H. R. 3590—837 
‘‘(B) is an environmental exposure affected individual 
described in subsection (e)(3) who— 
‘‘(i) is deemed under subsection (a)(2); and 
‘‘(ii) meets such other criteria or conditions for 
participation in a pilot program under paragraph (1)(B) 
as the Secretary specifies. 
‘‘(3) FLEXIBLE BENEFITS AND SERVICES.—A pilot program 
under this subsection may provide for the furnishing of benefits, 
items, or services not otherwise covered or authorized under 
this title, if the Secretary determines that furnishing such 
benefits, items, or services will further the purposes of such 
pilot program (as described in paragraph (1)). 
‘‘(4) INNOVATIVE
REIMBURSEMENT
METHODOLOGIES.—For 
purposes of the pilot program under this subsection, the Sec-
retary— 
‘‘(A) shall develop and implement appropriate meth-
odologies to reimburse providers for furnishing benefits, 
items, or services for which payment is not otherwise cov-
ered or authorized under this title, if such benefits, items, 
or services are furnished pursuant to paragraph (3); and 
‘‘(B) may develop and implement innovative approaches 
to reimbursing providers for any benefits, items, or services 
furnished under this subsection. 
‘‘(5) LIMITATION.—Consistent with section 1862(b), no pay-
ment shall be made under the pilot program under this sub-
section with respect to benefits, items, or services furnished 
to an environmental exposure affected individual (as defined 
in subsection (e)) to the extent that such individual is eligible 
to receive such benefits, items, or services through any other 
public or private benefits plan or legal agreement. 
‘‘(6) WAIVER AUTHORITY.—The Secretary may waive such 
provisions of this title and title XI as are necessary to carry 
out pilot programs under this subsection. 
‘‘(7) FUNDING.—For purposes of carrying out pilot programs 
under this subsection, the Secretary shall provide for the 
transfer, from the Federal Hospital Insurance Trust Fund under 
section 1817 and the Federal Supplementary Medical Insurance 
Trust Fund under section 1841, in such proportion as the 
Secretary determines appropriate, of such sums as the Sec-
retary determines necessary, to the Centers for Medicare & 
Medicaid Services Program Management Account. 
‘‘(8) WAIVER OF BUDGET NEUTRALITY.—The Secretary shall 
not require that pilot programs under this subsection be budget 
neutral with respect to expenditures under this title. 
‘‘(c) DETERMINATIONS.— 
‘‘(1) BY THE COMMISSIONER OF SOCIAL SECURITY.—For pur-
poses of this section, the Commissioner of Social Security, in 
consultation with the Secretary, and using the cost allocation 
method prescribed in section 201(g), shall determine whether 
individuals are environmental exposure affected individuals. 
‘‘(2) BY THE SECRETARY.—The Secretary shall determine 
eligibility for pilot programs under subsection (b). 
‘‘(d) EMERGENCY DECLARATION DEFINED.—For purposes of this 
section, the term ‘emergency declaration’ means a declaration of 
a public health emergency under section 104(a) of the Comprehen-
sive Environmental Response, Compensation, and Liability Act of 
1980.
H. R. 3590—838 
‘‘(e) 
ENVIRONMENTAL
EXPOSURE
AFFECTED
INDIVIDUAL 
DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this section, the term 
‘environmental exposure affected individual’ means— 
‘‘(A) an individual described in paragraph (2); and 
‘‘(B) an individual described in paragraph (3). 
‘‘(2) INDIVIDUAL DESCRIBED.— 
‘‘(A) IN GENERAL.—An individual described in this para-
graph is any individual who— 
‘‘(i) is diagnosed with 1 or more conditions 
described in subparagraph (B); 
‘‘(ii) as demonstrated in such manner as the Sec-
retary determines appropriate, has been present for 
an aggregate total of 6 months in the geographic area 
subject to an emergency declaration specified in sub-
section (b)(2)(A), during a period ending— 
‘‘(I) not less than 10 years prior to such diag-
nosis; and 
‘‘(II) prior to the implementation of all the 
remedial and removal actions specified in the 
Record of Decision for Operating Unit 4 and the 
Record of Decision for Operating Unit 7; 
‘‘(iii) files an application for benefits under this 
title (or has an application filed on behalf of the indi-
vidual), including pursuant to this section; and 
‘‘(iv) is determined under this section to meet the 
criteria in this subparagraph. 
‘‘(B) CONDITIONS DESCRIBED.—For purposes of subpara-
graph (A), the following conditions are described in this 
subparagraph: 
‘‘(i) Asbestosis, pleural thickening, or pleural 
plaques as established by— 
‘‘(I) interpretation by a ‘B Reader’ qualified 
physician of a plain chest x-ray or interpretation 
of a computed tomographic radiograph of the chest 
by a qualified physician, as determined by the 
Secretary; or 
‘‘(II) such other diagnostic standards as the 
Secretary specifies, 
except that this clause shall not apply to pleural thick-
ening or pleural plaques unless there are symptoms 
or conditions requiring medical treatment as a result 
of these diagnoses. 
‘‘(ii) Mesothelioma, or malignancies of the lung, 
colon, rectum, larynx, stomach, esophagus, pharynx, 
or ovary, as established by— 
‘‘(I) pathologic examination of biopsy tissue; 
‘‘(II) cytology from bronchioalveolar lavage; or 
‘‘(III) such other diagnostic standards as the 
Secretary specifies. 
‘‘(iii) Any other diagnosis which the Secretary, in 
consultation with the Commissioner of Social Security, 
determines is an asbestos-related medical condition, 
as established by such diagnostic standards as the 
Secretary specifies. 
