sponse efforts needs a comprehensive, coordinated 
long-term response 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 appointment of 
Dr. John Howard as Director of the National Insti-
tute for Occupational Safety and Health in July 
2008 is not in the interests of the administration of 
such Institute nor the continued operation of the 
World Trade Center Medical Monitoring and Treat-
ment Program which he has headed, and the Sec-
retary of Health and Human Services should recon-
sider extending such appointment. 
SEC. 3. EMERGENCY FUNDING. 
Amounts appropriated pursuant to this Act (other 
than amounts appropriated for the WTC Health Program 
Steering Committees or for the WTC Health Program Sci-
entific/Technical Advisory Committee) are designated as 
emergency requirements and necessary to meet emergency 
needs pursuant to section 204(a) of S. Con. Res. 21 
(110th Congress) and section 301(b)(2) of S. Con. Res. 
70 (110th Congress), the concurrent resolutions on the 
budget for fiscal years 2008 and 2009. 
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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 established with-
in the National Institute for Occupational 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 medical monitoring and treatment 
benefits— 
‘‘(1) to eligible emergency responders and re-
covery 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 
‘‘(2) to residents and other building occupants 
and area workers in New York City who were di-
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rectly impacted and adversely affected by such at-
tacks. 
‘‘(b) COMPONENTS OF PROGRAM.—The WTC pro-
gram includes the following components: 
‘‘(1) MEDICAL
MONITORING.—Medical moni-
toring under sections 3011 and 3021, including 
screening, clinical examinations, 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) TREATMENT
FOR
WTC-RELATED
CONDI-
TIONS.—Provision under sections 3012, 3022, and 
3023 of treatment and payment, subject to the pro-
visions of subsection (d), for all medically necessary 
health and mental health care expenses (including 
necessary prescription drugs) of individuals with a 
WTC-related health condition. 
‘‘(3) OUTREACH.—Establishment under section 
3004 of an outreach program to potentially eligible 
individuals concerning the benefits under this title. 
‘‘(4) UNIFORM DATA COLLECTION.—Collection 
under section 3005 of health and mental health data 
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on individuals receiving monitoring or treatment 
benefits, using a uniform system of data collection. 
‘‘(5) RESEARCH ON WTC CONDITIONS.—Estab-
lishment under subtitle C of a research program on 
health conditions resulting from the September 11, 
2001, terrorist attacks on the World Trade Center. 
‘‘(c) NO COST-SHARING.—Monitoring and treatment 
benefits are provided under subtitle B without any 
deductibles, copayments, or other cost-sharing to an eligi-
ble WTC responder or any eligible WTC resident or other 
non-responder. 
‘‘(d) PAYOR.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graphs (2) and (3), the cost of monitoring and treat-
ment benefits provided under subtitle B shall be 
paid for by the WTC program. 
‘‘(2) WORKERS’ COMPENSATION
PAYMENT.— 
Payment for treatment under subtitle B of a WTC- 
related condition in an individual that is work-re-
lated shall be reduced or recouped to the extent that 
a payment is made under a workers’ compensation 
law or plan of the United States or a State for such 
treatment. 
‘‘(3) HEALTH INSURANCE COVERAGE.— 
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‘‘(A) IN GENERAL.—If an individual has a 
WTC-related condition that is not work-related 
and has health coverage for such condition 
through any public or private health plan, the 
WTC program shall be secondary payor with 
respect to the payment for items and services 
for such condition to the extent such items and 
services are covered under such plan and such 
plan has an arrangement with the health care 
provider or facility allowing such payment. 
‘‘(B) BILLING HEALTH PLAN.—In the case 
described in subparagraph (A), the Clinical 
Center of Excellence providing the items or 
services involved shall bill the public or private 
health plan for such items or services. The 
health plan shall be responsible for payment for 
such items or services to the extent that the 
health plan has or had a responsibility under 
the terms of coverage of that health plan to 
make such payment with respect to such items 
or services. If the health plan refuses to make 
such payment to such Clinical Center, the WTC 
Program Administrator shall seek to recover 
such payment with respect to the item or serv-
ice involved to the extent it is demonstrated 
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that the health plan has or had a responsibility 
to make payment with respect to such item or 
service. 
‘‘(C) REMAINING COSTS UNDER TITLE.— 
Any costs for such covered items and services 
that are not reimbursed by such health plan, 
due to the application of deductibles, copay-
ments, coinsurance, other cost-sharing, or oth-
erwise, are reimbursable under this title to the 
extent that they are covered under the WTC 
program. 
‘‘(4) WORK-RELATED
DESCRIBED.—For the 
purposes of this subsection, a WTC-related condition 
diagnosed in an eligible WTC responder, or in an in-
dividual who qualifies as an eligible WTC resident or 
other non-responder on the basis of being a rescue, 
recovery, clean-up worker, or area worker, shall be 
treated as a condition that is work-related. 
‘‘(e) QUALITY ASSURANCE
AND MONITORING
OF 
CLINICAL EXPENDITURES.— 
‘‘(1) QUALITY
ASSURANCE.—The WTC Pro-
gram Administrator working with the Clinical Cen-
ters of Excellence shall develop and implement a 
quality assurance program for the medical moni-
toring and treatment delivered by such Centers of 
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Excellence and any other participating health care 
providers. 
‘‘(2) FRAUD PREVENTION.—The WTC Program 
Administrator shall develop and implement a pro-
gram to review the program’s health care expendi-
tures to detect fraudulent or duplicate billing and 
payment for inappropriate services. Such program 
shall be similar to current methods used in connec-
tion 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 sec-
tion 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 Na-
tional Institute for Occupational Safety and Health, or a 
designee of such Director. 
‘‘(g) ANNUAL PROGRAM REPORT.— 
‘‘(1) IN GENERAL.—Not later than 6 months 
after the end of each fiscal year in which the WTC 
program is in operation, the WTC Program Admin-
istrator shall submit an annual report to the Con-
gress on the operations of this title for such fiscal 
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year and for the entire period of operation of the 
program. 
‘‘(2) CONTENTS OF REPORT.—Each annual re-
port under paragraph (1) shall include the following: 
‘‘(A) ELIGIBLE
INDIVIDUALS.—Informa-
tion for each clinical program described in para-
graph (3)— 
‘‘(i) on the number of individuals who 
applied for certification under subtitle B 
and the number of such individuals who 
were so certified; 
‘‘(ii) of the individuals who were cer-
tified, on the number who received medical 
monitoring under the program and the 
number of such individuals who received 
medical treatment under the program; 
‘‘(iii) with respect to individuals so 
certified who received such treatment, on 
the WTC-related health conditions for 
which they were treated; and 
‘‘(iv) on the projected number of indi-
viduals who will be certified under subtitle 
B in the succeeding fiscal year. 
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‘‘(B) 
MONITORING
AND
TREATMENT 
COSTS.—For each clinical program so de-
scribed— 
‘‘(i) information on the costs of moni-
toring and the costs of treatment and on 
the estimated costs of such monitoring and 
treatment in the succeeding fiscal year; 
and 
‘‘(ii) an estimate of the cost of med-
ical treatment for WTC-related conditions 
that have been paid for or reimbursed by 
workers’ compensation, by public or private 
health plans, or by the City of New York 
under section 3012(c)(4). 
‘‘(C) ADMINISTRATIVE
COSTS.—Informa-
tion on the cost of administering the program, 
including costs of program support, data collec-
tion and analysis, and research conducted under 
the program. 
‘‘(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 
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‘‘(ii) a list of the Clinical Centers of 
Excellence and other providers that are 
participating in the program. 
‘‘(E) SCIENTIFIC
REPORTS.—A summary 
of the findings of any new scientific reports or 
studies on the health effects associated with 
WTC center exposures. 
‘‘(F) 
ADVISORY
COMMITTEE
REC-
OMMENDATIONS.—A list of recommendations by 
the WTC Scientific/Technical Advisory Com-
mittee on additional WTC program eligibility 
criteria and on additional WTC-related health 
conditions and the action of the WTC Program 
Administrator 
concerning 
each 
such 
rec-
ommendation. 
‘‘(G) RESEARCH RESULTS.—The findings 
research conducted under section 3041(a). 
‘‘(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 benefits 
provided for eligible WTC responders described 
in section 3006(b)(1)(A). 
