In the Senate of the United States, 
December 22, 2010. 
Resolved, That the bill from the House of Representa-
tives (H.R. 847) entitled ‘‘An Act to amend the Public 
Health Service Act to extend and improve protections and 
services to individuals directly impacted by the terrorist at-
tack in New York City on September 11, 2001, and for other 
purposes.’’, do pass with the following 
AMENDMENT: 
Strike all after the enacting clause and insert the 
following: 
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.
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‘‘TITLE XXXIII—WORLD TRADE CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Program; Advisory Committee 
‘‘Sec. 3301. Establishment of World Trade Center Health Program. 
‘‘Sec. 3302. WTC Health Program Scientific/Technical Advisory Committee; 
WTC Health Program Steering Committees. 
‘‘Sec. 3303. Education and outreach. 
‘‘Sec. 3304. Uniform data collection and analysis. 
‘‘Sec. 3305. Clinical Centers of Excellence and Data Centers. 
‘‘Sec. 3306. Definitions. 
‘‘Subtitle B—Program of Monitoring, Initial Health Evaluations, and 
Treatment 
‘‘PART 1—WTC RESPONDERS 
‘‘Sec. 3311. Identification of WTC responders and provision of WTC-related 
monitoring services. 
‘‘Sec. 3312. Treatment of enrolled WTC responders for WTC-related health 
conditions. 
‘‘Sec. 3313. National arrangement for benefits for eligible individuals outside 
New York. 
‘‘PART 2—WTC SURVIVORS 
‘‘Sec. 3321. Identification and initial health evaluation of screening-eligible 
and certified-eligible WTC survivors. 
‘‘Sec. 3322. Followup monitoring and treatment of certified-eligible WTC 
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—REVENUE RELATED PROVISIONS 
Sec. 301. Excise tax on foreign procurement.
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Sec. 302. Renewal of fees for visa-dependent employers. 
TITLE IV—BUDGETARY EFFECTS 
Sec. 401. Compliance with Statutory Pay-As-You-Go Act of 2010. 
TITLE I—WORLD TRADE CENTER 
HEALTH PROGRAM 
SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM. 
The Public Health Service Act is amended by adding 
at the end the following new title: 
‘‘TITLE XXXIII—WORLD TRADE 
CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of 
Program; Advisory Committee 
‘‘SEC. 3301. ESTABLISHMENT OF WORLD TRADE CENTER 
HEALTH PROGRAM. 
‘‘(a) IN GENERAL.—There is hereby established within 
the Department of Health and Human Services a program 
to be known as the World Trade Center Health Program, 
which shall be administered by the WTC Program Adminis-
trator, 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 em-
ployees) who responded to the September 11, 2001, 
terrorist attacks; and 
‘‘(2) initial health evaluation, monitoring, and 
treatment benefits to residents and other building oc-
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cupants and area workers in New York City who were 
directly impacted and adversely affected by such at-
tacks. 
‘‘(b) COMPONENTS OF PROGRAM.—The WTC Program 
includes the following components: 
‘‘(1) MEDICAL MONITORING FOR RESPONDERS.— 
Medical monitoring under section 3311, including 
clinical examinations and long-term health moni-
toring and analysis for enrolled WTC responders who 
were likely to have been exposed to airborne toxins 
that were released, or to other hazards, as a result of 
the September 11, 2001, terrorist attacks. 
‘‘(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 sections 
3312, 3322, and 3323 of followup monitoring and 
treatment and payment, subject to the provisions of 
subsection (d), for all medically necessary health and 
mental health care expenses of an individual with re-
spect to a WTC-related health condition (including 
necessary prescription drugs).
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‘‘(4) OUTREACH.—Establishment under section 
3303 of an education and outreach program to poten-
tially 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 bene-
fits are provided under subtitle B without any deductibles, 
copayments, or other cost sharing to a screening-eligible 
WTC survivor. 
‘‘(d) PREVENTING FRAUD AND UNREASONABLE AD-
MINISTRATIVE COSTS.—
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‘‘(1) FRAUD.—The Inspector General of the De-
partment 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 pro-
gram (as defined in section 1128B(f) of the Social Se-
curity Act) and is a health plan (as defined in section 
1128C(c) of such Act) for purposes of applying sec-
tions 1128 through 1128E of such Act. 
‘‘(2) UNREASONABLE ADMINISTRATIVE COSTS.— 
The Inspector General of the Department of Health 
and Human Services shall develop and implement a 
program to review the WTC Program for unreason-
able administrative costs, including with respect to 
infrastructure, administration, and claims processing. 
‘‘(e) QUALITY ASSURANCE.—The WTC Program Ad-
ministrator working with the Clinical Centers of Excellence 
shall develop and implement a quality assurance program 
for the monitoring and treatment delivered by such Centers 
of Excellence and any other participating health care pro-
viders. Such program shall include— 
‘‘(1) adherence to monitoring and treatment pro-
tocols;
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‘‘(2) appropriate diagnostic and treatment refer-
rals 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 Adminis-
trator shall submit an annual report to the Congress 
on the operations of this title for such fiscal year and 
for the entire period of operation of the program. 
‘‘(2) CONTENTS
INCLUDED
IN
REPORT.—Each 
annual report under paragraph (1) shall include at 
least the following: 
‘‘(A) ELIGIBLE INDIVIDUALS.—Information 
for each clinical program described in paragraph 
(3)— 
‘‘(i) on the number of individuals who 
applied for certification under subtitle B 
and the number of such individuals who 
were so certified;
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‘‘(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 suc-
ceeding 10-year period. 
‘‘(B) MONITORING, INITIAL HEALTH EVAL-
UATION, AND TREATMENT COSTS.—For each clin-
ical 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 medical 
treatment for WTC-related health conditions 
that have been paid for or reimbursed by 
workers’ compensation, by public or private
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health plans, or by New York City under 
section 3331. 
‘‘(C) ADMINISTRATIVE COSTS.—Information 
on the cost of administering the program, includ-
ing costs of program support, data collection and 
analysis, and research conducted under the pro-
gram. 
‘‘(D) ADMINISTRATIVE
EXPERIENCE.—In-
formation on the administrative performance of 
the program, including— 
‘‘(i) the performance of the program in 
providing timely evaluation of and treat-
ment to eligible individuals; and 
‘‘(ii) a list of the Clinical Centers of 
Excellence and other providers that are par-
ticipating in the program. 
‘‘(E) SCIENTIFIC REPORTS.—A summary of 
the findings of any new scientific reports or 
studies on the health effects associated with expo-
sure described in section 3306(1), including the 
findings of research conducted under section 
3341(a). 
‘‘(F) ADVISORY COMMITTEE RECOMMENDA-
TIONS.—A list of recommendations by the WTC 
Scientific/Technical Advisory Committee on ad-
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ditional WTC Program eligibility criteria and 
on additional WTC-related health conditions and 
the action of the WTC Program Administrator 
concerning each such recommendation. 
‘‘(3) 
SEPARATE
CLINICAL
PROGRAMS
DE-
SCRIBED.—In paragraph (2), each of the following 
shall be treated as a separate clinical program of the 
WTC Program: 
‘‘(A) FIREFIGHTERS
AND
RELATED
PER-
SONNEL.—The benefits provided for enrolled 
WTC 
responders 
described 
in 
section 
3311(a)(2)(A). 
‘‘(B) OTHER WTC RESPONDERS.—The bene-
fits provided for enrolled WTC responders not de-
scribed in subparagraph (A). 
‘‘(C) WTC SURVIVORS.—The benefits pro-
vided for screening-eligible WTC survivors and 
certified-eligible 
WTC 
survivors 
in 
section 
3321(a). 
‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING 80 
PERCENT OF ELIGIBILITY NUMERICAL LIMITS.—The Sec-
retary shall promptly notify the Congress of each of the fol-
lowing:
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‘‘(1) When the number of enrollments of WTC re-
sponders subject to the limit established under section 
3311(a)(4) has reached 80 percent of such limit. 
‘‘(2) When the number of certifications for cer-
tified-eligible WTC survivors subject to the limit es-
tablished under section 3321(a)(3) has reached 80 
percent of such limit. 
