111TH CONGRESS 
2D SESSION 
H. R. 847 
AN ACT 
To amend the Public Health Service Act to extend and 
improve protections and services to individuals directly 
impacted by the terrorist attack in New York City on 
September 11, 2001, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘James Zadroga 9/11 Health and Compensation Act of 
2010’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 
Sec. 101. World Trade Center Health Program. 
‘‘TITLE XXXIII—WORLD TRADE CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Program; Advisory Committee 
‘‘Sec. 3301. Establishment of World Trade Center Health Program. 
‘‘Sec. 3302. WTC Health Program Scientific/Technical Advisory Com-
mittee; WTC Health Program Steering Committees. 
‘‘Sec. 3303. Education and outreach. 
‘‘Sec. 3304. Uniform data collection and analysis. 
‘‘Sec. 3305. Clinical Centers of Excellence and Data Centers. 
‘‘Sec. 3306. Definitions. 
‘‘Subtitle B—Program of Monitoring, Initial Health Evaluations, and 
Treatment 
‘‘PART 1—WTC RESPONDERS 
‘‘Sec. 3311. Identification of WTC responders and provision of WTC-re-
lated monitoring services. 
‘‘Sec. 3312. Treatment of enrolled WTC responders for WTC-related 
health conditions. 
‘‘Sec. 3313. National arrangement for benefits for eligible individuals out-
side New York. 
‘‘PART 2—WTC SURVIVORS 
‘‘Sec. 3321. Identification and initial health evaluation of screening-eligible 
and certified-eligible WTC survivors. 
‘‘Sec. 3322. Followup monitoring and treatment of certified-eligible WTC 
survivors for WTC-related health conditions. 
‘‘Sec. 3323. Followup monitoring and treatment of other individuals with 
WTC-related health conditions. 
‘‘PART 3—PAYOR PROVISIONS 
‘‘Sec. 3331. Payment of claims. 
‘‘Sec. 3332. Administrative arrangement authority. 
‘‘Subtitle C—Research Into Conditions
‘‘Sec. 3341. Research regarding certain health conditions related to Sep-
tember 11 terrorist attacks. 
‘‘Sec. 3342. World Trade Center Health Registry. 
‘‘Subtitle D—Funding 
‘‘Sec. 3351. World Trade Center Health Program Fund. 
TITLE II—SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 
2001 
Sec. 201. Definitions. 
Sec. 202. Extended and expanded eligibility for compensation. 
Sec. 203. Requirement to update regulations. 
Sec. 204. Limited liability for certain claims. 
Sec. 205. Funding; attorney fees. 
TITLE III—LIMITATION ON TREATY BENEFITS FOR CERTAIN DE-
DUCTIBLE PAYMENTS; TIME FOR PAYMENT OF CORPORATE ES-
TIMATED TAXES 
Sec. 301. Limitation on treaty benefits for certain deductible payments. 
Sec. 302. Time for payment of corporate estimated taxes. 
TITLE IV—BUDGETARY EFFECTS 
Sec. 401. Compliance with Statutory Pay-As-You-Go Act of 2010. 
TITLE I—WORLD TRADE CENTER 
HEALTH PROGRAM 
SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 
The Public Health Service Act is amended by adding 
at the end the following new title: 
‘‘TITLE XXXIII—WORLD TRADE 
CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of 
Program; Advisory Committee 
‘‘SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER 
HEALTH PROGRAM. 
‘‘(a) IN GENERAL.—There is hereby established with-
in the Department of Health and Human Services a pro-
gram to be known as the World Trade Center Health Pro-
gram, which shall be administered by the WTC Program 
Administrator, to provide beginning on July 1, 2011— 
‘‘(1) medical monitoring and treatment benefits 
to eligible emergency responders and recovery and 
cleanup workers (including those who are Federal 
employees) who responded to the September 11, 
2001, terrorist attacks; and 
‘‘(2) initial health evaluation, monitoring, and 
treatment benefits to residents and other building 
occupants and area workers in New York City who 
were directly impacted and adversely affected by 
such attacks. 
‘‘(b) COMPONENTS OF PROGRAM.—The WTC Pro-
gram includes the following components: 
‘‘(1) MEDICAL
MONITORING
FOR
RESPOND-
ERS.—Medical monitoring under section 3311, in-
cluding clinical examinations and long-term health 
monitoring and analysis for enrolled WTC respond-
ers 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. 
‘‘(2) INITIAL HEALTH EVALUATION FOR SUR-
VIVORS.—An initial health evaluation under section 
3321, including an evaluation to determine eligibility 
for followup monitoring and treatment.
‘‘(3) FOLLOWUP MONITORING AND TREATMENT 
FOR WTC-RELATED HEALTH CONDITIONS FOR RE-
SPONDERS AND SURVIVORS.—Provision under sec-
tions 3312, 3322, and 3323 of followup monitoring 
and treatment and payment, subject to the provi-
sions of subsection (d), for all medically necessary 
health and mental health care expenses of an indi-
vidual with respect to a WTC-related health condi-
tion (including necessary prescription drugs). 
