Attachment A_Zadroga Act

H. R. 847

One Hundred Eleventh Congress
of the
United States of America
AT T H E S E C O N D S E S S I O N
Begun and held at the City of Washington on Tuesday,
the fifth day of January, two thousand and ten

An Act
To amend the Public Health Service Act to extend and improve protections and
services to individuals directly impacted by the terrorist attack in New York
City on September 11, 2001, and for other purposes.

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.—This Act may be cited as the ‘‘James Zadroga
9/11 Health and Compensation Act of 2010’’.
(b) TABLE OF CONTENTS.—The table of contents of this Act
is as follows:
Sec. 1. Short title; table of contents.
TITLE I—WORLD TRADE CENTER HEALTH PROGRAM
Sec. 101. World Trade Center Health Program.
‘‘TITLE XXXIII—WORLD TRADE CENTER HEALTH PROGRAM
‘‘Subtitle A—Establishment of Program; Advisory Committee
‘‘Sec. 3301. Establishment of World Trade Center Health Program.
‘‘Sec. 3302. WTC Health Program Scientific/Technical Advisory 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 WTCrelated 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 September
11 terrorist attacks.

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‘‘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.
Sec.
Sec.
Sec.
Sec.

201.
202.
203.
204.
205.

Definitions.
Extended and expanded eligibility for compensation.
Requirement to update regulations.
Limited liability for certain claims.
Funding; attorney fees.
TITLE III—REVENUE RELATED PROVISIONS

Sec. 301. Excise tax on foreign procurement.
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 Administrator, to provide beginning
on July 1, 2011—
‘‘(1) medical monitoring and treatment benefits to eligible
emergency responders and recovery and cleanup workers
(including those who are Federal employees) who responded
to the September 11, 2001, terrorist attacks; and
‘‘(2) initial health evaluation, monitoring, and treatment
benefits to residents and other building occupants and area
workers in New York City who were directly impacted and
adversely affected by such attacks.
‘‘(b) COMPONENTS OF PROGRAM.—The WTC Program includes
the following components:
‘‘(1) MEDICAL MONITORING FOR RESPONDERS.—Medical monitoring under section 3311, including clinical examinations and
long-term health monitoring 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.

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‘‘(2) INITIAL HEALTH EVALUATION FOR SURVIVORS.—An initial health evaluation under section 3321, including an evaluation to determine eligibility for followup monitoring and treatment.
‘‘(3) FOLLOWUP MONITORING AND TREATMENT FOR WTCRELATED HEALTH CONDITIONS FOR RESPONDERS 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
respect to a WTC-related health condition (including necessary
prescription drugs).
‘‘(4) OUTREACH.—Establishment under section 3303 of an
education and outreach program to potentially eligible individuals concerning the benefits under this title.
‘‘(5) CLINICAL DATA COLLECTION AND ANALYSIS.—Collection
and analysis under section 3304 of health and mental health
data relating to individuals receiving monitoring or treatment
benefits in a uniform manner in collaboration with the collection
of epidemiological data under section 3342.
‘‘(6) RESEARCH ON HEALTH CONDITIONS.—Establishment
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 certified-eligible WTC survivor. Initial health evaluation benefits are provided under subtitle B without
any deductibles, copayments, or other cost sharing to a screeningeligible WTC survivor.
‘‘(d) PREVENTING FRAUD AND UNREASONABLE ADMINISTRATIVE
COSTS.—
‘‘(1) FRAUD.—The Inspector General of the Department of
Health and Human Services shall develop and implement a
program to review the WTC Program’s health care expenditures
to detect fraudulent or duplicate billing and payment for
inappropriate services. This title is a Federal health care program (as defined in section 1128B(f) of the Social Security
Act) and is a health plan (as defined in section 1128C(c) of
such Act) for purposes of applying sections 1128 through 1128E
of such Act.
‘‘(2) UNREASONABLE ADMINISTRATIVE COSTS.—The Inspector
General of the Department of Health and Human Services
shall develop and implement a program to review the WTC
Program for unreasonable administrative costs, including with
respect to infrastructure, administration, and claims processing.
‘‘(e) QUALITY ASSURANCE.—The WTC Program Administrator
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 providers. Such program shall include—
‘‘(1) adherence to monitoring and treatment protocols;
‘‘(2) appropriate diagnostic and treatment referrals for
participants;
‘‘(3) prompt communication of test results to participants;
and

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‘‘(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 Administrator 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;
‘‘(ii) of the individuals who were certified, on the
number who received 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 individuals who
will be certified under subtitle B in the succeeding
fiscal year and the succeeding 10-year period.
‘‘(B) MONITORING, INITIAL HEALTH EVALUATION, AND
TREATMENT
COSTS.—For
each clinical program so
described—
‘‘(i) information on the costs of monitoring 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 health plans, or by New York City under
section 3331.
‘‘(C) ADMINISTRATIVE COSTS.—Information on the cost
of administering the program, including costs of program
support, data collection and analysis, and research conducted under the program.
‘‘(D) ADMINISTRATIVE EXPERIENCE.—Information on the
administrative performance of the program, including—
‘‘(i) the performance of the program in providing
timely evaluation of and treatment 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 exposure described in section 3306(1),
including the findings of research conducted under section
3341(a).
‘‘(F) ADVISORY COMMITTEE RECOMMENDATIONS.—A list
of recommendations by the WTC Scientific/Technical
Advisory Committee on additional WTC Program eligibility

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criteria and on additional WTC-related health conditions
and the action of the WTC Program Administrator concerning each such recommendation.
‘‘(3) SEPARATE CLINICAL PROGRAMS DESCRIBED.—In paragraph (2), each of the following shall be treated as a separate
clinical program of the WTC Program:
‘‘(A) FIREFIGHTERS AND RELATED PERSONNEL.—The
benefits provided for enrolled WTC responders described
in section 3311(a)(2)(A).
‘‘(B) OTHER WTC RESPONDERS.—The benefits provided
for enrolled WTC responders not described in subparagraph
(A).
‘‘(C) WTC SURVIVORS.—The benefits provided for
screening-eligible WTC survivors and certified-eligible WTC
survivors in section 3321(a).
‘‘(g) NOTIFICATION TO CONGRESS UPON REACHING 80 PERCENT
OF ELIGIBILITY NUMERICAL LIMITS.—The Secretary shall promptly
notify the Congress of each of the following:
‘‘(1) When the number of enrollments of WTC responders
subject to the limit established under section 3311(a)(4) has
reached 80 percent of such limit.
‘‘(2) When the number of certifications for certified-eligible
WTC survivors subject to the limit established under section
3321(a)(3) has reached 80 percent of such limit.
‘‘(h) CONSULTATION.—The WTC Program Administrator shall
engage in ongoing outreach and consultation with relevant stakeholders, including the WTC Health Program Steering Committees
and the Advisory Committee under section 3302, regarding the
implementation and improvement of programs under this title.
‘‘SEC. 3302. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY
COMMITTEE; WTC HEALTH PROGRAM STEERING COMMITTEES.

‘‘(a) ADVISORY COMMITTEE.—
‘‘(1) ESTABLISHMENT.—The WTC Program Administrator
shall establish an advisory committee to be known as the
WTC Health Program Scientific/Technical Advisory Committee
(in this subsection referred to as the ‘Advisory Committee’)
to review scientific and medical evidence and to make recommendations to the Administrator on additional WTC Program eligibility criteria and on additional WTC-related health
conditions.
‘‘(2) COMPOSITION.—The WTC Program Administrator 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 pulmonary medicine;
‘‘(C) 2 environmental medicine or environmental 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.

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‘‘(3) MEETINGS.—The Advisory Committee shall meet at
such frequency as may be required to carry out its duties.
‘‘(4) REPORTS.—The WTC Program Administrator shall provide for publication of recommendations 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 continue in operation during
the period in which the WTC Program is in operation.
‘‘(6) APPLICATION OF FACA.—Except as otherwise specifically
provided, the Advisory Committee shall be subject to the Federal Advisory Committee Act.
‘‘(b) WTC HEALTH PROGRAM STEERING COMMITTEES.—
‘‘(1) CONSULTATION.—The WTC Program Administrator
shall consult with 2 steering committees (each in this section
referred to as a ‘Steering Committee’) that are established
as follows:
‘‘(A) WTC RESPONDERS STEERING COMMITTEE.—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 enrolled
WTC responders under part 1 of subtitle B.
‘‘(B) WTC SURVIVORS STEERING COMMITTEE.—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 treatment
programs for screening-eligible and certified-eligible WTC
survivors under part 2 of subtitle B.
‘‘(2) MEMBERSHIP.—
‘‘(A) WTC RESPONDERS STEERING COMMITTEE.—
‘‘(i) REPRESENTATION.—The WTC Responders
Steering Committee shall include—
‘‘(I) representatives of the Centers of Excellence providing services to WTC responders;
‘‘(II) representatives of labor organizations representing firefighters, police, other New York City
employees, and recovery and cleanup workers who
responded to the September 11, 2001, terrorist
attacks; and
‘‘(III) 3 representatives of New York City, 1
of whom will be selected by the police commissioner of New York City, 1 by the health commissioner of New York City, and 1 by the mayor
of New York City.
‘‘(ii) INITIAL MEMBERSHIP.—The WTC Responders
Steering Committee shall initially be composed of
members of the WTC Monitoring and Treatment Program Steering Committee (as in existence on the day
before the date of the enactment of this title).
‘‘(B) WTC SURVIVORS STEERING COMMITTEE.—
WTC
Survivors
‘‘(i)
REPRESENTATION.—The
Steering Committee shall include representatives of—
‘‘(I) the Centers of Excellence providing services to screening-eligible and certified-eligible WTC
survivors;

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‘‘(II) the population of residents, students, and
area and other workers affected by the September
11, 2001, terrorist attacks;
‘‘(III) screening-eligible and certified-eligible
survivors receiving initial health evaluations, monitoring, or treatment under part 2 of subtitle B
and organizations advocating on their behalf; and
‘‘(IV) New York City.
‘‘(ii) INITIAL MEMBERSHIP.—The WTC Survivors
Steering Committee shall initially be composed of
members of the WTC Environmental Health Center
Survivor Advisory 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 approved by a majority of voting
members of the Committee, additional members to the
Committee.
‘‘(D) VACANCIES.—A vacancy in a Steering Committee
shall be filled by an individual recommended by the
Steering Committee.
‘‘SEC. 3303. EDUCATION AND OUTREACH.