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‘‘(B) OTHER
ELIGIBLE
WTC
RESPOND-
ERS.—The benefits provided for eligible WTC 
responders not described in subparagraph (A). 
‘‘(C) ELIGIBLE
WTC
RESIDENTS
AND 
OTHER
NON-RESPONDERS.—The benefits pro-
vided for eligible WTC residents and other non- 
responders. 
‘‘(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 certifications for eligi-
ble WTC responders subject to the limit established 
under section 3011(a)(5) has reached 80 percent of 
such limit; and 
‘‘(2) when the number of certifications for eligi-
ble WTC residents or other non-responders subject 
to the limit established under section 3021(a)(5) has 
reached 80 percent of such limit. 
‘‘SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECH-
NICAL ADVISORY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—The WTC Program Admin-
istrator shall establish an advisory committee to be known 
as the WTC Health Program Scientific/Technical Advisory 
Committee (in this section referred to as the ‘Advisory 
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Committee’) to review scientific and medical evidence and 
to make recommendations to the Administrator on addi-
tional WTC program eligibility criteria and on additional 
WTC-related health conditions. 
‘‘(b) COMPOSITION.—The WTC Program Adminis-
trator shall appoint the members of the Advisory Com-
mittee and shall include at least— 
‘‘(1) 4 occupational physicians, at least two of 
whom have experience treating WTC rescue and re-
covery workers; 
‘‘(2) 2 environmental medicine or environmental 
health specialists; 
‘‘(3) 2 representatives of eligible WTC respond-
ers; 
‘‘(4) 2 representatives of WTC residents and 
other non-responders; 
‘‘(5) an industrial hygienist; 
‘‘(6) a toxicologist; 
‘‘(7) an epidemiologist; and 
‘‘(8) a mental health professional. 
‘‘(c) MEETINGS.—The Advisory Committee shall 
meet at such frequency as may be required to carry out 
its duties. 
‘‘(d) REPORTS.—The WTC Program Administrator 
shall provide for publication of recommendations of the 
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Advisory Committee on the public website established for 
the WTC program. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, 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 provi-
sion of law, the Advisory Committee shall continue in op-
eration during the period in which the WTC program is 
in operation. 
‘‘(g) APPLICATION OF FACA.—Except as otherwise 
specifically provided, the Advisory Committee shall be sub-
ject to the Federal Advisory Committee Act. 
‘‘SEC. 3003. WTC HEALTH PROGRAM STEERING COMMIT-
TEES. 
‘‘(a) ESTABLISHMENT.—The WTC Program Admin-
istrator shall establish two steering committees (each in 
this section referred to as a ‘Steering Committee’) as fol-
lows: 
‘‘(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 
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monitoring and treatment programs for the eligible 
WTC responders under part 1 of subtitle B. 
‘‘(2) WTC COMMUNITY
PROGRAM
STEERING 
COMMITTEE.—One steering committee, to be known 
as the WTC Community Program Steering Com-
mittee, for the purpose of facilitating the coordina-
tion of medical monitoring and treatment programs 
for eligible WTC residents and other non-responders 
under part 2 of subtitle B. 
‘‘(b) MEMBERSHIP.— 
‘‘(1) INITIAL MEMBERSHIP OF WTC RESPOND-
ERS STEERING COMMITTEE.—The WTC Responders 
Steering Committee shall initially 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). 
‘‘(2) INITIAL MEMBERSHIP OF WTC COMMUNITY 
PROGRAM STEERING COMMITTEE.— 
‘‘(A) IN GENERAL.—The WTC Community 
Program Steering Committee shall initially be 
composed of the following: 
‘‘(i) The Medical Director of the WTC 
Environmental Health Center. 
‘‘(ii) The Executive Director of the 
WTC Environmental Health Center. 
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‘‘(iii) Three physicians, one each rep-
resenting the three WTC Environmental 
Health Center treatment sites of Bellevue 
Hospital Center, Gouverneur Healthcare 
Services, and Elmhurst Hospital Center. 
‘‘(iv) Three physicians or specialists, 
including a pediatrician, an epidemiologist, 
a psychiatrist or psychologist, with experi-
ence with non-responder WTC diseases. 
‘‘(v) One environmental/occupational 
specialist with WTC experience. 
‘‘(vi) One social worker with experi-
ence treating non-responders at a WTC 
Environmental Health Center treatment 
site. 
‘‘(vii) 10 representatives of the af-
fected populations of residents, students, 
area workers, and other non-responders. 
Such Committee shall also include, as nonvoting 
members, members of the WTC Environmental 
Health Center Community Advisory Committee 
(as in existence on the day before the date of 
the enactment of this title) who are not other-
wise appointed under clause (vii). 
‘‘(B) APPOINTMENTS.— 
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‘‘(i) NYC HEALTH
AND
HOSPITALS 
CORPORATION.—The 
New 
York 
City 
Health and Hospitals Corporation shall 
nominate members for positions described 
in clauses (iii) through (vi) of subpara-
graph (A). 
‘‘(ii) WTC EHC COMMUNITY ADVISORY 
COMMITTEE.—The WTC Environmental 
Health Center Community Advisory Com-
mittee as in existence on the date of the 
enactment of this title shall nominate 
members for positions described in sub-
paragraph (A)(vii). 
‘‘(iii) TIMING.—Nominations under 
clauses (i) and (ii) shall be recommended 
to the WTC Program Administrator not 
later than 60 days after the date of the en-
actment of this title. 
‘‘(iv) APPOINTMENT.—The WTC Pro-
gram Administrator shall appoint members 
of the WTC Community Program Steering 
Committee not later than 90 days after the 
date of the enactment of this title. 
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‘‘(v) GENERAL
REPRESENTATIVES.— 
Of the members appointed under subpara-
graph (A)(vii)— 
‘‘(I) the representation shall re-
flect the broad and diverse WTC-af-
fected populations and constituencies 
and the diversity of impacted neigh-
borhoods, including residents, hard-to- 
reach 
populations, 
students, 
area 
workers, school parents, community- 
based 
organizations, 
Community 
Boards, WTC Environmental Health 
Center patients, labor unions, and 
labor advocacy organizations; and 
‘‘(II) no one individual organiza-
tion can have more than one rep-
resentative. 
‘‘(3) 
ADDITIONAL
APPOINTMENTS.—Each 
Steering Committee may appoint additional mem-
bers to the Committee, subject to the approval of the 
WTC Program Administrator. 
‘‘(4) VACANCIES.—A vacancy in a Steering 
Committee shall be filled by the Steering Committee, 
subject to the approval of the WTC Program Ad-
ministrator, so long as— 
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‘‘(A) in the case of the WTC Responders 
Steering Committee, the composition of the 
Committee includes representatives of eligible 
WTC responders and representatives of each 
Clinical Center of Excellence and each Coordi-
nating Center of Excellence that serves eligible 
WTC responders; or 
‘‘(B) in the case of the WTC Community 
Program Steering Committee, the composition 
of the Committee includes representatives in-
cludes representatives of eligible WTC residents 
and other non-responders and representatives of 
each Clinical Center of Excellence and each Co-
ordinating Center of Excellence that serves eli-
gible WTC residents and other non-responders. 
‘‘(5) CO-CHAIRS OF WTC COMMUNITY PROGRAM 
STEERING COMMITTEE.—The WTC Community Pro-
gram Steering Committee shall have two Co-Chairs 
as follows: 
‘‘(A) ENVIRONMENTAL HEALTH CLINIC CO- 
CHAIR.—A WTC Environmental Health Clinic 
Co-Chair who shall be chosen by the WTC En-
vironmental Health Center members on the 
Steering Committee. 
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‘‘(B) COMMUNITY/LABOR
CO-CHAIR.—A 
Community/Labor Co-Chair who shall be chosen 
by the community and labor-based members of 
the Steering Committee. 
‘‘(c) RELATION
TO FACA.—Each Steering Com-
mittee shall not be subject to the Federal Advisory Com-
mittee 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 other Steering Committee for the purpose of exchang-
ing information regarding the WTC program. 
‘‘(e) DURATION.—Notwithstanding any other provi-
sion of law, each Steering Committee shall continue in op-
eration during the period in which the WTC program is 
in operation. 
‘‘SEC. 3004. COMMUNITY EDUCATION AND OUTREACH. 