‘‘(h) CONSULTATION.—The WTC Program Adminis-
trator shall engage in ongoing outreach and consultation 
with relevant stakeholders, including the WTC Health Pro-
gram Steering Committees and the Advisory Committee 
under section 3302, regarding the implementation and im-
provement of programs under this title. 
‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL 
ADVISORY COMMITTEE; WTC HEALTH PRO-
GRAM STEERING COMMITTEES. 
‘‘(a) ADVISORY COMMITTEE.— 
‘‘(1) ESTABLISHMENT.—The WTC Program Ad-
ministrator shall establish an advisory committee to 
be known as the WTC Health Program Scientific/ 
Technical Advisory Committee (in this subsection re-
ferred to as the ‘Advisory Committee’) to review sci-
entific and medical evidence and to make rec-
ommendations to the Administrator on additional
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WTC Program eligibility criteria and on additional 
WTC-related health conditions. 
‘‘(2) COMPOSITION.—The WTC Program Admin-
istrator shall appoint the members of the Advisory 
Committee and shall include at least— 
‘‘(A) 4 occupational physicians, at least 2 
of whom have experience treating WTC rescue 
and recovery workers; 
‘‘(B) 1 physician with expertise in pul-
monary medicine; 
‘‘(C) 2 environmental medicine or environ-
mental health specialists; 
‘‘(D) 2 representatives of WTC responders; 
‘‘(E) 2 representatives of certified-eligible 
WTC survivors; 
‘‘(F) an industrial hygienist; 
‘‘(G) a toxicologist; 
‘‘(H) an epidemiologist; and 
‘‘(I) a mental health professional. 
‘‘(3) MEETINGS.—The Advisory Committee shall 
meet at such frequency as may be required to carry 
out its duties. 
‘‘(4) REPORTS.—The WTC Program Adminis-
trator shall provide for publication of recommenda-
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tions of the Advisory Committee on the public Web 
site established for the WTC Program. 
‘‘(5) DURATION.—Notwithstanding any other 
provision of law, the Advisory Committee shall con-
tinue in operation during the period in which the 
WTC Program is in operation. 
‘‘(6) APPLICATION OF FACA.—Except as other-
wise specifically provided, the Advisory Committee 
shall be subject to the Federal Advisory Committee 
Act. 
‘‘(b) WTC HEALTH PROGRAM STEERING COMMIT-
TEES.— 
‘‘(1) CONSULTATION.—The WTC Program Ad-
ministrator shall consult with 2 steering committees 
(each in this section referred to as a ‘Steering Com-
mittee’) that are established as follows: 
‘‘(A) WTC RESPONDERS
STEERING
COM-
MITTEE.—One Steering Committee, to be known 
as the WTC Responders Steering Committee, for 
the purpose of receiving input from affected 
stakeholders and facilitating the coordination of 
monitoring and treatment programs for the en-
rolled WTC responders under part 1 of subtitle 
B.
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‘‘(B) WTC 
SURVIVORS
STEERING
COM-
MITTEE.—One Steering Committee, to be known 
as the WTC Survivors Steering Committee, for 
the purpose of receiving input from affected 
stakeholders and facilitating the coordination of 
initial health evaluations, monitoring, and treat-
ment programs for screening-eligible and cer-
tified-eligible WTC survivors under part 2 of 
subtitle B. 
‘‘(2) MEMBERSHIP.— 
‘‘(A) WTC RESPONDERS
STEERING
COM-
MITTEE.— 
‘‘(i) REPRESENTATION.—The WTC Re-
sponders Steering Committee shall in-
clude— 
‘‘(I) representatives of the Centers 
of Excellence providing services to 
WTC responders; 
‘‘(II) representatives of labor or-
ganizations representing firefighters, 
police, other New York City employees, 
and recovery and cleanup workers who 
responded to the September 11, 2001, 
terrorist attacks; and
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‘‘(III) 3 representatives of New 
York City, 1 of whom will be selected 
by the police commissioner of New 
York City, 1 by the health commis-
sioner of New York City, and 1 by the 
mayor of New York City. 
‘‘(ii) INITIAL MEMBERSHIP.—The WTC 
Responders Steering Committee shall ini-
tially be composed of members of the WTC 
Monitoring and Treatment Program Steer-
ing Committee (as in existence on the day 
before the date of the enactment of this 
title). 
‘‘(B) WTC 
SURVIVORS
STEERING
COM-
MITTEE.— 
‘‘(i) 
REPRESENTATION.—The 
WTC 
Survivors Steering Committee shall include 
representatives of— 
‘‘(I) the Centers of Excellence pro-
viding services to screening-eligible and 
certified-eligible WTC survivors; 
‘‘(II) the population of residents, 
students, and area and other workers 
affected by the September 11, 2001, ter-
rorist attacks;
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‘‘(III) screening-eligible and cer-
tified-eligible survivors receiving ini-
tial health evaluations, monitoring, or 
treatment under part 2 of subtitle B 
and organizations advocating on their 
behalf; and 
‘‘(IV) New York City. 
‘‘(ii) INITIAL MEMBERSHIP.—The WTC 
Survivors Steering Committee shall ini-
tially be composed of members of the WTC 
Environmental Health Center Survivor Ad-
visory Committee (as in existence on the 
day before the date of the enactment of this 
title). 
‘‘(C) ADDITIONAL
APPOINTMENTS.—Each 
Steering Committee may recommend, if ap-
proved by a majority of voting members of the 
Committee, additional members to the Com-
mittee. 
‘‘(D) VACANCIES.—A vacancy in a Steering 
Committee shall be filled by an individual rec-
ommended by the Steering Committee. 
‘‘SEC. 3303. EDUCATION AND OUTREACH. 
‘‘The WTC Program Administrator shall institute a 
program that provides education and outreach on the exist-
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ence and availability of services under the WTC Program. 
The outreach and education program— 
‘‘(1) shall include— 
‘‘(A) the establishment of a public Web site 
with information about the WTC Program; 
‘‘(B) meetings with potentially eligible pop-
ulations; 
‘‘(C) development and dissemination of out-
reach materials informing people about the pro-
gram; and 
‘‘(D) the establishment of phone information 
services; and 
‘‘(2) shall be conducted in a manner intended— 
‘‘(A) to reach all affected populations; and 
‘‘(B) to include materials for culturally and 
linguistically diverse populations. 
‘‘SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS. 
‘‘(a) IN GENERAL.—The WTC Program Administrator 
shall provide for the uniform collection of data, including 
claims data (and analysis of data and regular reports to 
the Administrator) on the prevalence of WTC-related health 
conditions and the identification of new WTC-related health 
conditions. Such data shall be collected for all individuals 
provided monitoring or treatment benefits under subtitle B 
and regardless of their place of residence or Clinical Center
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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.—
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‘‘(1) CONTRACTS
WITH
CLINICAL
CENTERS
OF 
EXCELLENCE.—The WTC Program Administrator 
shall, subject to subsection (b)(1)(B), enter into con-
tracts with Clinical Centers of Excellence (as defined 
in subsection (b)(1)(A))— 
‘‘(A) for the provision of monitoring and 
treatment benefits and initial health evaluation 
benefits under subtitle B; 
‘‘(B) for the provision of outreach activities 
to individuals eligible for such monitoring and 
treatment benefits, for initial health evaluation 
benefits, and for followup to individuals who are 
enrolled in the monitoring program; 
‘‘(C) for the provision of counseling for ben-
efits under subtitle B, with respect to WTC-re-
lated health conditions, for individuals eligible 
for such benefits; 
‘‘(D) for the provision of counseling for ben-
efits for WTC-related health conditions that may 
be available under workers’ compensation or 
other benefit programs for work-related injuries 
or illnesses, health insurance, disability insur-
ance, or other insurance plans or through public 
or private social service agencies and assisting 
eligible individuals in applying for such benefits;
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‘‘(E) for the provision of translational and 
interpretive services for program participants 
who are not English language proficient; and 
‘‘(F) for the collection and reporting of 
data, including claims data, in accordance with 
section 3304. 
