 3302(a)— 
‘‘(A) for the last calendar quarter of fiscal year 2011, 
$25,000; 
‘‘(B) for fiscal year 2012, $100,000; and 
‘‘(C) for each subsequent fiscal year, the amount speci-
fied under this paragraph for the previous fiscal year 
increased by the percentage increase in the consumer price 
index for all urban consumers (all items; United States 
city average) as estimated by the Secretary for the 12- 
month period ending with March of the previous year. 
‘‘(3) EDUCATION AND OUTREACH.—For the purpose of car-
rying out section 3303—
H. R. 847—37 
‘‘(A) for the last calendar quarter of fiscal year 2011, 
$500,000; 
‘‘(B) for fiscal year 2012, $2,000,000; and 
‘‘(C) for each subsequent fiscal year, the amount speci-
fied under this paragraph for the previous fiscal year 
increased by the percentage increase in the consumer price 
index for all urban consumers (all items; United States 
city average) as estimated by the Secretary for the 12- 
month period ending with March of the previous year. 
‘‘(4) UNIFORM DATA COLLECTION.—For the purpose of car-
rying out section 3304 and for reimbursing Data Centers (as 
defined in section 3305(b)(2)) for the costs incurred by such 
Centers in carrying out activities under contracts entered into 
under section 3305(a)(2)— 
‘‘(A) for the last calendar quarter of fiscal year 2011, 
$2,500,000; 
‘‘(B) for fiscal year 2012, $10,000,000; and 
‘‘(C) for each subsequent fiscal year, the amount speci-
fied under this paragraph for the previous fiscal year 
increased by the percentage increase in the consumer price 
index for all urban consumers (all items; United States 
city average) as estimated by the Secretary for the 12- 
month period ending with March of the previous year. 
‘‘(5) RESEARCH REGARDING CERTAIN HEALTH CONDITIONS.— 
For the purpose of carrying out section 3341— 
‘‘(A) for the last calendar quarter of fiscal year 2011, 
$3,750,000; 
‘‘(B) for fiscal year 2012, $15,000,000; and 
‘‘(C) for each subsequent fiscal year, the amount speci-
fied under this paragraph for the previous fiscal year 
increased by the percentage increase in the consumer price 
index for all urban consumers (all items; United States 
city average) as estimated by the Secretary for the 12- 
month period ending with March of the previous year. 
‘‘(6) WORLD TRADE CENTER HEALTH REGISTRY.—For the pur-
pose of carrying out section 3342— 
‘‘(A) for the last calendar quarter of fiscal year 2011, 
$1,750,000; 
‘‘(B) for fiscal year 2012, $7,000,000; and 
‘‘(C) for each subsequent fiscal year, the amount speci-
fied under this paragraph for the previous fiscal year 
increased by the percentage increase in the consumer price 
index for all urban consumers (all items; United States 
city average) as estimated by the Secretary for the 12- 
month period ending with March of the previous year.’’. 
TITLE II—SEPTEMBER 11TH VICTIM 
COMPENSATION FUND OF 2001 
SEC. 201. DEFINITIONS. 
Section 402 of the Air Transportation Safety and System Sta-
bilization Act (49 U.S.C. 40101 note) is amended— 
(1) in paragraph (6) by inserting ‘‘, or debris removal, 
including under the World Trade Center Health Program estab-
lished under section 3001 of the Public Health Service Act,
H. R. 847—38 
and payments made pursuant to the settlement of a civil action 
described in section 405(c)(3)(C)(iii)’’ after ‘‘September 11, 2001’’; 
(2) by inserting after paragraph (6) the following new para-
graphs and redesignating subsequent paragraphs accordingly: 
‘‘(7) CONTRACTOR
AND
SUBCONTRACTOR.—The term ‘con-
tractor and subcontractor’ means any contractor or subcon-
tractor (at any tier of a subcontracting relationship), including 
any general contractor, construction manager, prime contractor, 
consultant, or any parent, subsidiary, associated or allied com-
pany, affiliated company, corporation, firm, organization, or 
joint venture thereof that participated in debris removal at 
any 9/11 crash site. Such term shall not include any entity, 
including the Port Authority of New York and New Jersey, 
with a property interest in the World Trade Center, on Sep-
tember 11, 2001, whether fee simple, leasehold or easement, 
direct or indirect. 
