‘‘(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, includ-
ing costs of program support, data collection and 
analysis, and research conducted under the pro-
gram. 
‘‘(D) ADMINISTRATIVE
EXPERIENCE.—In-
formation on the administrative performance of 
the program, including— 
‘‘(i) the performance of the program in 
providing timely evaluation of and treat-
ment to eligible individuals; and 
‘‘(ii) a list of the Clinical Centers of 
Excellence and other providers that are par-
ticipating in the program. 
‘‘(E) SCIENTIFIC REPORTS.—A summary of 
the findings of any new scientific reports or 
studies on the health effects associated with expo-
sure described in section 3306(1), including the 
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findings of research conducted under section 
3341(a). 
‘‘(F) ADVISORY COMMITTEE RECOMMENDA-
TIONS.—A list of recommendations by the WTC 
Scientific/Technical Advisory Committee on ad-
ditional WTC Program eligibility criteria and 
on additional WTC-related health conditions and 
the action of the WTC Program Administrator 
concerning each such recommendation. 
‘‘(3) 
SEPARATE
CLINICAL
PROGRAMS
DE-
SCRIBED.—In paragraph (2), each of the following 
shall be treated as a separate clinical program of the 
WTC Program: 
‘‘(A) FIREFIGHTERS
AND
RELATED
PER-
SONNEL.—The benefits provided for enrolled 
WTC 
responders 
described 
in 
section 
3311(a)(2)(A). 
‘‘(B) OTHER WTC RESPONDERS.—The bene-
fits provided for enrolled WTC responders not de-
scribed in subparagraph (A). 
‘‘(C) WTC SURVIVORS.—The benefits pro-
vided for screening-eligible WTC survivors and 
certified-eligible 
WTC 
survivors 
in 
section 
3321(a). 
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‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING 80 
PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The Sec-
retary shall promptly notify the Congress of each of the fol-
lowing: 
‘‘(1) When the number of enrollments of WTC re-
sponders subject to the limit established under section 
3311(a)(4) has reached 80 percent of such limit. 
‘‘(2) When the number of certifications for cer-
tified-eligible WTC survivors subject to the limit es-
tablished under section 3321(a)(3) has reached 80 
percent of such limit. 
‘‘(h) CONSULTATION.—The WTC Program Adminis-
trator shall engage in ongoing outreach and consultation 
with relevant stakeholders, including the WTC Health Pro-
gram Steering Committees and the Advisory Committee 
under section 3302, regarding the implementation and im-
provement of programs under this title. 
‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL 
ADVISORY COMMITTEE; WTC HEALTH PRO-
GRAM STEERING COMMITTEES. 
‘‘(a) ADVISORY COMMITTEE.— 
‘‘(1) ESTABLISHMENT.—The WTC Program Ad-
ministrator shall establish an advisory committee to 
be known as the WTC Health Program Scientific/ 
Technical Advisory Committee (in this subsection re-
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ferred to as the ‘Advisory Committee’) to review sci-
entific and medical evidence and to make rec-
ommendations to the Administrator on additional 
WTC Program eligibility criteria and on additional 
WTC-related health conditions. 
‘‘(2) COMPOSITION.—The WTC Program Admin-
istrator 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 pul-
monary medicine; 
‘‘(C) 2 environmental medicine or environ-
mental health specialists; 
‘‘(D) 2 representatives of WTC responders; 
‘‘(E) 2 representatives of certified-eligible 
WTC survivors; 
‘‘(F) an industrial hygienist; 
‘‘(G) a toxicologist; 
‘‘(H) an epidemiologist; and 
‘‘(I) a mental health professional. 
‘‘(3) MEETINGS.—The Advisory Committee shall 
meet at such frequency as may be required to carry 
out its duties. 
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‘‘(4) REPORTS.—The WTC Program Adminis-
trator shall provide for publication of recommenda-
tions of the Advisory Committee on the public Web 
site established for the WTC Program. 
‘‘(5) DURATION.—Notwithstanding any other 
provision of law, the Advisory Committee shall con-
tinue in operation during the period in which the 
WTC Program is in operation. 
‘‘(6) APPLICATION OF FACA.—Except as other-
wise specifically provided, the Advisory Committee 
shall be subject to the Federal Advisory Committee 
Act. 
‘‘(b) WTC HEALTH PROGRAM STEERING COMMIT-
TEES.— 
‘‘(1) CONSULTATION.—The WTC Program Ad-
ministrator shall consult with 2 steering committees 
(each in this section referred to as a ‘Steering Com-
mittee’) that are established as follows: 
‘‘(A) WTC RESPONDERS
STEERING
COM-
MITTEE.—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 en-
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rolled WTC responders under part 1 of subtitle 
B. 
‘‘(B) WTC 
SURVIVORS
STEERING
COM-
MITTEE.—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 treat-
ment programs for screening-eligible and cer-
tified-eligible WTC survivors under part 2 of 
subtitle B. 
‘‘(2) MEMBERSHIP.— 
‘‘(A) WTC RESPONDERS
STEERING
COM-
MITTEE.— 
‘‘(i) REPRESENTATION.—The WTC Re-
sponders Steering Committee shall in-
clude— 
‘‘(I) representatives of the Centers 
of Excellence providing services to 
WTC responders; 
‘‘(II) representatives of labor or-
ganizations representing firefighters, 
police, other New York City employees, 
and recovery and cleanup workers who 
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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 commissioner 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 ini-
tially be composed of members of the WTC 
Monitoring and Treatment Program Steer-
ing Committee (as in existence on the day 
before the date of the enactment of this 
title). 
‘‘(B) WTC 
SURVIVORS
STEERING
COM-
MITTEE.— 
‘‘(i) 
REPRESENTATION.—The 
WTC 
Survivors Steering Committee shall include 
representatives of— 
‘‘(I) the Centers of Excellence pro-
viding services to screening-eligible and 
certified-eligible WTC survivors; 
‘‘(II) the population of residents, 
students, and area and other workers 
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affected by the September 11, 2001, ter-
rorist attacks; 
‘‘(III) screening-eligible and cer-
tified-eligible survivors receiving ini-
tial health evaluations, monitoring, 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 ini-
tially be composed of members of the WTC 
Environmental Health Center Survivor Ad-
visory Committee (as in existence on the 
day before the date of the enactment of this 
title). 
‘‘(C) ADDITIONAL
APPOINTMENTS.—Each 
Steering Committee may recommend, if ap-
proved by a majority of voting members of the 
Committee, additional members to the Com-
mittee. 
‘‘(D) VACANCIES.—A vacancy in a Steering 
Committee shall be filled by an individual rec-
ommended by the Steering Committee. 
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‘‘SEC. 3303. EDUCATION AND OUTREACH. 
‘‘The WTC Program Administrator shall institute a 
program that provides education and outreach on the exist-
ence and availability 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 pop-
ulations; 
‘‘(C) development and dissemination of out-
reach materials informing people about the pro-
gram; 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 
linguistically diverse populations. 
‘‘SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS. 
‘‘(a) IN GENERAL.—The WTC Program Administrator 
shall provide for the uniform collection of data (and anal-
ysis 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 moni-
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toring 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 Centers or 
otherwise, for the integration of such data into the moni-
toring and treatment program activities under this title. 
‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL-
LENCE.—Each Clinical Center of Excellence shall collect 
data described in subsection (a) and report such data to 
the corresponding Data Center for analysis by such Data 
Center. 
‘‘(c) COLLABORATION WITH WTC HEALTH REG-
ISTRY.—The WTC Program Administrator shall provide for 
collaboration between the Data Centers and the World 
Trade Center Health Registry described in section 3342. 
‘‘(d) PRIVACY.—The data collection and analysis 
under this section 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.— 
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‘‘(1) CONTRACTS
WITH
CLINICAL
CENTERS
OF 
EXCELLENCE.—The WTC Program Administrator 
shall, subject to subsection (b)(1)(B), enter into con-
tracts with Clinical Centers of Excellence (as defined 
in subsection (b)(1)(A))— 
‘‘(A) for the provision of monitoring and 
treatment benefits and initial health evaluation 
benefits under subtitle B; 
‘‘(B) for the provision of outreach activities 
to individuals 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 ben-
efits under subtitle B, with respect to WTC-re-
lated health conditions, for individuals eligible 
for such benefits; 
‘‘(D) for the provision of counseling for ben-
efits 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 insur-
ance, or other insurance plans or through public 
or private social service agencies and assisting 
eligible individuals in applying for such benefits; 
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‘‘(E) for the provision of translational and 
interpretive services for program participants 
who are not English language proficient; and 
‘‘(F) for the collection and reporting of data 
in accordance with section 3304. 
‘‘(2) CONTRACTS WITH DATA CENTERS.— 
‘‘(A) IN GENERAL.—The WTC Program Ad-
ministrator shall enter into contracts with Data 
Centers (as defined in subsection (b)(2))— 
‘‘(i) for receiving, analyzing, and re-
porting 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 moni-
toring, initial health evaluation, and treat-
ment protocols, with respect to WTC-related 
health conditions; 
‘‘(iii) for coordinating the outreach ac-
tivities conducted under paragraph (1)(B) 
by each corresponding Clinical Center of 
Excellence; 
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‘‘(iv) for establishing criteria for the 
credentialing of medical providers partici-
pating in the nationwide network under 
section 3313; 
‘‘(v) for coordinating and admin-
istering the activities of the WTC Health 
Program Steering Committees established 
under section 3002(b); and 
‘‘(vi) for meeting periodically with the 
corresponding Clinical Centers of Excellence 
to obtain input on the analysis and report-
ing 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 providers under subparagraph (A)(iv) 
shall be selected by the WTC Program Adminis-
trator on the basis of their experience treating or 
diagnosing the health conditions included in the 
list of WTC-related health conditions. 
‘‘(C) CLINICAL DISCUSSIONS.—In carrying 
out subparagraph (A)(ii), a Data Center shall 
engage in clinical discussions across the WTC 
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Program to guide treatment approaches for indi-
viduals 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 sub-
section 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 sur-
vivors, 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 Cen-
ter of Excellence may be in the form of a cooperative 
agreement. 
‘‘(b) CENTERS OF EXCELLENCE.— 
‘‘(1) CLINICAL CENTERS OF EXCELLENCE.— 
‘‘(A) DEFINITION.—For purposes of this 
title, the term ‘Clinical Center of Excellence’ 
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means a Center that demonstrates to the satisfac-
tion of the Administrator that the Center— 
‘‘(i) uses an integrated, centralized 
health care provider 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 sur-
vivors or includes health care providers who 
have been trained pursuant to section 
3313(c); 
‘‘(iii) employs health care provider 
staff with expertise that includes, at a min-
imum, 
occupational 
medicine, 
environ-
mental medicine, trauma-related psychiatry 
and psychology, and social services coun-
seling; 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 Excel-
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lence 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 re-
ceiving monitoring and treatment benefits 
under subtitle B from such Center. 
‘‘(ii) Coordinate monitoring and treat-
ment 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 cor-
responding Data Center data in accordance 
with section 3304(b). 
‘‘(iv) Have in place safeguards against 
fraud that are satisfactory to the Adminis-
trator, in consultation with the Inspector 
General of the Department of Health and 
Human Services. 
‘‘(v) Treat or refer for treatment all in-
dividuals who are enrolled WTC responders 
or certified-eligible WTC survivors with re-
spect to such Center who present themselves 
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for treatment of a WTC-related health con-
dition. 
‘‘(vi) Have in place safeguards, con-
sistent with section 3304(c), to ensure the 
confidentiality of an individual’s individ-
ually identifiable health information, in-
cluding requiring that such information not 
be disclosed to the individual’s employer 
without the authorization of the individual. 
‘‘(vii) Use amounts paid under sub-
section (c)(1) only for costs incurred in car-
rying out the activities described in sub-
section (a), other than those described in 
subsection (a)(1)(A). 
‘‘(viii) Utilize health care providers 
with occupational and environmental medi-
cine expertise to conduct physical and men-
tal health assessments, in accordance with 
protocols 
developed 
under 
subsection 
(a)(2)(A)(ii). 
‘‘(ix) Communicate with WTC re-
sponders and screening-eligible and cer-
tified-eligible WTC survivors in appropriate 
languages and conduct outreach activities 
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with relevant stakeholder worker or commu-
nity associations. 
‘‘(x) Meet all the other applicable re-
quirements of this title, including regula-
tions implementing such requirements. 
‘‘(C) TRANSITION RULE TO ENSURE CON-
TINUITY OF CARE.—The WTC Program Admin-
istrator shall to the maximum extent feasible en-
sure continuity of care in any period of transi-
tion from monitoring and treatment of an en-
rolled WTC responder or certified-eligible WTC 
survivor by a provider to a Clinical Center of 
Excellence or a health care provider partici-
pating 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 Administrator determines has the capacity 
to carry out the responsibilities 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. 
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‘‘(c) PAYMENT FOR INFRASTRUCTURE COSTS.— 
‘‘(1) IN GENERAL.—The WTC Program Adminis-
trator shall reimburse a Clinical Center of Excellence 
for the fixed infrastructure costs of such Center in 
carrying out the activities described in subtitle B at 
a rate negotiated by the Administrator and such Cen-
ters. 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 pur-
poses of paragraph (1), the term ‘fixed infrastructure 
costs’ means, with respect to a Clinical Center of Ex-
cellence, the costs incurred by such Center that are 
not reimbursable by the WTC Program Administrator 
under section 3312(c). 
‘‘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 expo-
sure 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, 
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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. 
‘‘(4) The term ‘enrolled WTC responder’ means a 
WTC responder enrolled under section 3311(a)(3). 
‘‘(5) The term ‘initial health evaluation’ in-
cludes, with respect to an individual, a medical and 
exposure history, a physical examination, and addi-
tional 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 condi-
tions’ means— 
‘‘(A) for WTC responders, the health condi-
tions listed in section 3312(a)(3); and 
‘‘(B) for screening-eligible and certified-eli-
gible WTC survivors, the health conditions listed 
in section 3322(b). 