‘‘(2) CONTRACTS WITH DATA CENTERS.— 
‘‘(A) IN GENERAL.—The WTC Program Ad-
ministrator shall enter into contracts with one or 
more Data Centers (as defined in subsection 
(b)(2))— 
‘‘(i) for receiving, analyzing, and re-
porting to the WTC Program Administrator 
on data, in accordance with section 3304, 
that have been collected and reported to such 
Data Centers by the corresponding Clinical 
Centers of Excellence under subsection 
(b)(1)(B)(iii); 
‘‘(ii) for the development of moni-
toring, initial health evaluation, and treat-
ment protocols, with respect to WTC-related 
health conditions; 
‘‘(iii) for coordinating the outreach ac-
tivities conducted under paragraph (1)(B)
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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 Excellence 
to obtain input on the analysis and report-
ing of data collected under clause (i) and on 
the development of monitoring, initial 
health evaluation, and treatment protocols 
under clause (ii). 
‘‘(B) MEDICAL PROVIDER SELECTION.—The 
medical providers under subparagraph (A)(iv) 
shall be selected by the WTC Program Adminis-
trator on the basis of their experience treating or 
diagnosing the health conditions included in the 
list of WTC-related health conditions. 
‘‘(C) CLINICAL DISCUSSIONS.—In carrying 
out subparagraph (A)(ii), a Data Center shall
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engage in clinical discussions across the WTC 
Program to guide treatment approaches for indi-
viduals with a WTC-related health condition. 
‘‘(D) TRANSPARENCY OF DATA.—A contract 
entered into under this subsection with a Data 
Center shall require the Data Center to make 
any data collected and reported to such Center 
under subsection (b)(1)(B)(iii) available to 
health researchers and others as provided in the 
CDC/ATSDR Policy on Releasing and Sharing 
Data. 
‘‘(3) AUTHORITY FOR CONTRACTS TO BE CLASS 
SPECIFIC.—A contract entered into under this sub-
section with a Clinical Center of Excellence or a Data 
Center may be with respect to one or more class of 
enrolled WTC responders, screening-eligible WTC sur-
vivors, or certified-eligible WTC survivors. 
‘‘(4) USE OF COOPERATIVE AGREEMENTS.—Any 
contract under this title between the WTC Program 
Administrator and a Data Center or a Clinical Cen-
ter of Excellence may be in the form of a cooperative 
agreement. 
‘‘(5) REVIEW ON FEASIBILITY OF CONSOLIDATING 
DATA CENTERS.—Not later than July 1, 2011, the 
Comptroller General of the United States shall submit
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to the Committee on Energy and Commerce of the 
House of Representatives and the Committee on 
Health, Education, Labor, and Pensions of the Senate 
a report on the feasibility of consolidating Data Cen-
ters into a single Data Center. 
‘‘(b) CENTERS OF EXCELLENCE.— 
‘‘(1) CLINICAL CENTERS OF EXCELLENCE.— 
‘‘(A) DEFINITION.—For purposes of this 
title, the term ‘Clinical Center of Excellence’ 
means a Center that demonstrates to the satisfac-
tion of the Administrator that the Center— 
‘‘(i) uses an integrated, centralized 
health care provider approach to create a 
comprehensive suite of health services under 
this title that are accessible to enrolled WTC 
responders, screening-eligible WTC sur-
vivors, or certified-eligible WTC survivors; 
‘‘(ii) has experience in caring for WTC 
responders and screening-eligible WTC sur-
vivors or includes health care providers who 
have been trained pursuant to section 
3313(c); 
‘‘(iii) employs health care provider 
staff with expertise that includes, at a min-
imum, occupational 
medicine, 
environ-
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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 routine 
medical care provided for the treatment of 
conditions other than WTC-related health 
conditions. 
‘‘(iii) Collect and report to the cor-
responding Data Center data, including 
claims data, in accordance with section 
3304(b).
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‘‘(iv) Have in place safeguards against 
fraud that are satisfactory to the Adminis-
trator, in consultation with the Inspector 
General of the Department of Health and 
Human Services. 
‘‘(v) Treat or refer for treatment all in-
dividuals who are enrolled WTC responders 
or certified-eligible WTC survivors with re-
spect to such Center who present themselves 
for treatment of a WTC-related health con-
dition. 
‘‘(vi) Have in place safeguards, con-
sistent with section 3304(c), to ensure the 
confidentiality of an individual’s individ-
ually identifiable health information, in-
cluding requiring that such information not 
be disclosed to the individual’s employer 
without the authorization of the individual. 
‘‘(vii) Use amounts paid under sub-
section (c)(1) only for costs incurred in car-
rying out the activities described in sub-
section (a), other than those described in 
subsection (a)(1)(A). 
‘‘(viii) Utilize health care providers 
with occupational and environmental medi-
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cine expertise to conduct physical and men-
tal health assessments, in accordance with 
protocols 
developed 
under 
subsection 
(a)(2)(A)(ii). 
‘‘(ix) Communicate with WTC re-
sponders and screening-eligible and cer-
tified-eligible WTC survivors in appropriate 
languages and conduct outreach activities 
with relevant stakeholder worker or commu-
nity associations. 
‘‘(x) Meet all the other applicable re-
quirements of this title, including regula-
tions implementing such requirements. 
‘‘(C) TRANSITION RULE TO ENSURE CON-
TINUITY OF CARE.—The WTC Program Admin-
istrator shall to the maximum extent feasible en-
sure continuity of care in any period of transi-
tion from monitoring and treatment of an en-
rolled WTC responder or certified-eligible WTC 
survivor by a provider to a Clinical Center of 
Excellence or a health care provider partici-
pating in the nationwide network under section 
3313. 
‘‘(2) DATA CENTERS.—For purposes of this title, 
the term ‘Data Center’ means a Center that the WTC
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Program Administrator determines has the capacity 
to carry out the responsibilities for a Data Center 
under subsection (a)(2). 
‘‘(3) CORRESPONDING CENTERS.—For purposes 
of this title, a Clinical Center of Excellence and a 
Data Center shall be treated as ‘corresponding’ to the 
extent that such Clinical Center and Data Center 
serve the same population group. 
‘‘(c) PAYMENT FOR INFRASTRUCTURE COSTS.— 
‘‘(1) IN GENERAL.—The WTC Program Adminis-
trator shall reimburse a Clinical Center of Excellence 
for the fixed infrastructure costs of such Center in 
carrying out the activities described in subtitle B at 
a rate negotiated by the Administrator and such Cen-
ters. Such negotiated rate shall be fair and appro-
priate and take into account the number of enrolled 
WTC responders receiving services from such Center 
under this title. 
‘‘(2) FIXED INFRASTRUCTURE COSTS.—For pur-
poses of paragraph (1), the term ‘fixed infrastructure 
costs’ means, with respect to a Clinical Center of Ex-
cellence, the costs incurred by such Center that are 
not otherwise reimbursable by the WTC Program Ad-
ministrator under section 3312(c) for patient evalua-
tion, monitoring, or treatment but which are needed
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to operate the WTC program such as the costs in-
volved in outreach to participants or recruiting par-
ticipants, data collection and analysis, social services 
for counseling patients on other available assistance 
outside the WTC program, and the development of 
treatment protocols. Such term does not include costs 
for new construction or other capital costs. 
‘‘(d) GAO ANALYSIS.—Not later than July 1, 2011, 
the Comptroller General shall submit to the Committee on 
Energy and Commerce of the House of Representatives and 
the Committee on Health, Education, Labor, and Pensions 
of the Senate an analysis on whether Clinical Centers of 
Excellence with which the WTC Program Administrator en-
ters into a contract under this section have financial sys-
tems that will allow for the timely submission of claims 
data for purposes of section 3304 and subsections (a)(1)(F) 
and (b)(1)(B)(iii). 
‘‘SEC. 3306. DEFINITIONS. 
‘‘In this title: 
‘‘(1) The term ‘aggravating’ means, with respect 
to a health condition, a health condition that existed 
on September 11, 2001, and that, as a result of expo-
sure to airborne toxins, any other hazard, or any 
other adverse condition resulting from the September 
11, 2001, terrorist attacks, requires medical treatment
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that is (or will be) in addition to, more frequent than, 
or of longer duration than the medical treatment that 
would have been required for such condition in the 
absence of such exposure. 