‘‘The WTC Program Administrator shall institute a program
that provides education and outreach on the existence 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 populations;
‘‘(C) development and dissemination of outreach materials informing people about the program; 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 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 EXCELLENCE.—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 REGISTRY.—The WTC
Program Administrator shall provide for collaboration between the

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Data Centers and the World Trade Center Health Registry
described in section 3342.
‘‘(d) PRIVACY.—The data collection and analysis under this section shall be conducted and maintained in a manner that protects
the confidentiality of individually identifiable health information
consistent with applicable statutes and regulations, including, as
applicable, HIPAA privacy and security law (as defined in section
3009(a)(2)) and section 552a of title 5, United States Code.
‘‘SEC. 3305. CLINICAL CENTERS OF EXCELLENCE AND DATA CENTERS.

‘‘(a) IN GENERAL.—
‘‘(1) CONTRACTS WITH CLINICAL CENTERS OF EXCELLENCE.—
The WTC Program Administrator shall, subject to subsection
(b)(1)(B), enter into contracts with Clinical Centers of Excellence (as defined in subsection (b)(1)(A))—
‘‘(A) for the provision of monitoring and treatment
benefits and initial health evaluation benefits under subtitle B;
‘‘(B) for the provision of outreach activities to individuals eligible for such monitoring and treatment benefits,
for initial health evaluation benefits, and for followup to
individuals who are enrolled in the monitoring program;
‘‘(C) for the provision of counseling for benefits under
subtitle B, with respect to WTC-related health conditions,
for individuals eligible for such benefits;
‘‘(D) for the provision of counseling for benefits for
WTC-related health conditions that may be available under
workers’ compensation or other benefit programs for workrelated injuries or illnesses, health insurance, disability
insurance, or other insurance plans or through public or
private social service agencies and assisting eligible individuals in applying for such benefits;
‘‘(E) for the provision of translational and interpretive
services for program participants who are not English language proficient; and
‘‘(F) for the collection and reporting of data, including
claims data, in accordance with section 3304.
‘‘(2) CONTRACTS WITH DATA CENTERS.—
‘‘(A) IN GENERAL.—The WTC Program Administrator
shall enter into contracts with one or more Data Centers
(as defined in subsection (b)(2))—
‘‘(i) for receiving, analyzing, and reporting 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 monitoring, initial
health evaluation, and treatment protocols, with
respect to WTC-related health conditions;
‘‘(iii) for coordinating the outreach activities conducted under paragraph (1)(B) by each corresponding
Clinical Center of Excellence;
‘‘(iv) for establishing criteria for the credentialing
of medical providers participating in the nationwide
network under section 3313;

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‘‘(v) for coordinating and administering 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 reporting 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 Administrator 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 engage in clinical discussions across the WTC Program to guide treatment
approaches for individuals 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 subsection with a Clinical
Center of Excellence or a Data Center may be with respect
to one or more class of enrolled WTC responders, screeningeligible WTC survivors, 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 Center 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 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 Centers 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 satisfaction 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 survivors, or certified-eligible WTC survivors;
‘‘(ii) has experience in caring for WTC responders
and screening-eligible WTC survivors or includes
health care providers who have been trained pursuant
to section 3313(c);

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‘‘(iii) employs health care provider staff with expertise that includes, at a minimum, occupational medicine, environmental medicine, trauma-related psychiatry and psychology, and social services counseling;
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 Excellence 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 receiving monitoring and treatment benefits under subtitle B from such Center.
‘‘(ii) Coordinate monitoring and treatment 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 corresponding Data
Center data, including claims data, in accordance with
section 3304(b).
‘‘(iv) Have in place safeguards against fraud that
are satisfactory to the Administrator, in consultation
with the Inspector General of the Department of
Health and Human Services.
‘‘(v) Treat or refer for treatment all individuals
who are enrolled WTC responders or certified-eligible
WTC survivors with respect to such Center who
present themselves for treatment of a WTC-related
health condition.
‘‘(vi) Have in place safeguards, consistent with section 3304(c), to ensure the confidentiality of an individual’s individually identifiable health information,
including requiring that such information not be disclosed to the individual’s employer without the
authorization of the individual.
‘‘(vii) Use amounts paid under subsection (c)(1)
only for costs incurred in carrying out the activities
described in subsection (a), other than those described
in subsection (a)(1)(A).
‘‘(viii) Utilize health care providers with occupational and environmental medicine expertise to conduct
physical and mental health assessments, in accordance
with protocols developed under subsection (a)(2)(A)(ii).
‘‘(ix) Communicate with WTC responders and
screening-eligible and certified-eligible WTC survivors
in appropriate languages and conduct outreach activities with relevant stakeholder worker or community
associations.
‘‘(x) Meet all the other applicable requirements
of this title, including regulations implementing such
requirements.
‘‘(C) TRANSITION RULE TO ENSURE CONTINUITY OF
CARE.—The WTC Program Administrator shall to the maximum extent feasible ensure continuity of care in any period
of transition from monitoring and treatment of an enrolled

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WTC responder or certified-eligible WTC survivor by a
provider to a Clinical Center of Excellence or a health
care provider participating in the nationwide network
under section 3313.
‘‘(2) DATA CENTERS.—For purposes of this title, the term
‘Data Center’ means a Center that the WTC Program Administrator determines has the capacity to carry out the responsibilities for a Data Center under subsection (a)(2).
‘‘(3) CORRESPONDING CENTERS.—For purposes of this title,
a Clinical Center of Excellence and a Data Center shall be
treated as ‘corresponding’ to the extent that such Clinical
Center and Data Center serve the same population group.
‘‘(c) PAYMENT FOR INFRASTRUCTURE COSTS.—
‘‘(1) IN GENERAL.—The WTC Program Administrator 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 Centers. Such negotiated rate shall be fair and appropriate and take into account the number of enrolled WTC
responders receiving services from such Center under this title.
‘‘(2) FIXED INFRASTRUCTURE COSTS.—For purposes of paragraph (1), the term ‘fixed infrastructure costs’ means, with
respect to a Clinical Center of Excellence, the costs incurred
by such Center that are not otherwise reimbursable by the
WTC Program Administrator under section 3312(c) for patient
evaluation, monitoring, or treatment but which are needed
to operate the WTC program such as the costs involved in
outreach to participants or recruiting participants, 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 enters into a contract under this section
have financial systems 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 exposure to airborne toxins,
any other hazard, or any other adverse condition resulting
from the September 11, 2001, terrorist attacks, 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 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.

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‘‘(4) The term ‘enrolled WTC responder’ means a WTC
responder enrolled under section 3311(a)(3).
‘‘(5) The term ‘initial health evaluation’ includes, with
respect to an individual, a medical and exposure history, a
physical examination, and additional 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 conditions’
means—
‘‘(A) for WTC responders, the health conditions listed
in section 3312(a)(3); and
‘‘(B) for screening-eligible and certified-eligible WTC
survivors, the health conditions listed in section 3322(b).
‘‘(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 Administrator, within
which WTC responders and eligible WTC screening-eligible survivors who reside in such area are reasonably able to access
monitoring and treatment benefits and initial health evaluation
benefits under this title through a Clinical Center of Excellence
described in subparagraphs (A), (B), or (C) of section 3305(b)(1).
‘‘(9) The term ‘screening-eligible WTC survivor’ has the
meaning given such term in section 3321(a)(1).
‘‘(10) Any reference to ‘September 11, 2001’ shall be deemed
a reference to the period on such date subsequent to the terrorist attacks at the World Trade Center, Shanksville, Pennsylvania, or the Pentagon, as applicable, on such date.
‘‘(11) The term ‘September 11, 2001, terrorist attacks’
means the terrorist attacks that occurred on September 11,
2001, in New York City, in Shanksville, Pennsylvania, and
at the Pentagon, and includes the aftermath of such attacks.
‘‘(12) The term ‘WTC Health Program Steering Committee’
means such a Steering Committee established under section
3302(b).
‘‘(13) The term ‘WTC Program’ means the Word Trade
Center Health Program established under section 3301(a).
‘‘(14)(A) The term ‘WTC Program Administrator’ means—
‘‘(i) subject to subparagraph (B), with respect to paragraphs (3) and (4) of section 3311(a) (relating to enrollment
of WTC responders), section 3312(c) and the corresponding
provisions of section 3322 (relating to payment for initial
health evaluation, monitoring, and treatment, paragraphs
(1)(C), (2)(B), and (3) of section 3321(a) (relating to determination or certification of screening-eligible or certifiedeligible WTC responders), and part 3 of subtitle B (relating
to payor provisions), an official in the 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 designee of such Director.

H. R. 847—13
‘‘(B) In no case may the Secretary designate under subparagraph (A)(i) the Director of the National Institute for Occupational Safety and Health or a designee of such Director with
respect to section 3322 (relating to payment for initial health
evaluation, 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 Advisory Committee’ means such Committee established under section
3302(a).

‘‘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.