‘‘(4) OUTREACH.—Establishment under section 
3303 of an education and outreach program to po-
tentially eligible individuals concerning the benefits 
under this title. 
‘‘(5) CLINICAL DATA COLLECTION AND ANAL-
YSIS.—Collection and analysis under section 3304 of 
health and mental health data relating to individuals 
receiving monitoring or treatment benefits in a uni-
form manner in collaboration with the collection of 
epidemiological data under section 3342. 
‘‘(6) RESEARCH ON HEALTH CONDITIONS.—Es-
tablishment under subtitle C of a research program 
on health conditions resulting from the September 
11, 2001, terrorist attacks. 
‘‘(c) NO COST SHARING.—Monitoring and treatment 
benefits and initial health evaluation benefits are provided
under subtitle B without any deductibles, copayments, or 
other cost sharing to an enrolled WTC responder or cer-
tified-eligible WTC survivor. Initial health evaluation ben-
efits are provided under subtitle B without any 
deductibles, copayments, or other cost sharing to a screen-
ing-eligible WTC survivor. 
‘‘(d) PREVENTING FRAUD AND UNREASONABLE AD-
MINISTRATIVE COSTS.— 
‘‘(1) FRAUD.—The Inspector General of the 
Department of Health and Human Services shall de-
velop and implement a program to review the WTC 
Program’s health care expenditures to detect fraudu-
lent or duplicate billing and payment for inappro-
priate services. This title is a Federal health care 
program (as defined in section 1128B(f) of the So-
cial Security Act) and is a health plan (as defined 
in section 1128C(c) of such Act) for purposes of ap-
plying sections 1128 through 1128E of such Act. 
‘‘(2) 
UNREASONABLE
ADMINISTRATIVE 
COSTS.—The Inspector General of the Department 
of Health and Human Services shall develop and im-
plement a program to review the WTC Program for 
unreasonable administrative costs, including with re-
spect to infrastructure, administration, and claims 
processing.
‘‘(e) QUALITY ASSURANCE.—The WTC Program Ad-
ministrator working with the Clinical Centers of Excel-
lence shall develop and implement a quality assurance pro-
gram for the monitoring and treatment delivered by such 
Centers of Excellence and any other participating health 
care providers. Such program shall include— 
‘‘(1) adherence to monitoring and treatment 
protocols; 
‘‘(2) appropriate diagnostic and treatment re-
ferrals for participants; 
‘‘(3) prompt communication of test results to 
participants; and 
‘‘(4) such other elements as the Administrator 
specifies in consultation with the Clinical Centers of 
Excellence. 
‘‘(f) ANNUAL PROGRAM REPORT.— 
‘‘(1) IN GENERAL.—Not later than 6 months 
after the end of each fiscal year in which the WTC 
Program is in operation, the WTC Program Admin-
istrator 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 INCLUDED IN REPORT.—Each 
annual report under paragraph (1) shall include at 
least 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 moni-
toring 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 and the 
succeeding 10-year period.
‘‘(B) MONITORING, INITIAL HEALTH EVAL-
UATION, AND
TREATMENT
COSTS.—For each 
clinical program so described— 
‘‘(i) information on the costs of moni-
toring and initial health evaluation and the 
costs of treatment and on the estimated 
costs of such monitoring, evaluation, and 
treatment in the succeeding fiscal year; 
and 
‘‘(ii) an estimate of the cost of med-
ical treatment for WTC-related health con-
ditions that have been paid for or reim-
bursed by workers’ compensation, by public 
or private health plans, or by New York 
City under section 3331. 
‘‘(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 
‘‘(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 ex-
posure described in section 3306(1), including 
the findings of research conducted under sec-
tion 3341(a). 
‘‘(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. 
‘‘(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 ben-
efits provided for enrolled WTC responders not 
described in subparagraph (A). 
‘‘(C) WTC SURVIVORS.—The benefits pro-
vided for screening-eligible WTC survivors and 
certified-eligible WTC survivors in section 
3321(a). 
‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING 
80 PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The 
Secretary shall promptly notify the Congress of each of 
the following: 
‘‘(1) When the number of enrollments of WTC 
responders subject to the limit established under sec-
tion 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 
Program Steering Committees and the Advisory Com-
mittee under section 3302, regarding the implementation 
and improvement of programs under this title. 
‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECH-
NICAL ADVISORY COMMITTEE; WTC HEALTH 
PROGRAM STEERING COMMITTEES. 
‘‘(a) ADVISORY COMMITTEE.— 
‘‘(1) ESTABLISHMENT.—The WTC Program 
Administrator shall establish an advisory committee 
to be known as the WTC Health Program Scientific/ 
Technical Advisory Committee (in this subsection re-
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 Ad-
ministrator shall appoint the members of the Advi-
sory 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. 
‘‘(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 Com-
mittee, for the purpose of receiving input from 
affected stakeholders and facilitating the coordi-
nation of monitoring and treatment programs 
for the enrolled 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 Com-
mittee, for the purpose of receiving input from 
affected stakeholders and facilitating the coordi-
nation of initial health evaluations, monitoring, 
and treatment programs for screening-eligible 
and certified-eligible WTC survivors under part 
2 of subtitle B. 