‘‘(2) The term ‘certified-eligible WTC survivor’ 
has the meaning given such term in section 
3321(a)(2). 
‘‘(3) The terms ‘Clinical Center of Excellence’ 
and ‘Data Center’ have the meanings given such 
terms in section 3305. 
‘‘(4) The term ‘enrolled WTC responder’ means a 
WTC responder enrolled under section 3311(a)(3). 
‘‘(5) The term ‘initial health evaluation’ in-
cludes, with respect to an individual, a medical and 
exposure history, a physical examination, and addi-
tional medical testing as needed to evaluate whether 
the individual has a WTC-related health condition 
and is eligible for treatment under the WTC Program. 
‘‘(6) The term ‘list of WTC-related health condi-
tions’ means— 
‘‘(A) for WTC responders, the health condi-
tions listed in section 3312(a)(3); and 
‘‘(B) for screening-eligible and certified-eli-
gible WTC survivors, the health conditions listed 
in section 3322(b).
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‘‘(7) The term ‘New York City disaster area’ 
means the area within New York City that is— 
‘‘(A) the area of Manhattan that is south of 
Houston Street; and 
‘‘(B) any block in Brooklyn that is wholly 
or partially contained within a 1.5-mile radius 
of the former World Trade Center site. 
‘‘(8) The term ‘New York metropolitan area’ 
means an area, specified by the WTC Program Ad-
ministrator, within which WTC responders and eligi-
ble WTC screening-eligible survivors who reside in 
such area are reasonably able to access monitoring 
and treatment benefits and initial health evaluation 
benefits under this title through a Clinical Center of 
Excellence described in subparagraphs (A), (B), or 
(C) of section 3305(b)(1). 
‘‘(9) The term ‘screening-eligible WTC survivor’ 
has the meaning given such term in section 
3321(a)(1). 
‘‘(10) Any reference to ‘September 11, 2001’ shall 
be deemed a reference to the period on such date sub-
sequent to the terrorist attacks at the World Trade 
Center, Shanksville, Pennsylvania, or the Pentagon, 
as applicable, on such date.
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‘‘(11) The term ‘September 11, 2001, terrorist at-
tacks’ means the terrorist attacks that occurred on 
September 11, 2001, in New York City, in 
Shanksville, Pennsylvania, and at the Pentagon, and 
includes the aftermath of such attacks. 
‘‘(12) The term ‘WTC Health Program Steering 
Committee’ means such a Steering Committee estab-
lished under section 3302(b). 
‘‘(13) The term ‘WTC Program’ means the Word 
Trade Center Health Program established under sec-
tion 3301(a). 
‘‘(14)(A) The term ‘WTC Program Adminis-
trator’ means— 
‘‘(i) subject to subparagraph (B), with re-
spect to paragraphs (3) and (4) of section 
3311(a) (relating to enrollment of WTC respond-
ers), section 3312(c) and the corresponding pro-
visions of section 3322 (relating to payment for 
initial health evaluation, monitoring, and treat-
ment, paragraphs (1)(C), (2)(B), and (3) of sec-
tion 3321(a) (relating to determination or cer-
tification of screening-eligible or certified-eligible 
WTC responders), and part 3 of subtitle B (re-
lating to payor provisions), an official in the
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Department of Health and Human Services, to 
be designated by the Secretary; and 
‘‘(ii) with respect to any other provision of 
this title, the Director of the National Institute 
for Occupational Safety and Health, or a des-
ignee of such Director. 
‘‘(B) In no case may the Secretary designate 
under subparagraph (A)(i) the Director of the Na-
tional Institute for Occupational Safety and Health 
or a designee of such Director with respect to section 
3322 (relating to payment for initial health evalua-
tion, monitoring, and treatment). 
‘‘(15) The term ‘WTC-related health condition’ is 
defined in section 3312(a). 
‘‘(16) The term ‘WTC responder’ is defined in 
section 3311(a). 
‘‘(17) The term ‘WTC Scientific/Technical Advi-
sory Committee’ means such Committee established 
under section 3302(a).
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‘‘Subtitle 
B—Program 
of 
Moni-
toring, Initial Health Evalua-
tions, and Treatment 
‘‘PART 1—WTC RESPONDERS 
‘‘SEC. 3311. IDENTIFICATION OF WTC RESPONDERS AND 
PROVISION OF WTC-RELATED MONITORING 
SERVICES. 
‘‘(a) WTC RESPONDER DEFINED.— 
‘‘(1) IN GENERAL.—For purposes of this title, the 
term ‘WTC responder’ means any of the following in-
dividuals, subject to paragraph (4): 
‘‘(A) 
CURRENTLY
IDENTIFIED
RE-
SPONDER.—An individual who has been identi-
fied as eligible for monitoring under the arrange-
ments as in effect on the date of the enactment 
of this title between the National Institute for 
Occupational Safety and Health and— 
‘‘(i) the consortium coordinated by Mt. 
Sinai Hospital in New York City that co-
ordinates the monitoring and treatment for 
enrolled WTC responders other than with 
respect to those covered under the arrange-
ment with the Fire Department of New 
York City; or
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‘‘(ii) the Fire Department of New York 
City. 
‘‘(B) RESPONDER
WHO
MEETS
CURRENT 
ELIGIBILITY
CRITERIA.—An 
individual 
who 
meets the current eligibility criteria described in 
paragraph (2). 
‘‘(C) RESPONDER
WHO
MEETS
MODIFIED 
ELIGIBILITY CRITERIA.—An individual who— 
‘‘(i) performed rescue, recovery, demoli-
tion, debris cleanup, or other related serv-
ices in the New York City disaster area in 
response to the September 11, 2001, ter-
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.
† HR 847 EAS 
The WTC Program Administrator shall not mod-
ify such eligibility criteria on or after the date 
that the number of enrollments of WTC respond-
ers has reached 80 percent of the limit described 
in paragraph (4) or on or after the date that the 
number of certifications for certified-eligible 
WTC survivors under section 3321(a)(2)(B) has 
reached 80 percent of the limit described in sec-
tion 3321(a)(3). 
‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eli-
gibility criteria described in this paragraph for an 
individual is that the individual is described in any 
of the following categories: 
‘‘(A) FIREFIGHTERS
AND
RELATED
PER-
SONNEL.—The individual— 
‘‘(i) was a member of the Fire Depart-
ment of New York City (whether fire or 
emergency personnel, active or retired) who 
participated at least one day in the rescue 
and recovery effort at any of the former 
World Trade Center sites (including Ground 
Zero, Staten Island Landfill, and the New 
York City Chief Medical Examiner’s Office) 
for any time during the period beginning
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on September 11, 2001, and ending on July 
31, 2002; or 
‘‘(ii)(I) is a surviving immediate fam-
ily member of an individual who was a 
member of the Fire Department of New 
York City (whether fire or emergency per-
sonnel, active or retired) and was killed at 
the World Trade site on September 11, 
2001; and 
‘‘(II) received any treatment for a 
WTC-related health condition described in 
section 3312(a)(1)(A)(ii) (relating to mental 
health conditions) on or before September 1, 
2008. 