‘‘(a) WTC RESPONDER DEFINED.—
‘‘(1) IN GENERAL.—For purposes of this title, the term ‘WTC
responder’ means any of the following individuals, subject to
paragraph (4):
‘‘(A) CURRENTLY IDENTIFIED RESPONDER.—An individual who has been identified as eligible for monitoring
under the arrangements 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 coordinates the monitoring
and treatment for enrolled WTC responders other than
with respect to those covered under the arrangement
with the Fire Department of New York City; or
‘‘(ii) the Fire Department of New York City.
‘‘(B) RESPONDER WHO MEETS CURRENT ELIGIBILITY CRITERIA.—An individual who meets the current eligibility
criteria described in paragraph (2).
‘‘(C) RESPONDER WHO MEETS MODIFIED ELIGIBILITY CRITERIA.—An individual who—
‘‘(i) performed rescue, recovery, demolition, debris
cleanup, or other related services in the New York
City disaster area in response to the September 11,
2001, terrorist attacks, regardless of whether such
services were performed by a State or Federal employee
or member of the National Guard or otherwise; and
‘‘(ii) 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 Program Administrator,
after consultation with the WTC Scientific/Technical
Advisory Committee, determines appropriate.
The WTC Program Administrator shall not modify such
eligibility criteria on or after the date that the number
of enrollments of WTC responders has reached 80 percent
of the limit described in paragraph (4) or on or after the

H. R. 847—14
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 section 3321(a)(3).
‘‘(2) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria
described in this paragraph for an individual is that the individual is described in any of the following categories:
‘‘(A) FIREFIGHTERS AND RELATED PERSONNEL.—The
individual—
‘‘(i) was a member of the Fire Department 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 on September 11, 2001, and ending on July
31, 2002; or
‘‘(ii)(I) is a surviving immediate family member
of an individual who was a member of the Fire Department of New York City (whether fire or emergency
personnel, 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 WORKERS.—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 period beginning on September 11, 2001, and ending on September 30, 2001,
or for at least 80 hours during the period beginning
on September 11, 2001, and ending on July 31, 2002;
‘‘(ii)(I) was a member of the Police Department
of New York City (whether active or retired) or a
member of the Port Authority Police of the Port
Authority of New York and New Jersey (whether active
or retired) who participated onsite in 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, recovery, 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, recovery, debris
cleanup, or related services in lower Manhattan (south
of Canal St.) for at least 24 hours during the period

H. R. 847—15
beginning on September 11, 2001, and ending on September 30, 2001; or
‘‘(IV) participated onsite in rescue, recovery, 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 handling of human remains from the
World Trade Center attacks, or other morgue worker
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 Authority TransHudson Corporation Tunnel for at least 24 hours
during the period beginning on February 1, 2002, and
ending on July 1, 2002; or
‘‘(v) was a vehicle-maintenance worker who was
exposed to debris from the former World Trade Center
while retrieving, driving, cleaning, repairing, and
maintaining vehicles contaminated by airborne toxins
from the September 11, 2001, terrorist attacks during
a duration and period described 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 police department
(whether fire or emergency personnel, active or
retired), worked for a recovery or cleanup contractor,
or was a volunteer; and performed rescue, recovery,
demolition, debris cleanup, or other related services
at the Pentagon site of the terrorist-related aircraft
crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date
on which the cleanup of the site was concluded, as
determined by the WTC Program Administrator; or
‘‘(II) was a member of a fire or police department
(whether fire or emergency personnel, active or
retired), worked for a recovery or cleanup contractor,
or was a volunteer; and performed rescue, recovery,
demolition, debris cleanup, or other related services
at the Shanksville, Pennsylvania, site of the terroristrelated aircraft crash of September 11, 2001, during
the period beginning on September 11, 2001, and
ending on the date on which the cleanup of the site
was concluded, as determined by the WTC Program
Administrator; and
‘‘(ii) is determined by the WTC Program Administrator to be at an increased risk of developing a WTCrelated health condition as a result of exposure to
airborne toxins, other hazards, or adverse conditions
resulting from the September 11, 2001, terrorist
attacks, and meets such eligibility criteria related to
such exposures, as the WTC Program Administrator
determines are appropriate, after consultation with the
WTC Scientific/Technical Advisory Committee.

H. R. 847—16
‘‘(3) ENROLLMENT PROCESS.—
‘‘(A) IN GENERAL.—The WTC Program Administrator
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 enrolled in such Program;
‘‘(ii) subject to clause (iii), the Administrator shall
enroll in such program individuals who are determined
to be WTC responders;
‘‘(iii) the Administrator shall deny such enrollment
to an individual if the Administrator 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 enrollment in
such Program shall have an opportunity to appeal
such determination in a manner established under
such process.
‘‘(B) TIMING.—
‘‘(i) CURRENTLY IDENTIFIED RESPONDERS.—In
accordance with subparagraph (A)(i), the WTC Program Administrator shall enroll an individual
described in paragraph (1)(A) in the WTC Program
not later than July 1, 2011.
‘‘(ii) OTHER RESPONDERS.—In accordance with
subparagraph (A)(ii) and consistent with paragraph
(4), the WTC Program Administrator shall enroll any
other individual who is determined to be a WTC
responder in the WTC Program at the time of such
determination.
‘‘(4)
NUMERICAL
LIMITATION
ON
ELIGIBLE
WTC
RESPONDERS.—
‘‘(A) IN GENERAL.—The total number of individuals not
described in paragraph (1)(A) or (2)(A)(ii) who may be
enrolled under paragraph (3)(A)(ii) shall not exceed 25,000
at any time, of which no more than 2,500 may be individuals enrolled based on modified eligibility criteria established under paragraph (1)(C).
‘‘(B) PROCESS.—In implementing subparagraph (A), the
WTC Program Administrator shall—
‘‘(i) limit the number of enrollments made under
paragraph (3)—
‘‘(I) in accordance with such subparagraph;
and
‘‘(II) to such number, as determined by the
Administrator based on the best available information and subject 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 fiscal
year 2020; and

H. R. 847—17
‘‘(ii) provide priority (subject to paragraph (3)(A)(i))
in such enrollments in the order in which individuals
apply for enrollment 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 WTC responder. Before enrolling any
individual as a WTC responder in the WTC Program under
paragraph (3), the Administrator, in consultation with the Secretary of Homeland Security, shall 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 subsection (a)(2)(A)(ii)), the WTC
Program shall provide for monitoring benefits that include monitoring consistent with protocols approved by the WTC Program
Administrator and including clinical examinations and longterm health monitoring and analysis. In the case of an enrolled
WTC responder who is an active member of the Fire Department of New York City, the responder shall receive such benefits as part of the individual’s periodic company medical exams.
‘‘(2) PROVISION OF MONITORING BENEFITS.—The monitoring
benefits under paragraph (1) shall be provided through the
Clinical Center of Excellence for the type of individual involved
or, in the case of an individual residing outside the New York
metropolitan area, under an arrangement under section 3313.
‘‘SEC. 3312. TREATMENT OF ENROLLED WTC RESPONDERS FOR WTCRELATED HEALTH CONDITIONS.

‘‘(a) WTC-RELATED HEALTH CONDITION DEFINED.—
‘‘(1) IN GENERAL.—For purposes of this title, the term ‘WTCrelated health condition’ means a condition that—
‘‘(A)(i) is an illness or health condition for which exposure to airborne toxins, any other hazard, or any other
adverse condition resulting from the September 11, 2001,
terrorist attacks, based on an examination by a medical
professional with experience in treating or diagnosing the
health conditions included in the applicable list of WTCrelated health conditions, is substantially likely to be a
significant factor in aggravating, contributing to, or causing
the illness or health condition, as determined under paragraph (2); or
‘‘(ii) is a mental health condition for which such
attacks, based on an examination by a medical professional
with experience in treating or diagnosing the health conditions included in the applicable list of WTC-related health
conditions, is substantially likely to be a significant factor
in aggravating, contributing to, or causing the condition,
as determined under paragraph (2); and
‘‘(B) is included in the applicable list of WTC-related
health conditions or—
‘‘(i) with respect to a WTC responder, is provided
certification of coverage under subsection (b)(2)(B)(iii);
or
‘‘(ii) with respect to a screening-eligible WTC survivor or certified-eligible WTC survivor, is provided

H. R. 847—18
certification of coverage under subsection (b)(2)(B)(iii),
as applied under section 3322(a).
In the case of a WTC responder described in section
3311(a)(2)(A)(ii) (relating to a surviving immediate family
member of a firefighter), such term does not include an illness
or health condition described in subparagraph (A)(i).
‘‘(2) DETERMINATION.—The determination under paragraph
(1) or subsection (b) of whether the September 11, 2001, terrorist attacks were substantially likely to be a significant factor
in aggravating, contributing to, or causing an individual’s illness or health condition shall be made based on an assessment
of the following:
‘‘(A) The individual’s exposure to airborne toxins, any
other hazard, or any other adverse condition resulting from
the terrorist attacks. Such exposure shall be—
‘‘(i) evaluated and characterized through the use
of a standardized, population-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 included 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 medical questionnaire approved
by the Director of the National Institute for Occupational Safety and Health and a medical examination;
and
‘‘(ii) diagnosed and documented by a medical
professional described in subparagraph (A)(ii).
‘‘(3) LIST OF HEALTH CONDITIONS FOR WTC RESPONDERS.—
The list of health conditions for WTC responders consists of
the following:
‘‘(A) AERODIGESTIVE DISORDERS.—
‘‘(i) Interstitial lung diseases.
‘‘(ii) Chronic respiratory disorder—fumes/vapors.
‘‘(iii) Asthma.
‘‘(iv) Reactive airways dysfunction syndrome
(RADS).
‘‘(v) WTC-exacerbated chronic obstructive 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 previous clause.
‘‘(B) MENTAL HEALTH CONDITIONS.—
‘‘(i) Posttraumatic stress disorder (PTSD).
‘‘(ii) Major depressive disorder.
‘‘(iii) Panic disorder.
‘‘(iv) Generalized anxiety disorder.
‘‘(v) Anxiety disorder (not otherwise specified).

