I 
111TH CONGRESS 
1ST SESSION 
H. R. 847 
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. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 4, 2009 
Mrs. MALONEY (for herself, Mr. NADLER of New York, Mr. KING of New 
York, Mr. MCMAHON, Mr. RANGEL, Mr. ACKERMAN, Mr. ARCURI, Mr. 
BISHOP of New York, Mr. BURGESS, Mr. CROWLEY, Mr. ENGEL, Mr. 
HALL of New York, Mr. HIGGINS, Mr. HIMES, Mr. HINCHEY, Mr. 
ISRAEL, Mr. LEE of New York, Mrs. LOWEY, Mr. MAFFEI, Mr. MASSA, 
Mrs. MCCARTHY of New York, Mr. MCGOVERN, Mr. MCHUGH, Mr. 
MEEKS of New York, Mr. PASCRELL, Mr. SERRANO, Ms. SUTTON, Mr. 
TONKO, Mr. TOWNS, Mr. WEINER, Ms. WOOLSEY, and Ms. CLARKE) in-
troduced the following bill; which was referred to the Committee on En-
ergy and Commerce, and in addition to the Committee on the Judiciary, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
A BILL 
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, 
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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 
2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—WORLD TRADE CENTER HEALTH PROGRAM 
Sec. 101. World Trade Center Health Program. 
‘‘TITLE XXX—WORLD TRADE CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Program; Advisory and Steering Committees 
‘‘Sec. 3001. Establishment of World Trade Center Health Program within 
NIOSH. 
‘‘Sec. 3002. WTC Health Program Scientific/Technical Advisory Com-
mittee. 
‘‘Sec. 3003. WTC Health Program Steering Committees. 
‘‘Sec. 3004. Community education and outreach. 
‘‘Sec. 3005. Uniform data collection. 
‘‘Sec. 3006. Centers of excellence. 
‘‘Sec. 3007. Entitlement authorities. 
‘‘Sec. 3008. Definitions. 
‘‘Subtitle B—Program of Monitoring, Initial Health Evaluations, and 
Treatment 
‘‘PART 1—FOR WTC RESPONDERS 
‘‘Sec. 3011. Identification of eligible WTC responders and provision of 
WTC-related monitoring services. 
‘‘Sec. 3012. Treatment of certified eligible WTC responders for WTC-re-
lated health conditions. 
‘‘PART 2—COMMUNITY PROGRAM 
‘‘Sec. 3021. Identification and initial health evaluation of eligible WTC 
community members. 
‘‘Sec. 3022. Followup monitoring and treatment of certified eligible WTC 
community members for WTC-related health conditions. 
‘‘Sec. 3023. Followup monitoring and treatment of other individuals with 
WTC-related health conditions. 
‘‘PART 3—NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE 
INDIVIDUALS OUTSIDE NEW YORK 
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‘‘Sec. 3031. National arrangement for benefits for eligible individuals out-
side New York. 
‘‘Subtitle C—Research Into Conditions 
‘‘Sec. 3041. Research regarding certain health conditions related to Sep-
tember 11 terrorist attacks in New York City. 
‘‘Subtitle D—Programs of the New York City Department of Health and 
Mental Hygiene 
‘‘Sec. 3051. World Trade Center Health Registry. 
‘‘Sec. 3052. Mental health services. 
TITLE II—SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 
2001 
Sec. 201. Definitions. 
Sec. 202. Extended and expanded eligibility for compensation. 
Sec. 203. Requirement to update regulations. 
Sec. 204. Limited liability for certain claims. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Thousands of rescue workers who responded 
to the areas devastated by the terrorist attacks of 
September 11, local residents, office and area work-
ers, and school children continue to suffer significant 
medical problems as a result of compromised air 
quality and the release of other toxins from the at-
tack sites. 
(2) In a September 2006 peer-reviewed study 
conducted by the World Trade Center Medical Moni-
toring Program, of 9,500 World Trade Center re-
sponders, almost 70 percent of World Trade Center 
responders had a new or worsened respiratory symp-
tom that developed during or after their time work-
ing at the World Trade Center; among the respond-
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ers who were asymptomatic before 9/11, 61 percent 
developed respiratory symptoms while working at the 
World Trade Center; close to 60 percent still had a 
new or worsened respiratory symptom at the time of 
their examination; one-third had abnormal pul-
monary function tests; and severe respiratory condi-
tions including pneumonia were significantly more 
common in the 6 months after 9/11 than in the 
prior 6 months. 
(3) An April 2006 study documented that, on 
average, a New York City firefighter who responded 
to the World Trade Center has experienced a loss of 
12 years of lung capacity. 
(4) A peer-reviewed study of residents who lived 
near the World Trade Center titled ‘‘The World 
Trade Center Residents’ Respiratory Health Study: 
New Onset Respiratory Symptoms and Pulmonary 
Function’’, found that data demonstrated a three- 
fold increase in new-onset, persistent lower res-
piratory symptoms in residents near the former 
World Trade Center as compared to a control popu-
lation. 
(5) Previous research on the health impacts of 
the devastation caused by the September 11 terrorist 
attacks has shown relationships between the air 
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quality from Ground Zero and a host of health im-
pacts, including lower pregnancy rates, higher rates 
of respiratory and lung disorders, and a variety of 
post-disaster mental health conditions (including 
posttraumatic stress disorder) in workers and resi-
dents near Ground Zero. 
(6) A variety of tests conducted by independent 
scientists have concluded that significant WTC con-
tamination settled in indoor environments sur-
rounding the disaster site. The Environmental Pro-
tection Agency’s (EPA) cleanup programs for indoor 
residential spaces, in 2003 and 2005, though lim-
ited, are an acknowledgment that indoor contamina-
tion continued after the WTC attacks. 
(7) At the request of the Department of En-
ergy, the Davis DELTA Group at the University of 
California conducted outdoor dust sampling in Octo-
ber 2001 at Varick and Houston Streets (approxi-
mately 1.2 miles north of Ground Zero) and found 
that the contamination from the World Trade Cen-
ter ‘‘outdid even the worst pollution from the Ku-
wait oil fields fires’’. Further, the United States Ge-
ological Survey (USGS) reported on November 27, 
2001, that dust samples collected from indoor sur-
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faces registered at levels that were ‘‘as caustic as 
liquid drain cleaners’’. 