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‘‘(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 Ad-
ministrator, within which WTC responders and eligi-
ble WTC screening-eligible survivors 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 sub-
sequent to the terrorist attacks at the World Trade 
Center, Shanksville, Pennsylvania, or the Pentagon, 
as applicable, on such date. 
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‘‘(11) The term ‘September 11, 2001, terrorist at-
tacks’ 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 estab-
lished under section 3302(b). 
‘‘(13) The term ‘WTC Program’ means the Word 
Trade Center Health Program established under sec-
tion 3301(a). 
‘‘(14) The term ‘WTC Program Administrator’ 
means— 
‘‘(A) with respect to paragraphs (3) and (4) 
of section 3311(a) (relating to enrollment of 
WTC responders), section 3312(c) and the cor-
responding provisions of section 3322 (relating 
to payment for initial health evaluation, moni-
toring, and treatment), paragraphs (1)(C), 
(2)(B), and (3) of section 3321(a) (relating to 
determination or certification of screening-eligi-
ble or certified-eligible WTC responders), and 
part 3 of subtitle B (relating to payor provi-
sions), an official in the Department of Health 
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and Human Services, to be designated by the 
Secretary; and 
‘‘(B) with respect to any other provision of 
this title, the Director of the National Institute 
for Occupational Safety and Health, or a des-
ignee of such Director. 
‘‘(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 Advi-
sory Committee’ means such Committee established 
under section 3302(a). 
‘‘Subtitle 
B—Program 
of 
Moni-
toring, Initial Health Evalua-
tions, 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 in-
dividuals, subject to paragraph (4): 
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‘‘(A) 
CURRENTLY
IDENTIFIED
RE-
SPONDER.—An individual who has been identi-
fied as eligible for monitoring under the arrange-
ments 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 Hospital in New York City that co-
ordinates the monitoring and treatment for 
enrolled WTC responders other than with 
respect to those covered under the arrange-
ment with the Fire Department of New 
York City; or 
‘‘(ii) the Fire Department of New York 
City. 
‘‘(B) RESPONDER
WHO
MEETS
CURRENT 
ELIGIBILITY
CRITERIA.—An 
individual 
who 
meets the current eligibility criteria described in 
paragraph (2). 
‘‘(C) RESPONDER
WHO
MEETS
MODIFIED 
ELIGIBILITY CRITERIA.—An individual who— 
‘‘(i) performed rescue, recovery, demoli-
tion, debris cleanup, or other related serv-
ices in the New York City disaster area in 
response to the September 11, 2001, ter-
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rorist attacks, regardless of whether such 
services were performed by a State or Fed-
eral employee or member of the National 
Guard or otherwise; and 
‘‘(ii) meets such eligibility criteria re-
lating to exposure to airborne toxins, other 
hazards, or adverse conditions resulting 
from the September 11, 2001, terrorist at-
tacks as the WTC Program Administrator, 
after consultation with the WTC Scientific/ 
Technical Advisory Committee, determines 
appropriate. 
The WTC Program Administrator shall not mod-
ify such eligibility criteria on or after the date 
that the number of enrollments of WTC respond-
ers has reached 80 percent of the limit described 
in paragraph (4) or on or after the 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 sec-
tion 3321(a)(3). 
‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eli-
gibility criteria described in this paragraph for an 
individual is that the individual is described in any 
of the following categories: 
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‘‘(A) FIREFIGHTERS
AND
RELATED
PER-
SONNEL.—The individual— 
‘‘(i) was a member of the Fire Depart-
ment 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 fam-
ily member of an individual who was a 
member of the Fire Department of New 
York City (whether fire or emergency per-
sonnel, 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 September 1, 
2008. 
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‘‘(B) LAW
ENFORCEMENT
OFFICERS
AND 
WTC RESCUE, RECOVERY, AND CLEANUP WORK-
ERS.—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 pe-
riod beginning on September 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 De-
partment of New York City (whether active 
or retired) or a member of the Port Author-
ity 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 
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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, re-
covery, debris cleanup, or related services in 
at Ground Zero, the Staten Island Landfill, 
or the barge loading piers, for at least one 
day during the period beginning on Sep-
tember 11, 2001, and ending on July 31, 
2002; 
‘‘(III) participated onsite in rescue, re-
covery, debris cleanup, or related services in 
lower Manhattan (south of Canal St.) for at 
least 24 hours during the period beginning 
on September 11, 2001, and ending on Sep-
tember 30, 2001; or 
‘‘(IV) participated onsite in rescue, re-
covery, 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 han-
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dling of human remains from the World 
Trade Center attacks, or other morgue work-
er 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 Author-
ity Trans-Hudson Corporation Tunnel for 
at least 24 hours during the period begin-
ning 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, driv-
ing, cleaning, repairing, and maintaining 
vehicles contaminated by airborne toxins 
from the September 11, 2001, terrorist at-
tacks during a duration and period de-
scribed 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 po-
lice department (whether fire or emergency 
personnel, active or retired), worked for a 
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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 beginning on Sep-
tember 11, 2001, and ending on the date on 
which the cleanup of the site was concluded, 
as determined by the WTC Program Ad-
ministrator; or 
‘‘(II) was a member of a fire or police 
department (whether fire or emergency per-
sonnel, active or retired), worked for a re-
covery or cleanup contractor, or was a vol-
unteer; 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 be-
ginning 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 Pro-
gram Administrator to be at an increased 
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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, ter-
rorist attacks, and meets such eligibility cri-
teria related to such exposures, as the WTC 
Program Administrator determines are ap-
propriate, after consultation with the WTC 
Scientific/Technical Advisory Committee. 
‘‘(3) ENROLLMENT PROCESS.— 
‘‘(A) IN GENERAL.—The WTC Program Ad-
ministrator 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 en-
rolled in such Program; 
‘‘(ii) subject to clause (iii), the Admin-
istrator shall enroll in such program indi-
viduals who are determined to be WTC re-
sponders; 
‘‘(iii) the Administrator shall deny 
such enrollment to an individual if the Ad-
ministrator determines that the numerical 
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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 in-
dividuals 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 individuals 
enrolled based on modified eligibility criteria es-
tablished under paragraph (1)(C). 
‘‘(B) PROCESS.—In implementing subpara-
graph (A), the WTC Program Administrator 
shall— 
‘‘(i) limit the number of enrollments 
made under paragraph (3)— 
‘‘(I) in accordance with such sub-
paragraph; and 
‘‘(II) to such number, as deter-
mined by the Administrator based on 
the best available information and sub-
ject to amounts available under section 
3351, that will ensure sufficient funds 
will be available to provide treatment 
and monitoring benefits under this 
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title, with respect to all individuals 
who are enrolled through the end of fis-
cal year 2020; and 
‘‘(ii) provide priority (subject to para-
graph (3)(A)(i)) in such enrollments in the 
order in which individuals apply for enroll-
ment 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 para-
graph (3), the Administrator, in consultation with the 
Secretary of Homeland Security, shall determine 
whether the individual is on such list. 
‘‘(b) MONITORING BENEFITS.— 
‘‘(1) IN GENERAL.—In the case of an enrolled 
WTC responder (other than one described in sub-
section (a)(2)(A)(ii)), the WTC Program shall provide 
for monitoring benefits that include monitoring con-
sistent 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 
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member of the Fire Department of New York City, the 
responder shall receive such benefits as part of the in-
dividual’s periodic company medical exams. 
‘‘(2) PROVISION OF MONITORING BENEFITS.—The 
monitoring benefits under paragraph (1) shall be pro-
vided through the Clinical Center of Excellence for the 
type of individual involved or, in the case of an indi-
vidual 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 condi-
tion that— 
‘‘(A)(i) is an illness or health condition for 
which exposure 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 profes-
sional with experience in treating or diagnosing 
the health conditions included in the applicable 
list of WTC-related health conditions, is substan-
tially likely to be a significant factor in aggra-
vating, contributing to, or causing the illness or 
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health condition, as determined under paragraph 
(2); or 
‘‘(ii) is a mental health condition for which 
such attacks, based on an examination by a med-
ical 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 
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-eligi-
ble WTC survivor or certified-eligible WTC 
survivor, is provided certification of cov-
erage under subsection (b)(2)(B)(iii), as ap-
plied 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 
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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, terrorist attacks were substan-
tially likely to be a significant factor in aggravating, 
contributing to, or causing an individual’s illness or 
health condition shall be made based on an assess-
ment 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, popu-
lation-appropriate questionnaire approved 
by the Director of the National Institute for 
Occupational Safety and Health; and 
‘‘(ii) assessed and documented by a 
medical professional with experience in 
treating or diagnosing health conditions in-
cluded on the list of WTC-related health 
conditions. 
‘‘(B) The type of symptoms and temporal 
sequence of symptoms. Such symptoms shall be— 
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‘‘(i) assessed through the use of a 
standardized, population-appropriate med-
ical questionnaire approved by the Director 
of the National Institute for Occupational 
Safety and Health and a medical examina-
tion; and 
‘‘(ii) diagnosed and documented by a 
medical professional described in subpara-
graph (A)(ii). 
‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC RE-
SPONDERS.—The list of health conditions for WTC re-
sponders 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 obstruc-
tive pulmonary disease (COPD). 
‘‘(vi) Chronic cough syndrome. 
‘‘(vii) Upper airway hyperreactivity. 
‘‘(viii) Chronic rhinosinusitis. 
‘‘(ix) Chronic nasopharyngitis. 
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‘‘(x) Chronic laryngitis. 
‘‘(xi) Gastroesophageal reflux disorder 
(GERD). 
‘‘(xii) Sleep apnea exacerbated by or 
related to a condition described in a pre-
vious 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). 
‘‘(vi) Depression (not otherwise speci-
fied). 
‘‘(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. 
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‘‘(D) ADDITIONAL CONDITIONS.—Any can-
cer (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 re-
ceived any treatment for a WTC-related mus-
culoskeletal disorder on or before September 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 
musculoskeletal disorder’ means a chronic or re-
current 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 Sep-
tember 11, 2001, terrorist attacks. 
‘‘(5) CANCER.— 
‘‘(A) IN GENERAL.—The WTC Program Ad-
ministrator shall periodically conduct a review 
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of all available scientific and medical evidence, 
including findings and recommendations 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-re-
lated health conditions. The WTC Program Ad-
ministrator 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 RULE-
MAKING.—Based on the periodic reviews under 
subparagraph (A), if the WTC Program Admin-
istrator determines that cancer or a certain type 
of cancer should be added to such list of WTC- 
related health conditions, the WTC Program Ad-
ministrator 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 cer-
tain type of cancer should be added to such list 
of WTC-related health conditions. If such a de-
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termination is made to make such an addition, 
the WTC Program Administrator shall by regu-
lation add cancer or the certain type of cancer 
to such list. 
‘‘(D) DETERMINATIONS NOT TO ADD CAN-
CER OR CERTAIN TYPES OF CANCER.—In the case 
that the WTC Program Administrator deter-
mines under subparagraph (B) or (C) that can-
cer or a certain type of cancer should not be 
added to such list of WTC-related health condi-
tions, the WTC Program Administrator shall 
publish an explanation for such determination 
in the Federal Register. Any such determination 
to not make such an addition shall not preclude 
the addition of cancer or the certain type of can-
cer 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 pro-
posed rule should be promulgated to add a health 
condition to the list of health conditions in para-
graph (3), the Administrator may request a rec-
ommendation of the Advisory Committee or may 
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publish such a proposed rule in the Federal Reg-
ister in accordance with subparagraph (D). 
‘‘(B) ADMINISTRATOR’S OPTIONS AFTER RE-
CEIPT OF PETITION.—In the case that the WTC 
Program Administrator receives a written peti-
tion by an interested party to add a health con-
dition 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 condi-
tion, in accordance with subparagraph (D); 
‘‘(iii) publish in the Federal Register 
the Administrator’s determination not to 
publish such a proposed rule and the basis 
for such determination; or 
‘‘(iv) publish in the Federal Register a 
determination that insufficient evidence ex-
ists to take action under clauses (i) through 
(iii). 
‘‘(C) ACTION BY ADVISORY COMMITTEE.—In 
the case that the Administrator requests a rec-
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ommendation of the Advisory Committee under 
this paragraph, with respect to adding a health 
condition to the list in paragraph (3), the Advi-
sory Committee shall submit to the Adminis-
trator 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 Administrator. Not 
later than 60 days after the date of receipt of 
such recommendation, the Administrator shall, 
in accordance with subparagraph (D), publish in 
the Federal Register 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 pro-
posed rule under this paragraph— 
‘‘(i) publish such proposed rule in ac-
cordance with section 553 of title 5, United 
States Code; and 
‘‘(ii) provide interested parties a pe-
riod of 30 days after such publication to 
submit written comments on the proposed 
rule. 
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The WTC Program Administrator may extend 
the period described in clause (ii) upon a finding 
of good cause. In 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 representative of any organiza-
tion 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 RE-
SPONDERS BASED ON A WTC-RELATED HEALTH CON-
DITION.— 
‘‘(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 determination 
that the responder has a WTC-related health con-
dition that is in the list in subsection (a)(3) and 
that exposure to airborne toxins, other hazards, 
or adverse conditions resulting from the Sep-
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tember 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 Adminis-
trator shall review determinations made 
under subparagraph (A). 
‘‘(ii) CERTIFICATION.—The Adminis-
trator shall provide a certification of such 
condition based upon reviews conducted 
under clause (i). Such a certification shall 
be provided unless the Administrator deter-
mines that the responder’s condition is not 
a WTC-related health condition in the list 
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in subsection (a)(3) or that exposure to air-
borne toxins, other hazards, or adverse con-
ditions resulting from the September 1, 
2001, terrorist attacks is not substantially 
likely to be a significant factor in aggra-
vating, contributing to, or causing the con-
dition. 