H. R. 847—19
‘‘(vi) Depression (not otherwise specified).
‘‘(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 cancer (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 received any treatment for
a WTC-related musculoskeletal disorder on or before September 11, 2003, the list of health conditions in paragraph
(3) shall include:
‘‘(i) Low back pain.
‘‘(ii) Carpal tunnel syndrome (CTS).
‘‘(iii) Other musculoskeletal disorders.
‘‘(B) DEFINITION.—The term ‘WTC-related musculoskeletal disorder’ means a chronic or recurrent disorder
of the musculoskeletal system caused by heavy lifting or
repetitive strain on the joints or musculoskeletal system
occurring during rescue or recovery efforts in the New
York City disaster area in the aftermath of the September
11, 2001, terrorist attacks.
‘‘(5) CANCER.—
‘‘(A) IN GENERAL.—The WTC Program Administrator
shall periodically conduct a review of all available scientific
and medical evidence, including findings and recommendations of Clinical Centers of Excellence, published in peerreviewed journals to determine if, based on such evidence,
cancer or a certain type of cancer should be added to
the applicable list of WTC-related health conditions. The
WTC Program Administrator shall conduct the first review
under this subparagraph not later than 180 days after
the date of the enactment of this title.
‘‘(B) PROPOSED REGULATIONS AND RULEMAKING.—Based
on the periodic reviews under subparagraph (A), if the
WTC Program Administrator determines that cancer or
a certain type of cancer should be added to such list of
WTC-related health conditions, the WTC Program Administrator 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 certain type of cancer should be added to
such list of WTC-related health conditions. If such a determination is made to make such an addition, the WTC
Program Administrator shall by regulation add cancer or
the certain type of cancer to such list.
‘‘(D) DETERMINATIONS NOT TO ADD CANCER OR CERTAIN
TYPES OF CANCER.—In the case that the WTC Program
Administrator determines under subparagraph (B) or (C)
that cancer or a certain type of cancer should not be added

H. R. 847—20
to such list of WTC-related health conditions, the WTC
Program Administrator shall publish an explanation for
such determination in the Federal Register. Any such determination to not make such an addition shall not preclude
the addition of cancer or the certain type of cancer to
such list at a later date.
‘‘(6) ADDITION OF HEALTH CONDITIONS TO LIST FOR WTC
RESPONDERS.—
‘‘(A) IN GENERAL.—Whenever the WTC Program
Administrator determines that a proposed rule should be
promulgated to add a health condition to the list of health
conditions in paragraph (3), the Administrator may request
a recommendation of the Advisory Committee or may publish such a proposed rule in the Federal Register in accordance with subparagraph (D).
‘‘(B) ADMINISTRATOR’S OPTIONS AFTER RECEIPT OF PETITION.—In the case that the WTC Program Administrator
receives a written petition by an interested party to add
a health condition to the list of health conditions in paragraph (3), not later than 60 days after the date of receipt
of such petition the Administrator shall—
‘‘(i) request a recommendation of the Advisory
Committee;
‘‘(ii) publish a proposed rule in the Federal Register
to add such health condition, 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 exists to take action
under clauses (i) through (iii).
‘‘(C) ACTION BY ADVISORY COMMITTEE.—In the case that
the Administrator requests a recommendation of the
Advisory Committee under this paragraph, with respect
to adding a health condition to the list in paragraph (3),
the Advisory Committee shall submit to the Administrator
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 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 proposed rule under this paragraph—
‘‘(i) publish such proposed rule in accordance with
section 553 of title 5, United States Code; and
‘‘(ii) provide interested parties a period 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

H. R. 847—21
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 organization 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 RESPONDERS BASED
ON A WTC-RELATED HEALTH CONDITION.—
‘‘(A) IN GENERAL.—If a physician at a Clinical Center
of Excellence that is providing monitoring benefits under
section 3311 for an enrolled WTC responder makes a determination that the responder has a WTC-related health
condition that is in the list in subsection (a)(3) and that
exposure to airborne toxins, other hazards, or adverse
conditions resulting from the September 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 supporting such determination; and
‘‘(ii) on and after the date of such transmittal
and subject to subparagraph (B), the WTC Program
shall provide for payment under subsection (c) for
medically necessary treatment for such condition.
‘‘(B) REVIEW; CERTIFICATION; APPEALS.—
‘‘(i) REVIEW.—A Federal employee designated by
the WTC Program Administrator shall review determinations made under subparagraph (A).
‘‘(ii) CERTIFICATION.—The Administrator shall provide a certification of such condition based upon
reviews conducted under clause (i). Such a certification
shall be provided unless the Administrator determines
that the responder’s condition is not a WTC-related
health condition in the list in subsection (a)(3) or that
exposure to airborne toxins, other hazards, or adverse
conditions resulting from the September 1, 2001, terrorist attacks is not substantially likely to be a significant factor in aggravating, contributing to, or causing
the condition.
‘‘(iii) APPEAL PROCESS.—The Administrator shall
establish, by rule, a process for the appeal of determinations under clause (ii).
‘‘(2) DETERMINATION BASED ON MEDICALLY ASSOCIATED WTCRELATED HEALTH CONDITIONS.—
‘‘(A) IN GENERAL.—If a physician at a Clinical Center
of Excellence determines pursuant to subsection (a) that
the enrolled WTC responder has a health condition
described in subsection (a)(1)(A) that is not in the list
in subsection (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

H. R. 847—22
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 determination.
‘‘(B) PROCEDURES FOR REVIEW, CERTIFICATION, AND
APPEAL.—The WTC Program Administrator shall, by rule,
establish procedures for the review and certification of
physician determinations under subparagraph (A). Such
rule shall provide for—
‘‘(i) the timely review of such a determination by
a physician panel with appropriate expertise for the
condition and recommendations to the WTC Program
Administrator;
‘‘(ii) not later than 60 days after the date of the
transmittal under subparagraph (A)(i), a determination
by the WTC Program Administrator on whether or
not the condition involved is described in subsection
(a)(1)(A) and is medically associated with a WTCrelated 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
associated with a WTC-related health condition; and
‘‘(iv) a process for appeals of determinations
relating to such conditions.
‘‘(C) INCLUSION IN LIST OF HEALTH CONDITIONS.—If the
WTC Program Administrator provides certification under
subparagraph (B)(iii) for coverage of a condition, the
Administrator may, pursuant to subsection (a)(6), add the
condition to the list in subsection (a)(3).
‘‘(D) CONDITIONS ALREADY DECLINED FOR INCLUSION
IN LIST.—If the WTC Program Administrator publishes a
determination under subsection (a)(6)(B) not to include a
condition in the list in subsection (a)(3), the WTC Program
Administrator shall not provide certification under
subparagraph (B)(iii) for coverage of the condition. In the
case of an individual who is certified under subparagraph
(B)(iii) with respect to such condition before the date of
the publication of such determination the previous sentence
shall not apply.
‘‘(3) REQUIREMENT OF MEDICAL NECESSITY.—
‘‘(A) IN GENERAL.—In providing treatment for a WTCrelated 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 WTC Program Administrator shall issue regulations specifying a standard for
determining medical necessity with respect to health care
services and prescription pharmaceuticals, a process for
determining whether treatment furnished and pharmaceuticals prescribed under this title meet such standard
(including any prior authorization requirement), and a
process for appeal of a determination under subsection
(c)(3).

H. R. 847—23
‘‘(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, diagnostic 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 necessary outpatient
prescription drugs, such drugs shall be provided, under
arrangements made by the WTC Program Administrator,
directly through participating Clinical Centers of Excellence or through one or more outside vendors.
‘‘(C) TRANSPORTATION EXPENSES FOR NATIONWIDE NETWORK.—The WTC Program Administrator may provide for
necessary and reasonable transportation and expenses
incident to the securing of medically necessary treatment
through the nationwide network under section 3313
involving travel of more than 250 miles and for which
payment is made under this section in the same manner
in which individuals may be furnished necessary and
reasonable transportation and expenses incident to services
involving travel of more than 250 miles under regulations
implementing section 3629(c) of the Energy Employees
Occupational Illness Compensation Program Act of 2000
(title XXXVI of Public Law 106–398; 42 U.S.C. 7384t(c)).
‘‘(5) PROVISION OF TREATMENT PENDING CERTIFICATION.—
With respect to an enrolled WTC responder for whom a determination is made by an examining physician under paragraph
(1) or (2), but for whom the WTC Program Administrator has
not yet determined whether to certify the determination, the
WTC Program Administrator may establish by rule a process
through which the Administrator may approve the provision
of medical treatment under this subsection (and payment under
subsection (c)) with respect to such responder and such
responder’s WTC-related health condition (under such terms
and conditions as the Administrator may provide) until the
Administrator makes a decision on whether to certify the determination.
‘‘(c) PAYMENT FOR INITIAL HEALTH EVALUATION, MONITORING,
AND TREATMENT OF WTC-RELATED HEALTH CONDITIONS.—
‘‘(1) MEDICAL TREATMENT.—
‘‘(A) USE OF FECA PAYMENT RATES.—
‘‘(i) IN GENERAL.—Subject to clause (ii):
‘‘(I) Subject to subparagraphs (B) and (C), the
WTC Program Administrator shall reimburse costs
for medically necessary treatment under this title
for WTC-related health conditions according to the
payment rates that would apply to the provision
of such treatment and services by the facility under
the Federal Employees Compensation Act.
‘‘(II) For treatment not covered under subclause (i) or subparagraph (B), the WTC Program
Administrator shall establish by regulation a
reimbursement 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