‘‘(2) MEMBERSHIP.—
‘‘(A) WTC RESPONDERS STEERING COM-
MITTEE.— 
‘‘(i) REPRESENTATION.—The WTC 
Responders Steering Committee shall in-
clude— 
‘‘(I) representatives of the Cen-
ters of Excellence providing services 
to WTC responders; 
‘‘(II) representatives of labor or-
ganizations representing firefighters, 
police, other New York City employ-
ees, and recovery and cleanup workers 
who responded to the September 11, 
2001, terrorist attacks; and 
‘‘(III) 3 representatives of New 
York City, 1 of whom will be selected 
by the police 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 
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). 
‘‘(B) WTC SURVIVORS
STEERING
COM-
MITTEE.— 
‘‘(i) REPRESENTATION.—The WTC 
Survivors Steering Committee shall include 
representatives of— 
‘‘(I) the Centers of Excellence 
providing services to screening-eligible 
and certified-eligible WTC survivors; 
‘‘(II) the population of residents, 
students, and area and other workers 
affected by the September 11, 2001, 
terrorist attacks; 
‘‘(III) screening-eligible and cer-
tified-eligible survivors receiving initial 
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 
initially be composed of members of the 
WTC Environmental Health Center Sur-
vivor Advisory Committee (as in existence 
on the day before the date of the enact-
ment 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 Steer-
ing Committee shall be filled by an individual 
recommended by the Steering Committee. 
‘‘SEC. 3303. EDUCATION AND OUTREACH. 
‘‘The WTC Program Administrator shall institute a 
program that provides education and outreach on the ex-
istence and availability of services under the WTC Pro-
gram. 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 
outreach materials informing people about the 
program; and
‘‘(D) the establishment of phone informa-
tion 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 Adminis-
trator shall provide for the uniform collection of data (and 
analysis of data and regular reports to the Administrator) 
on the prevalence of WTC-related health conditions and 
the identification of new WTC-related health conditions. 
Such data shall be collected for all individuals provided 
monitoring or treatment benefits under subtitle B and re-
gardless 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 monitoring 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.— 
‘‘(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 
benefits under subtitle B, with respect to WTC- 
related health conditions, for individuals eligible 
for such benefits; 
‘‘(D) for the provision of counseling for 
benefits for WTC-related health conditions that 
may be available under workers’ compensation 
or other benefit programs for work-related inju-
ries or illnesses, health insurance, disability in-
surance, or other insurance plans or through 
public or private social service agencies and as-
sisting eligible individuals in applying for such 
benefits; 
‘‘(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 
Administrator shall enter into contracts with 
Data 
Centers 
(as 
defined 
in 
subsection 
(b)(2))—
‘‘(i) for receiving, analyzing, and re-
porting to the WTC Program Adminis-
trator on data, in accordance with section 
3304, that have been collected and re-
ported to such Data Centers by the cor-
responding 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-re-
lated health conditions; 
‘‘(iii) for coordinating the outreach ac-
tivities conducted under paragraph (1)(B) 
by each corresponding Clinical Center of 
Excellence; 
‘‘(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 Excel-
lence to obtain input on the analysis and 
reporting of data collected under clause (i) 
and on the development of monitoring, ini-
tial health evaluation, and treatment proto-
cols under clause (ii). 
‘‘(B) MEDICAL
PROVIDER
SELECTION.— 
The medical providers under subparagraph 
(A)(iv) shall be selected by the WTC Program 
Administrator on the basis of their experience 
treating or diagnosing the health conditions in-
cluded in the list of WTC-related health condi-
tions. 
‘‘(C) CLINICAL DISCUSSIONS.—In carrying 
out subparagraph (A)(ii), a Data Center shall 
engage in clinical discussions across the WTC 
Program to guide treatment approaches for in-
dividuals with a WTC-related health condition. 
‘‘(D) TRANSPARENCY
OF
DATA.—A con-
tract 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 survivors, or certified-eligible WTC survivors. 
‘‘(4) USE
OF
COOPERATIVE
AGREEMENTS.— 
Any contract under this title between the WTC Pro-
gram Administrator and a Data Center or a Clinical 
Center of Excellence may be in the form of a cooper-
ative agreement. 
‘‘(b) CENTERS OF EXCELLENCE.— 
‘‘(1) CLINICAL CENTERS OF EXCELLENCE.— 
‘‘(A) DEFINITION.—For purposes of this 
title, the term ‘Clinical Center of Excellence’ 
means a Center that demonstrates to the satis-
faction 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 en-
rolled WTC responders, screening-eligible 
WTC survivors, or certified-eligible WTC 
survivors;
‘‘(ii) has experience in caring for 
WTC responders and screening-eligible 
WTC survivors or includes health care pro-
viders 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-
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 rou-
tine medical care provided for the treat-
ment 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 
individuals who are enrolled WTC respond-
ers or certified-eligible WTC survivors with 
respect to such Center who present them-
selves for treatment of a WTC-related 
health condition. 
‘‘(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 em-
ployer without the authorization of the in-
dividual.