‘‘(iii) APPEAL PROCESS.—The Admin-
istrator shall establish, by rule, a process for 
the appeal of determinations under clause 
(ii). 
‘‘(2) DETERMINATION BASED ON MEDICALLY AS-
SOCIATED WTC-RELATED HEALTH CONDITIONS.— 
‘‘(A) IN
GENERAL.—If a physician at a 
Clinical Center of Excellence determines pursu-
ant to subsection (a) that the enrolled WTC re-
sponder has a health condition described in sub-
section (a)(1)(A) that is not in the list in sub-
section (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 provide the 
Administrator with the facts supporting 
such determination; and 
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‘‘(ii) the Administrator shall make a 
determination under subparagraph (B) 
with respect to such physician’s determina-
tion. 
‘‘(B) PROCEDURES FOR REVIEW, CERTIFI-
CATION, AND APPEAL.—The WTC Program Ad-
ministrator shall, by rule, establish procedures 
for the review and certification of physician de-
terminations under subparagraph (A). Such rule 
shall provide for— 
‘‘(i) the timely review of such a deter-
mination by a physician panel with appro-
priate expertise for the condition and rec-
ommendations to the WTC Program Ad-
ministrator; 
‘‘(ii) not later than 60 days after the 
date of the transmittal under subparagraph 
(A)(i), a determination by the WTC Pro-
gram 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 
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subsection (a)(1)(A) and medically associ-
ated with a WTC-related health condition; 
and 
‘‘(iv) a process for appeals of deter-
minations relating to such conditions. 
‘‘(C) INCLUSION IN LIST OF HEALTH CONDI-
TIONS.—If the WTC Program Administrator 
provides 
certification 
under 
subparagraph 
(B)(iii) for coverage of a condition, the Adminis-
trator 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 Ad-
ministrator publishes a determination under 
subsection (a)(6)(B) not to include a condition 
in the list in subsection (a)(3), the WTC Pro-
gram Administrator shall not provide certifi-
cation 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 pre-
vious sentence shall not apply. 
‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 
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‘‘(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 Administrator shall issue regula-
tions specifying a standard for determining med-
ical necessity with respect to health care services 
and prescription pharmaceuticals, a process for 
determining whether treatment furnished and 
pharmaceuticals prescribed under this title meet 
such standard (including any prior authoriza-
tion requirement), and a process for appeal of a 
determination under subsection (c)(3). 
‘‘(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, diag-
nostic and laboratory tests, prescription drugs, 
inpatient and outpatient hospital services, and 
other medically necessary treatment. 
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‘‘(B) PHARMACEUTICAL
COVERAGE.—With 
respect to ensuring coverage of medically nec-
essary 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 NA-
TIONWIDE NETWORK.—The WTC Program Ad-
ministrator may provide for necessary and rea-
sonable 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 sec-
tion 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 Com-
pensation Program Act of 2000 (title XXXVI of 
Public Law 106–398; 42 U.S.C. 7384t(c)). 
‘‘(5) PROVISION OF TREATMENT PENDING CER-
TIFICATION.—With respect to an enrolled WTC re-
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sponder for whom a determination is made by an ex-
amining 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 condi-
tions as the Administrator may provide) until the 
Administrator makes a decision on whether to certify 
the determination. 
‘‘(c) PAYMENT
FOR INITIAL HEALTH EVALUATION, 
MONITORING, AND TREATMENT OF WTC-RELATED HEALTH 
CONDITIONS.— 
‘‘(1) MEDICAL TREATMENT.— 
‘‘(A) USE OF FECA PAYMENT RATES.—Sub-
ject 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. 
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For treatment not covered under the previous 
sentence or subparagraph (B), the WTC Program 
Administrator shall establish by regulation a re-
imbursement rate for such treatment. 
‘‘(B) PHARMACEUTICALS.— 
‘‘(i) IN GENERAL.—The WTC Program 
Administrator shall establish a program for 
paying for the medically necessary out-
patient prescription pharmaceuticals pre-
scribed under this title for WTC-related 
health conditions through one or more con-
tracts with outside vendors. 
‘‘(ii) COMPETITIVE
BIDDING.—Under 
such program the Administrator shall— 
‘‘(I) select one or more appro-
priate vendors through a Federal com-
petitive bid process; and 
‘‘(II) select the lowest bidder (or 
bidders) meeting the requirements for 
providing pharmaceutical benefits for 
participants in the WTC Program. 
‘‘(iii) TREATMENT OF FDNY PARTICI-
PANTS.—Under such program the Adminis-
trator may enter into an agreement with a 
separate vendor to provide pharmaceutical 
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benefits to enrolled WTC responders for 
whom the Clinical Center of Excellence is 
described in section 3305 if such an ar-
rangement is deemed necessary and bene-
ficial to the program by the WTC Program 
Administrator. 
‘‘(C) IMPROVING QUALITY AND EFFICIENCY 
THROUGH MODIFICATION OF PAYMENT AMOUNTS 
AND METHODOLOGIES.—The WTC Program Ad-
ministrator may modify the amounts and meth-
odologies for making payments for initial health 
evaluations, monitoring, or treatment, if, taking 
into account utilization and quality data fur-
nished by the Clinical Centers of Excellence 
under section 3305(b)(1)(B)(iii), the Adminis-
trator determines that a bundling, capitation, 
pay for performance, or other payment method-
ology would better ensure high quality and effi-
cient delivery of initial health evaluations, moni-
toring, or treatment to an enrolled WTC re-
sponder, screening-eligible WTC survivor, or cer-
tified-eligible WTC survivor. 
‘‘(2) MONITORING AND INITIAL HEALTH EVALUA-
TION.—The WTC Program Administrator shall reim-
burse the costs of monitoring and the costs of an ini-
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tial 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 reim-
bursement or payment under this subsection, the 
WTC Program Administrator shall provide for 
the review of claims for reimbursement or pay-
ment for the provision of medical treatment to 
determine if such treatment is medically nec-
essary and in accordance with medical treatment 
protocols established under subsection (d). 
‘‘(B) WITHHOLDING
OF
PAYMENT
FOR 
MEDICALLY
UNNECESSARY
TREATMENT.—The 
Administrator shall withhold such reimburse-
ment or payment for treatment that the Admin-
istrator determines is not medically necessary or 
is not in accordance with such medical treatment 
protocols. 
‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 
‘‘(1) DEVELOPMENT.—The Data Centers shall 
develop medical 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. 
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‘‘(2) APPROVAL.—The medical treatment proto-
cols 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 ac-
cess to benefits 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 met-
ropolitan area, the WTC Program Administrator shall es-
tablish 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 preventing such individuals from being provided such 
monitoring and treatment benefits or initial health evalua-
tion 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; 
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‘‘(2) follow the monitoring, initial health evalua-
tion, 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 requirements as the WTC Program Adminis-
trator establishes, including sections 1128 through 
1128E of the Social Security Act, as applied by sec-
tion 3301(d). 
‘‘(c) TRAINING
AND TECHNICAL ASSISTANCE.—The 
WTC Program Administer may provide, including through 
contract, for the provision of training and technical assist-
ance to health care providers participating in the network 
under subsection (a). 
‘‘PART 2—WTC SURVIVORS 
‘‘SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUA-
TION OF SCREENING-ELIGIBLE AND CER-
TIFIED-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 in-
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dividual who is described in any of the following 
clauses: 
‘‘(i) CURRENTLY
IDENTIFIED
SUR-
VIVOR.—An individual, including a WTC 
responder, who has been identified as eligi-
ble for medical treatment and monitoring 
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 subsection 
(b), claims symptoms of a WTC-related 
health condition and meets any of the cur-
rent eligibility criteria described in sub-
paragraph (B). 
‘‘(iii) SURVIVOR
WHO
MEETS
MODI-
FIED
ELIGIBILITY
CRITERIA.—An indi-
vidual who is not a WTC responder, for 
purposes of the initial health evaluation 
under subsection (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, 
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2001, terrorist attacks as the WTC Admin-
istrator determines, after consultation with 
the Data Centers described in section 3305 
and the WTC Scientific/Technical 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 certifications for certified-eligible 
WTC survivors under paragraph (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 sec-
tion 3311(a)(4). 
‘‘(B) CURRENT ELIGIBILITY CRITERIA.—The 
eligibility criteria described in this subpara-
graph 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 September 11, 2001. 
‘‘(ii) A person who worked, resided, or 
attended school, childcare, or adult daycare 
in the New York City disaster area for— 
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‘‘(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 beginning 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 sub-
paragraph (B)(i) and had extensive expo-
sure to WTC dust as a result of such work. 
‘‘(iv) A person who was deemed eligible 
to receive a grant from the Lower Manhat-
tan Development Corporation Residential 
Grant Program, who possessed a lease for a 
residence or purchased a residence in the 
New York City disaster area, and who re-
sided in such residence during the period 
beginning on September 11, 2001, and end-
ing on May 31, 2003. 
‘‘(v) A person whose place of employ-
ment— 
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‘‘(I) at any time during the pe-
riod 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 re-
ceive a grant from the Lower Manhat-
tan Development Corporation WTC 
Small Firms Attraction and Retention 
Act program or other government in-
centive program 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 
Administrator in consultation with the 
Data Centers shall establish a process for 
individuals, other than individuals de-
scribed in subparagraph (A)(i), to be deter-
mined to be screening-eligible WTC sur-
vivors. Under such process— 
‘‘(I) there shall be no fee charged 
to the applicant for making an appli-
cation for such determination; 
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‘‘(II) 
the 
Administrator 
shall 
make a determination on such an ap-
plication 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 compliance 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 Ad-
ministrator determines that— 
‘‘(aa) based on the applica-
tion submitted, the individual 
does not meet the eligibility cri-
teria; or 
‘‘(bb) the numerical limita-
tion on certifications of certified- 
eligible WTC survivors set forth in 
paragraph (3) has been met; and 
‘‘(IV) an individual who is deter-
mined not to be a screening-eligible 
WTC survivor shall have an oppor-
tunity to appeal such determination in 
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a manner established under such proc-
ess. 
‘‘(ii) WRITTEN
DOCUMENTATION
OF 
SCREENING-ELIGIBILITY.— 
‘‘(I) IN GENERAL.—In the case of 
an individual who is described in sub-
paragraph (A)(i) or who is determined 
under clause (i) (consistent with para-
graph (3)) to be a screening-eligible 
WTC survivor, the WTC Program Ad-
ministrator shall provide an appro-
priate written documentation of such 
fact. 
‘‘(II) TIMING.— 
‘‘(aa) CURRENTLY
IDENTI-
FIED SURVIVORS.—In the case of 
an individual who is described in 
subparagraph (A)(i), the WTC 
Program Administrator shall pro-
vide the written documentation 
under subclause (I) not later than 
July 1, 2011. 
‘‘(bb) OTHER MEMBERS.—In 
the case of another individual who 
is determined under clause (i) 
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and consistent with paragraph (3) 
to be a screening-eligible WTC 
survivor, the WTC Program Ad-
ministrator 
shall 
provide 
the 
written documentation under sub-
clause (I) at the time of such de-
termination. 
‘‘(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—The term ‘certified-eligi-
ble WTC survivor’ means, subject to paragraph 
(3), a screening-eligible WTC survivor who the 
WTC Program Administrator certifies 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 
Administrator shall establish a certification 
process under which the Administrator shall 
provide appropriate certification to screen-
ing-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. 
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‘‘(ii) TIMING.— 
‘‘(I) CURRENTLY IDENTIFIED SUR-
VIVORS.—In the case of an individual 
who 
is 
described 
in 
paragraph 
(1)(A)(i), the WTC Program Adminis-
trator shall provide the certification 
under clause (i) not later than July 1, 
2011. 
‘‘(II) OTHER
MEMBERS.—In the 
case of another individual who is de-
termined 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 determina-
tion. 
‘‘(3) NUMERICAL LIMITATION ON CERTIFIED-ELI-
GIBLE WTC SURVIVORS.— 
‘‘(A) IN GENERAL.—The total number of in-
dividuals not described in paragraph (1)(A)(i) 
who may be certified as certified-eligible WTC 
survivors under paragraph (2)(B) shall not ex-
ceed 25,000 at any time. 
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‘‘(B) PROCESS.—In implementing subpara-
graph (A), the WTC Program Administrator 
shall— 
‘‘(i) limit the number of certifications 
provided under paragraph (2)(B)— 
‘‘(I) in accordance with such sub-
paragraph; and 
‘‘(II) to such number, as deter-
mined by the Administrator based on 
the best available information and sub-
ject 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 in-
dividuals receiving such certifications 
through the end of fiscal year 2020; 
and 
‘‘(ii) provide priority in such certifi-
cations 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 
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of Homeland Security shall qualify as a screening-eli-
gible WTC survivor or a certified-eligible WTC sur-
vivor. 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 Adminis-
trator, in consultation with the Secretary of Home-
land Security, shall determine whether the individual 
is on such list. 
‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE 
ELIGIBILITY
FOR FOLLOWUP MONITORING
OR TREAT-
MENT.— 
‘‘(1) IN GENERAL.—In the case of a screening-el-
igible 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 bene-
fits under the WTC Program. Initial health evalua-
tion protocols under section 3305(a)(2)(A)(ii) shall be 
subject to approval by the WTC Program Adminis-
trator. 
‘‘(2) 
INITIAL
HEALTH
EVALUATION
PRO-
VIDERS.—The initial health evaluation described in 
paragraph (1) shall be provided through a Clinical 
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Center of Excellence with respect to the individual in-
volved. 
‘‘(3) LIMITATION ON INITIAL HEALTH EVALUA-
TION BENEFITS.—Benefits for an initial health eval-
uation under this part for a screening-eligible WTC 
survivor shall consist only of a single medical initial 
health evaluation consistent with initial health eval-
uation 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 indi-
vidual. 