H. R. 847—24
Programs in the Department Labor would pay for such
products or services rendered at the time such products
or services were provided.
‘‘(B) PHARMACEUTICALS.—
‘‘(i) IN GENERAL.—The WTC Program Administrator shall establish a program for paying for the
medically necessary outpatient prescription pharmaceuticals prescribed under this title for WTC-related
health conditions through one or more contracts with
outside vendors.
‘‘(ii) COMPETITIVE BIDDING.—Under such program
the Administrator shall—
‘‘(I) select one or more appropriate vendors
through a Federal competitive bid process; and
‘‘(II) select the lowest bidder (or bidders)
meeting the requirements for providing pharmaceutical benefits for participants in the WTC Program.
‘‘(iii) TREATMENT OF FDNY PARTICIPANTS.—Under
such program the Administrator 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 arrangement is deemed necessary and
beneficial 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 programs can provide
pharmaceutical benefits more efficiently and effectively
than through the WTC program.
‘‘(C) IMPROVING QUALITY AND EFFICIENCY THROUGH
MODIFICATION OF PAYMENT AMOUNTS AND METHODOLOGIES.—The WTC Program Administrator may modify the
amounts and methodologies for making payments for initial
health evaluations, monitoring, or treatment, if, taking into
account utilization and quality data furnished by the Clinical Centers of Excellence under section 3305(b)(1)(B)(iii),
the Administrator determines that a bundling, capitation,
pay for performance, or other payment methodology would
better ensure high quality and efficient delivery of initial
health evaluations, monitoring, or treatment to an enrolled
WTC responder, screening-eligible WTC survivor, or certified-eligible WTC survivor.
‘‘(2) MONITORING AND INITIAL HEALTH EVALUATION.—The
WTC Program Administrator shall reimburse the costs of monitoring and the costs of an initial 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 reimbursement or payment under
this subsection, the WTC Program Administrator shall provide for the review of claims for reimbursement or payment

H. R. 847—25
for the provision of medical treatment to determine if such
treatment is medically necessary and in accordance with
medical treatment protocols established under subsection
(d).
‘‘(B) WITHHOLDING OF PAYMENT FOR MEDICALLY
UNNECESSARY TREATMENT.—The Administrator shall withhold such reimbursement or payment for treatment that
the Administrator 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 protocols 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 access to benefits under this subtitle for individuals who are enrolled WTC
responders, screening-eligible WTC survivors, or certified-eligible
WTC survivors and who reside in any State, as defined in section
2(f), outside the New York metropolitan area, the WTC Program
Administrator shall establish a nationwide network of health care
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 evaluation 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 evaluation, 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 Administrator establishes,
including sections 1128 through 1128E of the Social Security
Act, as applied by section 3301(d).
‘‘(c) TRAINING AND TECHNICAL ASSISTANCE.—The WTC Program
Administer may provide, including through contract, for the provision of training and technical assistance to health care providers
participating in the network under subsection (a).
‘‘(d) PROVISION OF SERVICES THROUGH THE VA.—
‘‘(1) IN GENERAL.—The WTC Program Administrator may
enter into an agreement with the Secretary of Veterans Affairs
for the Secretary to provide services under this section through
facilities of the Department of Veterans Affairs.
‘‘(2) NATIONAL PROGRAM.—Not later than July 1, 2011,
the Comptroller General of the United States shall submit

H. R. 847—26
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 the
Department of Veterans Affairs can provide monitoring and
treatment services to individuals under this section more efficiently and effectively than through the nationwide network
to be established under subsection (a).

‘‘PART 2—WTC SURVIVORS
‘‘SEC. 3321. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF
SCREENING-ELIGIBLE AND CERTIFIED-ELIGIBLE WTC
SURVIVORS.
AND

‘‘(a) IDENTIFICATION OF SCREENING-ELIGIBLE WTC SURVIVORS
CERTIFIED-ELIGIBLE WTC SURVIVORS.—
‘‘(1) SCREENING-ELIGIBLE WTC SURVIVORS.—
‘‘(A) DEFINITION.—In this title, the term ‘screeningeligible WTC survivor’ means, subject to subparagraph (C)
and paragraph (3), an individual who is described in any
of the following clauses:
‘‘(i) CURRENTLY IDENTIFIED SURVIVOR.—An individual, including a WTC responder, who has been
identified as eligible 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 current eligibility criteria described in subparagraph (B).
‘‘(iii) SURVIVOR WHO MEETS MODIFIED 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 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 Administrator
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 section 3311(a)(4).
‘‘(B) CURRENT ELIGIBILITY CRITERIA.—The eligibility criteria described in this subparagraph 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.

H. R. 847—27
‘‘(ii) A person who worked, resided, or attended
school, childcare, or adult daycare in the New York
City disaster area for—
‘‘(I) at least 4 days during the 4-month period
beginning on September 11, 2001, and ending on
January 10, 2002; or
‘‘(II) at least 30 days during the period beginning on September 11, 2001, and ending on July
31, 2002.
‘‘(iii) Any person who worked as a cleanup worker
or performed maintenance work in the New York City
disaster area during the 4-month period described in
subparagraph (B)(i) and had extensive exposure to
WTC dust as a result of such work.
‘‘(iv) A person who was deemed eligible to receive
a grant from the Lower Manhattan 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 resided
in such residence during the period beginning on September 11, 2001, and ending on May 31, 2003.
‘‘(v) A person whose place of employment—
‘‘(I) at any time during the period 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 receive a grant
from the Lower Manhattan Development Corporation WTC Small Firms Attraction and Retention
Act program or other government incentive 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 Data Centers shall
establish a process for individuals, other than individuals described in subparagraph (A)(i), to be determined
to be screening-eligible WTC survivors. Under such
process—
‘‘(I) there shall be no fee charged to the
applicant for making an application for such determination;
‘‘(II) the Administrator shall make a determination on such an application 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 Administrator determines that—
‘‘(aa) based on the application submitted,
the individual does not meet the eligibility
criteria; or

H. R. 847—28
‘‘(bb) the numerical limitation on certifications of certified-eligible WTC survivors set
forth in paragraph (3) has been met; and
‘‘(IV) an individual who is determined not to
be a screening-eligible WTC survivor shall have
an opportunity to appeal such determination in
a manner established under such process.
‘‘(ii) WRITTEN DOCUMENTATION OF SCREENINGELIGIBILITY.—
‘‘(I) IN GENERAL.—In the case of an individual
who is described in subparagraph (A)(i) or who
is determined under clause (i) (consistent with
paragraph (3)) to be a screening-eligible WTC survivor, the WTC Program Administrator shall provide an appropriate written documentation of such
fact.
‘‘(II) TIMING.—
‘‘(aa) CURRENTLY IDENTIFIED SURVIVORS.—
In the case of an individual who is described
in subparagraph (A)(i), the WTC Program
Administrator shall provide 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 Administrator shall provide the
written documentation under subclause (I) at
the time of such determination.
‘‘(2) CERTIFIED-ELIGIBLE WTC SURVIVORS.—
‘‘(A) DEFINITION.—The term ‘certified-eligible 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.—
‘‘(i) IN GENERAL.—The WTC Program Administrator shall establish a certification process under
which the Administrator shall provide appropriate certification to screening-eligible WTC survivors who,
pursuant to the initial health evaluation under subsection (b), are determined to be eligible for followup
monitoring and treatment under this part.
‘‘(ii) TIMING.—
‘‘(I) CURRENTLY IDENTIFIED SURVIVORS.—In the
case of an individual who is described in paragraph
(1)(A)(i), the WTC Program Administrator shall
provide the certification under clause (i) not later
than July 1, 2011.
‘‘(II) OTHER MEMBERS.—In the case of another
individual who is determined 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
determination.

H. R. 847—29
‘‘(3) NUMERICAL LIMITATION ON CERTIFIED-ELIGIBLE WTC
SURVIVORS.—
‘‘(A) IN GENERAL.—The total number of individuals not
described in paragraph (1)(A)(i) who may be certified as
certified-eligible WTC survivors under paragraph (2)(B)
shall not exceed 25,000 at any time.
‘‘(B) PROCESS.—In implementing subparagraph (A), the
WTC Program Administrator shall—
‘‘(i) limit the number of certifications provided
under paragraph (2)(B)—
‘‘(I) in accordance with such subparagraph;
and
‘‘(II) to such number, as determined by the
Administrator based on the best available information and subject to amounts made available under
section 3351, that will ensure sufficient funds will
be available to provide treatment and monitoring
benefits under this title, with respect to all individuals receiving such certifications through the end
of fiscal year 2020; and
‘‘(ii) provide priority in such certifications in the
order in which individuals apply for a determination
under paragraph (2)(B).
‘‘(4) DISQUALIFICATION OF INDIVIDUALS ON TERRORIST
WATCH LIST.—No individual who is on the terrorist watch list
maintained by the Department of Homeland Security shall
qualify as a screening-eligible WTC survivor or a certifiedeligible WTC survivor. Before determining any individual to
be a screening-eligible WTC survivor under paragraph (1) or
certifying any individual as a certified eligible WTC survivor
under paragraph (2), the Administrator, in consultation with
the Secretary of Homeland Security, shall determine whether
the individual is on such list.
‘‘(b) INITIAL HEALTH EVALUATION TO DETERMINE ELIGIBILITY
FOR FOLLOWUP MONITORING OR TREATMENT.—
‘‘(1) IN GENERAL.—In the case of a screening-eligible WTC
survivor, the WTC Program shall provide for an initial health
evaluation to determine if the survivor has a WTC-related
health condition and is eligible for followup monitoring and
treatment benefits under the WTC Program. Initial health
evaluation protocols under section 3305(a)(2)(A)(ii) shall be subject to approval by the WTC Program Administrator.
‘‘(2) INITIAL HEALTH EVALUATION PROVIDERS.—The initial
health evaluation described in paragraph (1) shall be provided
through a Clinical Center of Excellence with respect to the
individual involved.
‘‘(3) LIMITATION ON INITIAL HEALTH EVALUATION BENEFITS.—Benefits for an initial health evaluation under this part
for a screening-eligible WTC survivor shall consist only of a
single medical initial health evaluation consistent with initial
health evaluation protocols described in paragraph (1). Nothing
in this paragraph shall be construed as preventing such an
individual from seeking additional medical initial health
evaluations at the expense of the individual.

H. R. 847—30
‘‘SEC. 3322. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIEDELIGIBLE WTC SURVIVORS FOR WTC-RELATED HEALTH
CONDITIONS.