‘‘(a) IN GENERAL.—The WTC Program Adminis-
trator shall institute a program that provides education 
and outreach on the existence and availability of services 
under the WTC program. The outreach and education 
program— 
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‘‘(1) shall include the establishment of a public 
website with information about the WTC program; 
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. 
‘‘(b) PARTNERSHIPS.—To the greatest extent pos-
sible, in carrying out this section, the WTC Program Ad-
ministrator shall enter into partnerships with local govern-
ments and organizations with experience performing out-
reach to the affected populations, including community 
and labor-based organizations. 
‘‘SEC. 3005. UNIFORM DATA COLLECTION. 
‘‘(a) IN GENERAL.—The WTC Program Adminis-
trator shall provide for the uniform collection of data (and 
analysis of data and regular reports to the Administrator) 
on the utilization of monitoring and treatment benefits 
provided to eligible WTC responders and eligible WTC 
residents and other non-responders, the prevalence 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 treat-
ment benefits under subtitle B and regardless of their 
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place of residence or Clinical Center of Excellence through 
which the benefits are provided. 
‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL-
LENCE.—Each Clinical Center of Excellence shall, under 
section 3006(d)(3), collect data described in subsection (a) 
and report such data to the corresponding Coordinating 
Center of Excellence for analysis by such Coordinating 
Center of Excellence under section 3006(a)(2)(A). 
‘‘(c) PRIVACY.—The data collection and analysis 
under this section shall be conducted in a manner that 
protects the confidentiality of individually identifiable 
health information consistent with applicable legal require-
ments. 
‘‘SEC. 3006. CENTERS OF EXCELLENCE. 
‘‘(a) IN GENERAL.— 
‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF 
EXCELLENCE.—The WTC Program Administrator 
shall enter into contracts with Clinical Centers of 
Excellence specified in subsection (b)(1)— 
‘‘(A) for the provision of monitoring and 
treatment benefits under subtitle B; 
‘‘(B) for the provision of outreach activities 
to individuals eligible for such monitoring and 
treatment benefits and follow-up to individuals 
who are enrolled in the program; 
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‘‘(C) for the provision of counseling for 
benefits under subtitle B, with respect to WTC- 
related health conditions, for individuals eligible 
for such benefits; 
‘‘(D) for the provision of counseling for 
benefits for WTC-related health conditions that 
may be available under Workers’ Compensation, 
health insurance, disability insurance, or other 
insurance plans or through public or private so-
cial service agencies and assisting eligible indi-
viduals in applying for such benefits; 
‘‘(E) for the provision of translational and 
interpretive services as for program participants 
who are not English language proficient; and 
‘‘(F) for the collection and reporting of 
data in accordance with section 3005. 
‘‘(2) CONTRACTS
WITH
COORDINATING
CEN-
TERS
OF
EXCELLENCE.—The WTC Program Ad-
ministrator shall enter into contracts with Coordi-
nating Centers of Excellence specified in subsection 
(b)(2)— 
‘‘(A) for receiving, analyzing, and report-
ing to the WTC Program Administrator on 
data, in accordance with section 3005, that has 
been collected and reported to such Coordi-
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nating Centers by the corresponding Clinical 
Centers of Excellence under subsection (d)(3); 
‘‘(B) for the development of medical moni-
toring and treatment protocols, with respect to 
WTC-related health conditions; 
‘‘(C) for coordinating the outreach activi-
ties conducted under paragraph (1)(B) by each 
corresponding Clinical Center of Excellence; 
‘‘(D) for establishing criteria for the 
credentialing of medical providers participating 
in the nationwide network under section 3031; 
and 
‘‘(E) for coordinating and administrating 
the activities of the WTC Health Program 
Steering Committees established under section 
3003(a). 
The medical providers under subparagraph (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 identi-
fied WTC-related conditions for responders and of 
identified WTC-related conditions for residents and 
other non-responders. 
‘‘(b) CENTERS OF EXCELLENCE DEFINED.— 
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‘‘(1) CLINICAL CENTER OF EXCELLENCE.—In 
this title, the term ‘Clinical Center of Excellence’ 
means the following: 
‘‘(A) FOR
FDNY
RESPONDERS
IN
NEW 
YORK.—With respect to an eligible WTC re-
sponder who responded to the 9/11 attacks as 
an employee of the Fire Department of the City 
of New York and who resides in the New York 
Metropolitan area, such Fire Department (or 
such entity as has entered into a contract with 
the Fire Department for monitoring or treat-
ment of such responders). 
‘‘(B) OTHER ELIGIBLE WTC RESPONDERS 
IN NEW YORK.—With respect to other eligible 
WTC responders who reside in the New York 
Metropolitan area, the Mt. Sinai coordinated 
consortium, Queens College, State University of 
New York at Stony Brook, University of Medi-
cine and Dentistry of New Jersey, and Bellevue 
Hospital. 
‘‘(C) WTC RESIDENTS AND OTHER NON- 
RESPONDERS IN NEW YORK.—With respect to 
eligible WTC residents and other non-respond-
ers who reside in the New York Metropolitan 
area, the World Trade Center Environmental 
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Health Center at Bellevue Hospital and such 
hospitals or other facilities, including but not 
limited to those within the New York City 
Health and Hospitals Corporation, as are iden-
tified by the WTC Program Administrator. 
‘‘(D) ALL
ELIGIBLE
WTC
RESPONDERS 
AND
ELIGIBLE
WTC
RESIDENTS
AND
OTHER 
NON-RESPONDERS.—With respect to all eligible 
WTC responders and eligible WTC residents 
and other non-responders, such other hospitals 
or other facilities as are identified by the WTC 
Program Administrator. 
The WTC Program Administrator shall limit the 
number of additional Centers of Excellence identified 
under subparagraph (D) to ensure that the partici-
pating centers have adequate experience in the treat-
ment and diagnosis of identified WTC-related med-
ical conditions. 
‘‘(2) 
COORDINATING
CENTER
OF
EXCEL-
LENCE.—In this title, the term ‘Coordinating Center 
of Excellence’ means the following: 
‘‘(A) FOR FDNY RESPONDERS.—With re-
spect to an eligible WTC responder who re-
sponded to the 9/11 attacks as an employee of 
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the Fire Department of the City of New York, 
such Fire Department. 
‘‘(B) OTHER WTC RESPONDERS.—With re-
spect to other eligible WTC responders, the Mt. 
Sinai coordinated consortium. 
‘‘(C) WTC RESIDENTS AND OTHER NON- 
RESPONDERS.—With respect to eligible WTC 
residents and other non-responders, the World 
Trade Center 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 ‘cor-
responding’ to the extent that such Clinical Center 
and Coordinating Center serve the same population 
group. 
‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, NON- 
MONITORING PROGRAM COSTS.—A Clinical or Coordi-
nating Center of Excellence with a contract under this sec-
tion shall be reimbursed for the costs of such Center in 
carrying out the activities described in subsection (a), 
other than those described in subsection (a)(1)(A), subject 
to the provisions of section 3001(d), as follows: 
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‘‘(1) CLINICAL
CENTERS
OF
EXCELLENCE.— 
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 Responders in New 
York specified in subsection (b)(1)(A) shall be 
reimbursed— 
‘‘(i) in the first year of the contract 
under this section, $900 per participant in 
the medical treatment program, and $400 
per participant in the monitoring program; 
and 
‘‘(ii) in each subsequent contract year, 
subject to paragraph (3), at the rates spec-
ified in this subparagraph for the previous 
contract year adjusted by the WTC Pro-
gram Administrator to reflect the rate of 
medical care inflation during the previous 
contract year. 
‘‘(B) CLINICAL CENTERS SERVING OTHER 
ELIGIBLE WTC RESPONDERS IN NEW YORK.—A 
Clinical Center of Excellence for other WTC re-
sponders in New York specified in subsection 
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(b)(1)(B) shall be reimbursed the amounts 
specified in subparagraph (A). 
‘‘(C) CLINICAL
CENTERS
SERVING
WTC 
RESIDENTS AND OTHER NON-RESPONDERS.—A 
Clinical Center of Excellence for eligible WTC 
residents and other non-responders in New 
York specified in subsection (b)(1)(C) shall be 
reimbursed— 
‘‘(i) for each participant in a medical 
treatment program enrolled at a non-hos-
pital-based facility, the amount specified in 
subparagraph (A) per participant in a 
medical treatment program; and 
‘‘(ii) for each participant in a medical 
treatment program enrolled at a hospital- 
based facility, 2⁄3 of the amount specified 
in clause (i). 