‘‘SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF 
CERTIFIED-ELIGIBLE WTC SURVIVORS FOR 
WTC-RELATED HEALTH CONDITIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), the pro-
visions 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 SURVIVORS.—The list of health conditions for screen-
ing-eligible WTC survivors and certified-eligible WTC sur-
vivors consists of the following: 
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‘‘(1) AERODIGESTIVE DISORDERS.— 
‘‘(A) Interstitial lung diseases. 
‘‘(B) Chronic respiratory disorder—fumes/ 
vapors. 
‘‘(C) Asthma. 
‘‘(D) Reactive airways dysfunction syn-
drome (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 condition 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 speci-
fied). 
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‘‘(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 pro-
visions of section 3322 shall apply to the followup moni-
toring 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 mon-
itoring and treatment of WTC-related health conditions for 
certified-eligible WTC survivors. 
‘‘(b) INDIVIDUALS DESCRIBED.—An individual de-
scribed in this subsection is an individual who, regardless 
of location of residence— 
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‘‘(1) is not an enrolled WTC responder or a cer-
tified-eligible WTC survivor; and 
‘‘(2) is diagnosed at a Clinical Center of Excel-
lence with a WTC-related health condition for cer-
tified-eligible WTC survivors. 
‘‘(c) LIMITATION.— 
‘‘(1) IN GENERAL.—The WTC Program Adminis-
trator 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 fis-
cal year increased by the annual percentage in-
crease in the medical care component of the con-
sumer price index for all urban consumers. 
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‘‘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 Pro-
gram 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 indi-
vidual that is work-related shall be reduced or re-
couped to the extent that the WTC Program Adminis-
trator determines that payment has been made, or 
can reasonably be expected to be made, under a work-
ers’ 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’ compensa-
tion law or plan, or other work-related injury or ill-
ness plan of the employer involved, and such indi-
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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), 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 condi-
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tion through any public or private health plan (in-
cluding 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 man-
ner as they apply to group health plan and an indi-
vidual 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 paragraph (1) shall be construed as re-
quiring an entity providing monitoring and treat-
ment under this title to seek reimbursement under a 
health plan with which the entity has no contract for 
reimbursement. 
‘‘(3) MAINTENANCE OF REQUIRED MINIMUM ES-
SENTIAL COVERAGE.—No payment may be made for 
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monitoring and treatment under this title for an in-
dividual for a month (beginning with July 2014) if 
with respect to such month the individual— 
‘‘(A) is an applicable individual (as defined 
in subsection (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 essen-
tial 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 dis-
bursed from the World Trade Center Health Pro-
gram Fund under section 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 subparagraph (E)(i). 
Such contract shall specify the terms under 
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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 contract, with respect to the last calendar 
quarter of fiscal year 2011 and each calendar 
quarter in fiscal years 2012 through 2020 the 
full contribution amount under this subpara-
graph shall be equal to 10 percent of the expendi-
tures in carrying out this title for the respective 
quarter. 
‘‘(C) SATISFACTION
OF
PAYMENT
OBLIGA-
TION.—The payment obligation under such con-
tract may not be satisfied through any of the fol-
lowing: 
‘‘(i) An amount derived from Federal 
sources. 
‘‘(ii) An amount paid before the date 
of the enactment 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 pay-
ment obligation under such contract for a cal-
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endar 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 cal-
endar quarter by the day specified in sub-
paragraph (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 percentage 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 ac-
tion in the same manner as payments made 
under title XVIII of the Social Security Act 
may be recoverable in an action brought 
under section 1862(b)(2)(B)(iii) of such Act. 
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‘‘(F) DEPOSIT IN FUND.—The WTC Pro-
gram 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 Administrator 
shall— 
‘‘(A) provide New York City with an esti-
mate of such amount of the required contribution 
at the beginning of such quarter and with an up-
dated 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. 
Such amount shall initially be estimated by the WTC 
Program Administrator and shall be subject to adjust-
ment and reconciliation based upon actual expendi-
tures in carrying out this title. 
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‘‘(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 section, 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 work-
ers’ 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 ar-
rangements with other government agencies, insurance com-
panies, or other third-party administrators to provide for 
timely and accurate processing of claims under sections 
3312, 3313, 3322, and 3323. 
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‘‘Subtitle C—Research Into 
Conditions 
‘‘SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CON-
DITIONS RELATED TO SEPTEMBER 11 TER-
RORIST ATTACKS. 
‘‘(a) IN GENERAL.—With respect to individuals, in-
cluding enrolled WTC responders and certified-eligible WTC 
survivors, receiving monitoring or treatment under subtitle 
B, the WTC Program Administrator shall conduct or sup-
port— 
‘‘(1) research on physical and mental health con-
ditions 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 condi-
tions for which there has been diagnostic uncertainty; 
and 
‘‘(3) research on treating WTC-related health 
conditions of such individuals, in the case of condi-
tions for which there has been treatment uncertainty. 
The Administrator may provide such support through con-
tinuation and expansion of research that was initiated be-
fore the date of the enactment of this title and through the 
World Trade Center Health Registry (referred to in section 
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3342), through a Clinical Center of Excellence, or through 
a Data Center. 
‘‘(b) TYPES OF RESEARCH.—The research under sub-
section (a)(1) shall include epidemiologic and other research 
studies on WTC-related health conditions or emerging con-
ditions— 
‘‘(1) among enrolled WTC responders and cer-
tified-eligible WTC survivors under treatment; and 
‘‘(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 pop-
ulations, to identify potential for long-term adverse 
health effects in less exposed populations. 
‘‘(c) CONSULTATION.—The WTC Program Adminis-
trator shall carry out this section in consultation with the 
WTC Scientific/Technical Advisory Committee. 
‘‘(d) APPLICATION OF PRIVACY AND HUMAN SUBJECT 
PROTECTIONS.—The privacy and human subject protec-
tions 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 at-
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tacks, 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 Reg-
istry 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 Pro-
gram Fund (referred to in this section as the ‘Fund’). 
‘‘(2) FUNDING.—Out of any money in the Treas-
ury not otherwise appropriated, there shall be depos-
ited into the Fund for each of fiscal years 2012 
through 2020 (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 fis-
cal year (initially based on estimates, sub-
ject to subsequent reconciliation based on 
actual expenditures); or 
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‘‘(ii) $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, $431,000,000 for fiscal year 2015, 
$481,000,000 
for 
fiscal 
year 
2016, 
$537,000,000 
for 
fiscal 
year 
2017, 
$601,000,000 
for 
fiscal 
year 
2018, 
$672,000,000 for fiscal year 2019, and 
$743,000,000 for fiscal year 2020; 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 dis-
bursed 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— 
‘‘(i) the amount is recoverable under 
subparagraph (E)(ii) of such section; 
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‘‘(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. 
‘‘(b) MANDATORY FUNDS FOR MONITORING, INITIAL 
HEALTH EVALUATIONS, TREATMENT, AND CLAIMS PROC-
ESSING.— 
‘‘(1) IN GENERAL.—The amounts deposited into 
the Fund under subsection (a)(2) shall be available, 
without further appropriation, consistent with para-
graph (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 avail-
able from the Fund for such purpose. 
‘‘(3) LIMITATION ON AUTHORIZATION FOR FUR-
THER APPROPRIATIONS.—This title does not establish 
any authorization for appropriation of amounts in 
excess of the amounts available from the Fund under 
paragraph (1). 
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‘‘(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 FIREFIGHTERS.—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 specified 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 pre-
vious year. 
‘‘(2) WTC HEALTH PROGRAM SCIENTIFIC/TECH-
NICAL
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 
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12-month period ending with March of the pre-
vious year. 
‘‘(6) WORLD
TRADE
CENTER
HEALTH
REG-
ISTRY.—For the purpose 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 specified 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 pre-
vious year.’’. 
TITLE II—SEPTEMBER 11TH VIC-
TIM COMPENSATION FUND OF 
2001 
SEC. 201. DEFINITIONS. 
Section 402 of the Air Transportation Safety and Sys-
tem Stabilization Act (49 U.S.C. 40101 note) is amended— 
(1) in paragraph (6) by inserting ‘‘, or debris re-
moval, including under the World Trade Center 
Health Program established under section 3001 of the 
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Public Health Service Act,’’ after ‘‘September 11, 
2001’’; 
(2) by inserting after paragraph (6) the fol-
lowing new paragraphs and redesignating subsequent 
paragraphs accordingly: 
‘‘(7) CONTRACTOR
AND
SUBCONTRACTOR.—The 
term ‘contractor and subcontractor’ means any con-
tractor or subcontractor (at any tier of a subcon-
tracting relationship), including any general con-
tractor, construction manager, prime contractor, con-
sultant, or any parent, subsidiary, associated or al-
lied company, affiliated company, corporation, firm, 
organization, or joint venture thereof that partici-
pated 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 prop-
erty interest in the World Trade Center, on September 
11, 2001, whether fee simple, leasehold or easement, 
direct or indirect. 
‘‘(8) DEBRIS
REMOVAL.—The term ‘debris re-
moval’ means rescue and recovery efforts, removal of 
debris, cleanup, remediation, and response during the 
immediate aftermath of the terrorist-related aircraft 
crashes of September 11, 2001, with respect to a 9/11 
crash site.’’; 
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(3) by inserting after paragraph (10), as so re-
designated, the following new paragraph and redesig-
nating the subsequent paragraphs accordingly: 
‘‘(11) IMMEDIATE AFTERMATH.—The term ‘im-
mediate aftermath’ means any period beginning with 
the terrorist-related aircraft crashes of September 11, 
2001, and ending on August 30, 2002.’’; and 
(4) by adding at the end the following new para-
graph: 
‘‘(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 de-
monstrable 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 
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100 
‘‘(D) any area related to, or along, routes of 
debris removal, such as barges and Fresh Kills.’’. 
SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR 
COMPENSATION. 
(a) INFORMATION ON LOSSES RESULTING FROM DE-
BRIS
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 re-
moval during the immediate aftermath’’ after ‘‘Sep-
tember 11, 2001’’; 
(2) in clause (ii), by inserting ‘‘or debris re-
moval during the immediate aftermath’’ after ‘‘crash-
es’’; and 
(3) in clause (iii), by inserting ‘‘or debris re-
moval during the immediate aftermath’’ after ‘‘crash-
es’’. 
(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 
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101 
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 paragraph (1), in accordance with sub-
section (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 
section 407(b) and ending on December 22, 
2031.’’. 
(c) REQUIREMENTS FOR FILING CLAIMS DURING EX-
TENDED FILING PERIOD.—Section 405(c)(3) of such Act is 
amended— 
(1) by redesignating subparagraphs (A) and (B) 
as subparagraphs (B) and (C), respectively; and 
(2) by inserting before subparagraph (B), as so 
redesignated, the following new subparagraph: 
‘‘(A) REQUIREMENTS
FOR
FILING
CLAIMS 
DURING EXTENDED FILING PERIOD.— 
‘‘(i) TIMING REQUIREMENTS FOR FIL-
ING CLAIMS.—An individual (or a personal 
representative on behalf of a deceased indi-
vidual) may file a claim during the period 
described in subsection (a)(3)(B) as follows: 
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102 
‘‘(I) In the case that the Special 
Master determines the individual knew 
(or reasonably should have known) be-
fore 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 indi-
vidual knew (or should have known) 
before such specified date that the indi-
vidual 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 determines the individual first 
knew 
(or 
reasonably 
should 
have 
known) on or after the date specified 
in clause (iii) that the individual suf-
fered 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 
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103 
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 determines 
the individual first knew (or should 
have known) that the individual both 
suffered from such harm and was eligi-
ble to file a claim under this title. 
‘‘(ii) OTHER
ELIGIBILITY
REQUIRE-
MENTS FOR FILING CLAIMS.—An individual 
may file a claim during the period de-
scribed 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 di-
rection of the medical professional who 
provided the medical care. 
‘‘(iii) DATE
SPECIFIED.—The date 
specified in this clause is the date on which 
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104 
the regulations are updated under section 
407(a).’’. 
(d) CLARIFYING APPLICABILITY TO ALL 9/11 CRASH 
SITES.—Section 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 DE-
BRIS REMOVAL.—Clause (i) of section 405(c)(3)(C) of 
such Act, as redesignated by subsection (c), is amend-
ed by inserting ‘‘, or for damages arising from or re-
lated to debris removal’’ after ‘‘September 11, 2001’’. 
(2) PENDING ACTIONS.—Clause (ii) of such sec-
tion, as so redesignated, is amended to read as fol-
lows: 
‘‘(ii) PENDING ACTIONS.—In the case 
of an individual who is a party to a civil 
action described in clause (i), such indi-
vidual may not submit a claim under this 
title— 
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105 
‘‘(I) during the period described 
in subsection (a)(3)(A) unless such in-
dividual withdraws from such action 
by the date that is 90 days after the 
date on which regulations are promul-
gated under section 407(a); and 
‘‘(II) during the period described 
in subsection (a)(3)(B) unless such in-
dividual withdraws from such action 
by the date that is 90 days after the 
date on which the regulations are up-
dated under section 407(b).’’. 
(3) AUTHORITY TO REINSTITUTE CERTAIN LAW-
SUITS.—Such section, as so redesignated, is further 
amended by adding at the end the following new 
clause: 
‘‘(iii) AUTHORITY
TO
REINSTITUTE 
CERTAIN
LAWSUITS.—In the case of a 
claimant who was a party to a civil action 
described in clause (i), who withdrew from 
such action pursuant to clause (ii), and 
who is subsequently determined to not be an 
eligible individual for purposes of this sub-
section, such claimant may reinstitute such 
action without prejudice during the 90-day 
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106 
period beginning after the date of such in-
eligibility determination.’’. 
SEC. 203. REQUIREMENT TO UPDATE REGULATIONS. 