‘‘(vii) Use amounts paid under sub-
section (c)(1) only for costs incurred in 
carrying 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 
mental 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 
with relevant stakeholder worker or com-
munity 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 
ensure continuity of care in any period of tran-
sition 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 Cen-
ter serve the same population group. 
‘‘(c) PAYMENT FOR INFRASTRUCTURE COSTS.— 
‘‘(1) IN GENERAL.—The WTC Program Admin-
istrator shall reimburse a Clinical Center of Excel-
lence for the fixed infrastructure costs of such Cen-
ter in carrying out the activities described in subtitle 
B at a rate negotiated by the Administrator and 
such Centers. Such negotiated rate shall be fair and 
appropriate and take into account the number of en-
rolled WTC responders receiving services from such 
Center under this title.
‘‘(2) FIXED
INFRASTRUCTURE
COSTS.—For 
purposes of paragraph (1), the term ‘fixed infra-
structure costs’ means, with respect to a Clinical 
Center of Excellence, the costs incurred by such 
Center that are not reimbursable by the WTC Pro-
gram Administrator under section 3312(c). 
‘‘SEC. 3306. 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, 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 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.
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 subsequent to the terrorist attacks at the World 
Trade Center, Shanksville, Pennsylvania, or the 
Pentagon, as applicable, on such date. 
‘‘(11) The term ‘September 11, 2001, terrorist 
attacks’ means the terrorist attacks that occurred on 
September 11, 2001, in New York City, in 
Shanksville, Pennsylvania, and at the Pentagon, and 
includes the aftermath of such attacks. 
‘‘(12) The term ‘WTC Health Program Steer-
ing Committee’ means such a Steering Committee 
established under section 3302(b).
‘‘(13) The term ‘WTC Program’ means the 
Word Trade Center Health Program established 
under section 3301(a). 
‘‘(14) 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 
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 Ad-
visory Committee’ means such Committee estab-
lished 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 fol-
lowing individuals, subject to paragraph (4): 
‘‘(A) 
CURRENTLY
IDENTIFIED
RE-
SPONDER.—An individual who has been identi-
fied as eligible for monitoring under the ar-
rangements as in effect on the date of the en-
actment of this title between the National Insti-
tute for Occupational Safety and Health and— 
‘‘(i) the consortium coordinated by 
Mt. Sinai Hospital in New York City that 
coordinates the monitoring and treatment
for enrolled WTC responders other than 
with respect to those covered under the ar-
rangement 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, 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, 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 
modify such eligibility criteria on or after the 
date that the number of enrollments of WTC 
responders has reached 80 percent of the limit 
described in paragraph (4) or on or after the 
date that the number of certifications for cer-
tified-eligible WTC survivors under section 
3321(a)(2)(B) has reached 80 percent of the 
limit described in section 3321(a)(3). 
‘‘(2) CURRENT
ELIGIBILITY
CRITERIA.—The 
eligibility criteria described in this paragraph for an 
individual is that the individual is described in any 
of the following categories: 
‘‘(A) FIREFIGHTERS AND RELATED PER-
SONNEL.—The individual— 
‘‘(i) was a member of the Fire De-
partment 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 (includ-
ing Ground Zero, Staten Island Landfill,
and the New York City Chief Medical Ex-
aminer’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 men-
tal health conditions) on or before Sep-
tember 1, 2008. 
‘‘(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 Sep-
tember 11, 2001, and ending on Sep-
tember 14, 2001, for at least 24 hours 
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)(I) was a member of the Police 
Department of New York City (whether 
active or retired) or a member of the Port 
Authority Police of the Port Authority of 
New York and New Jersey (whether active 
or retired) who participated onsite in res-
cue, recovery, debris cleanup, or related 
services in lower Manhattan (south of 
Canal St.), including Ground Zero, the 
Staten Island Landfill, or the barge load-
ing 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 September 11, 2001, and ending on 
July 31, 2002; 
‘‘(III) participated onsite in rescue, 
recovery, debris cleanup, or related services 
in lower Manhattan (south of Canal St.) 
for at least 24 hours during the period be-
ginning on September 11, 2001, and end-
ing on September 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 be-
ginning on September 11, 2001, and end-
ing 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-
dling of human remains from the World 
Trade Center attacks, or other morgue 
worker who performed similar post-Sep-
tember 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 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 
‘‘(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 
indi-
vidual— 
‘‘(i)(I) was a member of a fire or po-
lice department (whether fire or emergency 
personnel, active or retired), worked for a 
recovery or cleanup contractor, or was a 
volunteer; and performed rescue, recovery, 
demolition, debris cleanup, or other related 
services at the Pentagon site of the ter-
rorist-related aircraft crash of September 
11, 2001, during the period beginning on 
September 11, 2001, and ending on the
date on which the cleanup of the site was 
concluded, as determined by the WTC Pro-
gram Administrator; or 
‘‘(II) was a member of a fire or police 
department (whether fire or emergency 
personnel, active or retired), worked for a 
recovery or cleanup contractor, or was a 
volunteer; and performed rescue, recovery, 
demolition, debris cleanup, or other related 
services at the Shanksville, Pennsylvania, 
site of the terrorist-related aircraft crash 
of September 11, 2001, during the period 
beginning on September 11, 2001, and 
ending on the date on which the cleanup of 
the site was concluded, as determined by 
the WTC Program Administrator; and 
‘‘(ii) is determined by the WTC Pro-
gram Administrator to be at an increased 
risk of developing a WTC-related health 
condition as a result of exposure to air-
borne toxins, other hazards, or adverse 
conditions resulting from the September 
11, 2001, terrorist attacks, and meets such 
eligibility criteria related to such expo-
sures, as the WTC Program Administrator
determines are appropriate, after consulta-
tion with the WTC Scientific/Technical Ad-
visory Committee. 