(8) According to both the EPA’s own Inspector 
General’s (EPA IG) report of August 21, 2003 and 
General Accountability Offices’s (GAO) report of 
September 2007, no comprehensive program has 
ever been conducted in order to characterize the full 
extent of WTC contamination, and therefore the full 
impact of that contamination—geographic or other-
wise—remains unknown. 
(9) Such reports found that there has never 
been a comprehensive program to remediate WTC 
toxins from indoor spaces. Thus, area residents, 
workers and students may continue to be exposed to 
WTC contamination in their homes, workplaces and 
schools. 
(10) Because of the failure to release federally 
appropriated funds for community care, a lack of 
sufficient outreach, the fact that many community 
members are receiving care from physicians outside 
the current City-funded World Trade Center Envi-
ronmental Health Center program and thus fall out-
side data collection efforts, and other factors, the 
number of community members being treated at the 
World Trade Center Environmental Health Center 
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underrepresents the total number in the community 
that have been affected by exposure to Ground Zero 
toxins. 
(11) Research by Columbia University’s Center 
for Children’s Environmental Health has shown neg-
ative health effects on babies born to women living 
within 2 miles of the World Trade Center in the 
month following 9/11. 
(12) Federal funding allocated for the moni-
toring of rescue workers’ health is not sufficient to 
ensure the long-term study of health impacts of Sep-
tember 11. 
(13) A significant portion of those who have de-
veloped health problems as result of exposures to 
airborne toxins or other hazards resulting from the 
September 11, 2001, attacks on the World Trade 
Center have no health insurance, have lost their 
health insurance as a result of the attacks, or have 
inadequate health insurance. 
(14) The Federal program to provide medical 
treatments to those who responded to the September 
11 aftermath, and who continue to experience health 
problems as a result, was finally established more 
than five years after the attacks, but has no certain 
long-term funding. 
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(15) Rescue workers and volunteers seeking 
workers’ compensation have reported that their ap-
plications have been denied, delayed for months, or 
redirected, instead of receiving assistance in a timely 
and supportive manner. 
(16) A February 2007 report released by the 
City of New York estimated that approximately 
410,000 people were the most heavily exposed to the 
environmental hazards and trauma of the September 
11 terrorist attacks. More than 30 percent of the 
Fire Department of the City of New York first re-
sponders were still experiencing some respiratory 
symptoms more than five years after the attacks and 
according to the report, 59 percent of those seen by 
the WTC Environmental Health Center at Bellevue 
Hospital (which serves community members) are 
without insurance and 65 percent have incomes less 
than $15,000 per year. The report also found a need 
to continue and expand mental health services. 
(17) Since the 5th anniversary of the attack 
(September 11, 2006), hundreds of workers a month 
have been signing up with the monitoring and treat-
ment programs. 
(18) In April 2008, the Department of Health 
and Human Services reported to Congress that in 
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fiscal year 2007 11,359 patients received medical 
treatment in the existing WTC Responder Medical 
and Treatment program for WTC-related health 
problems, and that number of responders who need 
treatment and the severity of health problems is ex-
pected to increase. 
(19) The September 11 Victim Compensation 
Fund of 2001 was established to provide compensa-
tion to individuals who were physically injured or 
killed as a result of the terrorist-related aircraft 
crashes of September 11, 2001. 
(20) The deadline for filing claims for com-
pensation under the Victim Compensation Fund was 
December 22, 2003. 
(21) Some individuals did not know they were 
eligible to file claims for compensation for injuries or 
did not know they had suffered physical harm as a 
result of the terrorist-related aircraft crashes until 
after the December 22, 2003, deadline. 
(22) Further research is needed to evaluate 
more comprehensively the extent of the health im-
pacts of September 11, including research for 
emerging health problems such as cancer, which 
have been predicted. 
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(23) Research is needed regarding possible 
treatment for the illnesses and injuries of September 
11. 
(24) The Federal response to medical and fi-
nancial issues arising from the September 11 re-
sponse efforts needs a comprehensive, coordinated 
long-term response in order to meet the needs of all 
the individuals who were exposed to the toxins of 
Ground Zero and are suffering health problems from 
the disaster. 
(25) The failure to extend the appointment of 
Dr. John Howard as Director of the National Insti-
tute for Occupational Safety and Health in July 
2008 is not in the interests of the administration of 
such Institute nor the continued operation of the 
World Trade Center Medical Monitoring and Treat-
ment Program which he has headed, and the Sec-
retary of Health and Human Services should recon-
sider extending such appointment. 
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: 
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‘‘TITLE XXX—WORLD TRADE 
CENTER HEALTH PROGRAM 
‘‘Subtitle A—Establishment of Pro-
gram; Advisory and Steering 
Committees 
‘‘SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER 
HEALTH PROGRAM WITHIN NIOSH. 
‘‘(a) IN GENERAL.—There is hereby established with-
in the National Institute for Occupational Safety and 
Health a program to be known as the ‘World Trade Center 
Health Program’ (in this title referred to as the ‘WTC 
program’) to provide— 
‘‘(1) medical monitoring and treatment benefits 
to eligible emergency responders and recovery and 
clean-up workers (including those who are Federal 
employees) who responded to the September 11, 
2001, terrorist attacks on the World Trade Center; 
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: 
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‘‘(1) MEDICAL
MONITORING
FOR
RESPOND-
ERS.—Medical monitoring under section 3011, in-
cluding clinical examinations and long-term health 
monitoring and analysis for individuals who were 
likely to have been exposed to airborne toxins that 
were released, or to other hazards, as a result of the 
September 11, 2001, terrorist attacks on the World 
Trade Center. 
‘‘(2) INITIAL HEALTH EVALUATION FOR COM-
MUNITY
MEMBERS.—An initial health evaluation 
under section 3021, including an evaluation to deter-
mine eligibility for followup monitoring and treat-
ment. 