Section 407 of the Air Transportation Safety and Sys-
tem Stabilization Act (49 U.S.C. 40101 note) is amended— 
(1) by striking ‘‘Not later than’’ and inserting 
‘‘(a) IN GENERAL.—Not later than’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(b) UPDATED REGULATIONS.—Not later than 90 days 
after the date of the enactment of the James Zadroga 9/ 
11 Health and Compensation Act of 2008, the Special Mas-
ter shall update the regulations promulgated under sub-
section (a) to the extent necessary to comply with the provi-
sions 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 amend-
ed by adding at the end the following new paragraphs: 
‘‘(4) LIABILITY FOR CERTAIN CLAIMS.— 
‘‘(A) IN
GENERAL.—Notwithstanding any 
other provision of law, subject to subparagraph 
(B), liability for all claims and actions (includ-
ing claims or actions that have been previously 
resolved, that are currently pending, and that 
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107 
may be filed through December 22, 2031) for 
compensatory damages, contribution or indem-
nity, or any other form or type of relief, arising 
from or related to debris removal, against New 
York City, any entity (including the Port Au-
thority of New York and New Jersey) with a 
property interest in the World Trade Center on 
September 11, 2001 (whether fee simple, lease-
hold or easement, or direct or indirect) and any 
contractors and subcontractors thereof, shall not 
be in an amount that exceeds the sum of the fol-
lowing: 
‘‘(i) The amount of funds of the WTC 
Captive Insurance Company, including the 
cumulative interest. 
‘‘(ii) The amount of all available in-
surance identified in schedule 2 of the WTC 
Captive Insurance Company insurance pol-
icy. 
‘‘(iii) The amount that is the greater of 
New York City’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 clauses (i) and (ii) shall not be included. 
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108 
‘‘(iv) The amount of all available li-
ability insurance coverage maintained by 
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, lease-
hold or easement, or direct or indirect. 
‘‘(v) The amount of all available liabil-
ity insurance coverage maintained by con-
tractors and subcontractors. 
‘‘(B) EXCEPTION.—Subparagraph (A) shall 
not apply to claims or actions based upon con-
duct held to be intentionally tortious in nature 
or to acts of gross negligence or other such acts 
to the extent to which punitive damages are 
awarded as a result of such conduct or acts. 
‘‘(5) PRIORITY
OF
CLAIMS
PAYMENTS.—Pay-
ments to plaintiffs who obtain a settlement or judg-
ment with respect to a claim or action to which para-
graph (4)(A) applies, shall be paid solely from the fol-
lowing funds in the following order: 
‘‘(A) The funds described in clause (i) or 
(ii) of paragraph (4)(A). 
‘‘(B) If there are no funds available as de-
scribed in clause (i) or (ii) of paragraph (4)(A), 
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109 
the funds described in clause (iii) of such para-
graph. 
‘‘(C) If there are no funds available as de-
scribed in clause (i), (ii), or (iii) of paragraph 
(4)(A), the funds described in clause (iv) of such 
paragraph. 
‘‘(D) If there are no funds available as de-
scribed in clause (i), (ii), (iii), or (iv) of para-
graph (4)(A), the funds described in clause (v) of 
such paragraph. 
‘‘(6) DECLARATORY JUDGMENT ACTIONS AND DI-
RECT ACTION.—Any party to a claim or action to 
which paragraph (4)(A) applies may, with respect to 
such claim or action, either file an action for a de-
claratory judgment for insurance coverage or bring a 
direct action against the insurance company in-
volved.’’. 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as 
the ‘‘James Zadroga 9/11 Health and Com-
pensation Act of 2010’’. 
(b) TABLE OF CONTENTS.—The table of con-
tents of this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 
Sec. 101. World Trade Center Health Program. 
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‘‘TITLE XXX—WORLD TRADE CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Program; Advisory and Steering 
Committees 
‘‘Sec. 3001. Establishment of World Trade Center Health 
Program within NIOSH. 
‘‘Sec. 3002. WTC Health Program Scientific/Technical Advi-
sory Committee. 
‘‘Sec. 3003. WTC Health Program Steering Committees. 
‘‘Sec. 3004. Community education and outreach. 
‘‘Sec. 3005. Uniform data collection. 
‘‘Sec. 3006. Centers of excellence. 
‘‘Sec. 3007. Entitlement authorities. 
‘‘Sec. 3008. Definitions. 
‘‘Subtitle B—Program of Monitoring, Initial Health 
Evaluations, and Treatment 
‘‘PART 1—FOR WTC RESPONDERS 
‘‘Sec. 3011. Identification of eligible WTC responders and 
provision of WTC-related monitoring services. 
‘‘Sec. 3012. Treatment of certified eligible WTC responders 
for WTC-related health conditions. 
‘‘PART 2—COMMUNITY PROGRAM 
‘‘Sec. 3021. Identification and initial health evaluation of 
eligible WTC community members. 
‘‘Sec. 3022. Followup monitoring and treatment of certified 
eligible WTC community members for WTC-re-
lated health conditions. 
‘‘Sec. 3023. Followup monitoring and treatment of other in-
dividuals with WTC-related health conditions. 
‘‘PART 3—NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE 
INDIVIDUALS OUTSIDE NEW YORK 
‘‘Sec. 3031. National arrangement for benefits for eligible 
individuals outside New York. 
‘‘Subtitle C—Research Into Conditions 
‘‘Sec. 3041. Research regarding certain health conditions 
related to September 11 terrorist attacks in 
New York City. 
‘‘Subtitle D—Programs of the New York City Department of 
Health and Mental Hygiene 
‘‘Sec. 3051. World Trade Center Health Registry. 
‘‘Sec. 3052. Mental health services. 
TITLE II—SEPTEMBER 11TH VICTIM COMPENSATION 
FUND OF 2001 
Sec. 201. Definitions. 
Sec. 202. Extended and expanded eligibility for compensation. 
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Sec. 203. Requirement to update regulations. 
Sec. 204. Limited liability for certain claims. 
Sec. 205. Funding; attorney fees. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Thousands of rescue workers who 
responded to the areas devastated by the 
terrorist attacks of September 11, local 
residents, office and area workers, and 
school children continue to suffer signifi-
cant medical problems as a result of com-
promised air quality and the release of 
other toxins from the attack sites. 
(2) In a September 2006 peer-re-
viewed study conducted by the World 
Trade Center Medical Monitoring Pro-
gram, of 9,500 World Trade Center re-
sponders, almost 70 percent of World 
Trade Center responders had a new or 
worsened respiratory symptom that de-
veloped during or after their time work-
ing at the World Trade Center; among the 
responders who were asymptomatic be-
fore 9/11, 61 percent developed res-
piratory symptoms while working at the 
World Trade Center; close to 60 percent 
still had a new or worsened respiratory 
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112 
symptom at the time of their examina-
tion; one-third had abnormal pulmonary 
function tests; and severe respiratory 
conditions including pneumonia were sig-
nificantly more common in the 6 months 
after 9/11 than in the prior 6 months. 
(3) An April 2006 study documented 
that, on average, a New York City fire-
fighter who responded to the World 
Trade Center has experienced a loss of 12 
years of lung capacity. 
(4) A peer-reviewed study of residents 
who lived near the World Trade Center 
titled ‘‘The World Trade Center Resi-
dents’ Respiratory Health Study: New 
Onset Respiratory Symptoms and Pul-
monary Function’’, found that data dem-
onstrated a three-fold increase in new- 
onset, persistent lower respiratory symp-
toms in residents near the former World 
Trade Center as compared to a control 
population. 
(5) Previous research on the health 
impacts of the devastation caused by the 
September 11 terrorist attacks has shown 
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relationships between the air quality 
from Ground Zero and a host of health 
impacts, 
including 
lower 
pregnancy 
rates, higher rates of respiratory and 
lung disorders, and a variety of post-dis-
aster mental health conditions (including 
posttraumatic stress disorder) in workers 
and residents near Ground Zero. 
(6) A variety of tests conducted by 
independent scientists have concluded 
that significant WTC contamination set-
tled in indoor environments surrounding 
the disaster site. The Environmental Pro-
tection Agency’s (EPA) cleanup programs 
for indoor residential spaces, in 2003 and 
2005, though limited, are an acknowledg-
ment that indoor contamination contin-
ued after the WTC attacks. 
(7) At the request of the Department 
of Energy, the Davis DELTA Group at the 
University of California conducted out-
door dust sampling in October 2001 at 
Varick and Houston Streets (approxi-
mately 1.2 miles north of Ground Zero) 
and found that the contamination from 
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the World Trade Center ‘‘outdid even the 
worst pollution from the Kuwait oil fields 
fires’’. Further, the United States Geologi-
cal Survey (USGS) reported on November 
27, 2001, that dust samples collected from 
indoor surfaces registered at levels that 
were ‘‘as caustic as liquid drain clean-
ers’’. 
(8) According to both the EPA’s own 
Inspector General’s (EPA IG) report of 
August 21, 2003 and General Account-
ability Offices’s (GAO) report of Sep-
tember 2007, no comprehensive program 
has ever been conducted in order to char-
acterize the full extent of WTC contami-
nation, and therefore the full impact of 
that contamination—geographic or other-
wise—remains unknown. 
(9) Such reports found that there has 
never been a comprehensive program to 
remediate 
WTC 
toxins 
from 
indoor 
spaces. Thus, area residents, workers and 
students may continue to be exposed to 
WTC contamination in their homes, work-
places and schools. 
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(10) Because of the failure to release 
federally appropriated funds for commu-
nity care, a lack of sufficient outreach, 
the fact that many community members 
are receiving care from physicians out-
side the current City-funded World Trade 
Center Environmental Health Center pro-
gram and thus fall outside data collection 
efforts, and other factors, the number of 
community members being treated at the 
World 
Trade 
Center 
Environmental 
Health Center underrepresents the total 
number in the community that have been 
affected by exposure to Ground Zero tox-
ins. 
(11) Research by Columbia Univer-
sity’s Center for Children’s Environ-
mental Health has shown negative health 
effects on babies born to women living 
within 2 miles of the World Trade Center 
in the month following 9/11. 
(12) Federal funding allocated for the 
monitoring of rescue workers’ health is 
not sufficient to ensure the long-term 
study of health impacts of September 11. 
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116 
(13) A significant portion of those 
who have developed health problems as 
result of exposures to airborne toxins or 
other hazards resulting from the Sep-
tember 11, 2001, attacks on the World 
Trade Center have no health insurance, 
have lost their health insurance as a re-
sult of the attacks, or have inadequate 
health insurance. 
(14) The Federal program to provide 
medical treatments to those who re-
sponded to the September 11 aftermath, 
and who continue to experience health 
problems as a result, was finally estab-
lished more than five years after the at-
tacks, but has no certain long-term fund-
ing. 
(15) Rescue workers and volunteers 
seeking workers’ compensation have re-
ported that their applications have been 
denied, delayed for months, or redi-
rected, instead of receiving assistance in 
a timely and supportive manner. 
(16) A February 2007 report released 
by the City of New York estimated that 
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117 
approximately 410,000 people were the 
most heavily exposed to the environ-
mental hazards and trauma of the Sep-
tember 11 terrorist attacks. More than 30 
percent of the Fire Department of the 
City of New York first responders were 
still experiencing some respiratory symp-
toms more than five years after the at-
tacks and according to the report, 59 per-
cent of those seen by the WTC Environ-
mental Health Center at Bellevue Hos-
pital (which serves community members) 
are without insurance and 65 percent 
have incomes less than $15,000 per year. 
The report also found a need to continue 
and expand mental health services. 
(17) Since the 5th anniversary of the 
attack (September 11, 2006), hundreds of 
workers a month have been signing up 
with the monitoring and treatment pro-
grams. 
(18) In April 2008, the Department of 
Health and Human Services reported to 
Congress that in fiscal year 2007 11,359 
patients received medical treatment in 
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the existing WTC Responder Medical and 
Treatment 
program 
for 
WTC-related 
health problems, and that number of re-
sponders who need treatment and the se-
verity of health problems is expected to 
increase. 
(19) The September 11 Victim Com-
pensation Fund of 2001 was established 
to provide compensation to individuals 
who were physically injured or killed as 
a result of the terrorist-related aircraft 
crashes of September 11, 2001. 
(20) The deadline for filing claims for 
compensation under the Victim Com-
pensation Fund was December 22, 2003. 
(21) Some individuals did not know 
they were eligible to file claims for com-
pensation for injuries or did not know 
they had suffered physical harm as a re-
sult 
of 
the 
terrorist-related 
aircraft 
crashes until after the December 22, 2003, 
deadline. 
(22) Further research is needed to 
evaluate more comprehensively the ex-
tent of the health impacts of September 
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119 
11, 
including 
research 
for 
emerging 
health problems such as cancer, which 
have been predicted. 
(23) Research is needed regarding 
possible treatment for the illnesses and 
injuries of September 11. 
(24) The Federal response to medical 
and financial issues arising from the Sep-
tember 11 response efforts needs a com-
prehensive, coordinated long-term re-
sponse in order to meet the needs of all 
the individuals who were exposed to the 
toxins of Ground Zero and are suffering 
health problems from the disaster. 
(25) The failure to extend the ap-
pointment of Dr. John Howard as Direc-
tor of the National Institute for Occupa-
tional Safety and Health in July 2008 is 
not in the interests of the administration 
of such Institute nor the continued oper-
ation of the World Trade Center Medical 
Monitoring 
and 
Treatment 
Program 
which he has headed, and the Secretary 
of Health and Human Services should re-
consider extending such appointment. 
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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 XXX—WORLD TRADE 
CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Pro-
gram; Advisory and Steering 
Committees 
‘‘SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER 
HEALTH PROGRAM WITHIN NIOSH. 
‘‘(a) IN GENERAL.—There is hereby estab-
lished within the National Institute for Occu-
pational Safety and Health a program to be 
known as the ‘World Trade Center Health 
Program’ (in this title referred to as the ‘WTC 
program’) to provide— 
‘‘(1) medical monitoring and treat-
ment benefits to eligible emergency re-
sponders and recovery and clean-up 
workers (including those who are Federal 
employees) who responded to the Sep-
tember 11, 2001, terrorist attacks on the 
World Trade Center; and 
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‘‘(2) initial health evaluation, moni-
toring, and treatment benefits to resi-
dents 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
RE-
SPONDERS.—Medical 
monitoring 
under 
section 3011, including clinical examina-
tions and long-term health monitoring 
and analysis for individuals 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 on the World 
Trade Center. 