‘‘(a) IN GENERAL.—Subject to subsection (b), the provisions of
sections 3311 and 3312 shall apply to followup monitoring and
treatment of WTC-related health conditions for certified-eligible
WTC survivors in the same manner as such provisions apply to
the monitoring and treatment of WTC-related health conditions
for enrolled WTC responders.
‘‘(b) LIST OF WTC-RELATED HEALTH CONDITIONS FOR SURVIVORS.—The list of health conditions for screening-eligible WTC
survivors and certified-eligible WTC survivors consists of the following:
‘‘(1) AERODIGESTIVE DISORDERS.—
‘‘(A) Interstitial lung diseases.
‘‘(B) Chronic respiratory disorder—fumes/vapors.
‘‘(C) Asthma.
‘‘(D) Reactive airways dysfunction syndrome (RADS).
‘‘(E) WTC-exacerbated chronic obstructive pulmonary
disease (COPD).
‘‘(F) Chronic cough syndrome.
‘‘(G) Upper airway hyperreactivity.
‘‘(H) Chronic rhinosinusitis.
‘‘(I) Chronic nasopharyngitis.
‘‘(J) Chronic laryngitis.
‘‘(K) Gastroesophageal reflux disorder (GERD).
‘‘(L) Sleep apnea exacerbated by or related to a condition described in a previous clause.
‘‘(2) MENTAL HEALTH CONDITIONS.—
‘‘(A) Posttraumatic stress disorder (PTSD).
‘‘(B) Major depressive disorder.
‘‘(C) Panic disorder.
‘‘(D) Generalized anxiety disorder.
‘‘(E) Anxiety disorder (not otherwise specified).
‘‘(F) Depression (not otherwise specified).
‘‘(G) Acute stress disorder.
‘‘(H) Dysthymic disorder.
‘‘(I) Adjustment disorder.
‘‘(J) Substance abuse.
‘‘(3) ADDITIONAL CONDITIONS.—Any cancer (or type of
cancer) or other condition added to the list in section 3312(a)(3)
pursuant to paragraph (5) or (6) of section 3312(a), as such
provisions are applied under subsection (a) with respect to
certified-eligible WTC survivors.
‘‘SEC. 3323. FOLLOWUP MONITORING AND TREATMENT OF OTHER
INDIVIDUALS WITH WTC-RELATED HEALTH CONDITIONS.

‘‘(a) IN GENERAL.—Subject to subsection (c), the provisions of
section 3322 shall apply to the followup monitoring and treatment
of WTC-related health conditions in the case of individuals described
in subsection (b) in the same manner as such provisions apply
to the followup monitoring and treatment of WTC-related health
conditions for certified-eligible WTC survivors.
‘‘(b) INDIVIDUALS DESCRIBED.—An individual described in this
subsection is an individual who, regardless of location of residence—
‘‘(1) is not an enrolled WTC responder or a certified-eligible
WTC survivor; and

H. R. 847—31
‘‘(2) is diagnosed at a Clinical Center of Excellence with
a WTC-related health condition for certified-eligible WTC survivors.
‘‘(c) LIMITATION.—
‘‘(1) IN GENERAL.—The WTC Program Administrator shall
limit benefits for any fiscal year under subsection (a) in a
manner so that payments under this section for such fiscal
year do not exceed the amount specified in paragraph (2) for
such fiscal year.
‘‘(2) LIMITATION.—The amount specified in this paragraph
for—
‘‘(A) the last calendar quarter of fiscal year 2011 is
$5,000,000;
‘‘(B) fiscal year 2012 is $20,000,000; or
‘‘(C) a succeeding fiscal year is the amount specified
in this paragraph for the previous fiscal year increased
by the annual percentage increase in the medical care
component of the consumer price index for all urban consumers.

‘‘PART 3—PAYOR PROVISIONS
‘‘SEC. 3331. PAYMENT OF CLAIMS.

‘‘(a) IN GENERAL.—Except as provided in subsections (b) and
(c), the cost of monitoring and treatment benefits and initial health
evaluation benefits provided under parts 1 and 2 of this subtitle
shall be paid for by the WTC Program from the World Trade
Center Health Program Fund.
‘‘(b) WORKERS’ COMPENSATION PAYMENT.—
‘‘(1) IN GENERAL.—Subject to paragraph (2), payment for
treatment under parts 1 and 2 of this subtitle of a WTCrelated health condition of an individual that is work-related
shall be reduced or recouped to the extent that the WTC Program Administrator determines that payment has been made,
or can reasonably be expected to be made, under a workers’
compensation law or plan of the United States, a State, or
a locality, or other work-related injury or illness benefit plan
of the employer of such individual, for such treatment. The
provisions of clauses (iii), (iv), (v), and (vi) of paragraph (2)(B)
of section 1862(b) of the Social Security Act and paragraphs
(3) and (4) of such section shall apply to the recoupment under
this subsection of a payment to the WTC Program (with respect
to a workers’ compensation law or plan, or other work-related
injury or illness plan of the employer involved, and such individual) in the same manner as such provisions apply to the
reimbursement 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) except that any reference in such paragraph (4) to payment
rates under title XVIII of the Social Security Act shall be
deemed a reference to payment rates under this title.
‘‘(2) EXCEPTION.—Paragraph (1) shall not apply for any
quarter, with respect to any workers’ compensation law or
plan, including line of duty compensation, to which New York
City is obligated to make payments, if, in accordance with
terms specified under the contract under subsection (d)(1)(A),

H. R. 847—32
New York City has made the full payment required under
such contract for such quarter.
‘‘(3) RULES OF CONSTRUCTION.—Nothing in this title shall
be construed to affect, modify, or relieve any obligations under
a worker’s compensation law or plan, other work-related injury
or illness benefit plan of an employer, or any health insurance
plan.
‘‘(c) HEALTH INSURANCE COVERAGE.—
‘‘(1) IN GENERAL.—In the case of an individual who has
a WTC-related health condition that is not work-related and
has health coverage for such condition through any public or
private health plan (including health benefits under title XVIII,
XIX, or XXI of the Social Security Act) the provisions of section
1862(b) of the Social Security Act shall apply to such a health
plan and such individual in the same manner as they apply
to group health plan and an individual entitled to benefits
under title XVIII of such Act pursuant to section 226(a) of
such Act. Any costs for items and services covered under such
plan that are not reimbursed by such health plan, due to
the application of deductibles, copayments, coinsurance, other
cost sharing, or otherwise, are reimbursable under this title
to the extent that they are covered under the WTC Program.
The program under this title shall not be treated as a legally
liable party for purposes of applying section 1902(a)(25) of
the Social Security Act.
‘‘(2) RECOVERY BY INDIVIDUAL PROVIDERS.—Nothing in paragraph (1) shall be construed as requiring an entity providing
monitoring and treatment under this title to seek reimbursement under a health plan with which the entity has no contract
for reimbursement.
‘‘(3) MAINTENANCE OF REQUIRED MINIMUM ESSENTIAL COVERAGE.—No payment may be made for monitoring and treatment under this title for an individual for a month (beginning
with July 2014) if with respect to such month the individual—
‘‘(A) is an applicable individual (as defined in subsection (d) of section 5000A of Internal Revenue Code of
1986) for whom the exemption under subsection (e) of such
section does not apply; and
‘‘(B) is not covered under minimum essential coverage,
as required under subsection (a) of such section.
‘‘(d) REQUIRED CONTRIBUTION BY NEW YORK CITY IN PROGRAM
COSTS.—
‘‘(1) CONTRACT REQUIREMENT.—
‘‘(A) IN GENERAL.—No funds may be disbursed from
the World Trade Center Health Program Fund under section 3351 unless New York City has entered into a contract
with the WTC Program Administrator under which New
York City agrees, in a form and manner specified by the
Administrator, to pay the full contribution described in
subparagraph (B) in accordance with this subsection on
a timely basis, plus any interest owed pursuant to subparagraph (E)(i). Such contract shall specify the terms under
which New York City shall be considered to have made
the full payment required for a quarter for purposes of
subsection (b)(2).
‘‘(B) FULL CONTRIBUTION AMOUNT.—Under such contract, with respect to the last calendar quarter of fiscal

H. R. 847—33
year 2011 and each calendar quarter in fiscal years 2012
through 2015 the full contribution amount under this
subparagraph shall be equal to 10 percent of the expenditures in carrying out this title for the respective quarter
and with respect to calendar quarters in fiscal year 2016,
such full contribution amount shall be equal to 1⁄9 of the
Federal expenditures in carrying out this title for the
respective quarter.
‘‘(C) SATISFACTION OF PAYMENT OBLIGATION.—The payment obligation under such contract may not be satisfied
through any of the following:
‘‘(i) An amount derived from Federal sources.
‘‘(ii) An amount paid before the date of the enactment of this title.
‘‘(iii) An amount paid to satisfy a judgment or
as part of a settlement related to injuries or illnesses
arising out of the September 11, 2001, terrorist attacks.
‘‘(D) TIMING OF CONTRIBUTION.—The payment obligation under such contract for a calendar quarter in a fiscal
year shall be paid not later than the last day of the second
succeeding calendar quarter.
‘‘(E) COMPLIANCE.—
‘‘(i) INTEREST FOR LATE PAYMENT.—If New York
City fails to pay to the WTC Program Administrator
pursuant to such contract the amount required for
any calendar quarter by the day specified in subparagraph (D), interest shall accrue on the amount not
so paid at the rate (determined by the Administrator)
based on the average yield to maturity, plus 1 percentage point, on outstanding municipal bonds issued by
New York City with a remaining maturity of at least
1 year.
‘‘(ii) RECOVERY OF AMOUNTS OWED.—The amounts
owed to the WTC Program Administrator under such
contract shall be recoverable by the United States in
an action in the same manner as payments made under
title XVIII of the Social Security Act may be recoverable
in
an
action
brought
under
section
1862(b)(2)(B)(iii) of such Act.
‘‘(F) DEPOSIT IN FUND.—The WTC Program Administer
shall deposit amounts paid under such contract into the
World Trade Center Health Program Fund under section
3351.
‘‘(2) PAYMENT OF NEW YORK CITY SHARE OF MONITORING
AND TREATMENT COSTS.—With respect to each calendar quarter
for which a contribution is required by New York City under
the contract under paragraph (1), the WTC Program Administrator shall—
‘‘(A) provide New York City with an estimate of such
amount of the required contribution at the beginning of
such quarter and with an updated estimate of such amount
at the beginning of each of the subsequent 2 quarters;
‘‘(B) bill such amount directly to New York City; and
‘‘(C) certify periodically, for purposes of this subsection,
whether or not New York City has paid the amount so
billed.