‘‘(3) FOLLOW-UP
MONITORING
AND
TREAT-
MENT
FOR
WTC-RELATED
CONDITIONS
FOR
RE-
SPONDERS
AND
COMMUNITY
MEMBERS.—Provision 
under sections 3012, 3022, and 3023 of follow-up 
monitoring and treatment and payment, subject to 
the provisions of subsection (d), for all medically 
necessary health and mental health care expenses 
(including necessary prescription drugs) of individ-
uals with a WTC-related health condition. 
‘‘(4) OUTREACH.—Establishment under section 
3004 of an outreach program to potentially eligible 
individuals concerning the benefits under this title. 
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‘‘(5) UNIFORM DATA COLLECTION.—Collection 
under section 3005 of health and mental health data 
on individuals receiving monitoring or treatment 
benefits, using a uniform system of data collection. 
‘‘(6) RESEARCH ON WTC CONDITIONS.—Estab-
lishment under subtitle C of a research program on 
health conditions resulting from the September 11, 
2001, terrorist attacks on the World Trade Center. 
‘‘(c) NO COST-SHARING.—Monitoring and treatment 
benefits and initial health evaluation benefits are provided 
under subtitle B without any deductibles, copayments, or 
other cost-sharing to an eligible WTC responder or any 
eligible WTC community member. 
‘‘(d) PAYOR.— 
‘‘(1) IN GENERAL.—Except as provided in para-
graphs (2) and (3), the cost of monitoring and treat-
ment benefits and initial health evaluation benefits 
provided under subtitle B shall be paid for by the 
WTC program. 
‘‘(2) WORKERS’ COMPENSATION PAYMENT.— 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), payment for treatment 
under subtitle B of a WTC-related condition in 
an individual that is work-related shall be re-
duced or recouped to the extent that the Sec-
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retary 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 or a State, or other work-re-
lated injury or illness benefit plan of the em-
ployer of such individual, for such treatment. 
The provisions of clauses (iii), (iv), (v), and (vi) 
of paragraph (2)(B) of section 1862(b) of the 
Social Security Act (42 U.S.C. 1395y(b)(2)) 
and paragraph (3) of such section shall apply to 
the recoupment under this paragraph of a pay-
ment to the WTC program with respect to a 
workers’ compensation law or plan, or other 
work-related injury or illness plan of the em-
ployer involved, and such individual in the same 
manner as such provisions apply to the reim-
bursement 
of 
a 
payment 
under 
section 
1862(b)(2) of such Act to the Secretary, with 
respect to such a law or plan and an individual 
entitled to benefits under title XVIII of such 
Act. 
‘‘(B) EXCEPTION.—If the WTC Program 
Administrator certifies that the City of New 
York has contributed the matching contribution 
required under section 3006(a)(3) for a 12- 
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month period (specified by the WTC Program 
Administrator), subparagraph (A) shall not 
apply for that 12-month period with respect to 
a workers’ compensation law or plan, including 
line of duty compensation, to which the City is 
obligated to make payments. 
‘‘(3) HEALTH INSURANCE COVERAGE.— 
‘‘(A) IN GENERAL.—In the case of an indi-
vidual who has a WTC-related condition that is 
not work-related and has health coverage for 
such condition through any public or private 
health plan, the provisions of section 1862(b) of 
the Social Security Act (42 U.S.C. 1395y(b)) 
shall apply to such a health plan and such indi-
vidual in the same manner as they apply to a 
group health plan and an individual entitled to 
benefits under title XVIII of such Act pursuant 
to section 226(a). Any costs for items and serv-
ices covered under such plan that are not reim-
bursed by such health plan, due to the applica-
tion of deductibles, copayments, coinsurance, 
other cost-sharing, or otherwise, are reimburs-
able under this title to the extent that they are 
covered under the WTC program. 
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‘‘(B) RECOVERY
BY
INDIVIDUAL
PRO-
VIDERS.—Nothing in subparagraph (A) shall be 
construed as requiring an entity providing mon-
itoring and treatment under this title to seek 
reimbursement under a health plan with which 
the entity has no contract for reimbursement. 
‘‘(4) WORK-RELATED
DESCRIBED.—For the 
purposes of this subsection, a WTC-related condition 
shall be treated as a condition that is work-related 
if— 
‘‘(A) the condition is diagnosed in an eligi-
ble WTC responder, or in an individual who 
qualifies as an eligible WTC community mem-
ber on the basis of being a rescue, recovery, or 
clean-up worker; or 
‘‘(B) with respect to the condition the indi-
vidual has filed and had established a claim 
under a workers’ compensation law or plan of 
the United States or a State, or other work-re-
lated injury or illness benefit plan of the em-
ployer of such individual. 
‘‘(e) QUALITY ASSURANCE
AND MONITORING
OF 
CLINICAL EXPENDITURES.— 
‘‘(1) QUALITY
ASSURANCE.—The WTC Pro-
gram Administrator working with the Clinical Cen-
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ters of Excellence shall develop and implement a 
quality assurance program for the medical moni-
toring and treatment delivered by such Centers of 
Excellence and any other participating health care 
providers. Such program shall include— 
‘‘(A) adherence to medical monitoring and 
treatment protocols; 
‘‘(B) appropriate diagnostic and treatment 
referrals for participants; 
‘‘(C) prompt communication of test results 
to participants; and 
‘‘(D) such other elements as the Adminis-
trator specifies in consultation with the Clinical 
Centers of Excellence. 
‘‘(2) FRAUD PREVENTION.—The WTC Program 
Administrator shall develop and implement a pro-
gram to review the program’s health care expendi-
tures to detect fraudulent or duplicate billing and 
payment for inappropriate services. Such program 
shall be similar to current methods used in connec-
tion with the Medicare program under title XVIII of 
the Social Security Act. This title is a Federal 
health care program (as defined in section 1128B(f) 
of such Act) and is a health plan (as defined in sec-
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tion 1128C(c) of such Act) for purposes of applying 
sections 1128 through 1128E of such Act. 
‘‘(f) WTC PROGRAM ADMINISTRATION.—The WTC 
program shall be administered by the Director of the Na-
tional Institute for Occupational Safety and Health, or a 
designee of such Director. 