‘‘(2) INITIAL
HEALTH
EVALUATION
FOR 
COMMUNITY
MEMBERS.—An initial health 
evaluation under section 3021, including 
an evaluation to determine eligibility for 
followup monitoring and treatment. 
‘‘(3) 
FOLLOW-UP
MONITORING
AND 
TREATMENT
FOR
WTC-RELATED
CONDITIONS 
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FOR
RESPONDERS
AND
COMMUNITY
MEM-
BERS.—Provision 
under 
sections 
3012, 
3022, and 3023 of follow-up monitoring 
and treatment and payment, subject to 
the provisions of subsection (d), for all 
medically necessary health and mental 
health care expenses (including nec-
essary prescription drugs) of individuals 
with a WTC-related health condition. 
‘‘(4) OUTREACH.—Establishment under 
section 3004 of an outreach program to 
potentially 
eligible 
individuals 
con-
cerning the benefits under this title. 
‘‘(5) UNIFORM DATA COLLECTION.—Col-
lection under section 3005 of health and 
mental health data on individuals receiv-
ing monitoring or treatment benefits, 
using a uniform system of data collection. 
‘‘(6) RESEARCH
ON
WTC
CONDITIONS.— 
Establishment under subtitle C of a re-
search program on health conditions re-
sulting from the September 11, 2001, ter-
rorist attacks on the World Trade Center. 
‘‘(c) NO
COST-SHARING.—Monitoring and 
treatment benefits and initial health evalua-
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tion benefits are provided under subtitle B 
without any deductibles, copayments, or 
other cost-sharing to an eligible WTC re-
sponder or any eligible WTC community mem-
ber. 
‘‘(d) PAYOR.— 
‘‘(1) IN GENERAL.—Except as provided 
in paragraphs (2) and (3), the cost of 
monitoring and treatment benefits and 
initial health evaluation benefits pro-
vided under subtitle B shall be paid for 
by the WTC program. 
‘‘(2) 
WORKERS’ 
COMPENSATION
PAY-
MENT.— 
‘‘(A) IN GENERAL.—Except as pro-
vided in subparagraph (B), payment 
for treatment under subtitle B of a 
WTC-related condition in an indi-
vidual that is work-related shall be 
reduced or recouped to the extent 
that the Secretary determines that 
payment has been made, or can rea-
sonably be expected to be made, 
under a workers’ compensation law 
or plan of the United States or a 
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State, 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 (42 U.S.C. 1395y(b)(2)) and para-
graph (3) of such section shall apply 
to the recoupment under this para-
graph of a payment to the WTC pro-
gram with respect to a workers’ com-
pensation 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 reimburse-
ment of a payment under section 
1862(b)(2) of such Act to the Sec-
retary, with respect to such a law or 
plan and an individual entitled to 
benefits under title XVIII of such Act. 
‘‘(B) EXCEPTION.—If the WTC Pro-
gram Administrator certifies that the 
City of New York has contributed the 
matching 
contribution 
required 
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under section 3006(a)(3) for a 12- 
month period (specified by the WTC 
Program 
Administrator), 
subpara-
graph (A) shall not apply for that 12- 
month period with respect to a work-
ers’ compensation law or plan, includ-
ing line of duty compensation, to 
which the City is obligated to make 
payments. 
‘‘(3) HEALTH INSURANCE COVERAGE.— 
‘‘(A) IN
GENERAL.—In the case of 
an individual who has a WTC-related 
condition that is not work-related 
and has health coverage for such con-
dition through any public or private 
health plan, the provisions of section 
1862(b) of the Social Security Act (42 
U.S.C. 1395y(b)) shall apply to such a 
health plan and such individual in 
the same manner as they apply to a 
group health plan and an individual 
entitled to benefits under title XVIII 
of such Act pursuant to section 
226(a). Any costs for items and serv-
ices covered under such plan that are 
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not reimbursed by such health plan, 
due to the application of deductibles, 
copayments, coinsurance, other cost- 
sharing, or otherwise, are reimburs-
able under this title to the extent that 
they are covered under the WTC pro-
gram. 
‘‘(B) RECOVERY BY INDIVIDUAL PRO-
VIDERS.—Nothing in subparagraph (A) 
shall be construed as requiring an en-
tity providing monitoring and treat-
ment under this title to seek reim-
bursement under a health plan with 
which the entity has no contract for 
reimbursement. 
‘‘(4) WORK-RELATED
DESCRIBED.—For 
the purposes of this subsection, a WTC- 
related condition shall be treated as a 
condition that is work-related if— 
‘‘(A) the condition is diagnosed in 
an eligible WTC responder, or in an 
individual who qualifies as an eligible 
WTC community member on the basis 
of being a rescue, recovery, or clean- 
up worker; or 
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‘‘(B) with respect to the condition 
the individual has filed and had es-
tablished 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 indi-
vidual. 
‘‘(e) QUALITY ASSURANCE AND MONITORING 
OF CLINICAL EXPENDITURES.— 
‘‘(1) QUALITY
ASSURANCE.—The WTC 
Program Administrator working with the 
Clinical Centers of Excellence shall de-
velop and implement a quality assurance 
program for the medical monitoring and 
treatment delivered by such Centers of 
Excellence and any other participating 
health care providers. Such program 
shall include— 
‘‘(A) adherence to medical moni-
toring and treatment protocols; 
‘‘(B) appropriate diagnostic and 
treatment referrals for participants; 
‘‘(C) prompt communication of 
test results to participants; and 
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‘‘(D) such other elements as the 
Administrator specifies in consulta-
tion with the Clinical Centers of Ex-
cellence. 
‘‘(2) FRAUD
PREVENTION.—The WTC 
Program Administrator shall develop and 
implement a program to review the pro-
gram’s health care expenditures to detect 
fraudulent or duplicate billing and pay-
ment for inappropriate services. Such 
program shall be similar to current meth-
ods used in connection with the Medicare 
program under title XVIII of the Social 
Security Act. This title is a Federal health 
care program (as defined in section 
1128B(f) of such 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. 
‘‘(f) WTC PROGRAM ADMINISTRATION.—The 
WTC program shall be administered by the 
Director of the National Institute for Occupa-
tional Safety and Health, or a designee of 
such Director. 
‘‘(g) ANNUAL PROGRAM REPORT.— 
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‘‘(1) IN
GENERAL.—Not later than 6 
months after the end of each fiscal year 
in which the WTC program is in oper-
ation, the WTC Program Administrator 
shall submit an annual report to the Con-
gress on the operations of this title for 
such fiscal year and for the entire period 
of operation of the program. 
‘‘(2) CONTENTS
OF
REPORT.—Each an-
nual report under paragraph (1) shall in-
clude the following: 
‘‘(A) ELIGIBLE INDIVIDUALS.—Infor-
mation for each clinical program de-
scribed in paragraph (3)— 
‘‘(i) on the number of individ-
uals 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 medical monitoring 
under the program and the num-
ber of such individuals who re-
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ceived medical treatment under 
the program; 
‘‘(iii) with respect to individ-
uals so certified who received 
such treatment, on the WTC-re-
lated health conditions for which 
they were treated; and 
‘‘(iv) on the projected number 
of individuals who will be cer-
tified under subtitle B in the suc-
ceeding fiscal year. 
‘‘(B) MONITORING, INITIAL
HEALTH 
EVALUATION, AND
TREATMENT
COSTS.— 
For each clinical program so de-
scribed— 
‘‘(i) information on the costs 
of monitoring and initial health 
evaluation and the costs of treat-
ment and on the estimated costs 
of such monitoring, evaluation, 
and treatment in the succeeding 
fiscal year; and 
‘‘(ii) an estimate of the cost of 
medical treatment for WTC-re-
lated conditions that have been 
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paid for or reimbursed by work-
ers’ compensation, by public or 
private health plans, or by the 
City of New York under section 
3012(c)(4). 
‘‘(C) ADMINISTRATIVE COSTS.—Infor-
mation on the cost of administering 
the program, including costs of pro-
gram support, data collection and 
analysis, 
and 
research 
conducted 
under the program. 
‘‘(D) 
ADMINISTRATIVE
EXPERI-
ENCE.—Information on the adminis-
trative performance of the program, 
including— 
‘‘(i) the performance of the 
program in providing timely eval-
uation of and treatment to eligi-
ble individuals; and 
‘‘(ii) a list of the Clinical Cen-
ters of Excellence and other pro-
viders that are participating in 
the program. 
‘‘(E) SCIENTIFIC REPORTS.—A sum-
mary of the findings of any new sci-
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entific reports or studies on the 
health effects associated with WTC 
center exposures, including the find-
ings of research conducted under sec-
tion 3041(a). 
‘‘(F) 
ADVISORY
COMMITTEE
REC-
OMMENDATIONS.—A 
list 
of 
rec-
ommendations by the WTC Scientific/ 
Technical Advisory Committee on ad-
ditional WTC program eligibility cri-
teria and on additional WTC-related 
health conditions and the action of 
the WTC Program Administrator con-
cerning each such recommendation. 
‘‘(3) SEPARATE CLINICAL PROGRAMS DE-
SCRIBED.—In paragraph (2), each of the 
following shall be treated as a separate 
clinical program of the WTC program: 
‘‘(A) FDNY RESPONDERS.—The ben-
efits provided for eligible WTC re-
sponders 
described 
in 
section 
3006(b)(1)(A). 
‘‘(B) OTHER ELIGIBLE WTC RESPOND-
ERS.—The benefits provided for eligi-
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ble WTC responders not described in 
subparagraph (A). 
‘‘(C) 
ELIGIBLE
WTC
COMMUNITY 
MEMBERS.—The benefits provided for 
eligible WTC community members in 
section 3006(b)(1)(C). 
‘‘(h) NOTIFICATION
TO
CONGRESS
WHEN 
REACH 80 PERCENT OF ELIGIBILITY NUMERICAL 
LIMITS.—The WTC Program Administrator 
shall promptly notify the Congress— 
‘‘(1) when the number of certifi-
cations for eligible WTC responders sub-
ject to the limit established under section 
3011(a)(5) has reached 80 percent of such 
limit; and 
‘‘(2) when the number of certifi-
cations for eligible WTC community mem-
bers subject to the limit established 
under section 3021(a)(5) has reached 80 
percent of such limit. 
‘‘(i) GAO REPORT.—Not later than 3 years 
after the date of the enactment of this Act, the 
Comptroller General of the United States 
shall submit to the Congress a report on the 
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costs of the monitoring and treatment pro-
grams provided under this title. 
‘‘(j) NYC RECOMMENDATIONS.—The City of 
New York may make recommendations to the 
WTC Program Administrator on ways to im-
prove the monitoring and treatment pro-
grams under this title for both eligible WTC 
responders and eligible WTC community 
members. 
‘‘SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECH-
NICAL ADVISORY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—The WTC Program 
Administrator shall establish an advisory 
committee to be known as the WTC Health 
Program Scientific/Technical Advisory Com-
mittee (in this section referred to as the ‘Advi-
sory Committee’) to review scientific and 
medical evidence and to make recommenda-
tions to the Administrator on additional WTC 
program eligibility criteria and on additional 
WTC-related health conditions. 
‘‘(b) COMPOSITION.—The WTC Program Ad-
ministrator shall appoint the members of the 
Advisory Committee and shall include at 
least— 
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‘‘(1) 4 occupational physicians, at 
least two of whom have experience treat-
ing WTC rescue and recovery workers; 
‘‘(2) 1 physician with expertise in pul-
monary medicine; 
‘‘(3) 2 environmental medicine or en-
vironmental health specialists; 
‘‘(4) 2 representatives of eligible WTC 
responders; 
‘‘(5) 2 representatives of WTC commu-
nity members; 
‘‘(6) an industrial hygienist; 
‘‘(7) a toxicologist; 
‘‘(8) an epidemiologist; and 
‘‘(9) a mental health professional. 
‘‘(c) MEETINGS.—The Advisory Committee 
shall meet at such frequency as may be re-
quired to carry out its duties. 
‘‘(d) REPORTS.—The WTC Program Admin-
istrator shall provide for publication of rec-
ommendations of the Advisory Committee on 
the public website established for the WTC 
program. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 
For the purpose of carrying out this section, 
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there are authorized to be appropriated such 
sums as may be necessary, not to exceed 
$100,000, for each fiscal year beginning with 
fiscal year 2009. 
‘‘(f) 
DURATION.—Notwithstanding 
any 
other provision of law, the Advisory Com-
mittee shall continue in operation during the 
period in which the WTC program is in oper-
ation. 
‘‘(g) APPLICATION OF FACA.—Except as oth-
erwise specifically provided, the Advisory 
Committee shall be subject to the Federal Ad-
visory Committee Act. 
‘‘SEC. 3003. WTC HEALTH PROGRAM STEERING COMMIT-
TEES. 
‘‘(a) ESTABLISHMENT.—The WTC Program 
Administrator shall establish two steering 
committees (each in this section referred to as 
a ‘Steering Committee’) as follows: 
‘‘(1) WTC RESPONDERS STEERING COM-
MITTEE.—One steering committee, to be 
known as the WTC Responders Steering 
Committee, for the purpose of facilitating 
the coordination of medical monitoring 
and treatment programs for the eligible 
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WTC responders under part 1 of subtitle 
B. 
‘‘(2) WTC COMMUNITY PROGRAM STEER-
ING COMMITTEE.—One steering committee, 
to be known as the WTC Community Pro-
gram Steering Committee, for the pur-
pose of facilitating the coordination of 
initial health evaluations, monitoring, 
and treatment programs for eligible WTC 
community members under part 2 of sub-
title B. 