H. R. 847—34
Such amount shall initially be estimated by the WTC Program
Administrator and shall be subject to adjustment and reconciliation based upon actual expenditures in carrying out this title.
‘‘(3) RULE OF CONSTRUCTION.—Nothing in this subsection
shall be construed as authorizing the WTC Administrator, with
respect to a fiscal year, to reduce the numerical limitation
under section 3311(a)(4) or 3321(a)(3) for such fiscal year if
New York City fails to comply with paragraph (1) for a calendar
quarter in such fiscal year.
‘‘(e) WORK-RELATED DESCRIBED.—For the purposes of this section, a WTC-related health condition shall be treated as a condition
that is work-related if—
‘‘(1) the condition is diagnosed in an enrolled WTC
responder, or in an individual who qualifies as a certifiedeligible WTC survivor on the basis of being a rescue, recovery,
or cleanup worker; or
‘‘(2) with respect to the condition the individual has filed
and had established a claim under a workers’ compensation
law or plan of the United States or a State, or other workrelated injury or illness benefit plan of the employer of such
individual.
‘‘SEC. 3332. ADMINISTRATIVE ARRANGEMENT AUTHORITY.

‘‘The WTC Program Administrator may enter into arrangements with other government agencies, insurance companies, or
other third-party administrators to provide for timely and accurate
processing of claims under sections 3312, 3313, 3322, and 3323.

‘‘Subtitle C—Research Into Conditions
‘‘SEC. 3341. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS
RELATED TO SEPTEMBER 11 TERRORIST ATTACKS.

‘‘(a) IN GENERAL.—With respect to individuals, including
enrolled WTC responders and certified-eligible WTC survivors,
receiving monitoring or treatment under subtitle B, the WTC Program Administrator shall conduct or support—
‘‘(1) research on physical and mental health conditions
that may be related to the September 11, 2001, terrorist
attacks;
‘‘(2) research on diagnosing WTC-related health conditions
of such individuals, in the case of conditions for which there
has been diagnostic uncertainty; and
‘‘(3) research on treating WTC-related health conditions
of such individuals, in the case of conditions for which there
has been treatment uncertainty.
The Administrator may provide such support through continuation
and expansion of research that was initiated before the date of
the enactment of this title and through the World Trade Center
Health Registry (referred to in section 3342), through a Clinical
Center of Excellence, or through a Data Center.
‘‘(b) TYPES OF RESEARCH.—The research under subsection (a)(1)
shall include epidemiologic and other research studies on WTCrelated health conditions or emerging conditions—
‘‘(1) among enrolled WTC responders and certified-eligible
WTC survivors under treatment; and

H. R. 847—35
‘‘(2) in sampled populations outside the New York City
disaster area in Manhattan as far north as 14th Street and
in Brooklyn, along with control populations, to identify potential
for long-term adverse health effects in less exposed populations.
‘‘(c) CONSULTATION.—The WTC Program Administrator shall
carry out this section in consultation with the WTC Scientific/
Technical Advisory Committee.
‘‘(d) APPLICATION OF PRIVACY AND HUMAN SUBJECT PROTECTIONS.—The privacy and human subject protections applicable to
research conducted under this section shall not be less than such
protections applicable to research conducted or funded by the
Department of Health and Human Services.
‘‘SEC. 3342. WORLD TRADE CENTER HEALTH REGISTRY.

‘‘For the purpose of ensuring ongoing data collection relating
to victims of the September 11, 2001, terrorist attacks, the WTC
Program Administrator shall ensure that a registry of such victims
is maintained that is at least as comprehensive as the World
Trade Center Health Registry maintained under the arrangements
in effect as of April 20, 2009, with the New York City Department
of Health and Mental Hygiene.

‘‘Subtitle D—Funding
‘‘SEC. 3351. WORLD TRADE CENTER HEALTH PROGRAM FUND.

‘‘(a) ESTABLISHMENT OF FUND.—
‘‘(1) IN GENERAL.—There is established a fund to be known
as the World Trade Center Health Program Fund (referred
to in this section as the ‘Fund’).
‘‘(2) FUNDING.—Out of any money in the Treasury not
otherwise appropriated, there shall be deposited into the Fund
for each of fiscal years 2012 through 2016 (and the last calendar
quarter of fiscal year 2011)—
‘‘(A) the Federal share, consisting of an amount equal
to the lesser of—
‘‘(i) 90 percent of the expenditures in carrying out
this title for the respective fiscal year (initially based
on estimates, subject to subsequent reconciliation
based on actual expenditures); or
‘‘(ii)(I) $71,000,000 for the last calendar quarter
of fiscal year 2011, $318,000,000 for fiscal year 2012,
$354,000,000 for fiscal year 2013, $382,000,000 for
fiscal year 2014, and $431,000,000 for fiscal year 2015;
and
‘‘(II) subject to paragraph (4), an additional amount
for fiscal year 2016 from unexpended amounts for previous fiscal years; plus
‘‘(B) the New York City share, consisting of the amount
contributed under the contract under section 3331(d).
‘‘(3) CONTRACT REQUIREMENT.—
‘‘(A) IN GENERAL.—No funds may be disbursed from
the Fund unless New York City has entered into a contract
with the WTC Program Administrator under section
3331(d)(1).
‘‘(B) BREACH OF CONTRACT.—In the case of a failure
to pay the amount so required under the contract—

H. R. 847—36
‘‘(i) the amount is recoverable under subparagraph
(E)(ii) of such section;
‘‘(ii) such failure shall not affect the disbursement
of amounts from the Fund; and
‘‘(iii) the Federal share described in paragraph
(2)(A) shall not be increased by the amount so unpaid.
‘‘(4) AGGREGATE LIMITATION ON FUNDING BEGINNING WITH
FISCAL YEAR 2016.—Beginning with fiscal year 2016, in no case
shall the share of Federal funds deposited into the Fund under
paragraph (2) for such fiscal year and previous fiscal years
and quarters exceed the sum of the amounts specified in paragraph (2)(A)(ii)(I).
‘‘(b) MANDATORY FUNDS FOR MONITORING, INITIAL HEALTH
EVALUATIONS, TREATMENT, AND CLAIMS PROCESSING.—
‘‘(1) IN GENERAL.—The amounts deposited into the Fund
under subsection (a)(2) shall be available, without further
appropriation, consistent with paragraph (2) and subsection
(c), to carry out subtitle B and sections 3302(a), 3303, 3304,
3305(a)(2), 3305(c), 3341, and 3342.
‘‘(2) LIMITATION ON MANDATORY FUNDING.—This title does
not establish any Federal obligation for payment of amounts
in excess of the amounts available from the Fund for such
purpose.
‘‘(3) LIMITATION ON AUTHORIZATION FOR FURTHER APPROPRIATIONS.—This title does not establish any authorization for
appropriation of amounts in excess of the amounts available
from the Fund under paragraph (1).
‘‘(c) LIMITS ON SPENDING FOR CERTAIN PURPOSES.—Of the
amounts made available under subsection (b)(1), not more than
each of the following amounts may be available for each of the
following purposes:
‘‘(1) SURVIVING IMMEDIATE FAMILY MEMBERS OF FIREFIGHTERS.—For the purposes of carrying out subtitle B with
respect
to
WTC
responders
described
in
section
3311(a)(2)(A)(ii)—
‘‘(A) for the last calendar quarter of fiscal year 2011,
$100,000;
‘‘(B) for fiscal year 2012, $400,000; and
‘‘(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
‘‘(2) WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY
COMMITTEE.—For the purpose of carrying out section 3302(a)—
‘‘(A) for the last calendar quarter of fiscal year 2011,
$25,000;
‘‘(B) for fiscal year 2012, $100,000; and
‘‘(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
‘‘(3) EDUCATION AND OUTREACH.—For the purpose of carrying out section 3303—

H. R. 847—37
‘‘(A) for the last calendar quarter of fiscal year 2011,
$500,000;
‘‘(B) for fiscal year 2012, $2,000,000; and
‘‘(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
‘‘(4) UNIFORM DATA COLLECTION.—For the purpose of carrying out section 3304 and for reimbursing Data Centers (as
defined in section 3305(b)(2)) for the costs incurred by such
Centers in carrying out activities under contracts entered into
under section 3305(a)(2)—
‘‘(A) for the last calendar quarter of fiscal year 2011,
$2,500,000;
‘‘(B) for fiscal year 2012, $10,000,000; and
‘‘(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
‘‘(5) RESEARCH REGARDING CERTAIN HEALTH CONDITIONS.—
For the purpose of carrying out section 3341—
‘‘(A) for the last calendar quarter of fiscal year 2011,
$3,750,000;
‘‘(B) for fiscal year 2012, $15,000,000; and
‘‘(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.
‘‘(6) WORLD TRADE CENTER HEALTH REGISTRY.—For the purpose of carrying out section 3342—
‘‘(A) for the last calendar quarter of fiscal year 2011,
$1,750,000;
‘‘(B) for fiscal year 2012, $7,000,000; and
‘‘(C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year
increased by the percentage increase in the consumer price
index for all urban consumers (all items; United States
city average) as estimated by the Secretary for the 12month period ending with March of the previous year.’’.