‘‘(g) ANNUAL PROGRAM REPORT.— 
‘‘(1) IN GENERAL.—Not later than 6 months 
after the end of each fiscal year in which the WTC 
program is in operation, the WTC Program Admin-
istrator shall submit an annual report to the Con-
gress on the operations of this title for such fiscal 
year and for the entire period of operation of the 
program. 
‘‘(2) CONTENTS OF REPORT.—Each annual re-
port under paragraph (1) shall include the following: 
‘‘(A) ELIGIBLE
INDIVIDUALS.—Informa-
tion for each clinical program described in para-
graph (3)— 
‘‘(i) on the number of individuals who 
applied for certification under subtitle B 
and the number of such individuals who 
were so certified; 
‘‘(ii) of the individuals who were cer-
tified, on the number who received medical 
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monitoring under the program and the 
number of such individuals who received 
medical treatment under the program; 
‘‘(iii) with respect to individuals so 
certified who received such treatment, on 
the WTC-related health conditions for 
which they were treated; and 
‘‘(iv) on the projected number of indi-
viduals who will be certified under subtitle 
B in the succeeding fiscal year. 
‘‘(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 conditions 
that have been paid for or reimbursed by 
workers’ compensation, by public or private 
health plans, or by the City of New York 
under section 3012(c)(4). 
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‘‘(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 
WTC center exposures, including the findings 
of research conducted under section 3041(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 
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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) FDNY RESPONDERS.—The benefits 
provided for eligible WTC responders described 
in section 3006(b)(1)(A). 
‘‘(B) OTHER
ELIGIBLE
WTC
RESPOND-
ERS.—The benefits provided for eligible WTC 
responders not described in subparagraph (A). 
‘‘(C) ELIGIBLE
WTC
COMMUNITY
MEM-
BERS.—The benefits provided for eligible WTC 
community members in section 3006(b)(1)(C). 
‘‘(h) NOTIFICATION TO CONGRESS WHEN REACH 80 
PERCENT
OF ELIGIBILITY NUMERICAL LIMITS.—The 
WTC Program Administrator shall promptly notify the 
Congress— 
‘‘(1) when the number of certifications for eligi-
ble WTC responders subject to the limit established 
under section 3011(a)(5) has reached 80 percent of 
such limit; and 
‘‘(2) when the number of certifications for eligi-
ble WTC community members subject to the limit 
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established under section 3021(a)(5) has reached 80 
percent of such limit. 
‘‘(i) GAO REPORT.—Not later than 3 years after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall submit to the Congress a report 
on the costs of the monitoring and treatment programs 
provided under this title. 
‘‘(j) NYC RECOMMENDATIONS.—The City of New 
York may make recommendations to the WTC Program 
Administrator on ways to improve the monitoring and 
treatment programs under this title for both eligible WTC 
responders and eligible WTC community members. 
‘‘SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECH-
NICAL ADVISORY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—The WTC Program Admin-
istrator shall establish an advisory committee to be known 
as the WTC Health Program Scientific/Technical Advisory 
Committee (in this section referred to as the ‘Advisory 
Committee’) to review scientific and medical evidence and 
to make recommendations to the Administrator on addi-
tional WTC program eligibility criteria and on additional 
WTC-related health conditions. 
‘‘(b) COMPOSITION.—The WTC Program Adminis-
trator shall appoint the members of the Advisory Com-
mittee and shall include at least— 
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‘‘(1) 4 occupational physicians, at least two of 
whom have experience treating WTC rescue and re-
covery workers; 
‘‘(2) 1 physician with expertise in pulmonary 
medicine; 
‘‘(3) 2 environmental medicine or environmental 
health specialists; 
‘‘(4) 2 representatives of eligible WTC respond-
ers; 
‘‘(5) 2 representatives of WTC community 
members; 
‘‘(6) an industrial hygienist; 
‘‘(7) a toxicologist; 
‘‘(8) an epidemiologist; and 
‘‘(9) a mental health professional. 
‘‘(c) MEETINGS.—The Advisory Committee shall 
meet at such frequency as may be required to carry out 
its duties. 
‘‘(d) REPORTS.—The WTC Program Administrator 
shall provide for publication of recommendations of the 
Advisory Committee on the public website established for 
the WTC program. 
‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 
purpose of carrying out this section, there are authorized 
to be appropriated such sums as may be necessary, not 
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to exceed $100,000, for each fiscal year beginning with 
fiscal year 2009. 
‘‘(f) DURATION.—Notwithstanding any other provi-
sion of law, the Advisory Committee shall continue in op-
eration during the period in which the WTC program is 
in operation. 
‘‘(g) APPLICATION OF FACA.—Except as otherwise 
specifically provided, the Advisory Committee shall be sub-
ject to the Federal Advisory Committee Act. 
‘‘SEC. 3003. WTC HEALTH PROGRAM STEERING COMMIT-
TEES. 
‘‘(a) ESTABLISHMENT.—The WTC Program Admin-
istrator shall establish two steering committees (each in 
this section referred to as a ‘Steering Committee’) as fol-
lows: 
‘‘(1) 
WTC 
RESPONDERS
STEERING
COM-
MITTEE.—One steering committee, to be known as 
the WTC Responders Steering Committee, for the 
purpose of facilitating the coordination of medical 
monitoring and treatment programs for the eligible 
WTC responders under part 1 of subtitle B. 
‘‘(2) WTC COMMUNITY
PROGRAM
STEERING 
COMMITTEE.—One steering committee, to be known 
as the WTC Community Program Steering Com-
mittee, for the purpose of facilitating the coordina-
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tion of initial health evaluations, monitoring, and 
treatment programs for eligible WTC community 
members under part 2 of subtitle B. 
‘‘(b) MEMBERSHIP.— 
‘‘(1) INITIAL MEMBERSHIP OF WTC RESPOND-
ERS STEERING COMMITTEE.—The WTC Responders 
Steering Committee shall initially be composed of 
members of the WTC Monitoring and Treatment 
Program Steering Committee (as in existence on the 
day before the date of the enactment of this title). 