‘‘(3) ENROLLMENT PROCESS.— 
‘‘(A) IN
GENERAL.—The WTC Program 
Administrator shall establish a process for en-
rolling 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 
limitation in paragraph (4) on enrollment 
of WTC responders has been met; 
‘‘(iv) there shall be no fee charged to 
the applicant for making an application for 
such enrollment; 
‘‘(v) the Administrator shall make a 
determination on such an application not
later than 60 days after the date of filing 
the application; and 
‘‘(vi) an individual who is denied en-
rollment in such Program shall have an op-
portunity to appeal such determination in 
a manner established under such process. 
‘‘(B) TIMING.— 
‘‘(i) CURRENTLY
IDENTIFIED
RE-
SPONDERS.—In accordance with subpara-
graph (A)(i), the WTC Program Adminis-
trator shall enroll an individual described 
in paragraph (1)(A) in the WTC Program 
not later than July 1, 2011. 
‘‘(ii) OTHER
RESPONDERS.—In ac-
cordance with subparagraph (A)(ii) and 
consistent with paragraph (4), the WTC 
Program Administrator shall enroll any 
other individual who is determined to be a 
WTC responder in the WTC Program at 
the time of such determination. 
‘‘(4) NUMERICAL
LIMITATION
ON
ELIGIBLE 
WTC RESPONDERS.— 
‘‘(A) IN GENERAL.—The total number of 
individuals not described in paragraph (1)(A) or 
(2)(A)(ii) who may be enrolled under paragraph
(3)(A)(ii) shall not exceed 25,000 at any time, 
of which no more than 2,500 may be individ-
uals enrolled based on modified eligibility cri-
teria established 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 
subject to amounts available under 
section 3351, that will ensure suffi-
cient funds will be available to provide 
treatment and monitoring benefits 
under this title, with respect to all in-
dividuals who are enrolled through the 
end of fiscal 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 Depart-
ment of Homeland Security shall qualify as an eligi-
ble WTC responder. Before enrolling any individual 
as a WTC responder in the WTC Program under 
paragraph (3), the Administrator, in consultation 
with the Secretary of Homeland Security, shall de-
termine 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 pro-
vide for monitoring benefits that include monitoring 
consistent with protocols approved by the WTC Pro-
gram Administrator and including clinical examina-
tions and long-term health monitoring and analysis. 
In the case of an enrolled WTC responder who is an 
active member of the Fire Department of New York 
City, 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 3313. 
‘‘SEC. 3312. TREATMENT OF ENROLLED 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 
condition 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 sub-
stantially likely to be a significant factor in ag-
gravating, contributing to, or causing the illness 
or health condition, as determined under para-
graph (2); or 
‘‘(ii) is a mental health condition for which 
such attacks, based on an examination by a
medical professional with experience in treating 
or diagnosing the health conditions included in 
the applicable list of WTC-related health condi-
tions, is substantially likely to be a significant 
factor in aggravating, contributing to, or caus-
ing the condition, as determined under para-
graph (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 
applied under section 3322(a). 
In the case of a WTC responder described in section 
3311(a)(2)(A)(ii) (relating to a surviving immediate 
family member of a firefighter), such term does not 
include an illness or health condition described in 
subparagraph (A)(i). 
‘‘(2) 
DETERMINATION.—The 
determination 
under paragraph (1) or subsection (b) of whether 
the September 11, 2001, terrorist attacks were sub-
stantially likely to be a significant factor in aggra-
vating, contributing to, or causing an individual’s ill-
ness or health condition shall be made based on an 
assessment of the following: 
‘‘(A) The individual’s exposure to airborne 
toxins, any other hazard, or any other adverse 
condition resulting from the terrorist attacks. 
Such exposure shall be— 
‘‘(i) 
evaluated 
and 
characterized 
through the use of a standardized, 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— 
‘‘(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 
RESPONDERS.—The list of health conditions for 
WTC responders consists of the following: 
‘‘(A) AERODIGESTIVE DISORDERS.— 
‘‘(i) Interstitial lung diseases. 
‘‘(ii) Chronic respiratory disorder— 
fumes/vapors. 
‘‘(iii) Asthma. 
‘‘(iv) Reactive airways dysfunction 
syndrome (RADS). 
‘‘(v) WTC-exacerbated chronic ob-
structive pulmonary disease (COPD). 
‘‘(vi) Chronic cough syndrome. 
‘‘(vii) Upper airway hyperreactivity. 
‘‘(viii) Chronic rhinosinusitis. 