‘‘(8) DEBRIS REMOVAL.—The term ‘debris removal’ means 
rescue and recovery efforts, removal of debris, cleanup, remedi-
ation, and response during the immediate aftermath of the 
terrorist-related aircraft crashes of September 11, 2001, with 
respect to a 9/11 crash site.’’; 
(3) by inserting after paragraph (10), as so redesignated, 
the following new paragraph and redesignating the subsequent 
paragraphs accordingly: 
‘‘(11) IMMEDIATE AFTERMATH.—The term ‘immediate after-
math’ means any period beginning with the terrorist-related 
aircraft crashes of September 11, 2001, and ending on May 
30, 2002.’’; and 
(4) by adding at the end the following new paragraph: 
‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash site’ means— 
‘‘(A) the World Trade Center site, Pentagon site, and 
Shanksville, Pennsylvania site; 
‘‘(B) the buildings or portions of buildings that were 
destroyed as a result of the terrorist-related aircraft crashes 
of September 11, 2001; 
‘‘(C) any area contiguous to a site of such crashes 
that the Special Master determines was sufficiently close 
to the site that there was a demonstrable risk of physical 
harm resulting from the impact of the aircraft or any 
subsequent fire, explosions, or building collapses (including 
the immediate area in which the impact occurred, fire 
occurred, portions of buildings fell, or debris fell upon and 
injured individuals); and 
‘‘(D) any area related to, or along, routes of debris 
removal, such as barges and Fresh Kills.’’. 
SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSA-
TION. 
(a) INFORMATION ON LOSSES RESULTING FROM DEBRIS REMOVAL 
INCLUDED IN CONTENTS OF CLAIM FORM.—Section 405(a)(2)(B) of 
the Air Transportation Safety and System Stabilization Act (49 
U.S.C. 40101 note) is amended— 
(1) in clause (i), by inserting ‘‘, or debris removal during 
the immediate aftermath’’ after ‘‘September 11, 2001’’; 
(2) in clause (ii), by inserting ‘‘or debris removal during 
the immediate aftermath’’ after ‘‘crashes’’; and
H. R. 847—39 
(3) in clause (iii), by inserting ‘‘or debris removal during 
the immediate aftermath’’ after ‘‘crashes’’. 
(b) EXTENSION OF DEADLINE FOR CLAIMS UNDER SEPTEMBER 
11TH VICTIM COMPENSATION FUND OF 2001.—Section 405(a)(3) of 
such Act is amended to read as follows: 
‘‘(3) LIMITATION.— 
‘‘(A) IN GENERAL.—Except as provided by subparagraph 
(B), no claim may be filed under paragraph (1) after the 
date that is 2 years after the date on which regulations 
are promulgated under section 407(a). 
‘‘(B) EXCEPTION.—A claim may be filed under para-
graph (1), in accordance with subsection (c)(3)(A)(i), by 
an individual (or by a personal representative on behalf 
of a deceased individual) during the period beginning on 
the date on which the regulations are updated under sec-
tion 407(b) and ending on the date that is 5 years after 
the date on which such regulations are updated.’’. 
(c) REQUIREMENTS
FOR
FILING
CLAIMS
DURING
EXTENDED 
FILING PERIOD.—Section 405(c)(3) of such Act is amended— 
(1) by redesignating subparagraphs (A) and (B) as subpara-
graphs (B) and (C), respectively; and 
(2) by inserting before subparagraph (B), as so redesig-
nated, the following new subparagraph: 
‘‘(A) 
REQUIREMENTS
FOR
FILING
CLAIMS
DURING 
EXTENDED FILING PERIOD.— 
‘‘(i) TIMING REQUIREMENTS FOR FILING CLAIMS.— 
An individual (or a personal representative on behalf 
of a deceased individual) may file a claim during the 
period described in subsection (a)(3)(B) as follows: 
‘‘(I) In the case that the Special Master deter-
mines the individual knew (or reasonably should 
have known) before the date specified in clause 
(iii) that the individual suffered a physical harm 
at a 9/11 crash site as a result of the terrorist- 
related aircraft crashes of September 11, 2001, 
or as a result of debris removal, and that the 
individual knew (or should have known) before 
such specified date that the individual was eligible 
to file a claim under this title, the individual may 
file a claim not later than the date that is 2 
years after such specified date. 