In addition, the committee membership shall in-
clude— 
‘‘(A) a representative of the Police Com-
missioner of the City of New York; 
‘‘(B) a representative of the Department of 
Health of the City of New York; 
‘‘(C) a representative of another agency of 
the City of New York, selected by the Mayor of 
New York City, which had a large number of 
non-uniformed City workers who responded to 
the WTC disaster; and 
‘‘(D) three representatives of eligible WTC 
responders; 
in order that eligible WTC responders constitute half 
the members of the Steering Committee. 
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‘‘(2) INITIAL MEMBERSHIP OF WTC COMMUNITY 
PROGRAM STEERING COMMITTEE.— 
‘‘(A) IN GENERAL.—The WTC Community 
Program Steering Committee shall initially be 
composed of members of the WTC Environ-
mental Health Center Community Advisory 
Committee (as in existence on the day before 
the date of the enactment of this title) and shall 
initially have, as voting members, the following: 
‘‘(i) 11 representatives of the affected 
populations of residents, students, area 
workers, and other community members. 
‘‘(ii) The Medical Director of the 
WTC Environmental Health Center. 
‘‘(iii) The Executive Director of the 
WTC Environmental Health Center. 
‘‘(iv) Three physicians, one each rep-
resenting the three WTC Environmental 
Health Center treatment sites of Bellevue 
Hospital Center, Gouverneur Healthcare 
Services, and Elmhurst Hospital Center. 
‘‘(v) Five specialists with WTC re-
lated expertise or experience in treating 
non-responder WTC diseases, such as a pe-
diatrician, an epidemiologist, a psychiatrist 
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or psychologist, an environmental/occupa-
tional specialists or a social worker from a 
WTC Environmental Health Center treat-
ment site, or other relevant specialists. 
‘‘(vi) A representative of the Depart-
ment of Health and Mental Hygiene of the 
City of New York. 
‘‘(B) APPOINTMENTS.— 
‘‘(i) WTC EHC COMMUNITY ADVISORY 
COMMITTEE.—The WTC Environmental 
Health Center Community Advisory Com-
mittee as in existence on the date of the 
enactment of this title shall nominate 
members for positions described in sub-
paragraph (A)(i). 
‘‘(ii) NYC HEALTH
AND
HOSPITALS 
CORPORATION.—The 
New 
York 
City 
Health and Hospitals Corporation shall 
nominate members for positions described 
in clauses (iv) and (v) of subparagraph 
(A). 
‘‘(iii) TIMING.—Nominations under 
clauses (i) and (ii) shall be recommended 
to the WTC Program Administrator not 
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later than 60 days after the date of the en-
actment of this title. 
‘‘(iv) APPOINTMENT.—The WTC Pro-
gram Administrator shall appoint members 
of the WTC Community Program Steering 
Committee not later than 90 days after the 
date of the enactment of this title. 
‘‘(v) GENERAL
REPRESENTATIVES.— 
Of the members appointed under subpara-
graph (A)(i)— 
‘‘(I) the representation shall re-
flect the broad and diverse WTC-af-
fected populations and constituencies 
and the diversity of impacted neigh-
borhoods, including residents, hard-to- 
reach 
populations, 
students, 
area 
workers, school parents, community- 
based 
organizations, 
Community 
Boards, WTC Environmental Health 
Center patients, labor unions, and 
labor advocacy organizations; and 
‘‘(II) no one individual organiza-
tion can have more than one rep-
resentative. 
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‘‘(3) 
ADDITIONAL
APPOINTMENTS.—Each 
Steering Committee may appoint, if approved by a 
majority of voting members of the Committee, addi-
tional members to the Committee. 
‘‘(4) VACANCIES.—A vacancy in a Steering 
Committee shall be filled by the Steering Committee, 
subject to the approval of the WTC Program Ad-
ministrator, so long as— 
‘‘(A) in the case of the WTC Responders 
Steering Committee, the composition of the 
Committee includes representatives of eligible 
WTC responders and representatives of each 
Clinical Center of Excellence and each Coordi-
nating Center of Excellence that serves eligible 
WTC responders and such composition has eli-
gible WTC responders constituting half of the 
membership of the Steering Committee; or 
‘‘(B) in the case of the WTC Community 
Program Steering Committee, the composition 
of the Committee includes representatives of eli-
gible WTC community members and represent-
atives of each Clinical Center of Excellence and 
each Coordinating Center of Excellence that 
serves eligible WTC community members and 
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the nominating process is consistent with para-
graph (2)(B). 
‘‘(5) CO-CHAIRS OF WTC COMMUNITY PROGRAM 
STEERING COMMITTEE.—The WTC Community Pro-
gram Steering Committee shall have two Co-Chairs 
as follows: 
‘‘(A) COMMUNITY/LABOR
CO-CHAIR.—A 
Community/Labor Co-Chair who shall be chosen 
by the community and labor-based members of 
the Steering Committee. 
‘‘(B) ENVIRONMENTAL
HEALTH
CLINIC 
CO-CHAIR.—A WTC Environmental Health 
Clinic Co-Chair who shall be chosen by the 
WTC Environmental Health Center members 
on the Steering Committee. 
‘‘(c) RELATION
TO FACA.—Each Steering Com-
mittee shall not be subject to the Federal Advisory Com-
mittee Act. 
‘‘(d) MEETINGS.—Each Steering Committee shall 
meet at such frequency necessary to carry out its duties, 
but not less than 4 times each calendar year and at least 
two such meetings each year shall be a joint meeting with 
the voting membership of the other Steering Committee 
for the purpose of exchanging information regarding the 
WTC program. 
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‘‘(e) DURATION.—Notwithstanding any other provi-
sion of law, each Steering Committee shall continue in op-
eration during the period in which the WTC program is 
in operation. 
‘‘SEC. 3004. COMMUNITY EDUCATION AND OUTREACH. 
‘‘(a) IN GENERAL.—The WTC Program Adminis-
trator shall institute a program that provides education 
and outreach on the existence and availability of services 
under the WTC program. The outreach and education 
program— 
‘‘(1) shall include— 
‘‘(A) the establishment of a public website 
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. 
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‘‘(b) PARTNERSHIPS.—To the greatest extent pos-
sible, in carrying out this section, the WTC Program Ad-
ministrator shall enter into partnerships with local govern-
ments and organizations with experience performing out-
reach to the affected populations, including community 
and labor-based organizations. 