‘‘(D) OTHER CLINICAL CENTERS.—A Clin-
ical Center of Excellence or other providers not 
described in a previous subparagraph shall be 
reimbursed at a rate set by the WTC Program 
Administrator. 
‘‘(E) REIMBURSEMENT RULES.—The reim-
bursement provided under subparagraphs (A), 
(B) and (C) shall be made for each participant 
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in the WTC program per year, regardless of the 
volume or cost of services required. 
‘‘(2) COORDINATING
CENTERS
OF
EXCEL-
LENCE.—A Coordinating Centers of Excellence spec-
ified 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 fifth contract year of the WTC program, 
the WTC Program Administrator shall conduct 
a review to determine whether the reimburse-
ment rates set forth in this subsection provide 
fair and appropriate reimbursement for such 
program services. Based on such review, the 
Administrator may, by rule beginning with the 
sixth contract year, may modify such rates, tak-
ing into account a reasonable and fair rate for 
the services being provided. 
‘‘(B) SUBSEQUENT
REVIEWS.—After the 
sixth contract year, the WTC Program Admin-
istrator shall conduct periodic reviews to deter-
mine whether the reimbursement rates in effect 
under this subsection provide fair and appro-
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priate reimbursement for such program serv-
ices. Based upon such a review, the Adminis-
trator may by rule modify such rates, taking 
into account a reasonable and fair rate for the 
services being provided. 
‘‘(C) GAO 
REVIEW.—The Comptroller 
General of the United States shall review the 
Secretary’s determinations regarding fair and 
appropriate reimbursement for program services 
under this paragraph. 
‘‘(d) REQUIREMENTS.—The WTC Program Adminis-
trator 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 receiving input from rep-
resentatives of eligible populations receiving moni-
toring and treatment benefits under subtitle B from 
such Center; 
‘‘(2) the Center provides for the coordination of 
monitoring and treatment benefits under subtitle B 
with routine medical care provided for the treatment 
of conditions other than WTC-related health condi-
tions; 
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‘‘(3) the Center collects and reports to the cor-
responding Coordinating Center of Excellence data 
in accordance with section 3005; 
‘‘(4) the Center has in place safeguards against 
fraud that are satisfactory to the Administrator; 
‘‘(5) the Center agrees to treat or refer for 
treatment all individuals who are eligible WTC re-
sponders or eligible WTC residents and other non-
responders with respect to such Center who present 
themselves for treatment of a WTC-related health 
condition; and 
‘‘(6) the Center agrees to meet all the other ap-
plicable requirements of this title, including regula-
tions implementing such requirements. 
‘‘SEC. 3007. PROGRAMS REGARDING ATTACK AT PENTAGON. 
‘‘The Secretary may, to the extent determined appro-
priate by the Secretary, establish with respect to the ter-
rorist attack at the Pentagon on September 11, 2001, pro-
grams similar to the programs that are established in sub-
titles B and C with respect to the September 11, 2001, 
terrorist attacks on the World Trade Center. 
‘‘SEC. 3008. ENTITLEMENT AUTHORITIES. 
‘‘Subtitle B constitutes budget authority in advance 
of appropriations Acts and represents the obligation of the 
Federal Government to provide for the payment for moni-
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toring and treatment in accordance with such subtitle and 
section 3006(c) constitutes such budget authority and rep-
resents the obligation of the Federal Government to pro-
vide for the payment described in such section. 
‘‘SEC. 3009. DEFINITIONS. 
‘‘In this title: 
‘‘(1) The term ‘aggravating’ means, with re-
spect to a health condition, a health condition that 
existed on September 11, 2001, and that, as a result 
of exposure to airborne toxins, any other hazard, or 
any other adverse condition resulting from the Sep-
tember 11, 2001, terrorist attacks on the World 
Trade Center requires medical treatment that is (or 
will be) in addition to, more frequent than, or of 
longer duration than the medical treatment that 
would have been required for such condition in the 
absence of such exposure. 
‘‘(2) The terms ‘Clinical Center of Excellence’ 
and ‘Coordinating Center of Excellence’ have the 
meanings given such terms in section 3006(b). 
‘‘(3) The term ‘current consortium arrange-
ments’ means the arrangements as in effect on the 
date of the enactment of this title between the Na-
tional Institute for Occupational Safety and Health 
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and the Mt. Sinai-coordinated consortium and the 
Fire Department of the City of New York. 
‘‘(4) The terms ‘eligible WTC responder’ and 
‘eligible WTC resident or other non-responder’ are 
defined in sections 3011(a) and 3021(a), respec-
tively. 
‘‘(5) The term ‘list of identified WTC-related 
health conditions’ means— 
‘‘(A) for eligible WTC responders, the 
identified WTC-related health condition for eli-
gible 
WTC 
responders 
under 
section 
3012(a)(3); or 
‘‘(B) for eligible WTC residents and other 
non-responders, the identified WTC-related 
health condition for WTC residents and other 
responders under section 3022(b)(1). 
‘‘(6) The term ‘Mt.-Sinai-coordinated consor-
tium’ means the consortium coordinated by Mt. 
Sinai hospital in New York City that coordinates the 
monitoring and treatment under the current consor-
tium arrangements for eligible WTC responders 
other than with respect to those covered under the 
arrangement with the Fire Department for the City 
of New York. 
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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 eligible WTC responders 
and eligible WTC residents and other non-respond-
ers who reside in such area are reasonably able to 
access monitoring and treatment benefits under this 
title through a Clinical Centers of Excellence de-
scribed in subparagraphs (A), (B), or (C) of section 
3006(b)(1). 
‘‘(9) The term ‘September 11, 2001, terrorist 
attacks on the World Trade Center’ means the ter-
rorist attacks that occurred on September 11, 2001, 
in New York City and includes the aftermath of 
such attacks. 
‘‘(10) The term ‘WTC Health Program Steer-
ing Committee’ means such a Steering Committee 
established under section 3003. 
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‘‘(11) The term ‘WTC Program Administrator’ 
means the individual responsible under section 
3001(d) for the administration of the WTC pro-
gram. 
‘‘(12) The term ‘WTC-related health condition’ 
is defined in section 3012(a). 
‘‘(13) The term ‘WTC Scientific/Technical Ad-
visory Committee’ means such Committee estab-
lished under section 3002. 
‘‘Subtitle B—Program of 
Monitoring and Treatment 
‘‘PART 1—FOR WTC RESPONDERS 
‘‘SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPOND-
ERS AND PROVISION OF WTC-RELATED MONI-
TORING SERVICES. 
‘‘(a) ELIGIBLE WTC RESPONDER DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this title, 
the term ‘eligible WTC responder’ means any of the 
following individuals, subject to paragraph (5): 
‘‘(A) 
CURRENTLY
IDENTIFIED
RE-
SPONDER.—An individual who has been identi-
fied as eligible for medical monitoring under the 
current consortium arrangements (as defined in 
section 3009(3)). 
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‘‘(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, demo-
lition, debris cleanup, or other related serv-
ices in the New York City disaster area in 
response to the September 11, 2001, ter-
rorist attacks on the World Trade Center, 
regardless of whether such services were 
performed by a State or Federal employee 
or member of the National Guard or other-
wise; 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 on the World Trade Center as the 
WTC Program Administrator, after con-
sultation with the WTC Responders Steer-
ing Committee and the WTC Scientific/ 
Technical Advisory Committee, determines 
appropriate. 
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‘‘(2) CURRENT
ELIGIBILITY
CRITERIA.—The 
eligibility criteria described in this paragraph for an 
individual is that the individual is described in either 
of the following categories: 
‘‘(A) FIRE FIGHTERS AND RELATED PER-
SONNEL.—All members of the Fire Department 
of the City of New York (whether fire or emer-
gency personnel, active or retired) who partici-
pated at least one day in the rescue and recov-
ery effort at any of the former World Trade 
sites (including Ground Zero, Staten Island 
land fill, and the NYC Chief Medical Exam-
iner’s office) for any time during the period be-
ginning on September 11, 2001, and ending on 
July 31, 2002. 