‘‘(II) In the case that the Special Master deter-
mines the individual first knew (or reasonably 
should have known) on or after the date specified 
in clause (iii) that the individual suffered such 
a physical harm or that the individual first knew 
(or should have known) on or after such specified 
date that the individual was eligible to file a claim 
under this title, the individual may file a claim 
not later than the last day of the 2-year period 
beginning on the date the Special Master deter-
mines the individual first knew (or should have 
known) that the individual both suffered from such 
harm and was eligible to file a claim under this 
title.
H. R. 847—40 
‘‘(ii) OTHER ELIGIBILITY REQUIREMENTS FOR FILING 
CLAIMS.—An individual may file a claim during the 
period described in subsection (a)(3)(B) only if— 
‘‘(I) the individual was treated by a medical 
professional for suffering from a physical harm 
described in clause (i)(I) within a reasonable time 
from the date of discovering such harm; and 
‘‘(II) the individual’s physical harm is verified 
by contemporaneous medical records created by 
or at the direction of the medical professional who 
provided the medical care. 
‘‘(iii) DATE SPECIFIED.—The date specified in this 
clause is the date on which the regulations are updated 
under section 407(a).’’. 
(d) CLARIFYING APPLICABILITY TO ALL 9/11 CRASH SITES.—Sec-
tion 405(c)(2)(A)(i) of such Act is amended by striking ‘‘or the 
site of the aircraft crash at Shanksville, Pennsylvania’’ and inserting 
‘‘the site of the aircraft crash at Shanksville, Pennsylvania, or 
any other 9/11 crash site’’. 
(e) INCLUSION OF PHYSICAL HARM RESULTING FROM DEBRIS 
REMOVAL.—Section 405(c) of such Act is amended in paragraph 
(2)(A)(ii), by inserting ‘‘or debris removal’’ after ‘‘air crash’’. 
(f) LIMITATIONS ON CIVIL ACTIONS.— 
(1) 
APPLICATION
TO
DAMAGES
RELATED
TO
DEBRIS 
REMOVAL.—Clause (i) of section 405(c)(3)(C) of such Act, as 
redesignated by subsection (c), is amended by inserting ‘‘, or 
for damages arising from or related to debris removal’’ after 
‘‘September 11, 2001’’. 
(2) PENDING ACTIONS.—Clause (ii) of such section, as so 
redesignated, is amended to read as follows: 
‘‘(ii) PENDING ACTIONS.—In the case of an indi-
vidual who is a party to a civil action described in 
clause (i), such individual may not submit a claim 
under this title— 
‘‘(I) during the period described in subsection 
(a)(3)(A) unless such individual withdraws from 
such action by the date that is 90 days after the 
date on which regulations are promulgated under 
section 407(a); and 
‘‘(II) during the period described in subsection 
(a)(3)(B) unless such individual withdraws from 
such action by the date that is 90 days after the 
date on which the regulations are updated under 
section 407(b).’’. 
(3) SETTLED ACTIONS.—Such section, as so redesignated, 
is further amended by adding at the end the following new 
clause: 
‘‘(iii) SETTLED ACTIONS.—In the case of an indi-
vidual who settled a civil action described in clause 
(i), such individual may not submit a claim under 
this title unless such action was commenced after 
December 22, 2003, and a release of all claims in 
such action was tendered prior to the date on which 
the James Zadroga 9/11 Health and Compensation Act 
of 2010 was enacted.’’.