‘‘SEC. 3005. UNIFORM DATA COLLECTION. 
‘‘(a) IN GENERAL.—The WTC Program Adminis-
trator shall provide for the uniform collection of data (and 
analysis of data and regular reports to the Administrator) 
on the utilization of monitoring and treatment benefits 
provided to eligible WTC responders and eligible WTC 
community members, the prevalence of WTC-related 
health conditions, and the identification of new WTC-re-
lated medical conditions. Such data shall be collected for 
all individuals provided monitoring or treatment benefits 
under subtitle B and regardless of their place of residence 
or Clinical Center of Excellence through which the benefits 
are provided. 
‘‘(b) COORDINATING THROUGH CENTERS OF EXCEL-
LENCE.—Each Clinical Center of Excellence shall collect 
data described in subsection (a) and report such data to 
the corresponding Coordinating Center of Excellence for 
analysis by such Coordinating Center of Excellence. 
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‘‘(c) PRIVACY.—The data collection and analysis 
under this section shall be conducted in a manner that 
protects the confidentiality of individually identifiable 
health information consistent with applicable legal require-
ments. 
‘‘SEC. 3006. CENTERS OF EXCELLENCE. 
‘‘(a) IN GENERAL.— 
‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF 
EXCELLENCE.—The WTC Program Administrator 
shall enter into contracts with Clinical Centers of 
Excellence specified in subsection (b)(1)— 
‘‘(A) for the provision of monitoring and 
treatment benefits 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 follow-up 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 
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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 as for program participants 
who are not English language proficient; and 
‘‘(F) for the collection and reporting of 
data in accordance with section 3005. 
‘‘(2) CONTRACTS
WITH
COORDINATING
CEN-
TERS
OF
EXCELLENCE.—The WTC Program Ad-
ministrator shall enter into contracts with Coordi-
nating Centers of Excellence specified in subsection 
(b)(2)— 
‘‘(A) for receiving, analyzing, and report-
ing to the WTC Program Administrator on 
data, in accordance with section 3005, that has 
been collected and reported to such Coordi-
nating Centers by the corresponding Clinical 
Centers of Excellence under subsection (d)(3); 
‘‘(B) for the development of medical moni-
toring, initial health evaluation, and treatment 
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protocols, with respect to WTC-related health 
conditions; 
‘‘(C) for coordinating the outreach activi-
ties conducted under paragraph (1)(B) by each 
corresponding Clinical Center of Excellence; 
‘‘(D) for establishing criteria for the 
credentialing of medical providers participating 
in the nationwide network under section 3031; 
‘‘(E) for coordinating and administrating 
the activities of the WTC Health Program 
Steering Committees established under section 
3003(a); and 
‘‘(F) for meeting periodically with the cor-
responding Clinical Centers of Excellence to ob-
tain input on the analysis and reporting of data 
collected under subparagraph (A) and on the 
development of medical monitoring, initial 
health evaluation, and treatment protocols 
under subparagraph (B). 
The medical providers under subparagraph (D) shall 
be selected by the WTC Program Administrator on 
the basis of their experience treating or diagnosing 
the medical conditions included in the list of identi-
fied WTC-related conditions for responders and of 
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identified WTC-related conditions for community 
members. 
‘‘(3) REQUIRED PARTICIPATION BY NEW YORK 
CITY
IN
MONITORING
AND
TREATMENT
PROGRAM 
AND COSTS.— 
‘‘(A) IN
GENERAL.—In order for New 
York City, any agency or Department thereof, 
or the New York City Health and Hospitals 
Corporation to qualify for a contract for the 
provision of monitoring and treatment benefits 
and other services under section 3006, New 
York City is required to contribute a matching 
amount of 10 percent of the amount of the cov-
ered monitoring and treatment payment (as de-
fined in subparagraph (B)). 
‘‘(B) COVERED MONITORING AND TREAT-
MENT PAYMENT DEFINED.—For the purposes 
of this paragraph, the term ‘covered monitoring 
and treatment payment’ means payment under 
paragraphs (1) and (2), including under such 
paragraph as applied under section 3021(b), 
3022(a), and 3023, and reimbursement under 
3006(c) for items and services furnished by a 
Clinical Center of Excellence or Coordinating 
Center of Excellence, and providers designated 
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by the WTC Program under section 3031, after 
the application of paragraphs (2) and (3) of 
section 3001 (d). 
‘‘(C) PAYMENT OF NEW YORK CITY SHARE 
OF MONITORING AND TREATMENT COSTS.—The 
WTC Program Administrator shall— 
‘‘(i) bill the amount specified in sub-
paragraph (A) directly to New York City; 
and 
‘‘(ii) certify periodically, for purposes 
of section 3001(d)(2), whether or not New 
York City has paid the amount so billed. 
‘‘(D) 
LIMITATION
ON
REQUIRED 
AMOUNT.—In no case is New York City re-
quired under this paragraph to contribute more 
than a total of $500,000,000 over any 10-year 
period. 
‘‘(b) CENTERS OF EXCELLENCE DEFINED.— 
‘‘(1) CLINICAL CENTER OF EXCELLENCE.—In 
this title, the term ‘Clinical Center of Excellence’ 
means the following: 
‘‘(A) FOR FDNY RESPONDERS.—With re-
spect to an eligible WTC responder who re-
sponded to the 9/11 attacks as an employee of 
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the Fire Department of the City of New York 
and who— 
‘‘(i) is an active employee of such De-
partment— 
‘‘(I) with respect to monitoring, 
such Fire Department; and 
‘‘(II) with respect to treatment, 
such Fire Department (or such entity 
as has entered into a contract with 
the Fire Department for treatment of 
such responders) or any other Clinical 
Center of Excellence described in sub-
paragraph (B), (C), or (D); or 
‘‘(ii) is not an active employee of such 
Department, such Fire Department (or 
such entity as has entered into a contract 
with the Fire Department for monitoring 
or treatment of such responders) or any 
other or any other Clinical Center of Ex-
cellence described in subparagraph (B), 
(C), or (D). 