‘‘(B) LAW
ENFORCEMENT
OFFICERS
AND 
WTC RESCUE, RECOVERY, AND CLEANUP WORK-
ERS.—The individual— 
‘‘(i) worked or volunteered onsite in 
rescue, recovery, debris cleanup, or related 
support services in lower Manhattan (south 
of Canal St.), the Staten Island Landfill, or 
the barge loading piers, for at least 4 hours 
during the period beginning on September 
11, 2001, and ending on September 14, 
2001, for at least 24 hours during the pe-
† HR 847 EAS 
riod beginning on September 11, 2001, and 
ending on September 30, 2001, or for at 
least 80 hours during the period beginning 
on September 11, 2001, and ending on July 
31, 2002; 
‘‘(ii)(I) was a member of the Police De-
partment of New York City (whether active 
or retired) or a member of the Port Author-
ity Police of the Port Authority of New York 
and New Jersey (whether active or retired) 
who participated onsite in rescue, recovery, 
debris cleanup, or related services in lower 
Manhattan (south of Canal St.), including 
Ground Zero, the Staten Island Landfill, or 
the barge loading piers, for at least 4 hours 
during the period beginning September 11, 
2001, and ending on September 14, 2001; 
‘‘(II) participated onsite in rescue, re-
covery, debris cleanup, or related services 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, re-
covery, debris cleanup, or related services in
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lower Manhattan (south of Canal St.) for at 
least 24 hours during the period beginning 
on September 11, 2001, and ending on Sep-
tember 30, 2001; or 
‘‘(IV) participated onsite in rescue, re-
covery, debris cleanup, or related services in 
lower Manhattan (south of Canal St.) for at 
least 80 hours during the period beginning 
on September 11, 2001, and ending on July 
31, 2002; 
‘‘(iii) was an employee of the Office of 
the Chief Medical Examiner of New York 
City involved in the examination and han-
dling of human remains from the World 
Trade Center attacks, or other morgue work-
er who performed similar post-September 11 
functions for such Office staff, during the 
period beginning on September 11, 2001, 
and ending on July 31, 2002; 
‘‘(iv) was a worker in the Port Author-
ity Trans-Hudson Corporation Tunnel for 
at least 24 hours during the period begin-
ning on February 1, 2002, and ending on 
July 1, 2002; or
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‘‘(v) was a vehicle-maintenance worker 
who was exposed to debris from the former 
World Trade Center while retrieving, driv-
ing, cleaning, repairing, and maintaining 
vehicles contaminated by airborne toxins 
from the September 11, 2001, terrorist at-
tacks during a duration and period de-
scribed in subparagraph (A). 
‘‘(C) RESPONDERS TO THE SEPTEMBER 11 
ATTACKS AT THE PENTAGON AND SHANKSVILLE, 
PENNSYLVANIA.—The individual— 
‘‘(i)(I) was a member of a fire or po-
lice department (whether fire or emergency 
personnel, active or retired), worked for a 
recovery or cleanup contractor, or was a 
volunteer; and performed rescue, recovery, 
demolition, debris cleanup, or other related 
services at the Pentagon site of the terrorist- 
related aircraft crash of September 11, 
2001, during the period beginning on Sep-
tember 11, 2001, and ending on the date on 
which the cleanup of the site was concluded, 
as determined by the WTC Program Ad-
ministrator; or
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‘‘(II) was a member of a fire or police 
department (whether fire or emergency per-
sonnel, active or retired), worked for a re-
covery or cleanup contractor, or was a vol-
unteer; and performed rescue, recovery, 
demolition, debris cleanup, or other related 
services at the Shanksville, Pennsylvania, 
site of the terrorist-related aircraft crash of 
September 11, 2001, during the period be-
ginning on September 11, 2001, and ending 
on the date on which the cleanup of the site 
was concluded, as determined by the WTC 
Program Administrator; and 
‘‘(ii) is determined by the WTC Pro-
gram Administrator to be at an increased 
risk of developing a WTC-related health 
condition as a result of exposure to airborne 
toxins, other hazards, or adverse conditions 
resulting from the September 11, 2001, ter-
rorist attacks, and meets such eligibility cri-
teria related to such exposures, as the WTC 
Program Administrator determines are ap-
propriate, after consultation with the WTC 
Scientific/Technical Advisory Committee. 
‘‘(3) ENROLLMENT PROCESS.—
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‘‘(A) IN GENERAL.—The WTC Program Ad-
ministrator shall establish a process for enrolling 
WTC responders in the WTC Program. Under 
such process— 
‘‘(i) WTC responders described in 
paragraph (1)(A) shall be deemed to be en-
rolled in such Program; 
‘‘(ii) subject to clause (iii), the Admin-
istrator shall enroll in such program indi-
viduals who are determined to be WTC re-
sponders; 
‘‘(iii) the Administrator shall deny 
such enrollment to an individual if the Ad-
ministrator determines that the numerical 
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-
† HR 847 EAS 
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 in-
dividuals not described in paragraph (1)(A) or 
(2)(A)(ii) who may be enrolled under paragraph 
(3)(A)(ii) shall not exceed 25,000 at any time, of 
which no more than 2,500 may be individuals 
enrolled based on modified eligibility criteria es-
tablished under paragraph (1)(C).
† HR 847 EAS 
‘‘(B) PROCESS.—In implementing subpara-
graph (A), the WTC Program Administrator 
shall— 
‘‘(i) limit the number of enrollments 
made under paragraph (3)— 
‘‘(I) in accordance with such sub-
paragraph; and 
‘‘(II) to such number, as deter-
mined by the Administrator based on 
the best available information and sub-
ject to amounts available under section 
3351, that will ensure sufficient funds 
will be available to provide treatment 
and monitoring benefits under this 
title, with respect to all individuals 
who are enrolled through the end of fis-
cal year 2020; and 
‘‘(ii) provide priority (subject to para-
graph (3)(A)(i)) in such enrollments in the 
order in which individuals apply for enroll-
ment under paragraph (3). 
‘‘(5) DISQUALIFICATION
OF
INDIVIDUALS
ON 
TERRORIST WATCH LIST.—No individual who is on 
the terrorist watch list maintained by the Department 
of Homeland Security shall qualify as an eligible
† HR 847 EAS 
WTC responder. Before enrolling any individual as a 
WTC responder in the WTC Program under para-
graph (3), the Administrator, in consultation with the 
Secretary of Homeland Security, shall determine 
whether the individual is on such list. 
‘‘(b) MONITORING BENEFITS.— 
‘‘(1) IN GENERAL.—In the case of an enrolled 
WTC responder (other than one described in sub-
section (a)(2)(A)(ii)), the WTC Program shall provide 
for monitoring benefits that include monitoring con-
sistent with protocols approved by the WTC Program 
Administrator and including clinical examinations 
and long-term health monitoring and analysis. In the 
case of an enrolled WTC responder who is an active 
member of the Fire Department of New York City, the 
responder shall receive such benefits as part of the in-
dividual’s periodic company medical exams. 
‘‘(2) PROVISION OF MONITORING BENEFITS.—The 
monitoring benefits under paragraph (1) shall be pro-
vided through the Clinical Center of Excellence for the 
type of individual involved or, in the case of an indi-
vidual residing outside the New York metropolitan 
area, under an arrangement under section 3313.
† HR 847 EAS 
‘‘(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).
† HR 847 EAS 
‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC RE-
SPONDERS.—The list of health conditions for WTC re-
sponders consists of the following: 
‘‘(A) AERODIGESTIVE DISORDERS.— 
‘‘(i) Interstitial lung diseases. 
‘‘(ii) Chronic respiratory disorder— 
fumes/vapors. 
‘‘(iii) Asthma. 
‘‘(iv) Reactive airways dysfunction 
syndrome (RADS). 
‘‘(v) WTC-exacerbated chronic obstruc-
tive pulmonary disease (COPD). 
‘‘(vi) Chronic cough syndrome. 
‘‘(vii) Upper airway hyperreactivity. 
‘‘(viii) Chronic rhinosinusitis. 
‘‘(ix) Chronic nasopharyngitis. 
‘‘(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).
† HR 847 EAS 
‘‘(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,
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2003, the list of health conditions in paragraph 
(3) shall include: 
‘‘(i) Low back pain. 
‘‘(ii) Carpal tunnel syndrome (CTS). 
‘‘(iii) Other musculoskeletal disorders. 
‘‘(B) DEFINITION.—The term ‘WTC-related 
musculoskeletal disorder’ means a chronic or re-
current disorder of the musculoskeletal system 
caused by heavy lifting or repetitive strain on 
the joints or musculoskeletal system occurring 
during rescue or recovery efforts in the New York 
City disaster area in the aftermath of the Sep-
tember 11, 2001, terrorist attacks. 