H. R. 847—41 
SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 
Section 407 of the Air Transportation Safety and System Sta-
bilization Act (49 U.S.C. 40101 note) is amended— 
(1) by striking ‘‘Not later than’’ and inserting ‘‘(a) IN GEN-
ERAL.—Not later than’’; and 
(2) by adding at the end the following new subsection: 
‘‘(b) UPDATED REGULATIONS.—Not later than 180 days after 
the date of the enactment of the James Zadroga 9/11 Health and 
Compensation Act of 2010, the Special Master shall update the 
regulations promulgated under subsection (a) to the extent nec-
essary to comply with the provisions of title II of such Act.’’. 
SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS. 
Section 408(a) of the Air Transportation Safety and System 
Stabilization Act (49 U.S.C. 40101 note) is amended by adding 
at the end the following new paragraphs: 
‘‘(4) LIABILITY FOR CERTAIN CLAIMS.—Notwithstanding any 
other provision of law, liability for all claims and actions 
(including claims or actions that have been previously resolved, 
that are currently pending, and that may be filed) for compen-
satory damages, contribution or indemnity, or any other form 
or type of relief, arising from or related to debris removal, 
against the City of New York, any entity (including the Port 
Authority of New York and New Jersey) with a property 
interest in the World Trade Center on September 11, 2001 
(whether fee simple, leasehold or easement, or direct or indirect) 
and any contractors and subcontractors, shall not be in an 
amount that exceeds the sum of the following, as may be 
applicable: 
‘‘(A) The amount of funds of the WTC Captive Insur-
ance Company, including the cumulative interest. 
‘‘(B) The amount of all available insurance identified 
in schedule 2 of the WTC Captive Insurance Company 
insurance policy. 
‘‘(C) As it relates to the limitation of liability of the 
City of New York, the amount that is the greater of the 
City of New York’s insurance coverage or $350,000,000. 
In determining the amount of the City’s insurance coverage 
for purposes of the previous sentence, any amount described 
in subparagraphs (A) and (B) shall not be included. 
‘‘(D) As it relates to the limitation of liability of any 
entity, including the Port Authority of New York and New 
Jersey, with a property interest in the World Trade Center 
on September 11, 2001 (whether fee simple, leasehold or 
easement, or direct or indirect), the amount of all available 
liability insurance coverage maintained by any such entity. 
‘‘(E) As it relates to the limitation of liability of any 
individual contractor or subcontractor, the amount of all 
available liability insurance coverage maintained by such 
contractor or subcontractor on September 11, 2001. 
‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Payments to plaintiffs 
who obtain a settlement or judgment with respect to a claim 
or action to which paragraph (4) applies, shall be paid solely 
from the following funds in the following order, as may be 
applicable: 
‘‘(A) The funds described in subparagraph (A) or (B) 
of paragraph (4).
H. R. 847—42 
‘‘(B) If there are no funds available as described in 
subparagraph (A) or (B) of paragraph (4), the funds 
described in subparagraph (C) of such paragraph. 
‘‘(C) If there are no funds available as described in 
subparagraph (A), (B), or (C) of paragraph (4), the funds 
described in subparagraph (D) of such paragraph. 
‘‘(D) If there are no funds available as described in 
subparagraph (A), (B), (C), or (D) of paragraph (4), the 
funds described in subparagraph (E) of such paragraph. 
‘‘(6) 
DECLARATORY
JUDGMENT
ACTIONS
AND
DIRECT 
ACTION.—Any claimant to a claim or action to which paragraph 
(4) applies may, with respect to such claim or action, either 
file an action for a declaratory judgment for insurance coverage 
or bring a direct action against the insurance company involved, 
except that no such action for declaratory judgment or direct 
action may be commenced until after the funds available in 
subparagraph (A), (B), (C), and (D) of paragraph (5) have been 
exhausted consistent with the order described in such para-
graph for payment.’’. 
SEC. 205. FUNDING; ATTORNEY FEES. 