‘‘(b) MEMBERSHIP.— 
‘‘(1) INITIAL
MEMBERSHIP
OF
WTC
RE-
SPONDERS STEERING COMMITTEE.—The WTC 
Responders Steering Committee shall ini-
tially be composed of members of the 
WTC Monitoring and Treatment Program 
Steering Committee (as in existence on 
the day before the date of the enactment 
of this title). In addition, the committee 
membership shall include— 
‘‘(A) a representative of the Police 
Commissioner of the City of New 
York; 
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‘‘(B) a representative of the De-
partment of Health of the City of New 
York; 
‘‘(C) a representative of another 
agency of the City of New York, se-
lected by the Mayor of New York 
City, which had a large number of 
non-uniformed City workers who re-
sponded to the WTC disaster; and 
‘‘(D) three representatives of eligi-
ble WTC responders; 
in order that eligible WTC responders 
constitute half the members of the Steer-
ing Committee. 
‘‘(2) INITIAL MEMBERSHIP OF WTC COM-
MUNITY PROGRAM STEERING COMMITTEE.— 
‘‘(A) IN GENERAL.—The WTC Com-
munity Program Steering Committee 
shall initially be composed of mem-
bers 
of 
the 
WTC 
Environmental 
Health Center Community Advisory 
Committee (as in existence on the day 
before the date of the enactment of 
this title) and shall initially have, as 
voting members, the following: 
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‘‘(i) 11 representatives of the 
affected populations of residents, 
students, area workers, and other 
community members. 
‘‘(ii) The Medical Director of 
the WTC Environmental Health 
Center. 
‘‘(iii) The Executive Director 
of the WTC Environmental Health 
Center. 
‘‘(iv) Three physicians, one 
each representing the three WTC 
Environmental 
Health 
Center 
treatment sites of Bellevue Hos-
pital 
Center, 
Gouverneur 
Healthcare Services, and Elm-
hurst Hospital Center. 
‘‘(v) Five specialists with WTC 
related expertise or experience in 
treating non-responder WTC dis-
eases, such as a pediatrician, an 
epidemiologist, a psychiatrist or 
psychologist, an environmental/ 
occupational specialists or a so-
cial worker from a WTC Environ-
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mental Health Center treatment 
site, or other relevant specialists. 
‘‘(vi) A representative of the 
Department of Health and Mental 
Hygiene of the City of New York. 
‘‘(B) APPOINTMENTS.— 
‘‘(i) WTC EHC COMMUNITY ADVI-
SORY COMMITTEE.—The WTC Envi-
ronmental Health Center Commu-
nity Advisory Committee as in ex-
istence on the date of the enact-
ment of this title shall nominate 
members for positions described 
in subparagraph (A)(i). 
‘‘(ii) NYC 
HEALTH
AND
HOS-
PITALS
CORPORATION.—The 
New 
York City Health and Hospitals 
Corporation shall nominate mem-
bers for positions described in 
clauses (iv) and (v) of subpara-
graph (A). 
‘‘(iii) 
TIMING.—Nominations 
under clauses (i) and (ii) shall be 
recommended to the WTC Pro-
gram 
Administrator 
not 
later 
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than 60 days after the date of the 
enactment of this title. 
‘‘(iv) APPOINTMENT.—The WTC 
Program Administrator shall ap-
point members of the WTC Com-
munity Program Steering Com-
mittee not later than 90 days after 
the date of the enactment of this 
title. 
‘‘(v) 
GENERAL
REPRESENTA-
TIVES.—Of the members appointed 
under subparagraph (A)(i)— 
‘‘(I) 
the 
representation 
shall reflect the broad and di-
verse 
WTC-affected 
popu-
lations and constituencies and 
the 
diversity 
of 
impacted 
neighborhoods, including resi-
dents, 
hard-to-reach 
popu-
lations, students, area work-
ers, school parents, commu-
nity-based 
organizations, 
Community Boards, WTC En-
vironmental 
Health 
Center 
patients, labor unions, and 
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142 
labor advocacy organizations; 
and 
‘‘(II) no one individual or-
ganization 
can 
have 
more 
than one representative. 
‘‘(3) ADDITIONAL APPOINTMENTS.—Each 
Steering Committee may appoint, if ap-
proved by a majority of voting members 
of the Committee, additional members to 
the Committee. 
‘‘(4) VACANCIES.—A vacancy in a Steer-
ing Committee shall be filled by the 
Steering Committee, subject to the ap-
proval of the WTC Program Adminis-
trator, so long as— 
‘‘(A) in the case of the WTC Re-
sponders Steering Committee, the 
composition of the Committee in-
cludes 
representatives 
of 
eligible 
WTC responders and representatives 
of each Clinical Center of Excellence 
and each Coordinating Center of Ex-
cellence that serves eligible WTC re-
sponders and such composition has 
eligible WTC responders constituting 
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half of the membership of the Steer-
ing Committee; or 
‘‘(B) in the case of the WTC Com-
munity Program Steering Committee, 
the composition of the Committee in-
cludes 
representatives 
of 
eligible 
WTC community members and rep-
resentatives of each Clinical Center 
of Excellence and each Coordinating 
Center of Excellence that serves eligi-
ble WTC community members and the 
nominating process is consistent with 
paragraph (2)(B). 
‘‘(5) CO-CHAIRS OF WTC COMMUNITY PRO-
GRAM
STEERING
COMMITTEE.—The 
WTC 
Community Program Steering Committee 
shall have two Co-Chairs as follows: 
‘‘(A) COMMUNITY/LABOR CO-CHAIR.— 
A Community/Labor Co-Chair who 
shall be chosen by the community 
and 
labor-based 
members 
of 
the 
Steering Committee. 
‘‘(B) ENVIRONMENTAL HEALTH CLIN-
IC
CO-CHAIR.—A WTC Environmental 
Health Clinic Co-Chair who shall be 
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chosen by the WTC Environmental 
Health Center members on the Steer-
ing Committee. 
‘‘(c) RELATION
TO FACA.—Each Steering 
Committee shall not be subject to the Federal 
Advisory Committee Act. 
‘‘(d) MEETINGS.—Each Steering Committee 
shall meet at such frequency necessary to 
carry out its duties, but not less than 4 times 
each calendar year and at least two such 
meetings each year shall be a joint meeting 
with the voting membership of the other 
Steering Committee for the purpose of ex-
changing information regarding the WTC pro-
gram. 
‘‘(e) 
DURATION.—Notwithstanding 
any 
other provision of law, each Steering Com-
mittee shall continue in operation during the 
period in which the WTC program is in oper-
ation. 
‘‘SEC. 3004. COMMUNITY EDUCATION AND OUTREACH. 
‘‘(a) IN GENERAL.—The WTC Program Ad-
ministrator shall institute a program that pro-
vides education and outreach on the exist-
ence and availability of services under the 
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WTC program. The outreach and education 
program— 
‘‘(1) shall include— 
‘‘(A) the establishment of a public 
website with information about the 
WTC program; 
‘‘(B) meetings with potentially eli-
gible populations; 
‘‘(C) development and dissemina-
tion of outreach materials 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 popu-
lations; and 
‘‘(B) to include materials for cul-
turally and linguistically diverse pop-
ulations. 
‘‘(b) PARTNERSHIPS.—To the greatest ex-
tent possible, in carrying out this section, the 
WTC Program Administrator shall enter into 
partnerships with local governments and or-
ganizations with experience performing out-
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reach to the affected populations, including 
community and labor-based organizations. 
‘‘SEC. 3005. UNIFORM DATA COLLECTION. 
‘‘(a) IN GENERAL.—The WTC Program Ad-
ministrator shall provide for the uniform col-
lection of data (and analysis of data and reg-
ular reports to the Administrator) on the utili-
zation of monitoring and treatment benefits 
provided to eligible WTC responders and eli-
gible WTC community members, the preva-
lence of WTC-related health conditions, and 
the identification of new WTC-related medical 
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. 
‘‘(b) COORDINATING THROUGH CENTERS OF 
EXCELLENCE.—Each Clinical Center of Excel-
lence shall collect data described in sub-
section (a) and report such data to the cor-
responding Coordinating Center of Excel-
lence for analysis by such Coordinating Cen-
ter of Excellence. 
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‘‘(c) PRIVACY.—The data collection and 
analysis under this section shall be conducted 
in a manner that protects the confidentiality 
of individually identifiable health informa-
tion consistent with applicable legal require-
ments. 
‘‘SEC. 3006. CENTERS OF EXCELLENCE. 
‘‘(a) IN GENERAL.— 
‘‘(1) CONTRACTS WITH CLINICAL CENTERS 
OF
EXCELLENCE.—The WTC Program Ad-
ministrator shall enter into contracts 
with Clinical Centers of Excellence speci-
fied in subsection (b)(1)— 
‘‘(A) for the provision of moni-
toring and treatment benefits and ini-
tial health evaluation benefits under 
subtitle B; 
‘‘(B) for the provision of outreach 
activities to individuals eligible for 
such monitoring and treatment bene-
fits, for initial health evaluation bene-
fits, and for follow-up to individuals 
who are enrolled in the monitoring 
program; 
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‘‘(C) for the provision of coun-
seling for benefits under subtitle B, 
with respect to WTC-related health 
conditions, for individuals eligible for 
such benefits; 
‘‘(D) for the provision of coun-
seling for benefits for WTC-related 
health conditions that may be avail-
able under Workers’ Compensation or 
other benefit programs for work-re-
lated injuries or illnesses, health in-
surance, 
disability 
insurance, 
or 
other insurance plans or through 
public or private social service agen-
cies and assisting eligible individuals 
in applying for such benefits; 
‘‘(E) 
for 
the 
provision 
of 
translational and interpretive serv-
ices as for program participants who 
are not English language proficient; 
and 
‘‘(F) for the collection and report-
ing of data in accordance with sec-
tion 3005. 
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‘‘(2) CONTRACTS
WITH
COORDINATING 
CENTERS OF EXCELLENCE.—The WTC Pro-
gram Administrator shall enter into con-
tracts with Coordinating Centers of Ex-
cellence specified in subsection (b)(2)— 
‘‘(A) for receiving, analyzing, and 
reporting to the WTC Program Ad-
ministrator on data, in accordance 
with section 3005, that has been col-
lected and reported to such Coordi-
nating Centers by the corresponding 
Clinical Centers of Excellence under 
subsection (d)(3); 
‘‘(B) for the development of med-
ical monitoring, initial health evalua-
tion, and treatment protocols, with 
respect to WTC-related health condi-
tions; 
‘‘(C) for coordinating the outreach 
activities conducted under paragraph 
(1)(B) by each corresponding Clinical 
Center of Excellence; 
‘‘(D) for establishing criteria for 
the credentialing of medical pro-
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viders participating in the nation-
wide network under section 3031; 
‘‘(E) for coordinating and admin-
istrating the activities of the WTC 
Health Program Steering Committees 
established 
under 
section 
3003(a); 
and 
‘‘(F) for meeting periodically with 
the corresponding Clinical Centers of 
Excellence to obtain input on the 
analysis and reporting of data col-
lected under subparagraph (A) and 
on the development of medical moni-
toring, initial health evaluation, and 
treatment protocols under subpara-
graph (B). 
The medical providers under subpara-
graph (D) shall be selected by the WTC 
Program Administrator on the basis of 
their experience treating or diagnosing 
the medical conditions included in the 
list of identified WTC-related conditions 
for responders and of identified WTC-re-
lated conditions for community members. 
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‘‘(3) REQUIRED
PARTICIPATION
BY
NEW 
YORK CITY IN MONITORING AND TREATMENT 
PROGRAM AND COSTS.— 
‘‘(A) IN
GENERAL.—In order for 
New York City, any agency or Depart-
ment thereof, or the New York City 
Health and Hospitals Corporation to 
qualify for a contract for the provi-
sion of monitoring and treatment 
benefits and other services under sec-
tion 3006, New York City is required 
to contribute a matching amount of 
10 percent of the amount of the cov-
ered monitoring and treatment pay-
ment (as defined in subparagraph 
(B)). 
‘‘(B) 
COVERED
MONITORING
AND 
TREATMENT
PAYMENT
DEFINED.—For 
the purposes of this paragraph, the 
term ‘covered monitoring and treat-
ment payment’ means payment under 
paragraphs (1) and (2), including 
under such paragraph as applied 
under section 3021(b), 3022(a), and 
3023, 
and 
reimbursement 
under 
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3006(c) for items and services fur-
nished by a Clinical Center of Excel-
lence or Coordinating Center of Ex-
cellence, and providers designated by 
the WTC Program under section 3031, 
after the application of paragraphs 
(2) and (3) of section 3001 (d). 
‘‘(C) PAYMENT
OF
NEW
YORK
CITY 
SHARE OF MONITORING AND TREATMENT 
COSTS.—The WTC Program Adminis-
trator shall— 
‘‘(i) bill the amount specified 
in subparagraph (A) directly to 
New York City; and 
‘‘(ii) certify periodically, for 
purposes of section 3001(d)(2), 
whether or not New York City has 
paid the amount so billed. 
‘‘(D) 
LIMITATION
ON
REQUIRED 
AMOUNT.—In no case is New York City 
required under this paragraph to 
contribute more than a total of 
$500,000,000 over any 10-year period. 
‘‘(b) CENTERS OF EXCELLENCE DEFINED.— 
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‘‘(1) 
CLINICAL
CENTER
OF
EXCEL-
LENCE.—In this title, the term ‘Clinical 
Center of Excellence’ means the fol-
lowing: 
‘‘(A) FOR FDNY RESPONDERS.—With 
respect to an eligible WTC responder 
who responded to the 9/11 attacks as 
an employee of the Fire Department 
of the City of New York and who— 
‘‘(i) is an active employee of 
such Department— 
‘‘(I) with respect to moni-
toring, such Fire Department; 
and 
‘‘(II) with respect to treat-
ment, such Fire Department 
(or such entity as has entered 
into a contract with the Fire 
Department for treatment of 
such responders) or any other 
Clinical Center of Excellence 
described 
in 
subparagraph 
(B), (C), or (D); or 
‘‘(ii) is not an active employee 
of such Department, such Fire De-
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partment (or such entity as has 
entered into a contract with the 
Fire Department for monitoring 
or treatment of such responders) 
or any other or any other Clinical 
Center of Excellence described in 
subparagraph (B), (C), or (D). 