‘‘(B) OTHER
WTC
RESCUE, RECOVERY, 
AND CLEAN-UP WORKERS.—The individual— 
‘‘(i) worked or volunteered on-site 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 Sep-
tember 11, 2001, and ending on Sep-
tember 14, 2001, for at least 24 hours 
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during the period 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) was an employee of the Office of 
the Chief Medical Examiner of the City of 
New York involved in the examination and 
processing of human remains, or other 
morgue worker who performed similar 
post-September 11 functions for such Of-
fice staff; 
‘‘(iii) was a worker in the Port Au-
thority Trans-Hudson Corporation tunnel 
for at least 24 hours during the period be-
ginning on February 1, 2002, and ending 
on July 1, 2002; or 
‘‘(iv) was a vehicle-maintenance work-
er who was exposed to debris from the 
former World Trade Center while retriev-
ing, driving, cleaning, repairing, and main-
taining vehicles contaminated by airborne 
toxins from the September 11, 2001, ter-
rorist attacks on the World Trade Center 
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during a duration and period described in 
subparagraph (A). 
‘‘(3) APPLICATION PROCESS.—The WTC Pro-
gram Administrator in consultation with the Coordi-
nating Centers of Excellence shall establish a proc-
ess for individuals, other than eligible WTC respond-
ers described in paragraph (1)(A), to apply to be de-
termined to be eligible WTC responders. Under such 
process— 
‘‘(A) there shall be no fee charged to the 
applicant for making an application for such 
determination; and 
‘‘(B) the Administrator shall make a deter-
mination on such an application not later than 
60 days after the date of filing the application. 
‘‘(4) CERTIFICATION.— 
‘‘(A) IN GENERAL.—In the case of an indi-
vidual who is described in paragraph (1)(A) or 
who is determined under paragraph (3) (con-
sistent with paragraph (5)) to be an eligible 
WTC responder, the WTC Program Adminis-
trator shall provide an appropriate certification 
of such fact and of eligibility for monitoring 
and treatment benefits under this part. The Ad-
ministrator shall make determinations of eligi-
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bility relating to an applicant’s compliance with 
this title, including the verification of informa-
tion submitted in support of the application, 
and shall not deny such a certification to an in-
dividual unless the Administrator determines 
that— 
‘‘(i) based on the application sub-
mitted, the individual does not meet the 
eligibility criteria; or 
‘‘(ii) the numerical limitation on eligi-
ble WTC responders set forth in paragraph 
(5) has been met. 
‘‘(B) TIMING.—In the case of an individual 
who is determined under paragraph (3) and 
consistent with paragraph (5) to be an eligible 
WTC responder, the WTC Program Adminis-
trator shall provide the certification under sub-
paragraph (A) at the time of the determination. 
‘‘(5) NUMERICAL
LIMITATION
ON
ELIGIBLE 
WTC RESPONDERS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this title, the total number of 
individuals not described in subparagraph (C) 
who may qualify as eligible WTC responders for 
purposes of this title, and be certified as eligible 
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WTC responders under paragraph (4), shall not 
exceed 35,000. 
‘‘(B) PROCESS.—In implementing subpara-
graph (A), the WTC Program Administrator 
shall— 
‘‘(i) limit the number of certifications 
provided under paragraph (4) in accord-
ance with such subparagraph; and 
‘‘(ii) provide priority in such certifi-
cations in the order in which individuals 
apply for a determination under paragraph 
(3). 
‘‘(C) CURRENTLY
IDENTIFIED
RESPOND-
ERS NOT COUNTED.—Individuals described in 
this subparagraph are individuals who are de-
scribed in paragraph (1)(A). 
‘‘(b) MONITORING BENEFITS.— 
‘‘(1) IN GENERAL.—In the case of an eligible 
WTC responder, the WTC program shall provide for 
monitoring benefits that include medical monitoring 
consistent with protocols approved by the WTC Pro-
gram Administrator and including screening, clinical 
examinations, and long-term health monitoring and 
analysis. In the case of an eligible WTC responder 
who is an active member of the Fire Department of 
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the City of New York, the responder shall receive 
such benefits as part of the individual’s periodic 
company medical exams. 
‘‘(2) PROVISION OF MONITORING BENEFITS.— 
The monitoring benefits under paragraph (1) shall 
be provided through the Clinical Center of Excel-
lence for the type of individual involved or, in the 
case of an individual residing outside the New York 
metropolitan area, under an arrangement under sec-
tion 3031. 
‘‘SEC. 3012. TREATMENT OF ELIGIBLE WTC RESPONDERS 
FOR WTC-RELATED HEALTH CONDITIONS. 
‘‘(a) WTC–RELATED
HEALTH
CONDITION
DE-
FINED.— 
‘‘(1) IN GENERAL.—For purposes of this title, 
the term ‘WTC-related health condition’ means— 
‘‘(A) 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 
on the World Trade Center, based on an exam-
ination by a medical professional with experi-
ence in treating or diagnosing the medical con-
ditions included in the applicable list of identi-
fied WTC-related conditions, is substantially 
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‘‘(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 medical conditions 
included on the list of identified WTC-re-
lated conditions. 
‘‘(B) The type of symptoms and temporal 
sequence of symptoms. Such symptoms shall 
be— 
‘‘(i) assessed through the use of a 
standardized, population appropriate med-
ical questionnaire approved by 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
IDENTIFIED
WTC-RELATED 
HEALTH CONDITIONS FOR ELIGIBLE WTC RESPOND-
ERS.—For purposes of this title, the term ‘identified 
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WTC-related health condition for eligible WTC re-
sponders’ means any of the following health condi-
tions, and any condition specified under paragraph 
(4): 
‘‘(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 ob-
structive pulmonary disease (COPD). 
‘‘(vi) Chronic cough syndrome. 
‘‘(vii) Upper airway hyperreactivity. 
‘‘(viii) Chronic rhinosinusitis. 
‘‘(ix) Chronic nasopharyngitis. 
‘‘(x) Chronic laryngitis. 
‘‘(xi) Gastro-esophageal reflux dis-
order (GERD). 
‘‘(xii) Sleep apnea exacerbated by or 
related to a condition described in a pre-
vious clause. 
‘‘(B) MENTAL HEALTH CONDITIONS.— 
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‘‘(i) Post traumatic 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. 
‘‘(xi) V codes (treatments not specifi-
cally related to psychiatric disorders, such 
as marital problems, parenting problems, 
etc.) 
‘‘(C) MUSCULOSKELETAL DISORDERS.— 
‘‘(i) Low back pain. 
‘‘(ii) Carpal tunnel syndrome (CTS). 
‘‘(iii) Other musculoskeletal disorders. 
‘‘(4) APPLICATION
FOR
ADDITIONAL
IDENTI-
FIED WTC-RELATED HEALTH CONDITIONS FOR ELI-
GIBLE WTC RESPONDERS.— 
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‘‘(A) APPLICATION.—Any individual or or-
ganization can apply to the WTC Program Ad-
ministrator for an illness or health condition 
not described in paragraph (3) to be added to 
the list of identified WTC-related conditions for 
eligible WTC responders. 
‘‘(B) REVIEW.—The WTC Program Ad-
ministrator shall establish a public process for 
receiving public input and comments on any ap-
plication under subparagraph (A). 
‘‘(C) CONSIDERATIONS.—In making deter-
minations on such applications, the WTC Pro-
gram Administrator shall give deference to the 
findings and recommendations of Clinical Cen-
ters of Excellence published in peer reviewed 
journals in the determination of whether an ad-
ditional illness or health condition, such as can-
cer, should be added to the list of identified 
WTC-related health conditions for eligible WTC 
responders. 
‘‘(D) CONSULTATION.—The WTC Pro-
gram Administrator shall consult with the WTC 
Responders Steering Committee and the WTC 
Scientific/Technical 
Advisory 
Committee 
in 
making a determination on whether an addi-
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tional health condition should be added to the 
list of identified WTC-related conditions for eli-
gible WTC responders. 