‘‘(5) CANCER.— 
‘‘(A) IN GENERAL.—The WTC Program Ad-
ministrator shall periodically conduct a review 
of all available scientific and medical evidence, 
including findings and recommendations of 
Clinical Centers of Excellence, published in peer- 
reviewed journals to determine if, based on such 
evidence, cancer or a certain type of cancer 
should be added to the applicable list of WTC-re-
lated health conditions. The WTC Program Ad-
ministrator shall conduct the first review under
† HR 847 EAS 
this subparagraph not later than 180 days after 
the date of the enactment of this title. 
‘‘(B) PROPOSED REGULATIONS AND RULE-
MAKING.—Based on the periodic reviews under 
subparagraph (A), if the WTC Program Admin-
istrator determines that cancer or a certain type 
of cancer should be added to such list of WTC- 
related health conditions, the WTC Program Ad-
ministrator shall propose regulations, through 
rulemaking, to add cancer or the certain type of 
cancer to such list. 
‘‘(C) FINAL
REGULATIONS.—Based on all 
the available evidence in the rulemaking record, 
the WTC Program Administrator shall make a 
final determination of whether cancer or a cer-
tain type of cancer should be added to such list 
of WTC-related health conditions. If such a de-
termination is made to make such an addition, 
the WTC Program Administrator shall by regu-
lation add cancer or the certain type of cancer 
to such list. 
‘‘(D) DETERMINATIONS NOT TO ADD CAN-
CER OR CERTAIN TYPES OF CANCER.—In the case 
that the WTC Program Administrator deter-
mines under subparagraph (B) or (C) that can-
† HR 847 EAS 
of receipt of such petition the Administrator 
shall— 
‘‘(i) request a recommendation of the 
Advisory Committee; 
‘‘(ii) publish a proposed rule in the 
Federal Register to add such health condi-
tion, in accordance with subparagraph (D); 
‘‘(iii) publish in the Federal Register 
the Administrator’s determination not to 
publish such a proposed rule and the basis 
for such determination; or 
‘‘(iv) publish in the Federal Register a 
determination that insufficient evidence ex-
ists to take action under clauses (i) through 
(iii). 
‘‘(C) ACTION BY ADVISORY COMMITTEE.—In 
the case that the Administrator requests a rec-
ommendation of the Advisory Committee under 
this paragraph, with respect to adding a health 
condition to the list in paragraph (3), the Advi-
sory Committee shall submit to the Adminis-
trator such recommendation not later than 60 
days after the date of such request or by such 
date (not to exceed 180 days after such date of 
request) as specified by the Administrator. Not
† HR 847 EAS 
later than 60 days after the date of receipt of 
such recommendation, the Administrator shall, 
in accordance with subparagraph (D), publish in 
the Federal Register a proposed rule with respect 
to such recommendation or a determination not 
to propose such a proposed rule and the basis for 
such determination. 
‘‘(D) PUBLICATION.—The WTC Program 
Administrator shall, with respect to any pro-
posed rule under this paragraph— 
‘‘(i) publish such proposed rule in ac-
cordance with section 553 of title 5, United 
States Code; and 
‘‘(ii) provide interested parties a pe-
riod of 30 days after such publication to 
submit written comments on the proposed 
rule. 
The WTC Program Administrator may extend 
the period described in clause (ii) upon a finding 
of good cause. In the case of such an extension, 
the Administrator shall publish such extension in 
the Federal Register. 
‘‘(E) INTERESTED
PARTY
DEFINED.—For 
purposes of this paragraph, the term ‘interested 
party’ includes a representative of any organiza-
† HR 847 EAS 
tion representing WTC responders, a nationally 
recognized medical association, a Clinical or 
Data Center, a State or political subdivision, or 
any other interested person. 
‘‘(b) COVERAGE OF TREATMENT FOR WTC-RELATED 
HEALTH CONDITIONS.— 
‘‘(1) DETERMINATION FOR ENROLLED WTC RE-
SPONDERS BASED ON A WTC-RELATED HEALTH CON-
DITION.— 
‘‘(A) IN
GENERAL.—If a physician at a 
Clinical Center of Excellence that is providing 
monitoring benefits under section 3311 for an 
enrolled WTC responder makes a determination 
that the responder has a WTC-related health con-
dition that is in the list in subsection (a)(3) and 
that exposure to airborne toxins, other hazards, 
or adverse conditions resulting from the Sep-
tember 1, 2001, terrorist attacks is substantially 
likely to be a significant factor in aggravating, 
contributing to, or causing the condition— 
‘‘(i) the physician shall promptly 
transmit such determination to the WTC 
Program Administrator and provide the 
Administrator with the medical facts sup-
porting such determination; and
† HR 847 EAS 
‘‘(ii) on and after the date of such 
transmittal and subject to subparagraph 
(B), the WTC Program shall provide for 
payment under subsection (c) for medically 
necessary treatment for such condition. 
‘‘(B) REVIEW; CERTIFICATION; APPEALS.— 
‘‘(i) REVIEW.—A Federal employee 
designated by the WTC Program Adminis-
trator shall review determinations made 
under subparagraph (A). 
‘‘(ii) CERTIFICATION.—The Adminis-
trator shall provide a certification of such 
condition based upon reviews conducted 
under clause (i). Such a certification shall 
be provided unless the Administrator deter-
mines that the responder’s condition is not 
a WTC-related health condition in the list 
in subsection (a)(3) or that exposure to air-
borne toxins, other hazards, or adverse con-
ditions resulting from the September 1, 
2001, terrorist attacks is not substantially 
likely to be a significant factor in aggra-
vating, contributing to, or causing the con-
dition.
† HR 847 EAS 
‘‘(iii) APPEAL PROCESS.—The Admin-
istrator shall establish, by rule, a process for 
the appeal of determinations under clause 
(ii). 
‘‘(2) DETERMINATION BASED ON MEDICALLY AS-
SOCIATED WTC-RELATED HEALTH CONDITIONS.— 
‘‘(A) IN
GENERAL.—If a physician at a 
Clinical Center of Excellence determines pursu-
ant to subsection (a) that the enrolled WTC re-
sponder has a health condition described in sub-
section (a)(1)(A) that is not in the list in sub-
section (a)(3) but which is medically associated 
with a WTC-related health condition— 
‘‘(i) the physician shall promptly 
transmit such determination to the WTC 
Program Administrator and provide the 
Administrator with the facts supporting 
such determination; and 
‘‘(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
† HR 847 EAS 
for the review and certification of physician de-
terminations under subparagraph (A). Such rule 
shall provide for— 
‘‘(i) the timely review of such a deter-
mination by a physician panel with appro-
priate expertise for the condition and rec-
ommendations to the WTC Program Ad-
ministrator; 
‘‘(ii) not later than 60 days after the 
date of the transmittal under subparagraph 
(A)(i), a determination by the WTC Pro-
gram Administrator on whether or not the 
condition involved is described in subsection 
(a)(1)(A) and is medically associated with 
a WTC-related health condition; 
‘‘(iii) certification in accordance with 
paragraph (1)(B)(ii) of coverage of such 
condition if determined to be described in 
subsection (a)(1)(A) and medically associ-
ated with a WTC-related health condition; 
and 
‘‘(iv) a process for appeals of deter-
minations relating to such conditions. 
‘‘(C) INCLUSION IN LIST OF HEALTH CONDI-
TIONS.—If the WTC Program Administrator
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provides 
certification 
under 
subparagraph 
(B)(iii) for coverage of a condition, the Adminis-
trator may, pursuant to subsection (a)(6), add 
the condition to the list in subsection (a)(3). 
‘‘(D) CONDITIONS ALREADY DECLINED FOR 
INCLUSION IN LIST.—If the WTC Program Ad-
ministrator publishes a determination under 
subsection (a)(6)(B) not to include a condition 
in the list in subsection (a)(3), the WTC Pro-
gram Administrator shall not provide certifi-
cation under subparagraph (B)(iii) for coverage 
of the condition. In the case of an individual 
who is certified under subparagraph (B)(iii) 
with respect to such condition before the date of 
the publication of such determination the pre-
vious sentence shall not apply. 
‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.— 
‘‘(A) IN GENERAL.—In providing treatment 
for a WTC-related health condition, a physician 
or other provider shall provide treatment that is 
medically necessary and in accordance with 
medical treatment protocols established under 
subsection (d). 