‘‘(B) OTHER ELIGIBLE WTC RESPOND-
ERS.—With respect to other eligible 
WTC responders, whether or not they 
reside in the New York Metropolitan 
area, the Mt. Sinai coordinated con-
sortium, Queens College, State Uni-
versity of New York at Stony Brook, 
University of Medicine and Dentistry 
of New Jersey, and Bellevue Hospital. 
‘‘(C) WTC COMMUNITY
MEMBERS.— 
With respect to eligible WTC commu-
nity members, whether or not they 
reside in the New York Metropolitan 
area, the World Trade Center Envi-
ronmental Health Center at Bellevue 
Hospital and such hospitals or other 
facilities, including but not limited to 
those within the New York City 
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Health and Hospitals Corporation, as 
are identified by the WTC Program 
Administrator. 
‘‘(D) ALL ELIGIBLE WTC RESPONDERS 
AND
ELIGIBLE
WTC
COMMUNITY
MEM-
BERS.—With respect to all eligible 
WTC responders and eligible WTC 
community members, such other hos-
pitals or other facilities as are identi-
fied by the WTC Program Adminis-
trator. 
The WTC Program Administrator shall 
limit the number of additional Centers of 
Excellence 
identified 
under 
subpara-
graph (D) to ensure that the participating 
centers have adequate experience in the 
treatment and diagnosis of identified 
WTC-related medical conditions. 
‘‘(2) COORDINATING
CENTER
OF
EXCEL-
LENCE.—In this title, the term ‘Coordi-
nating Center of Excellence’ means the 
following: 
‘‘(A) FOR FDNY RESPONDERS.—With 
respect to an eligible WTC responder 
who responded to the 9/11 attacks as 
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an employee of the Fire Department 
of the City of New York, such Fire De-
partment. 
‘‘(B) OTHER
WTC
RESPONDERS.— 
With respect to other eligible WTC re-
sponders, the Mt. Sinai coordinated 
consortium. 
‘‘(C) WTC
COMMUNITY
MEMBERS.— 
With respect to eligible WTC commu-
nity members, the World Trade Cen-
ter Environmental Health Center at 
Bellevue Hospital. 
‘‘(3) CORRESPONDING CENTERS.—In this 
title, a Clinical Center of Excellence and 
a Coordinating Center of Excellence shall 
be treated as ‘corresponding’ to the ex-
tent that such Clinical Center and Co-
ordinating Center serve the same popu-
lation group. 
‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, 
NON-MONITORING PROGRAM COSTS.—A Clinical 
or Coordinating Center of Excellence with a 
contract under this section shall be reim-
bursed for the costs of such Center in car-
rying out the activities described in sub-
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section (a), other than those described in sub-
section (a)(1)(A), subject to the provisions of 
section 3001(d), as follows: 
‘‘(1) 
CLINICAL
CENTERS
OF
EXCEL-
LENCE.—For carrying out subparagraphs 
(B) through (F) of subsection (a)(1)— 
‘‘(A) CLINICAL CENTER FOR FDNY RE-
SPONDERS IN NEW YORK.—The Clinical 
Center of Excellence for FDNY Re-
sponders in New York specified in 
subsection (b)(1)(A) shall be reim-
bursed— 
‘‘(i) in the first year of the 
contract under this section, $600 
per certified eligible WTC re-
sponder in the medical treatment 
program, and $300 per certified 
eligible WTC responder in the 
monitoring program; and 
‘‘(ii) in each subsequent con-
tract year, subject to paragraph 
(3), at the rates specified in this 
subparagraph for the previous 
contract year adjusted by the 
WTC Program Administrator to 
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reflect the rate of medical care in-
flation during the previous con-
tract year. 
‘‘(B) CLINICAL
CENTERS
SERVING 
OTHER
ELIGIBLE
WTC
RESPONDERS
IN 
NEW YORK.—A Clinical Center of Ex-
cellence for other WTC responders in 
New York specified in subsection 
(b)(1)(B) shall be reimbursed the 
amounts specified in subparagraph 
(A). 
‘‘(C) CLINICAL
CENTERS
SERVING 
WTC COMMUNITY MEMBERS.—A Clinical 
Center of Excellence for eligible WTC 
community members in New York 
specified in subsection (b)(1)(C) shall 
be reimbursed— 
‘‘(i) in the first year of the 
contract under this section, for 
each certified eligible WTC com-
munity member in a medical 
treatment program enrolled at a 
non-hospital-based facility, $600, 
and for each certified eligible 
WTC community member in a 
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medical treatment program en-
rolled at a hospital-based facility, 
$300; and 
‘‘(ii) in each subsequent con-
tract year, subject to paragraph 
(3), at the rates specified in this 
subparagraph for the previous 
contract year adjusted by the 
WTC Program Administrator to 
reflect the rate of medical care in-
flation during the previous con-
tract year. 
‘‘(D) OTHER CLINICAL CENTERS.—A 
Clinical Center of Excellence or other 
providers not described in a previous 
subparagraph shall be reimbursed at 
a rate set by the WTC Program Ad-
ministrator. 
‘‘(E) REIMBURSEMENT
RULES.—The 
reimbursement provided under sub-
paragraphs (A), (B) and (C) shall be 
made for each certified eligible WTC 
responder and for each WTC commu-
nity member in the WTC program per 
year that the member receives such 
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services, regardless of the volume or 
cost of services required. 
‘‘(2) COORDINATING CENTERS OF EXCEL-
LENCE.—A Coordinating Centers of Excel-
lence specified in section (a)(2) shall be 
reimbursed for the provision of services 
set forth in this section at such levels as 
are established by the WTC Program Ad-
ministrator. 
‘‘(3) REVIEW OF RATES.— 
‘‘(A) INITIAL
REVIEW.—Before the 
end of the third contract year of the 
WTC program, the WTC Program Ad-
ministrator shall conduct a review to 
determine whether the reimburse-
ment rates set forth in this subsection 
provide fair and appropriate reim-
bursement for such program services. 
Based on such review, the Adminis-
trator may, by rule beginning with 
the fourth contract year, may modify 
such rates, taking into account a rea-
sonable and fair rate for the services 
being provided. 
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‘‘(B) SUBSEQUENT
REVIEWS.—After 
the fourth contract year, the WTC 
Program Administrator shall conduct 
periodic reviews to determine wheth-
er the reimbursement rates in effect 
under this subsection provide fair 
and appropriate reimbursement for 
such program services. Based upon 
such a review, the Administrator may 
by rule modify such rates, taking into 
account a reasonable and fair rate for 
the services being provided. 
‘‘(C) 
GAO 
REVIEW.—The 
Comp-
troller General of the United States 
shall review the WTC Program Ad-
ministrator’s determinations regard-
ing fair and appropriate reimburse-
ment for program services under this 
paragraph. 
‘‘(d) REQUIREMENTS.—The WTC Program 
Administrator shall not enter into a contract 
with a Clinical Center of Excellence under 
subsection (a)(1) unless— 
‘‘(1) the Center establishes a formal 
mechanism for consulting with and re-
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ceiving input from representatives of eli-
gible populations receiving monitoring 
and treatment benefits under subtitle B 
from such Center; 
‘‘(2) the Center provides for the co-
ordination of monitoring and treatment 
benefits under subtitle B with routine 
medical care provided for the treatment 
of conditions other than WTC-related 
health conditions; 
‘‘(3) the Center collects and reports to 
the corresponding Coordinating Center 
of Excellence data in accordance with 
section 3005; 
‘‘(4) the Center has in place safe-
guards against fraud that are satisfactory 
to the Administrator; 
‘‘(5) the Center agrees to treat or 
refer for treatment all individuals who 
are eligible WTC responders or eligible 
WTC community members with respect to 
such Center who present themselves for 
treatment of a WTC-related health condi-
tion; 
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‘‘(6) the Center has in place safe-
guards to ensure the confidentiality of an 
individual’s 
individually 
identifiable 
health information, including requiring 
that such information not be disclosed to 
the individual’s employer without the au-
thorization of the individual; 
‘‘(7) the Center provides assurances 
that the amounts paid under subsection 
(c)(1) are used only for costs incurred in 
carrying out the activities described in 
subsection (a), other than those described 
in subsection (a)(1)(A); and 
‘‘(8) the Center agrees to meet all the 
other applicable requirements of this 
title, including regulations implementing 
such requirements. 
‘‘SEC. 3007. ENTITLEMENT AUTHORITIES. 
‘‘Subject to subsections (b)(4)(C) and (c)(5) 
of section 3012, subtitle B constitutes budget 
authority in advance of appropriations Acts 
and represents the obligation of the Federal 
Government to provide for the payment for 
monitoring, initial health evaluations, and 
treatment in accordance with such subtitle 
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and section 3006(c) constitutes such budget 
authority and represents the obligation of the 
Federal Government to provide for the pay-
ment described in such section. 
‘‘SEC. 3008. DEFINITIONS. 
‘‘In this title: 
‘‘(1) The term ‘aggravating’ means, 
with respect to a health condition, a 
health condition that existed on Sep-
tember 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 on the World Trade Cen-
ter requires medical treatment that is (or 
will be) in addition to, more frequent 
than, or of longer duration than the med-
ical treatment that would have been re-
quired for such condition in the absence 
of such exposure. 
‘‘(2) The terms ‘certified eligible WTC 
responder’ and ‘certified eligible WTC 
community member’ mean an individual 
who has been certified as an eligible WTC 
responder under section 3011(a)(4) or an 
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eligible WTC community member under 
section 3021(a)(4), respectively. 
‘‘(3) The terms ‘Clinical Center of Ex-
cellence’ and ‘Coordinating Center of Ex-
cellence’ have the meanings given such 
terms in section 3006(b). 
‘‘(4) The term ‘current consortium ar-
rangements’ means the arrangements as 
in effect on the date of the enactment of 
this title between the National Institute 
for Occupational Safety and Health and 
the Mt. Sinai-coordinated consortium and 
the Fire Department of the City of New 
York. 
‘‘(5) The terms ‘eligible WTC re-
sponder’ and ‘eligible WTC community 
member’ are defined in sections 3011(a) 
and 3021(a), respectively. 
‘‘(6) The term ‘initial health evalua-
tion’ includes, with respect to an indi-
vidual, a medical and exposure history, a 
physical 
examination, 
and 
additional 
medical testing as needed to evaluate 
whether the individual has a WTC-re-
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lated health condition and is eligible for 
treatment under the WTC program. 
‘‘(7) The term ‘list of identified WTC- 
related health conditions’ means— 
‘‘(A) for eligible WTC responders, 
the 
identified 
WTC-related 
health 
condition for eligible WTC responders 
under section 3012(a)(3) or 3012(a)(4); 
or 
‘‘(B) for eligible WTC community 
members, the identified WTC-related 
health condition for WTC community 
members under section 3022(b)(1) or 
3022(b)(2). 
‘‘(8) The term ‘Mt.-Sinai-coordinated 
consortium’ means the consortium co-
ordinated by Mt. Sinai hospital in New 
York City that coordinates the moni-
toring and treatment under the current 
consortium 
arrangements 
for 
eligible 
WTC responders other than with respect 
to those covered under the arrangement 
with the Fire Department of the City of 
New York. 
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thority of New York and New Jer-
sey (whether active or retired) 
who participated on-site in res-
cue, recovery, debris clean-up, or 
related services in lower Manhat-
tan (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 Sep-
tember 14, 2001; 
‘‘(II) participated on-site in 
rescue, recovery, debris clean-up, 
or related services in 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 on-site in 
rescue, recovery, debris clean-up, 
or related services in lower Man-
hattan (south of Canal St.) for at 
least 24 hours during the period 
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‘‘(ii) Chronic respiratory dis-
order-fumes/vapors. 
‘‘(iii) Asthma. 
‘‘(iv) Reactive airways dys-
function syndrome (RADS). 
‘‘(v) WTC-exacerbated chronic 
obstructive 
pulmonary 
disease 
(COPD). 
‘‘(vi) Chronic cough syndrome. 
‘‘(vii) 
Upper 
airway 
hyperreactivity. 
‘‘(viii) Chronic rhinosinusitis. 
‘‘(ix) Chronic nasopharyngitis. 
‘‘(x) Chronic laryngitis. 
‘‘(xi) Gastro-esophageal reflux 
disorder (GERD). 
‘‘(xii) Sleep apnea exacerbated 
by or related to a condition de-
scribed in a previous clause. 
‘‘(B) MENTAL HEALTH CONDITIONS.— 
‘‘(i) Post traumatic stress dis-
order (PTSD). 
‘‘(ii) 
Major 
depressive 
dis-
order. 
‘‘(iii) Panic disorder. 
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‘‘(iv) Generalized anxiety dis-
order. 
‘‘(v) Anxiety disorder (not oth-
erwise specified). 
‘‘(vi) Depression (not other-
wise specified). 
‘‘(vii) Acute stress disorder. 
‘‘(viii) Dysthymic disorder. 
‘‘(ix) Adjustment disorder. 
‘‘(x) Substance abuse. 
‘‘(xi) V codes (treatments not 
specifically related to psychiatric 
disorders, such as marital prob-
lems, parenting problems etc.), 
secondary to another identified 
WTC-related health condition for 
WTC eligible responders. 
‘‘(C) 
MUSCULOSKELETAL
DIS-
ORDERS.— 
‘‘(i) Low back pain. 
‘‘(ii) Carpal tunnel syndrome 
(CTS). 
‘‘(iii) 
Other 
musculoskeletal 
disorders. 
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