‘‘(E) DETERMINATION.—The WTC Pro-
gram Administrator shall add an illness or 
health condition to the list of identified WTC- 
related health conditions for eligible WTC re-
sponders if, based on a review of the evidence 
and consultations conducted under subpara-
graphs (B), (C), and (D), the Administrator de-
termines that exposure to airborne toxins, other 
hazards, or other adverse conditions resulting 
from the September 11, 2001, terrorist attacks 
on the World Trade Center is substantially like-
ly to be a significant factor in aggravating, con-
tributing to, or causing the illness or health 
condition. 
‘‘(b) COVERAGE OF TREATMENT FOR WTC-RELATED 
HEALTH CONDITIONS.— 
‘‘(1) DETERMINATION BASED ON AN IDENTI-
FIED WTC-RELATED HEALTH CONDITION FOR ELIGI-
BLE WTC RESPONDERS.— 
‘‘(A) IN GENERAL.—If a physician at a 
Clinical Center of Excellence that is providing 
monitoring benefits under section 3011 for an 
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eligible WTC responder determines that the re-
sponder has an identified WTC-related health 
condition, and the physician makes a clinical 
determination that exposure to airborne toxins, 
other hazards, or adverse conditions resulting 
from the 9/11 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 paragraph (2), 
the WTC program shall provide for pay-
ment under subsection (c) for medically 
necessary treatment for such condition. 
‘‘(B) 
REVIEW; 
CERTIFICATION; 
AP-
PEALS.— 
‘‘(i) REVIEW.—A Federal employee 
designated by the WTC Program Adminis-
trator shall review determinations made 
under subparagraph (A)(i) of a WTC-re-
lated health condition. 
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‘‘(ii) CERTIFICATION.—The Adminis-
trator shall provide a certification of cov-
erage of the treatment of such condition 
based upon reviews conducted under clause 
(i). Such a certification shall be provided 
unless the Administrator determines that 
the responder’s condition is not an identi-
fied WTC-related health condition or that 
exposure to airborne toxins, other hazards, 
or adverse conditions resulting from the 9/ 
11 terrorist attacks is not substantially 
likely to be a significant factor in signifi-
cantly aggravating, contributing to, or 
causing the condition. 
‘‘(iii) APPEAL PROCESS.—The Admin-
istrator shall provide a process for the ap-
peal of determinations under clause (ii). 
‘‘(2) DETERMINATION BASED ON OTHER WTC- 
RELATED HEALTH CONDITION.— 
‘‘(A) IN GENERAL.—If a physician at a 
Clinical Center of Excellence determines pursu-
ant to subsection (a) that the eligible WTC re-
sponder has a WTC-related health condition 
that is not an identified WTC-related health 
condition for eligible WTC responders— 
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‘‘(i) the physician shall promptly 
transmit such determination to the WTC 
Program Administrator and provide the 
Administrator with the facts supporting 
such determination; and 
‘‘(ii) on and after the date of such 
transmittal and pending a determination 
by the Administrator under subparagraph 
(B), the WTC program shall provide for 
payment under subsection (c) for medically 
necessary treatment for such condition. 
‘‘(B) REVIEW; CERTIFICATION.— 
‘‘(i) USE OF PHYSICIAN PANEL.—The 
WTC Program Administrator shall provide 
for the review of each determination made 
under subparagraph (A)(i) of a WTC-re-
lated health condition to be made by a 
physician panel with appropriate expertise 
appointed by the WTC Program Adminis-
trator. Such a panel shall make rec-
ommendations to the Administrator on the 
evidence supporting such determination. 
‘‘(ii) REVIEW OF RECOMMENDATIONS 
OF PANEL; CERTIFICATION.—The Adminis-
trator, based on such recommendations 
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shall determine whether or not the condi-
tion is a WTC-related health condition 
and, if it is, provide for a certification 
under paragraph (1)(B)(ii) of coverage of 
such condition. The Administrator shall 
provide a process for the appeal of deter-
minations that the responder’s condition is 
not a WTC-related health condition. 
‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 
The determination under paragraphs (1)(A)(ii) and 
(2)(A)(ii) of whether treatment is medically nec-
essary for a WTC-related health condition shall be 
made by physicians at the appropriate Clinical Cen-
ter of Excellence, taking into account, for identified 
WTC-related health conditions, medical treatment 
protocols established under subsection (d). 
‘‘(4) SCOPE OF TREATMENT COVERED.— 
‘‘(A) IN
GENERAL.—The scope of treat-
ment covered under such paragraphs includes 
services of physicians and other health care pro-
viders, diagnostic and laboratory tests, prescrip-
tion drugs, inpatient and outpatient hospital 
services, and other medically necessary treat-
ment. 
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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. 
‘‘(5) PROVISION OF TREATMENT PENDING CER-
TIFICATION.—In the case of an eligible WTC re-
sponder who has been determined by an examining 
physician under subsection (b)(1) to have an identi-
fied WTC-related health condition, but for whom a 
certification of the determination has not yet been 
made by the WTC Program Administrator, medical 
treatment may be provided under this subsection 
until the Administrator makes a decision on such 
certification. Medical treatment provided under this 
paragraph shall be considered to be medical treat-
ment for which payment may be made under sub-
section (c). 
‘‘(c) PAYMENT
FOR MEDICAL MONITORING
AND 
TREATMENT OF WTC-RELATED HEALTH CONDITIONS.— 
‘‘(1) MEDICAL TREATMENT.— 
‘‘(A) 
USE
OF
MEDICARE
PAYMENT 
RATES.— 
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‘‘(i) IN
GENERAL.—Subject to sub-
paragraph (B), the WTC Program Admin-
istrator shall reimburse costs for medically 
necessary treatment under this title for 
WTC-related health conditions provided 
under this title in a facility for which a 
payment rate is established under the 
Medicare program under title XVIII of the 
Social Security Act at the applicable per-
centage of such Medicare payment rate. 
‘‘(ii) APPLICABLE PERCENTAGE.—For 
purposes of this subparagraph, the term 
‘applicable percentage’ means— 
‘‘(I) 115 percent for treatment 
provided by a hospital or an ambula-
tory care facility; or 
‘‘(II) 130 percent for other treat-
ment. 
‘‘(B) PHARMACEUTICALS.— 
‘‘(i) IN
GENERAL.—The WTC Pro-
gram Administrator shall establish a pro-
gram for paying for the medically nec-
essary outpatient prescription pharma-
ceuticals prescribed under this title for 
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WTC-related conditions through one or 
more contracts 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 Admin-
istrator may enter select a separate vendor 
to provide pharmaceutical benefits to eligi-
ble WTC responders for whom the Clinical 
Center of Excellence is described in section 
3006(b)(1)(A) if such an arrangement is 
deemed necessary and beneficial to the 
program by the WTC Program Adminis-
trator. 
‘‘(C) OTHER TREATMENT.—For treatment 
not covered under a preceding subparagraph, 
the WTC Program Administrator shall des-
ignate a reimbursement rate for each such serv-
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ice based upon the rates of reimbursement spec-
ified in the preceding subparagraphs. 
‘‘(2) MEDICAL MONITORING.—The WTC Pro-
gram Administrator shall reimburse the costs of 
medical monitoring provided under this title at a 
rate set by the Administrator. 
‘‘(3) ADMINISTRATIVE ARRANGEMENT AUTHOR-
ITY.—The WTC Program Administrator may enter 
into arrangements with other government agencies, 
insurance companies, or other third-party adminis-
trators to provide for timely and accurate processing 
of claims under this section. 
‘‘(4) PARTICIPATION
BY
NEW
YORK
CITY
IN 
TREATMENT COSTS.— 
‘‘(A) IN
GENERAL.—The amount of the 
covered treatment payment (as defined in sub-
paragraph (B)) for a fiscal year shall be re-
duced by an amount equal to 5 percent of the 
amount of the covered treatment payment that 
would be made for the fiscal year but for this 
paragraph. 
‘‘(B) COVERED TREATMENT PAYMENT DE-
FINED.—For purposes of this paragraph, the 
term ‘covered treatment payment’ means pay-
ment under paragraph (1), including under 
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such paragraph as applied under section 
3022(a), for items and services furnished by a 
Clinical Center of Excellence within the New 
York City Health and Hospitals Corporation to 
eligible WTC responders and to eligible WTC 
residents or other non-responders. Such pay-
ment shall be determined after the application 
of paragraphs (2) and (3) of section 3001(d). 
‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 
‘‘(1) DEVELOPMENT.—The Coordinating Cen-
ters of Excellence shall develop medical treatment 
protocols for the treatment of eligible WTC respond-
ers and eligible WTC residents and other non-re-
sponders for identified WTC-related health condi-
tions under subsection (b). 
‘‘(2) APPROVAL.—The WTC Program Adminis-
trator shall approve the medical treatment protocols, 
in consultation with the WTC Health Program 
Steering Committees. 
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‘‘PART 2—COMMUNITY PROGRAM 
‘‘SEC. 3021. IDENTIFICATION OF ELIGIBLE WTC RESIDENTS 
AND OTHER NON-RESPONDERS AND PROVI-
SION OF WTC-RELATED MONITORING SERV-
ICES. 
‘‘(a) ELIGIBLE WTC RESIDENT AND OTHER NON- 
RESPONDER DEFINED.— 
‘‘(1) IN GENERAL.—In this title, the term ‘eligi-
ble WTC resident and other non-responder’ means, 
subject to paragraph (3), an individual who is not an 
eligible WTC responder and is described in any of 
the following subparagraphs: 
‘‘(A) A person who was present in the New 
York City disaster area in the dust or dust 
cloud on September 11, 2001. 
‘‘(B) A person who worked, resided or at-
tended school, child care or adult day care in 
the New York City disaster area for— 
‘‘(i) at least four 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 pe-
riod beginning on September 11, 2001, 
and ending on July 31, 2002. 
‘‘(C) Any person who worked as a clean-up 
worker or performed maintenance work in the 
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New York City disaster area during the 4- 
month period described in subparagraph (B)(i) 
and had extensive exposure to WTC dust as a 
result of such work. 
‘‘(D) A person who was deemed eligible to 
receive a grant from the Lower Manhattan De-
velopment Corporation Residential Grant Pro-
gram, who possessed a lease for a residence or 
purchased a residence in the New York City 
disaster area, and who resided in such residence 
during the period beginning on September 11, 
2001, and ending on May 31, 2003. 
‘‘(E) A person whose place of employ-
ment— 
‘‘(i) at any time during the period be-
ginning on September 11, 2001, and end-
ing on May 31, 2003, was in the New 
York City disaster area; and 
‘‘(ii) was deemed eligible to receive a 
grant from the Lower Manhattan Develop-
ment Corporation WTC Small Firms At-
traction and Retention Act program or 
other government incentive program de-
signed to revitalize the Lower Manhattan 
economy after the September 11, 2001, 
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terrorist attacks on the World Trade Cen-
ter. 
‘‘(F) A person who was receiving treat-
ment as of the date of the enactment of this 
title at the World Trade Center Environmental 
Health Center operated by the New York City 
Health and Hospitals Corporation. 
‘‘(2) ELIGIBILITY
CRITERIA.—In establishing 
eligibility criteria for purposes of subparagraphs (A) 
through (C) of paragraph (1) and for purposes of 
section 3011(a)(1)(D), the WTC Program Adminis-
trator shall— 
‘‘(A) take into account the period, and, to 
the extent feasible, intensity, of exposure to air-
borne toxins, other hazard, or other adverse 
condition; 
‘‘(B) base such criteria on best available 
evidence of exposure and related adverse health 
effects; and 
‘‘(C) consult with the WTC Community 
Program Steering Committee, Coordinating 
Centers of Excellence described in section 
3006(b)(1)(C), and affected populations. 
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The Administrator shall first establish such criteria 
not later than 90 days after the date of the enact-
ment of this title. 
‘‘(3) APPLICATION PROCESS.—The WTC Pro-
gram Administrator in consultation with the Coordi-
nating Centers of Excellence shall establish a proc-
ess for individuals to be determined eligible WTC 
residents and other non-responders. Under such 
process— 
‘‘(A) there shall be no fee charged to the 
applicant for making an application for such 
determination; and 
‘‘(B) the Administrator shall make a deter-
mination on such an application not later than 
60 days after the date of filing the application. 
‘‘(4) CERTIFICATION.— 
‘‘(A) IN GENERAL.—In the case of an indi-
vidual who is determined under paragraph (3) 
and consistent with paragraph (5) to be an eli-
gible WTC resident or other non-responder, the 
WTC Program Administrator shall provide an 
appropriate certification of such fact and of eli-
gibility for monitoring and treatment benefits 
under this part. The Administrator shall make 
determinations of eligibility relating to an appli-
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cant’s compliance with this title, including the 
verification of information submitted in support 
of the application and shall not deny such a 
certification to an individual unless the Admin-
istrator determines that— 
‘‘(i) based on the application sub-
mitted, the individual does not meet the 
eligibility criteria; or 
‘‘(ii) the numerical limitation on eligi-
ble WTC residents and other non-respond-
ers set forth in paragraph (5) has been 
met. 
‘‘(B) TIMING.—In the case of an individual 
who is determined under paragraph (3) and 
consistent with paragraph (5) to be an eligible 
WTC resident or other non-responder, the WTC 
Program Administrator shall provide the certifi-
cation under subparagraph (A) at the time of 
such determination. 
‘‘(5) NUMERICAL
LIMITATION
ON
ELIGIBLE 
WTC RESIDENTS AND OTHER NON-RESPONDERS.— 
‘‘(A) IN GENERAL.—Notwithstanding any 
other provision of this title, the total number of 
individuals not described in subparagraph (C) 
who may qualify as eligible WTC residents and 
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other non-responders for purposes of this title, 
and be certified as eligible WTC residents and 
other non-responders under paragraph (4), 
shall not exceed 35,000. 
‘‘(B) PROCESS.—In implementing subpara-
graph (A), the WTC Program Administrator 
shall— 
‘‘(i) limit the number of certifications 
provided under paragraph (4) in accord-
ance with such subparagraph; and 
‘‘(ii) provide priority in such certifi-
cations in the order in which individuals 
apply for a determination under paragraph 
(3). 
‘‘(C) INDIVIDUALS CURRENTLY RECEIVING 
MONITORING OR TREATMENT NOT COUNTED.— 
Individuals described in this subparagraph are 
individuals who, before the date of the enact-
ment of this title, have received any monitoring 
described in subsection (b)(1) or have received 
any treatment described in section 3022(a) for 
an identified WTC-related condition for eligible 
WTC residents and other non-responders. 
‘‘(b) MONITORING BENEFITS.— 
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‘‘(1) IN GENERAL.—In the case of an eligible 
WTC resident or other non-responder, the WTC pro-
gram shall provide for monitoring benefits that in-
clude medical monitoring consistent with protocols 
approved by the WTC Program Administrator, in 
consultation with the World Trade Center Environ-
mental Health Center at Bellevue Hospital and the 
WTC Community Program Steering Committee, and 
including screening, clinical examinations, and long- 
term health monitoring and analysis. 
‘‘(2) SOURCE OF BENEFITS.—The monitoring 
benefits under paragraph (1) shall be provided 
through a Clinical Center of Excellence with respect 
to the individual involved. 
‘‘SEC. 3022. TREATMENT OF ELIGIBLE WTC RESIDENTS AND 
OTHER 
NON-RESPONDERS 
FOR 
WTC-RE-
LATED HEALTH CONDITIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), the 
provisions of section 3012 shall apply to the treatment of 
WTC-related health conditions for eligible WTC residents 
and other non-responders in the same manner as such pro-
visions apply to the treatment of identified WTC-related 
health conditions for eligible WTC responders, except that 
an eligible WTC resident or other non-responder need not 
be receiving monitoring benefits to receive treatment for 
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a WTC-related health condition for eligible WTC residents 
and other non-responders. 
‘‘(b) LIST OF IDENTIFIED WTC-RELATED HEALTH 
CONDITIONS FOR WTC RESIDENTS AND OTHER NON-RE-
SPONDERS.— 
‘‘(1) IDENTIFIED WTC-RELATED HEALTH CON-
DITIONS FOR WTC RESIDENTS AND OTHER NON-RE-
SPONDERS.—For purposes of this title, the term 
‘identified WTC-related health conditions for WTC 
residents and non-responder’ means any of the fol-
lowing health conditions, and any condition specified 
under paragraph (2): 
‘‘(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 ob-
structive 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) Gastro-esophageal reflux dis-
order (GERD). 
‘‘(xii) Sleep apnea exacerbated by or 
related to a condition described in a pre-
vious clause. 