‘‘(ix) Chronic nasopharyngitis. 
‘‘(x) Chronic laryngitis. 
‘‘(xi) Gastroesophageal reflux disorder 
(GERD).
‘‘(xii) Sleep apnea exacerbated by or 
related to a condition described in a 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. 
‘‘(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-re-
lated musculoskeletal disorder’ means a chronic 
or recurrent disorder of the musculoskeletal 
system caused by heavy lifting or repetitive 
strain on the joints or musculoskeletal system 
occurring during rescue or recovery efforts in 
the New York City disaster area in the after-
math of the September 11, 2001, terrorist at-
tacks. 
‘‘(5) CANCER.— 
‘‘(A) IN
GENERAL.—The WTC Program 
Administrator shall periodically conduct a re-
view of all available scientific and medical evi-
dence, 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 can-
cer should be added to the applicable list of 
WTC-related health conditions. The WTC Pro-
gram Administrator shall conduct the first re-
view 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 Pro-
gram Administrator shall propose regulations, 
through rulemaking, to add cancer or the cer-
tain 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-
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 de-
termines under subparagraph (B) or (C) that 
cancer 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 determina-
tion to not make such an addition shall not pre-
clude the addition of cancer or the certain type 
of cancer to such list at a later date. 
‘‘(6) ADDITION
OF
HEALTH
CONDITIONS
TO 
LIST FOR WTC RESPONDERS.— 
‘‘(A) IN
GENERAL.—Whenever the WTC 
Program Administrator determines that a pro-
posed rule should be promulgated to add a 
health condition to the list of health conditions 
in paragraph (3), the Administrator may re-
quest a recommendation of the Advisory Com-
mittee or may publish such a proposed rule in 
the Federal Register in accordance with sub-
paragraph (D).
‘‘(B) ADMINISTRATOR’S
OPTIONS
AFTER 
RECEIPT OF PETITION.—In the case that the 
WTC Program Administrator receives a written 
petition by an interested party to add a health 
condition to the list of health conditions in 
paragraph (3), not later than 60 days after the 
date of receipt of such petition the Adminis-
trator 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 
recommendation of the Advisory Committee 
under this paragraph, with respect to adding a
health condition to the list in paragraph (3), 
the Advisory Committee shall submit to the Ad-
ministrator such recommendation not later than 
60 days after the date of such request or by 
such date (not to exceed 180 days after such 
date of request) as specified by the Adminis-
trator. Not later than 60 days after the date of 
receipt of such recommendation, the Adminis-
trator 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. 
The WTC Program Administrator may extend 
the period described in clause (ii) upon a find-
ing of good cause. In the case of such an exten-
sion, the Administrator shall publish such ex-
tension in the Federal Register. 
‘‘(E) INTERESTED PARTY DEFINED.—For 
purposes of this paragraph, the term ‘interested 
party’ includes a representative of any organi-
zation representing WTC responders, a nation-
ally 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 
condition that is in the list in subsection (a)(3) 
and that exposure to airborne toxins, other haz-
ards, or adverse conditions resulting from the 
September 1, 2001, terrorist attacks is substan-
tially likely to be a significant factor in aggra-
vating, contributing to, or causing the condi-
tion— 
‘‘(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; 
AP-
PEALS.— 
‘‘(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 de-
termines that the responder’s condition is 
not a WTC-related health condition in the
list in subsection (a)(3) or that exposure to 
airborne toxins, other hazards, or adverse 
conditions resulting from the September 1, 
2001, 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 
ASSOCIATED 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
‘‘(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 subpara-
graph (A)(i), a determination by the WTC 
Program Administrator on whether or not 
the condition involved is described in sub-
section (a)(1)(A) and is medically associ-
ated with a WTC-related health condition; 
‘‘(iii) certification in accordance with 
paragraph (1)(B)(ii) of coverage of such 
condition if determined to be described in
subsection (a)(1)(A) and medically 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 CON-
DITIONS.—If the WTC Program Administrator 
provides 
certification 
under 
subparagraph 
(B)(iii) for coverage of a condition, the Admin-
istrator may, pursuant to subsection (a)(6), add 
the condition to the list in subsection (a)(3). 
‘‘(D) CONDITIONS
ALREADY
DECLINED 
FOR INCLUSION IN LIST.—If the WTC Program 
Administrator publishes a determination under 
subsection (a)(6)(B) not to include a condition 
in the list in subsection (a)(3), the WTC 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 
previous sentence shall not apply. 
‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.—
‘‘(A) IN
GENERAL.—In providing treat-
ment for a WTC-related health condition, a 
physician or other provider shall provide treat-
ment that is medically necessary and in accord-
ance with medical treatment protocols estab-
lished under subsection (d). 
‘‘(B) REGULATIONS
RELATING
TO
MED-
ICAL NECESSITY.—For the purpose of this title, 
the WTC Program Administrator shall issue 
regulations specifying a standard for deter-
mining medical 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 authorization requirement), and a process 
for appeal of a determination under subsection 
(c)(3). 
‘‘(4) SCOPE OF TREATMENT COVERED.— 
‘‘(A) IN
GENERAL.—The scope of treat-
ment covered under this subsection 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. 