‘‘(B) REGULATIONS RELATING TO MEDICAL 
NECESSITY.—For the purpose of this title, the
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WTC Program Administrator shall issue regula-
tions specifying a standard for determining med-
ical necessity with respect to health care services 
and prescription pharmaceuticals, a process for 
determining whether treatment furnished and 
pharmaceuticals prescribed under this title meet 
such standard (including any prior authoriza-
tion requirement), and a process for appeal of a 
determination under subsection (c)(3). 
‘‘(4) SCOPE OF TREATMENT COVERED.— 
‘‘(A) IN GENERAL.—The scope of treatment 
covered under this subsection includes services of 
physicians and other health care providers, diag-
nostic and laboratory tests, prescription drugs, 
inpatient and outpatient hospital services, and 
other medically necessary treatment. 
‘‘(B) PHARMACEUTICAL
COVERAGE.—With 
respect to ensuring coverage of medically nec-
essary outpatient prescription drugs, such drugs 
shall be provided, under arrangements made by 
the WTC Program Administrator, directly 
through participating Clinical Centers of Excel-
lence or through one or more outside vendors. 
‘‘(C) TRANSPORTATION EXPENSES FOR NA-
TIONWIDE NETWORK.—The WTC Program Ad-
† HR 847 EAS 
ministrator may provide for necessary and rea-
sonable transportation and expenses incident to 
the securing of medically necessary treatment 
through the nationwide network under section 
3313 involving travel of more than 250 miles 
and for which payment is made under this sec-
tion in the same manner in which individuals 
may be furnished necessary and reasonable 
transportation and expenses incident to services 
involving travel of more than 250 miles under 
regulations implementing section 3629(c) of the 
Energy Employees Occupational Illness Com-
pensation Program Act of 2000 (title XXXVI of 
Public Law 106–398; 42 U.S.C. 7384t(c)). 
‘‘(5) PROVISION OF TREATMENT PENDING CER-
TIFICATION.—With respect to an enrolled WTC re-
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-
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related health condition (under such terms and condi-
tions as the Administrator may provide) until the 
Administrator makes a decision on whether to certify 
the determination. 
‘‘(c) PAYMENT
FOR INITIAL HEALTH EVALUATION, 
MONITORING, AND TREATMENT OF WTC-RELATED HEALTH 
CONDITIONS.— 
‘‘(1) MEDICAL TREATMENT.— 
‘‘(A) USE OF FECA PAYMENT RATES.— 
‘‘(i) IN
GENERAL.—Subject to clause 
(ii): 
‘‘(I) Subject to subparagraphs (B) 
and (C), the WTC Program Adminis-
trator shall reimburse costs for medi-
cally necessary treatment under this 
title for WTC-related health conditions 
according to the payment rates that 
would apply to the provision of such 
treatment and services by the facility 
under the Federal Employees Com-
pensation Act. 
‘‘(II) For treatment not covered 
under subclause (i) or subparagraph 
(B), the WTC Program Administrator
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shall establish by regulation a reim-
bursement rate for such treatment. 
‘‘(ii) EXCEPTION.—In no case shall 
payments for products or services under 
clause (i) be made at a rate higher than the 
Office of Worker’s Compensation Programs 
in the Department Labor would pay for 
such products or services rendered at the 
time such products or services were pro-
vided. 
‘‘(B) PHARMACEUTICALS.— 
‘‘(i) IN GENERAL.—The WTC Program 
Administrator shall establish a program for 
paying for the medically necessary out-
patient prescription pharmaceuticals pre-
scribed under this title for WTC-related 
health conditions through one or more con-
tracts with outside vendors. 
‘‘(ii) COMPETITIVE
BIDDING.—Under 
such program the Administrator shall— 
‘‘(I) select one or more appro-
priate vendors through a Federal com-
petitive bid process; and 
‘‘(II) select the lowest bidder (or 
bidders) meeting the requirements for
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providing pharmaceutical benefits for 
participants in the WTC Program. 
‘‘(iii) TREATMENT OF FDNY PARTICI-
PANTS.—Under such program the Adminis-
trator may enter into an agreement with a 
separate vendor to provide pharmaceutical 
benefits to enrolled WTC responders for 
whom the Clinical Center of Excellence is 
described in section 3305 if such an ar-
rangement is deemed necessary and bene-
ficial to the program by the WTC Program 
Administrator. 
‘‘(iv) PHARMACEUTICALS.—Not later 
than July 1, 2011, the Comptroller General 
of the United States shall submit to the 
Committee on Energy and Commerce of the 
House of Representatives and the Committee 
on Health, Education, Labor, and Pensions 
of the Senate a report on whether existing 
Federal pharmaceutical purchasing pro-
grams can provide pharmaceutical benefits 
more efficiently and effectively than through 
the WTC program. 
‘‘(C) IMPROVING QUALITY AND EFFICIENCY 
THROUGH MODIFICATION OF PAYMENT AMOUNTS
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AND METHODOLOGIES.—The WTC Program Ad-
ministrator may modify the amounts and meth-
odologies for making payments for initial health 
evaluations, monitoring, or treatment, if, taking 
into account utilization and quality data fur-
nished by the Clinical Centers of Excellence 
under section 3305(b)(1)(B)(iii), the Adminis-
trator determines that a bundling, capitation, 
pay for performance, or other payment method-
ology would better ensure high quality and effi-
cient delivery of initial health evaluations, moni-
toring, or treatment to an enrolled WTC re-
sponder, screening-eligible WTC survivor, or cer-
tified-eligible WTC survivor. 
‘‘(2) MONITORING AND INITIAL HEALTH EVALUA-
TION.—The WTC Program Administrator shall reim-
burse the costs of monitoring and the costs of an ini-
tial health evaluation provided under this title at a 
rate set by the Administrator by regulation. 
‘‘(3) DETERMINATION OF MEDICAL NECESSITY.— 
‘‘(A) REVIEW OF MEDICAL NECESSITY AND 
PROTOCOLS.—As part of the process for reim-
bursement or payment under this subsection, the 
WTC Program Administrator shall provide for 
the review of claims for reimbursement or pay-
† HR 847 EAS 
ment for the provision of medical treatment to 
determine if such treatment is medically nec-
essary and in accordance with medical treatment 
protocols established under subsection (d). 
‘‘(B) WITHHOLDING
OF
PAYMENT
FOR 
MEDICALLY
UNNECESSARY
TREATMENT.—The 
Administrator shall withhold such reimburse-
ment or payment for treatment that the Admin-
istrator determines is not medically necessary or 
is not in accordance with such medical treatment 
protocols. 
‘‘(d) MEDICAL TREATMENT PROTOCOLS.— 
‘‘(1) DEVELOPMENT.—The Data Centers shall 
develop medical treatment protocols for the treatment 
of enrolled WTC responders and certified-eligible 
WTC survivors for health conditions included in the 
applicable list of WTC-related health conditions. 
‘‘(2) APPROVAL.—The medical treatment proto-
cols developed under paragraph (1) shall be subject to 
approval by the WTC Program Administrator. 
‘‘SEC. 3313. NATIONAL ARRANGEMENT FOR BENEFITS FOR 
ELIGIBLE INDIVIDUALS OUTSIDE NEW YORK. 
‘‘(a) IN GENERAL.—In order to ensure reasonable ac-
cess to benefits under this subtitle for individuals who are 
enrolled WTC responders, screening-eligible WTC survivors,
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or certified-eligible WTC survivors and who reside in any 
State, as defined in section 2(f), outside the New York met-
ropolitan area, the WTC Program Administrator shall es-
tablish a nationwide network of health care providers to 
provide monitoring and treatment benefits and initial 
health evaluations near such individuals’ areas of residence 
in such States. Nothing in this subsection shall be construed 
as preventing such individuals from being provided such 
monitoring and treatment benefits or initial health evalua-
tion through any Clinical Center of Excellence. 