‘‘(B) MENTAL HEALTH CONDITIONS.— 
‘‘(i) Post traumatic 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. 
‘‘(xi) V codes (treatments not specifi-
cally related to psychiatric disorders, such 
as marital problems, parenting problems, 
etc.) 
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‘‘(2) APPLICATION
FOR
ADDITIONAL
IDENTI-
FIED WTC-RELATED HEALTH CONDITIONS FOR WTC 
RESIDENTS
AND
OTHER
NON-RESPONDERS.—The 
provisions of paragraph (4) of section 3012(a) shall 
apply with respect to an addition to the list of iden-
tified WTC-related conditions for eligible WTC resi-
dents and other non-responders under paragraph (1) 
in the same manner as such provisions apply to the 
addition to the list of identified WTC-related condi-
tions for eligible WTC responders under section 
3012(a)(3). 
‘‘SEC. 3023. TREATMENT OF OTHER INDIVIDUALS WITH 
WTC-RELATED HEALTH CONDITIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (c), the 
provisions of section 3022 shall apply to the treatment of 
WTC-related health conditions for eligible WTC residents 
and other non-responders in the case of individuals de-
scribed in subsection (b) in the same manner as such pro-
visions apply to the treatment of WTC-related health con-
ditions for WTC residents and other non-responders. 
‘‘(b) INDIVIDUALS DESCRIBED.—An individual de-
scribed in this subsection is an individual who, regardless 
of location of residence— 
‘‘(1) is not a eligible WTC responder or an eli-
gible WTC resident or other non-responder; and 
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‘‘PART 3—NATIONAL ARRANGEMENT FOR BENE-
FITS FOR ELIGIBLE INDIVIDUALS OUTSIDE 
NEW YORK 
‘‘SEC. 3031. NATIONAL ARRANGEMENT FOR BENEFITS FOR 
ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 
‘‘(a) IN GENERAL.—In order to ensure reasonable ac-
cess to monitoring and treatment benefits under this sub-
title for individuals who are eligible WTC responders or 
eligible WTC residents or other nonresponders and who 
reside in any State, as defined in section 2(f), outside the 
New York metropolitan area, the WTC Program Adminis-
trator shall establish a nationwide network of health care 
providers to provide such monitoring and treatment bene-
fits near such individuals’ areas of residence in such 
States, or to establish a mechanism whereby individuals 
who are entitled to benefits for such monitoring or treat-
ment can be reimbursed for the cost of such monitoring 
or treatment. Nothing in this subsection shall be construed 
as preventing such individuals from being provided such 
monitoring and treatment benefits through a Clinical Cen-
ter 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 Coordinating Centers of Excellence; 
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‘‘(2) follow the monitoring and treatment proto-
cols developed under section 3006(a)(1); and 
‘‘(3) collect and report data in accordance with 
section 3005. 
‘‘Subtitle C—Research Into 
Conditions 
‘‘SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CON-
DITIONS RELATED TO SEPTEMBER 11 TER-
RORIST ATTACKS IN NEW YORK CITY. 
‘‘(a) IN GENERAL.—With respect to individuals, in-
cluding eligible WTC responders and non-responders, re-
ceiving monitoring under subtitle B, the WTC Program 
Administrator shall conduct or support— 
‘‘(1) research on physical and mental health 
conditions that may be related to the September 11, 
2001, terrorist attacks; 
‘‘(2) research on diagnosing WTC-related 
health conditions of such individuals, in the case of 
conditions for which there has been diagnostic un-
certainty; and 
‘‘(3) research on treating WTC-related health 
conditions of such individuals, in the case of condi-
tions for which there has been treatment uncer-
tainty. 
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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 3051). 
‘‘(b) TYPES
OF RESEARCH.—The research under 
subsection (a)(1) shall include epidemiologic studies on 
WTC-related conditions or emerging conditions— 
‘‘(1) among WTC responders, residents, and 
non-responders 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 
populations, to identify potential for long-term ad-
verse health effects in less exposed populations. 
‘‘(c) CONSULTATION.—The WTC Program Adminis-
trator shall carry out this section in consultation with the 
WTC Health Program Steering Committees and the WTC 
Scientific/Technical Advisory Committee. 
‘‘(d) APPLICATION OF PRIVACY AND HUMAN SUB-
JECT PROTECTIONS.—The privacy and human subject 
protections applicable to research conducted under this 
section shall not be less than such protections applicable 
to research otherwise conducted by the National Institutes 
of Health. 
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‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated $15,000,000 for each fiscal year, in 
addition to any other authorizations of appropriations that 
are available for such purpose. 
‘‘Subtitle D—Programs of the New 
York City Department of Health 
and Mental Hygiene 
‘‘SEC. 3051. WORLD TRADE CENTER HEALTH REGISTRY. 
‘‘(a) PROGRAM EXTENSION.—For the purpose of en-
suring on-going data collection for victims of the Sep-
tember 11, 2001, terrorist attacks on the World Trade 
Center, the WTC Program Administrator, shall extend 
and expand the arrangements in effect as of January 1, 
2008, with the New York City Department of Health and 
Mental Hygiene that provide for the World Trade Center 
Health Registry. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $7,000,000 for each fis-
cal year to carry out this section. 
‘‘SEC. 3052. MENTAL HEALTH SERVICES. 
‘‘(a) IN GENERAL.—The WTC Program Adminis-
trator may make grants to the New York City Department 
of Health and Mental Hygiene to provide mental health 
services to address mental health needs relating to the 
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September 11, 2001, terrorist attacks on the World Trade 
Center. 
‘‘(b) AUTHORIZATION OF APPROPRIATIONS.—There 
are authorized to be appropriated $8,500,000 for each fis-
cal year to carry out this section.’’. 
TITLE II—SEPTEMBER 11 VICTIM 
COMPENSATION FUND OF 2001 
SEC. 201. DEADLINE EXTENSION FOR CERTAIN CLAIMS 
UNDER SEPTEMBER 11 VICTIM COMPENSA-
TION FUND OF 2001. 
Section 405(a)(3) of the Air Transportation Safety 
and System Stabilization Act (49 U.S.C. 40101 note) is 
amended to read as follows: 
‘‘(3) LIMITATION.— 
‘‘(A) IN GENERAL.—Except as provided by 
subparagraph (B), no claim may be filed under 
paragraph (1) after December 22, 2003. 
‘‘(B) EXCEPTIONS.— 
‘‘(i) IN GENERAL.—A claim may be 
filed under paragraph (1) by an individual 
(or by a personal representative on behalf 
of a deceased individual) during the period 
described in clause (ii), if the Special Mas-
ter determines that— 
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‘‘(I) the individual first knew 
that the individual had suffered a 
physical harm as a result of the ter-
rorist-related aircraft crashes of Sep-
tember 11, 2001, or the aftermath of 
such attacks, after December 22, 
2003, and before the date that is 5 
years after the date of the enactment 
of the James Zadroga 9/11 Health 
and Compensation Act of 2008; 
‘‘(II) the individual did not for 
any reason other than as described in 
subclause (I) know that the individual 
was eligible to file a claim under para-
graph (1) until after December 22, 
2003; 
‘‘(III) the individual filed a claim 
under this title before, on, or after 
December 22, 2003, and suffered a 
significantly greater physical harm as 
a result of the terrorist-related air-
craft crashes of September 11, 2001, 
or the aftermath of such attacks, than 
was known to the individual as of the 
date the most recent previous claim 
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was filed, and before the date that is 
5 years after the date of the enact-
ment of the James Zadroga 9/11 
Health and Compensation Act of 
2008; or 
‘‘(IV) the individual was not eli-
gible to file a claim under this title be-
fore December 22, 2003, but who be-
comes so eligible because of the 
amendments made by the James 
Zadroga 9/11 Health and Compensa-
tion Act of 2008. 
‘‘(ii) PERIOD.— 
‘‘(I) IN
GENERAL.—Except as 
provided in subclause (II), the period 
described in this clause is the two- 
year period beginning on the date of 
the enactment of the James Zadroga 
9/11 Health and Compensation Act of 
2008. 
‘‘(II) EXCEPTION.—In the case 
of an individual who first knew on a 
date after such date of enactment that 
the individual had suffered physical 
harm described in subclause (I) of 
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