‘‘(B) OTHER
ELIGIBLE
WTC
RESPOND-
ERS.—With respect to other eligible WTC re-
sponders, whether or not they reside in the New 
York Metropolitan area, the Mt. Sinai coordi-
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nated consortium, Queens College, State Uni-
versity of New York at Stony Brook, University 
of Medicine and Dentistry of New Jersey, and 
Bellevue Hospital. 
‘‘(C) WTC COMMUNITY MEMBERS.—With 
respect to eligible WTC community members, 
whether or not they reside in the New York 
Metropolitan area, the World Trade Center En-
vironmental Health Center at Bellevue Hospital 
and such hospitals or other facilities, including 
but not limited to those within the New York 
City Health and Hospitals Corporation, as are 
identified by the WTC Program Administrator. 
‘‘(D) ALL
ELIGIBLE
WTC
RESPONDERS 
AND ELIGIBLE WTC COMMUNITY MEMBERS.— 
With respect to all eligible WTC responders and 
eligible WTC community members, such other 
hospitals or other facilities as are identified by 
the WTC Program Administrator. 
The WTC Program Administrator shall limit the 
number of additional Centers of Excellence identified 
under subparagraph (D) to ensure that the partici-
pating centers have adequate experience in the treat-
ment and diagnosis of identified WTC-related med-
ical conditions. 
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‘‘(2) 
COORDINATING
CENTER
OF
EXCEL-
LENCE.—In this title, the term ‘Coordinating Center 
of Excellence’ means the following: 
‘‘(A) FOR FDNY RESPONDERS.—With re-
spect to an eligible WTC responder who re-
sponded to the 9/11 attacks as an employee of 
the Fire Department of the City of New York, 
such Fire Department. 
‘‘(B) OTHER WTC RESPONDERS.—With re-
spect to other eligible WTC responders, the Mt. 
Sinai coordinated consortium. 
‘‘(C) WTC
COMMUNITY
MEMBERS.—With 
respect to eligible WTC community members, 
the World Trade Center Environmental Health 
Center at Bellevue Hospital. 
‘‘(3) CORRESPONDING CENTERS.—In this title, 
a Clinical Center of Excellence and a Coordinating 
Center of Excellence shall be treated as ‘cor-
responding’ to the extent that such Clinical Center 
and Coordinating Center serve the same population 
group. 
‘‘(c) REIMBURSEMENT FOR NON-TREATMENT, NON- 
MONITORING PROGRAM COSTS.—A Clinical or Coordi-
nating Center of Excellence with a contract under this sec-
tion shall be reimbursed for the costs of such Center in 
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carrying out the activities described in subsection (a), 
other than those described in subsection (a)(1)(A), subject 
to the provisions of section 3001(d), as follows: 
‘‘(1) CLINICAL
CENTERS
OF
EXCELLENCE.— 
For carrying out subparagraphs (B) through (F) of 
subsection (a)(1)— 
‘‘(A) CLINICAL
CENTER
FOR
FDNY
RE-
SPONDERS IN NEW YORK.—The Clinical Center 
of Excellence for FDNY Responders in New 
York specified in subsection (b)(1)(A) shall be 
reimbursed— 
‘‘(i) in the first year of the contract 
under this section, $600 per certified eligi-
ble WTC responder in the medical treat-
ment program, and $300 per certified eli-
gible WTC responder in the monitoring 
program; and 
‘‘(ii) in each subsequent contract year, 
subject to paragraph (3), at the rates spec-
ified in this subparagraph for the previous 
contract year adjusted by the WTC Pro-
gram Administrator to reflect the rate of 
medical care inflation during the previous 
contract year. 
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‘‘(B) CLINICAL CENTERS SERVING OTHER 
ELIGIBLE WTC RESPONDERS IN NEW YORK.—A 
Clinical Center of Excellence for other WTC re-
sponders in New York specified in subsection 
(b)(1)(B) shall be reimbursed the amounts 
specified in subparagraph (A). 
‘‘(C) CLINICAL
CENTERS
SERVING
WTC 
COMMUNITY
MEMBERS.—A Clinical Center of 
Excellence for eligible WTC community mem-
bers in New York specified in subsection 
(b)(1)(C) shall be reimbursed— 
‘‘(i) in the first year of the contract 
under this section, for each certified eligi-
ble WTC community member in a medical 
treatment program enrolled at a non-hos-
pital-based facility, $600, and for each cer-
tified eligible WTC community member in 
a medical treatment program enrolled at a 
hospital-based facility, $300; and 
‘‘(ii) in each subsequent contract year, 
subject to paragraph (3), at the rates spec-
ified in this subparagraph for the previous 
contract year adjusted by the WTC Pro-
gram Administrator to reflect the rate of 
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medical care inflation during the previous 
contract year. 
‘‘(D) OTHER CLINICAL CENTERS.—A Clin-
ical Center of Excellence or other providers not 
described in a previous subparagraph shall be 
reimbursed at a rate set by the WTC Program 
Administrator. 
‘‘(E) REIMBURSEMENT RULES.—The reim-
bursement provided under subparagraphs (A), 
(B) and (C) shall be made for each certified eli-
gible WTC responder and for each WTC com-
munity member in the WTC program per year 
that the member receives such services, regard-
less of the volume or cost of services required. 
‘‘(2) COORDINATING
CENTERS
OF
EXCEL-
LENCE.—A Coordinating Centers of Excellence spec-
ified in section (a)(2) shall be reimbursed for the 
provision of services set forth in this section at such 
levels as are established by the WTC Program Ad-
ministrator. 
‘‘(3) REVIEW OF RATES.— 
‘‘(A) INITIAL REVIEW.—Before the end of 
the third contract year of the WTC program, 
the WTC Program Administrator shall conduct 
a review to determine whether the reimburse-
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ment rates set forth in this subsection provide 
fair and appropriate reimbursement for such 
program services. Based on such review, the 
Administrator may, by rule beginning with the 
fourth contract year, may modify such rates, 
taking into account a reasonable and fair rate 
for the services being provided. 
‘‘(B) SUBSEQUENT
REVIEWS.—After the 
fourth contract year, the WTC Program Ad-
ministrator shall conduct periodic reviews to de-
termine whether the reimbursement rates in ef-
fect under this subsection provide fair and ap-
propriate reimbursement for such program serv-
ices. Based upon such a review, the Adminis-
trator may by rule modify such rates, taking 
into account a reasonable and fair rate for the 
services being provided. 