Section 406 of the Air Transportation Safety and System Sta-
bilization Act (49 U.S.C. 40101 note) is amended— 
(1) in subsection (a), by striking ‘‘Not later than’’ and 
inserting ‘‘Subject to the limitations under subsection (d), not 
later than’’; 
(2) in subsection (b)— 
(A) by inserting ‘‘in the amounts provided under sub-
section (d)(1)’’ after ‘‘appropriations Acts’’; and 
(B) by inserting ‘‘subject to the limitations under sub-
section (d)’’ before the period; and 
(3) by adding at the end the following new subsections: 
‘‘(d) LIMITATION.— 
‘‘(1) IN GENERAL.—The total amount of Federal funds paid 
for compensation under this title, with respect to claims filed 
on or after the date on which the regulations are updated 
under section 407(b), shall not exceed $2,775,000,000. Of such 
amounts, not to exceed $875,000,000 shall be available to pay 
such claims during the 5-year period beginning on such date. 
‘‘(2) PRO-RATION
AND
PAYMENT
OF
REMAINING
CLAIMS.— 
‘‘(A) IN GENERAL.—The Special Master shall ratably 
reduce the amount of compensation due claimants under 
this title in a manner to ensure, to the extent possible, 
that— 
‘‘(i) all claimants who, before application of the 
limitation under the second sentence of paragraph (1), 
would have been determined to be entitled to a pay-
ment under this title during such 5-year period, receive 
a payment during such period; and 
‘‘(ii) the total amount of all such payments made 
during such 5-year period do not exceed the amount 
available under the second sentence of paragraph (1) 
to pay claims during such period. 
‘‘(B) PAYMENT
OF
REMAINDER
OF
CLAIM
AMOUNTS.— 
In any case in which the amount of a claim is ratably 
reduced pursuant to subparagraph (A), on or after the 
first day after the 5-year period described in paragraph
H. R. 847—43 
(1), but in no event later than 1 year after such 5-year 
period, the Special Master shall pay to the claimant the 
amount that is equal to the difference between— 
‘‘(i) the amount that the claimant would have been 
paid under this title during such period without regard 
to the limitation under the second sentence of para-
graph (1) applicable to such period; and 
‘‘(ii) the amount the claimant was paid under this 
title during such period. 
‘‘(C) TERMINATION.—Upon completion of all payments 
pursuant to this subsection, the Victim’s Compensation 
Fund shall be permanently closed. 
‘‘(e) ATTORNEY FEES.— 
‘‘(1) IN GENERAL.—Notwithstanding any contract, the rep-
resentative of an individual may not charge, for services ren-
dered in connection with the claim of an individual under 
this title, more than 10 percent of an award made under 
this title on such claim. 
‘‘(2) LIMITATION.— 
‘‘(A) IN GENERAL.—Except as provided in subparagraph 
(B), in the case of an individual who was charged a legal 
fee in connection with the settlement of a civil action 
described in section 405(c)(3)(C)(iii), the representative of 
the individual may not charge any amount for compensa-
tion for services rendered in connection with a claim filed 
under this title. 
‘‘(B) EXCEPTION.—If the legal fee charged in connection 
with the settlement of a civil action described in section 
405(c)(3)(C)(iii) of an individual is less than 10 percent 
of the aggregate amount of compensation awarded to such 
individual through such settlement, the representative of 
such individual may charge an amount for compensation 
for services rendered to the extent that such amount 
charged is not more than— 
‘‘(i) 10 percent of such aggregate amount through 
the settlement, minus 
‘‘(ii) the total amount of all legal fees charged 
for services rendered in connection with such settle-
ment. 
‘‘(3) DISCRETION TO LOWER FEE.—In the event that the 
special master finds that the fee limit set by paragraph (1) 
or (2) provides excessive compensation for services rendered 
in connection with such claim, the Special Master may, in 
the discretion of the Special Master, award as reasonable com-
pensation for services rendered an amount lesser than that 
permitted for in paragraph (1).’’. 
TITLE III—REVENUE RELATED 
PROVISIONS 
SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCUREMENT. 