‘‘(b) NETWORK REQUIREMENTS.—Any health care 
provider participating in the network under subsection (a) 
shall— 
‘‘(1) meet criteria for credentialing established 
by the Data Centers; 
‘‘(2) follow the monitoring, initial health evalua-
tion, and treatment protocols developed under section 
3305(a)(2)(A)(ii); 
‘‘(3) collect and report data in accordance with 
section 3304; and 
‘‘(4) meet such fraud, quality assurance, and 
other requirements as the WTC Program Adminis-
trator establishes, including sections 1128 through 
1128E of the Social Security Act, as applied by sec-
tion 3301(d).
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‘‘(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). 
‘‘(d) PROVISION OF SERVICES THROUGH THE VA.— 
‘‘(1) IN GENERAL.—The WTC Program Adminis-
trator may enter into an agreement with the Sec-
retary of Veterans Affairs for the Secretary to provide 
services under this section through facilities of the De-
partment of Veterans Affairs. 
‘‘(2) NATIONAL PROGRAM.—Not later than July 
1, 2011, the Comptroller General of the United States 
shall submit to the Committee on Energy and Com-
merce of the House of Representatives and the Com-
mittee on Health, Education, Labor, and Pensions of 
the Senate a report on whether the Department of 
Veterans Affairs can provide monitoring and treat-
ment services to individuals under this section more 
efficiently and effectively than through the nationwide 
network to be established under subsection (a).
† HR 847 EAS 
‘‘PART 2—WTC SURVIVORS 
‘‘SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUA-
TION OF SCREENING-ELIGIBLE AND CER-
TIFIED-ELIGIBLE WTC SURVIVORS. 
‘‘(a) IDENTIFICATION OF SCREENING-ELIGIBLE WTC 
SURVIVORS AND CERTIFIED-ELIGIBLE WTC SURVIVORS.— 
‘‘(1) SCREENING-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—In this title, the term 
‘screening-eligible WTC survivor’ means, subject 
to subparagraph (C) and paragraph (3), an in-
dividual who is described in any of the following 
clauses: 
‘‘(i) CURRENTLY
IDENTIFIED
SUR-
VIVOR.—An individual, including a WTC 
responder, who has been identified as eligi-
ble for medical treatment and monitoring 
by the WTC Environmental Health Center 
as of the date of enactment of this title. 
‘‘(ii) SURVIVOR WHO MEETS CURRENT 
ELIGIBILITY CRITERIA.—An individual who 
is not a WTC responder, for purposes of the 
initial health evaluation under subsection 
(b), claims symptoms of a WTC-related 
health condition and meets any of the cur-
rent eligibility criteria described in sub-
paragraph (B).
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‘‘(iii) SURVIVOR
WHO
MEETS
MODI-
FIED
ELIGIBILITY
CRITERIA.—An indi-
vidual who is not a WTC responder, for 
purposes of the initial health evaluation 
under subsection (b), claims symptoms of a 
WTC-related health condition and meets 
such eligibility criteria relating to exposure 
to airborne toxins, other hazards, or adverse 
conditions resulting from the September 11, 
2001, terrorist attacks as the WTC Admin-
istrator determines, after consultation with 
the Data Centers described in section 3305 
and the WTC Scientific/Technical Advisory 
Committee and WTC Health Program 
Steering Committees under section 3302. 
The Administrator shall not modify such criteria 
under clause (iii) on or after the date that the 
number of certifications for certified-eligible 
WTC survivors under paragraph (2)(B) has 
reached 80 percent of the limit described in 
paragraph (3) or on or after the date that the 
number of enrollments of WTC responders has 
reached 80 percent of the limit described in sec-
tion 3311(a)(4).
† HR 847 EAS 
‘‘(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 sub-
paragraph (B)(i) and had extensive expo-
sure to WTC dust as a result of such work. 
‘‘(iv) A person who was deemed eligible 
to receive a grant from the Lower Manhat-
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tan Development Corporation Residential 
Grant Program, who possessed a lease for a 
residence or purchased a residence in the 
New York City disaster area, and who re-
sided in such residence during the period 
beginning on September 11, 2001, and end-
ing on May 31, 2003. 
‘‘(v) A person whose place of employ-
ment— 
‘‘(I) at any time during the pe-
riod beginning on September 11, 2001, 
and ending on May 31, 2003, was in 
the New York City disaster area; and 
‘‘(II) was deemed eligible to re-
ceive a grant from the Lower Manhat-
tan Development Corporation WTC 
Small Firms Attraction and Retention 
Act program or other government in-
centive program designed to revitalize 
the lower Manhattan economy after the 
September 11, 2001, terrorist attacks. 
‘‘(C) APPLICATION
AND
DETERMINATION 
PROCESS FOR SCREENING ELIGIBILITY.— 
‘‘(i) IN GENERAL.—The WTC Program 
Administrator in consultation with the
† HR 847 EAS 
Data Centers shall establish a process for 
individuals, other than individuals de-
scribed in subparagraph (A)(i), to be deter-
mined to be screening-eligible WTC sur-
vivors. Under such process— 
‘‘(I) there shall be no fee charged 
to the applicant for making an appli-
cation for such determination; 
‘‘(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
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‘‘(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 proc-
ess. 
‘‘(ii) WRITTEN
DOCUMENTATION
OF 
SCREENING-ELIGIBILITY.— 
‘‘(I) IN GENERAL.—In the case of 
an individual who is described in sub-
paragraph (A)(i) or who is determined 
under clause (i) (consistent with para-
graph (3)) to be a screening-eligible 
WTC survivor, the WTC Program Ad-
ministrator shall provide an appro-
priate written documentation of such 
fact. 
‘‘(II) TIMING.— 
‘‘(aa) CURRENTLY
IDENTI-
FIED SURVIVORS.—In the case of 
an individual who is described in
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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 Program Ad-
ministrator 
shall 
provide 
the 
written documentation under sub-
clause (I) at the time of such de-
termination. 
‘‘(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.— 
‘‘(A) DEFINITION.—The term ‘certified-eligi-
ble WTC survivor’ means, subject to paragraph 
(3), a screening-eligible WTC survivor who the 
WTC Program Administrator certifies under 
subparagraph (B) to be eligible for followup 
monitoring and treatment under this part. 
‘‘(B) CERTIFICATION
OF
ELIGIBILITY
FOR 
MONITORING AND TREATMENT.—
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‘‘(i) IN GENERAL.—The WTC Program 
Administrator shall establish a certification 
process under which the Administrator shall 
provide appropriate certification to screen-
ing-eligible WTC survivors who, pursuant 
to the initial health evaluation under sub-
section (b), are determined to be eligible for 
followup monitoring and treatment under 
this part. 
‘‘(ii) TIMING.— 
‘‘(I) CURRENTLY IDENTIFIED SUR-
VIVORS.—In the case of an individual 
who 
is 
described 
in 
paragraph 
(1)(A)(i), the WTC Program Adminis-
trator shall provide the certification 
under clause (i) not later than July 1, 
2011. 
‘‘(II) OTHER
MEMBERS.—In the 
case of another individual who is de-
termined under clause (i) to be eligible 
for followup monitoring and treatment, 
the WTC Program Administrator shall 
provide the certification under such 
clause at the time of such determina-
tion.
† HR 847 EAS 
‘‘(3) NUMERICAL LIMITATION ON CERTIFIED-ELI-
GIBLE WTC SURVIVORS.— 
‘‘(A) IN GENERAL.—The total number of in-
dividuals not described in paragraph (1)(A)(i) 
who may be certified as certified-eligible WTC 
survivors under paragraph (2)(B) shall not ex-
ceed 25,000 at any time. 
‘‘(B) PROCESS.—In implementing subpara-
graph (A), the WTC Program Administrator 
shall— 
‘‘(i) limit the number of certifications 
provided under paragraph (2)(B)— 
‘‘(I) in accordance with such sub-
paragraph; and 
‘‘(II) to such number, as deter-
mined by the Administrator based on 
the best available information and sub-
ject to amounts made available under 
section 3351, that will ensure sufficient 
funds will be available to provide 
treatment and monitoring benefits 
under this title, with respect to all in-
dividuals receiving such certifications 
through the end of fiscal year 2020; 
and