‘‘(C) GAO 
REVIEW.—The Comptroller 
General of the United States shall review the 
WTC Program Administrator’s determinations 
regarding fair and appropriate reimbursement 
for program services under this paragraph. 
‘‘(d) REQUIREMENTS.—The WTC Program Adminis-
trator shall not enter into a contract with a Clinical Center 
of Excellence under subsection (a)(1) unless— 
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‘‘(1) the Center establishes a formal mechanism 
for consulting with and receiving input from rep-
resentatives of eligible populations receiving moni-
toring and treatment benefits under subtitle B from 
such Center; 
‘‘(2) the Center provides for the coordination of 
monitoring and treatment benefits under subtitle B 
with routine medical care provided for the treatment 
of conditions other than WTC-related health condi-
tions; 
‘‘(3) the Center collects and reports to the cor-
responding Coordinating Center of Excellence data 
in accordance with section 3005; 
‘‘(4) the Center has in place safeguards against 
fraud that are satisfactory to the Administrator; 
‘‘(5) the Center agrees to treat or refer for 
treatment all individuals who are eligible WTC re-
sponders or eligible WTC community members with 
respect to such Center who present themselves for 
treatment of a WTC-related health condition; 
‘‘(6) the Center has in place safeguards to en-
sure the confidentiality of an individual’s individ-
ually identifiable health information, including re-
quiring that such information not be disclosed to the 
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individual’s employer without the authorization of 
the individual; 
‘‘(7) the Center provides assurances that the 
amounts paid under subsection (c)(1) are used only 
for costs incurred in carrying out the activities de-
scribed in subsection (a), other than those described 
in subsection (a)(1)(A); and 
‘‘(8) the Center agrees to meet all the other ap-
plicable requirements of this title, including regula-
tions implementing such requirements. 
‘‘SEC. 3007. ENTITLEMENT AUTHORITIES. 
‘‘Subject to subsections (b)(4)(C) and (c)(5) of sec-
tion 3012, subtitle B constitutes budget authority in ad-
vance of appropriations Acts and represents the obligation 
of the Federal Government to provide for the payment for 
monitoring, initial health evaluations, and treatment in ac-
cordance with such subtitle and section 3006(c) con-
stitutes such budget authority and represents the obliga-
tion of the Federal Government to provide for the payment 
described in such section. 
‘‘SEC. 3008. 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 
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of exposure to airborne toxins, any other hazard, or 
any other adverse condition resulting from the Sep-
tember 11, 2001, terrorist attacks on the World 
Trade Center requires medical treatment that is (or 
will be) in addition to, more frequent than, or of 
longer duration than the medical treatment that 
would have been required for such condition in the 
absence of such exposure. 
‘‘(2) The terms ‘certified eligible WTC re-
sponder’ and ‘certified eligible WTC community 
member’ mean an individual who has been certified 
as an eligible WTC responder under section 
3011(a)(4) or an eligible WTC community member 
under section 3021(a)(4), respectively. 
‘‘(3) The terms ‘Clinical Center of Excellence’ 
and ‘Coordinating Center of Excellence’ have the 
meanings given such terms in section 3006(b). 
‘‘(4) The term ‘current consortium arrange-
ments’ means the arrangements as in effect on the 
date of the enactment of this title between the Na-
tional Institute for Occupational Safety and Health 
and the Mt. Sinai-coordinated consortium and the 
Fire Department of the City of New York. 
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‘‘(5) The terms ‘eligible WTC responder’ and 
‘eligible WTC community member’ are defined in 
sections 3011(a) and 3021(a), respectively. 
‘‘(6) 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 pro-
gram. 
‘‘(7) The term ‘list of identified WTC-related 
health conditions’ means— 
‘‘(A) for eligible WTC responders, the 
identified WTC-related health condition for eli-
gible WTC responders under section 3012(a)(3) 
or 3012(a)(4); or 
‘‘(B) for eligible WTC community mem-
bers, the identified WTC-related health condi-
tion for WTC community members under sec-
tion 3022(b)(1) or 3022(b)(2). 
‘‘(8) The term ‘Mt.-Sinai-coordinated consor-
tium’ means the consortium coordinated by Mt. 
Sinai hospital in New York City that coordinates the 
monitoring and treatment under the current consor-
tium arrangements for eligible WTC responders 
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Landfill or the barge loading piers, for at 
least one day during the period beginning 
on September 11, 2001, and ending on 
July 31, 2002; 
‘‘(III) participated on-site in rescue, 
recovery, debris clean-up, or related serv-
ices in lower Manhattan (south of Canal 
St.) for at least 24 hours during the period 
beginning on September 11, 2001, and 
ending on September 30, 2001; or 
‘‘(IV) participated on-site in rescue, 
recovery, debris clean-up, or related serv-
ices 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 the City of 
New York involved in the examination and 
handling of human remains from the 
World Trade Center attacks, or other 
morgue worker who performed similar 
post-September 11 functions for such Of-
fice staff, during the period beginning on 
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spending for such period, and the denomi-
nator of which is the CBO WTC spending 
estimate under this title for such period. 
‘‘(D) DEFINITIONS.—For purposes of this 
paragraph: 
‘‘(i) NET FEDERAL SPENDING.—The 
term ‘net Federal WTC spending’ means, 
with respect to a period of fiscal years, the 
net Federal spending under this title for 
such fiscal years. 
‘‘(ii) CBO WTC SPENDING ESTIMATE 
UNDER
THIS
TITLE.—The term ‘CBO 
WTC medical spending estimate under this 
title’ means, with respect to— 
‘‘(I) fiscal years 2009 through 
2011, $900,000,000; 
‘‘(II) fiscal years 2012 through 
2015, $1,890,000,000; and 
‘‘(III) fiscal years 2009 through 
2015, the sum of the amounts speci-
fied in subclauses (I) and (II). 
‘‘(iii) WTC EXPENDITURE-TO-CBO-ES-
TIMATE
PERCENTAGE.—The term ‘WTC 
expenditure-to-estimate percentage’ means, 
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