‘‘(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 
NATIONWIDE
NETWORK.—The WTC Program 
Administrator may provide for necessary and 
reasonable transportation and expenses incident 
to the securing of medically necessary treat-
ment through the nationwide network under 
section 3313 involving travel of more than 250 
miles and for which payment is made under this 
section in the same manner in which individuals 
may be furnished necessary and reasonable 
transportation and expenses incident to services 
involving travel of more than 250 miles under 
regulations implementing section 3629(c) of the 
Energy Employees Occupational Illness 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-
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 
conditions 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.— 
Subject to subparagraphs (B) and (C), the 
WTC Program Administrator shall reimburse 
costs for medically necessary treatment under 
this title for WTC-related health conditions ac-
cording to the payment rates that would apply
to the provision of such treatment and services 
by the facility under the Federal Employees 
Compensation Act. For treatment not covered 
under the previous sentence or subparagraph 
(B), the WTC Program Administrator shall es-
tablish by regulation a reimbursement rate for 
such treatment. 
‘‘(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 
WTC-related health conditions through one 
or more contracts with outside vendors. 
‘‘(ii) COMPETITIVE BIDDING.—Under 
such program the Administrator shall— 
‘‘(I) select one or more 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 into an agreement with 
a separate vendor to provide pharma-
ceutical benefits to enrolled WTC respond-
ers for whom the Clinical Center of Excel-
lence is described in section 3305 if such 
an arrangement is deemed necessary and 
beneficial to the program by the WTC Pro-
gram Administrator. 
‘‘(C) IMPROVING
QUALITY
AND
EFFI-
CIENCY THROUGH MODIFICATION OF PAYMENT 
AMOUNTS
AND
METHODOLOGIES.—The WTC 
Program 
Administrator 
may 
modify 
the 
amounts and methodologies for making pay-
ments for initial health evaluations, monitoring, 
or treatment, if, taking into account utilization 
and quality data furnished by the Clinical Cen-
ters 
of 
Excellence 
under 
section 
3305(b)(1)(B)(iii), the Administrator deter-
mines that a bundling, capitation, pay for per-
formance, or other payment methodology would 
better ensure high quality and efficient delivery 
of initial health evaluations, monitoring, or 
treatment to an enrolled WTC responder,
‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 
‘‘(1) DEVELOPMENT.—The Data Centers shall 
develop medical treatment protocols for the treat-
ment of enrolled WTC responders and certified-eligi-
ble WTC survivors for health conditions included in 
the applicable list of WTC-related health conditions. 
‘‘(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 sur-
vivors, or certified-eligible WTC survivors and who reside 
in any State, as defined in section 2(f), outside the New 
York metropolitan area, the WTC Program Administrator 
shall establish a nationwide network of health care pro-
viders 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 evaluation through any Clinical Center of Excel-
lence.
‘‘(b) NETWORK REQUIREMENTS.—Any health care 
provider participating in the network under subsection (a) 
shall— 
‘‘(1) meet criteria for credentialing established 
by the Data Centers; 
‘‘(2) follow the monitoring, initial health evalua-
tion, and treatment protocols developed under sec-
tion 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 SUR-
VIVORS.— 
‘‘(1) SCREENING-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—In this title, the term 
‘screening-eligible WTC survivor’ means, sub-
ject to subparagraph (C) and paragraph (3), an 
individual who is described in any of the fol-
lowing 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 sub-
section (b), claims symptoms of a WTC-re-
lated health condition and meets any of the
current 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 ad-
verse conditions resulting from the Sep-
tember 11, 2001, terrorist attacks as the 
WTC Administrator determines, after con-
sultation 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 cri-
teria 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— 
‘‘(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 
subparagraph (B)(i) and had extensive ex-
posure to WTC dust as a result of such 
work. 
‘‘(iv) A person who was deemed eligi-
ble to receive a grant from the Lower 
Manhattan Development Corporation Resi-
dential Grant Program, who possessed a 
lease for a residence or purchased a resi-
dence 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. 
‘‘(v) A person whose place of employ-
ment— 
‘‘(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 at-
tacks. 
‘‘(C) APPLICATION
AND
DETERMINATION 
PROCESS FOR SCREENING ELIGIBILITY.— 
‘‘(i) IN
GENERAL.—The WTC Pro-
gram Administrator in consultation with 
the Data Centers shall establish a process 
for individuals, other than individuals de-
scribed in subparagraph (A)(i), to be de-
termined 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; 
‘‘(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 
a manner established under such 
process. 
‘‘(ii) WRITTEN
DOCUMENTATION
OF 
SCREENING-ELIGIBILITY.— 
‘‘(I) IN GENERAL.—In the case 
of an individual who is described in 
subparagraph (A)(i) or who is deter-
mined under clause (i) (consistent 
with paragraph (3)) to be a screening- 
eligible WTC survivor, the WTC Pro-
gram Administrator shall provide an 
appropriate 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) and consistent with paragraph 
(3) to be a screening-eligible 
WTC survivor, the WTC Pro-
gram Administrator shall provide 
the written documentation under 
subclause (I) at the time of such 
determination. 