(a) IMPOSITION OF TAX.— 
(1) IN GENERAL.—Subtitle D of the Internal Revenue Code 
of 1986 is amended by adding at the end the following new 
chapter:
H. R. 847—44 
‘‘CHAPTER 50—FOREIGN PROCUREMENT 
‘‘Sec. 5000C. Imposition of tax on certain foreign procurement. 
‘‘SEC. 5000C. IMPOSITION OF TAX ON CERTAIN FOREIGN PROCURE-
MENT. 
‘‘(a) IMPOSITION OF TAX.—There is hereby imposed on any for-
eign person that receives a specified Federal procurement payment 
a tax equal to 2 percent of the amount of such specified Federal 
procurement payment. 
‘‘(b) SPECIFIED FEDERAL PROCUREMENT PAYMENT.—For pur-
poses of this section, the term ‘specified Federal procurement pay-
ment’ means any payment made pursuant to a contract with the 
Government of the United States for— 
‘‘(1) the provision of goods, if such goods are manufactured 
or produced in any country which is not a party to an inter-
national procurement agreement with the United States, or 
‘‘(2) the provision of services, if such services are provided 
in any country which is not a party to an international procure-
ment agreement with the United States. 
‘‘(c) FOREIGN PERSON.—For purposes of this section, the term 
‘foreign person’ means any person other than a United States per-
son. 
‘‘(d) ADMINISTRATIVE PROVISIONS.— 
‘‘(1) WITHHOLDING.—The amount deducted and withheld 
under chapter 3 shall be increased by the amount of tax 
imposed by this section on such payment. 
‘‘(2) OTHER ADMINISTRATIVE PROVISIONS.—For purposes of 
subtitle F, any tax imposed by this section shall be treated 
as a tax imposed by subtitle A.’’. 
(2) CLERICAL AMENDMENT.—The table of chapters for sub-
title D of the Internal Revenue Code of 1986 is amended by 
adding at the end the following new item: 
‘‘CHAPTER 50—FOREIGN PROCUREMENT’’. 
(3) EFFECTIVE DATE.—The amendments made by this sub-
section shall apply to payments received pursuant to contracts 
entered into on and after the date of the enactment of this 
Act. 
(b) PROHIBITION ON REIMBURSEMENT OF FEES.— 
(1) IN GENERAL.—The head of each executive agency shall 
take any and all measures necessary to ensure that no funds 
are disbursed to any foreign contractor in order to reimburse 
the tax imposed under section 5000C of the Internal Revenue 
Code of 1986. 
(2) ANNUAL
REVIEW.—The Administrator for Federal 
Procurement Policy shall annually review the contracting activi-
ties of each executive agency to monitor compliance with the 
requirements of paragraph (1). 
(3) EXECUTIVE AGENCY.—For purposes of this subsection, 
the term ‘‘executive agency’’ has the meaning given the term 
in section 4 of the Office of Federal Procurement Policy Act 
(41 U.S.C. 403). 
(c) APPLICATION.—This section and the amendments made by 
this section shall be applied in a manner consistent with United 
States obligations under international agreements.
H. R. 847—45 
SEC. 302. RENEWAL OF FEES FOR VISA-DEPENDENT EMPLOYERS. 
Subsections (a), (b), and (c) of section 402 of Public Law 111– 
230 are amended by striking ‘‘2014’’ each place that such appears 
and inserting ‘‘2015’’. 
TITLE IV—BUDGETARY EFFECTS 
SEC. 401. COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO ACT OF 2010. 
The budgetary effects of this Act, for the purpose of complying 
with the Statutory Pay-As-You-Go Act of 2010, shall be determined 
by reference to the latest statement titled ‘‘Budgetary Effects of 
PAYGO Legislation’’ for this Act, submitted for printing in the 
Congressional Record by the Chairman of the Senate Budget Com-
mittee, provided that such statement has been submitted prior 
to the vote on passage. 
Speaker of the House of Representatives. 
Vice President of the United States and
President of the Senate.