‘‘(3) 
OTHER
INDIVIDUAL
DESCRIBED.—An 
individual 
described in this paragraph is any individual who—
H. R. 3590—839 
‘‘(A) is not an individual described in paragraph (2); 
‘‘(B) is diagnosed with a medical condition caused by 
the exposure of the individual to a public health hazard 
to which an emergency declaration applies, based on such 
medical conditions, diagnostic standards, and other criteria 
as the Secretary specifies; 
‘‘(C) as demonstrated in such manner as the Secretary 
determines appropriate, has been present for an aggregate 
total of 6 months in the geographic area subject to the 
emergency declaration involved, during a period deter-
mined appropriate by the Secretary; 
‘‘(D) files an application for benefits under this title 
(or has an application filed on behalf of the individual), 
including pursuant to this section; and 
‘‘(E) is determined under this section to meet the cri-
teria in this paragraph.’’. 
(b) PROGRAM
FOR EARLY DETECTION
OF CERTAIN MEDICAL 
CONDITIONS RELATED TO ENVIRONMENTAL HEALTH HAZARDS.—Title 
XX of the Social Security Act (42 U.S.C. 1397 et seq.), as amended 
by section 5507, is amended by adding at the end the following: 
‘‘SEC. 2009. PROGRAM FOR EARLY DETECTION OF CERTAIN MEDICAL 
CONDITIONS RELATED TO ENVIRONMENTAL HEALTH 
HAZARDS. 
‘‘(a) PROGRAM ESTABLISHMENT.—The Secretary shall establish 
a program in accordance with this section to make competitive 
grants to eligible entities specified in subsection (b) for the purpose 
of— 
‘‘(1) screening at-risk individuals (as defined in subsection 
(c)(1)) for environmental health conditions (as defined in sub-
section (c)(3)); and 
‘‘(2) developing and disseminating public information and 
education concerning— 
‘‘(A) the availability of screening under the program 
under this section; 
‘‘(B) the detection, prevention, and treatment of 
environmental health conditions; and 
‘‘(C) the availability of Medicare benefits for certain 
individuals diagnosed with environmental health conditions 
under section 1881A. 
‘‘(b) ELIGIBLE ENTITIES.— 
‘‘(1) IN GENERAL.—For purposes of this section, an eligible 
entity is an entity described in paragraph (2) which submits 
an application to the Secretary in such form and manner, 
and containing such information and assurances, as the Sec-
retary determines appropriate. 
‘‘(2) TYPES OF ELIGIBLE ENTITIES.—The entities described 
in this paragraph are the following: 
‘‘(A) A hospital or community health center. 
‘‘(B) A Federally qualified health center. 
‘‘(C) A facility of the Indian Health Service. 
‘‘(D) A National Cancer Institute-designated cancer 
center. 
‘‘(E) An agency of any State or local government. 
‘‘(F) A nonprofit organization. 
‘‘(G) Any other entity the Secretary determines appro-
priate.
H. R. 3590—840 
‘‘(c) DEFINITIONS.—In this section: 
‘‘(1) AT-RISK
INDIVIDUAL.—The term ‘at-risk individual’ 
means an individual who— 
‘‘(A)(i) as demonstrated in such manner as the Sec-
retary determines appropriate, has been present for an 
aggregate total of 6 months in the geographic area subject 
to an emergency declaration specified under paragraph (2), 
during a period ending— 
‘‘(I) not less than 10 years prior to the date of 
such individual’s application under subparagraph (B); 
and 
‘‘(II) prior to the implementation of all the remedial 
and removal actions specified in the Record of Decision 
for Operating Unit 4 and the Record of Decision for 
Operating Unit 7; or 
‘‘(ii) meets such other criteria as the Secretary deter-
mines appropriate considering the type of environmental 
health condition at issue; and 
‘‘(B) has submitted an application (or has an applica-
tion submitted on the individual’s behalf), to an eligible 
entity receiving a grant under this section, for screening 
under the program under this section. 
‘‘(2) EMERGENCY DECLARATION.—The term ‘emergency dec-
laration’ means a declaration of a public health emergency 
under section 104(a) of the Comprehensive Environmental 
Response, Compensation, and Liability Act of 1980. 
‘‘(3) 
ENVIRONMENTAL
HEALTH
CONDITION.—The 
term 
‘environmental health condition’ means— 
‘‘(A) asbestosis, pleural thickening, or pleural plaques, 
as established by— 
‘‘(i) interpretation by a ‘B Reader’ qualified physi-
cian of a plain chest x-ray or interpretation of a com-
puted tomographic radiograph of the chest by a quali-
fied physician, as determined by the Secretary; or 
‘‘(ii) such other diagnostic standards as the Sec-
retary specifies; 
‘‘(B) mesothelioma, or malignancies of the lung, colon, 
rectum, larynx, stomach, esophagus, pharynx, or ovary, 
as established by— 
‘‘(i) pathologic examination of biopsy tissue; 
‘‘(ii) cytology from bronchioalveolar lavage; or 
‘‘(iii) such other diagnostic standards as the Sec-
retary specifies; and 
‘‘(C) any other medical condition which the Secretary 
determines is caused by exposure to a hazardous substance 
or pollutant or contaminant at a Superfund site to which 
an emergency declaration applies, based on such criteria 
and as established by such diagnostic standards as the 
Secretary specifies. 
‘‘(4) HAZARDOUS SUBSTANCE; POLLUTANT; CONTAMINANT.— 
The terms ‘hazardous substance’, ‘pollutant’, and ‘contaminant’ 
have the meanings given those terms in section 101 of the 
Comprehensive Environmental Response, Compensation, and 
Liability Act of 1980 (42 U.S.C. 9601). 
‘‘(5) SUPERFUND SITE.—The term ‘Superfund site’ means 
a site included on the National Priorities List developed by 
the President in accordance with section 105(a)(8)(B) of the