‘‘(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—The term ‘certified-eli-
gible WTC survivor’ means, subject to para-
graph (3), a screening-eligible WTC survivor 
who the WTC Program Administrator certifies 
under subparagraph (B) to be eligible for fol-
lowup monitoring and treatment under this 
part. 
‘‘(B) CERTIFICATION OF ELIGIBILITY FOR 
MONITORING AND TREATMENT.— 
‘‘(i) IN
GENERAL.—The WTC Pro-
gram Administrator shall establish a cer-
tification process under which the Adminis-
trator shall provide appropriate certifi-
cation to screening-eligible WTC survivors 
who, pursuant to the initial health evalua-
tion under subsection (b), are determined 
to be eligible for followup monitoring and 
treatment under this part. 
‘‘(ii) TIMING.— 
‘‘(I) 
CURRENTLY
IDENTIFIED 
SURVIVORS.—In the case of an indi-
vidual 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 eligi-
ble for followup monitoring and treat-
ment, the WTC Program Adminis-
trator shall provide the certification 
under such clause at the time of such 
determination. 
‘‘(3) NUMERICAL LIMITATION ON CERTIFIED- 
ELIGIBLE WTC SURVIVORS.— 
‘‘(A) IN GENERAL.—The total number of 
individuals not described in paragraph (1)(A)(i) 
who may be certified as certified-eligible WTC 
survivors under paragraph (2)(B) shall not ex-
ceed 25,000 at any time. 
‘‘(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
subject to amounts made available 
under section 3351, that will ensure 
sufficient funds will be available to 
provide treatment and monitoring 
benefits under this title, with respect 
to all individuals receiving such cer-
tifications 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 Depart-
ment of Homeland Security shall qualify as a screen-
ing-eligible WTC survivor or a certified-eligible WTC 
survivor. Before determining any individual to be a 
screening-eligible WTC survivor under paragraph (1) 
or certifying any individual as a certified eligible 
WTC survivor under paragraph (2), the 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- 
eligible WTC survivor, the WTC Program shall pro-
vide for an initial health evaluation to determine if 
the survivor has a WTC-related health condition and 
is eligible for followup monitoring and treatment 
benefits under the WTC Program. Initial health 
evaluation protocols under section 3305(a)(2)(A)(ii) 
shall be subject to approval by the WTC Program 
Administrator. 
‘‘(2) 
INITIAL
HEALTH
EVALUATION
PRO-
VIDERS.—The initial health evaluation described in 
paragraph (1) shall be provided through a Clinical 
Center of Excellence with respect to the individual 
involved. 
‘‘(3) LIMITATION ON INITIAL HEALTH 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 
provisions of sections 3311 and 3312 shall apply to fol-
lowup 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: 
‘‘(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). 
‘‘(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 ap-
plied under subsection (a) with respect to certified- 
eligible WTC survivors. 
‘‘SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF 
OTHER INDIVIDUALS WITH WTC-RELATED 
HEALTH CONDITIONS. 
‘‘(a) IN GENERAL.—Subject to subsection (c), the 
provisions of section 3322 shall apply to the followup mon-
itoring and treatment of WTC-related health conditions 
in the case of individuals described in subsection (b) in 
the same manner as such provisions apply to the followup 
monitoring and treatment of WTC-related health condi-
tions for certified-eligible WTC survivors. 
‘‘(b) INDIVIDUALS DESCRIBED.—An individual de-
scribed in this subsection is an individual who, regardless 
of location of residence— 
‘‘(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 Admin-
istrator 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 
consumer price index for all urban consumers. 
‘‘PART 3—PAYOR PROVISIONS 
‘‘SEC. 3331. PAYMENT OF CLAIMS. 
‘‘(a) IN GENERAL.—Except as provided in sub-
sections (b) and (c), the cost of monitoring and treatment 
benefits and initial health evaluation benefits provided 
under parts 1 and 2 of this subtitle shall be paid for by 
the WTC Program from the World Trade Center Health 
Program Fund. 
‘‘(b) WORKERS’ COMPENSATION PAYMENT.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), 
payment for treatment under parts 1 and 2 of this 
subtitle of a WTC-related health condition of an in-
dividual that is work-related shall be reduced or re-
couped to the extent that the WTC Program Admin-
istrator determines that payment has been made, or 
can reasonably be expected to be made, under a 
workers’ compensation law or plan of the United 
States, a State, or a locality, or other work-related 
injury or illness benefit plan of the employer of such 
individual, for such treatment. The provisions of 
clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) 
of section 1862(b) of the Social Security Act and 
paragraphs (3) and (4) of such section shall apply 
to the recoupment under this subsection of a pay-
ment to the WTC Program (with respect to a work-
ers’ compensation law or plan, or other work-related 
injury or illness plan of the employer involved, and 
such individual) in the same manner as such provi-
sions apply to the reimbursement 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) except that any reference in such para-
graph (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 re-
lieve any obligations under a worker’s compensation 
law or plan, other work-related injury or illness ben-
efit 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-
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 manner as they apply to group health plan 
and an individual entitled to benefits under title