TITLE II—SEPTEMBER 11TH VICTIM
COMPENSATION FUND OF 2001
SEC. 201. DEFINITIONS.

Section 402 of the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended—
(1) in paragraph (6) by inserting ‘‘, or debris removal,
including under the World Trade Center Health Program established under section 3001 of the Public Health Service Act,

H. R. 847—38
and payments made pursuant to the settlement of a civil action
described in section 405(c)(3)(C)(iii)’’ after ‘‘September 11, 2001’’;
(2) by inserting after paragraph (6) the following new paragraphs and redesignating subsequent paragraphs accordingly:
‘‘(7) CONTRACTOR AND SUBCONTRACTOR.—The term ‘contractor and subcontractor’ means any contractor or subcontractor (at any tier of a subcontracting relationship), including
any general contractor, construction manager, prime contractor,
consultant, or any parent, subsidiary, associated or allied company, affiliated company, corporation, firm, organization, or
joint venture thereof that participated in debris removal at
any 9/11 crash site. Such term shall not include any entity,
including the Port Authority of New York and New Jersey,
with a property interest in the World Trade Center, on September 11, 2001, whether fee simple, leasehold or easement,
direct or indirect.
‘‘(8) DEBRIS REMOVAL.—The term ‘debris removal’ means
rescue and recovery efforts, removal of debris, cleanup, remediation, and response during the immediate aftermath of the
terrorist-related aircraft crashes of September 11, 2001, with
respect to a 9/11 crash site.’’;
(3) by inserting after paragraph (10), as so redesignated,
the following new paragraph and redesignating the subsequent
paragraphs accordingly:
‘‘(11) IMMEDIATE AFTERMATH.—The term ‘immediate aftermath’ means any period beginning with the terrorist-related
aircraft crashes of September 11, 2001, and ending on May
30, 2002.’’; and
(4) by adding at the end the following new paragraph:
‘‘(14) 9/11 CRASH SITE.—The term ‘9/11 crash site’ means—
‘‘(A) the World Trade Center site, Pentagon site, and
Shanksville, Pennsylvania site;
‘‘(B) the buildings or portions of buildings that were
destroyed as a result of the terrorist-related aircraft crashes
of September 11, 2001;
‘‘(C) any area contiguous to a site of such crashes
that the Special Master determines was sufficiently close
to the site that there was a demonstrable risk of physical
harm resulting from the impact of the aircraft or any
subsequent fire, explosions, or building collapses (including
the immediate area in which the impact occurred, fire
occurred, portions of buildings fell, or debris fell upon and
injured individuals); and
‘‘(D) any area related to, or along, routes of debris
removal, such as barges and Fresh Kills.’’.
SEC. 202. EXTENDED AND EXPANDED ELIGIBILITY FOR COMPENSATION.

(a) INFORMATION ON LOSSES RESULTING FROM DEBRIS REMOVAL
INCLUDED IN CONTENTS OF CLAIM FORM.—Section 405(a)(2)(B) of
the Air Transportation Safety and System Stabilization Act (49
U.S.C. 40101 note) is amended—
(1) in clause (i), by inserting ‘‘, or debris removal during
the immediate aftermath’’ after ‘‘September 11, 2001’’;
(2) in clause (ii), by inserting ‘‘or debris removal during
the immediate aftermath’’ after ‘‘crashes’’; and

H. R. 847—39
(3) in clause (iii), by inserting ‘‘or debris removal during
the immediate aftermath’’ after ‘‘crashes’’.
(b) EXTENSION OF DEADLINE FOR CLAIMS UNDER SEPTEMBER
11TH VICTIM COMPENSATION FUND OF 2001.—Section 405(a)(3) of
such Act is amended to read as follows:
‘‘(3) LIMITATION.—
‘‘(A) IN GENERAL.—Except as provided by subparagraph
(B), no claim may be filed under paragraph (1) after the
date that is 2 years after the date on which regulations
are promulgated under section 407(a).
‘‘(B) EXCEPTION.—A claim may be filed under paragraph (1), in accordance with subsection (c)(3)(A)(i), by
an individual (or by a personal representative on behalf
of a deceased individual) during the period beginning on
the date on which the regulations are updated under section 407(b) and ending on the date that is 5 years after
the date on which such regulations are updated.’’.
(c) REQUIREMENTS FOR FILING CLAIMS DURING EXTENDED
FILING PERIOD.—Section 405(c)(3) of such Act is amended—
(1) by redesignating subparagraphs (A) and (B) as subparagraphs (B) and (C), respectively; and
(2) by inserting before subparagraph (B), as so redesignated, the following new subparagraph:
‘‘(A) REQUIREMENTS FOR FILING CLAIMS DURING
EXTENDED FILING PERIOD.—
‘‘(i) TIMING REQUIREMENTS FOR FILING CLAIMS.—
An individual (or a personal representative on behalf
of a deceased individual) may file a claim during the
period described in subsection (a)(3)(B) as follows:
‘‘(I) In the case that the Special Master determines the individual knew (or reasonably should
have known) before the date specified in clause
(iii) that the individual suffered a physical harm
at a 9/11 crash site as a result of the terroristrelated aircraft crashes of September 11, 2001,
or as a result of debris removal, and that the
individual knew (or should have known) before
such specified date that the individual was eligible
to file a claim under this title, the individual may
file a claim not later than the date that is 2
years after such specified date.
‘‘(II) In the case that the Special Master determines the individual first knew (or reasonably
should have known) on or after the date specified
in clause (iii) that the individual suffered such
a physical harm or that the individual first knew
(or should have known) on or after such specified
date that the individual was eligible to file a claim
under this title, the individual may file a claim
not later than the last day of the 2-year period
beginning on the date the Special Master determines the individual first knew (or should have
known) that the individual both suffered from such
harm and was eligible to file a claim under this
title.

H. R. 847—40
‘‘(ii) OTHER ELIGIBILITY REQUIREMENTS FOR FILING
CLAIMS.—An individual may file a claim during the
period described in subsection (a)(3)(B) only if—
‘‘(I) the individual was treated by a medical
professional for suffering from a physical harm
described in clause (i)(I) within a reasonable time
from the date of discovering such harm; and
‘‘(II) the individual’s physical harm is verified
by contemporaneous medical records created by
or at the direction of the medical professional who
provided the medical care.
‘‘(iii) DATE SPECIFIED.—The date specified in this
clause is the date on which the regulations are updated
under section 407(a).’’.
(d) CLARIFYING APPLICABILITY TO ALL 9/11 CRASH SITES.—Section 405(c)(2)(A)(i) of such Act is amended by striking ‘‘or the
site of the aircraft crash at Shanksville, Pennsylvania’’ and inserting
‘‘the site of the aircraft crash at Shanksville, Pennsylvania, or
any other 9/11 crash site’’.
(e) INCLUSION OF PHYSICAL HARM RESULTING FROM DEBRIS
REMOVAL.—Section 405(c) of such Act is amended in paragraph
(2)(A)(ii), by inserting ‘‘or debris removal’’ after ‘‘air crash’’.
(f) LIMITATIONS ON CIVIL ACTIONS.—
(1) APPLICATION TO DAMAGES RELATED TO DEBRIS
REMOVAL.—Clause (i) of section 405(c)(3)(C) of such Act, as
redesignated by subsection (c), is amended by inserting ‘‘, or
for damages arising from or related to debris removal’’ after
‘‘September 11, 2001’’.
(2) PENDING ACTIONS.—Clause (ii) of such section, as so
redesignated, is amended to read as follows:
‘‘(ii) PENDING ACTIONS.—In the case of an individual who is a party to a civil action described in
clause (i), such individual may not submit a claim
under this title—
‘‘(I) during the period described in subsection
(a)(3)(A) unless such individual withdraws from
such action by the date that is 90 days after the
date on which regulations are promulgated under
section 407(a); and
‘‘(II) during the period described in subsection
(a)(3)(B) unless such individual withdraws from
such action by the date that is 90 days after the
date on which the regulations are updated under
section 407(b).’’.
(3) SETTLED ACTIONS.—Such section, as so redesignated,
is further amended by adding at the end the following new
clause:
‘‘(iii) SETTLED ACTIONS.—In the case of an individual who settled a civil action described in clause
(i), such individual may not submit a claim under
this title unless such action was commenced after
December 22, 2003, and a release of all claims in
such action was tendered prior to the date on which
the James Zadroga 9/11 Health and Compensation Act
of 2010 was enacted.’’.

H. R. 847—41
SEC. 203. REQUIREMENT TO UPDATE REGULATIONS.

Section 407 of the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended—
(1) by striking ‘‘Not later than’’ and inserting ‘‘(a) IN GENERAL.—Not later than’’; and
(2) by adding at the end the following new subsection:
‘‘(b) UPDATED REGULATIONS.—Not later than 180 days after
the date of the enactment of the James Zadroga 9/11 Health and
Compensation Act of 2010, the Special Master shall update the
regulations promulgated under subsection (a) to the extent necessary to comply with the provisions of title II of such Act.’’.
SEC. 204. LIMITED LIABILITY FOR CERTAIN CLAIMS.

Section 408(a) of the Air Transportation Safety and System
Stabilization Act (49 U.S.C. 40101 note) is amended by adding
at the end the following new paragraphs:
‘‘(4) LIABILITY FOR CERTAIN CLAIMS.—Notwithstanding any
other provision of law, liability for all claims and actions
(including claims or actions that have been previously resolved,
that are currently pending, and that may be filed) for compensatory damages, contribution or indemnity, or any other form
or type of relief, arising from or related to debris removal,
against the City of New York, any entity (including the Port
Authority of New York and New Jersey) with a property
interest in the World Trade Center on September 11, 2001
(whether fee simple, leasehold or easement, or direct or indirect)
and any contractors and subcontractors, shall not be in an
amount that exceeds the sum of the following, as may be
applicable:
‘‘(A) The amount of funds of the WTC Captive Insurance Company, including the cumulative interest.
‘‘(B) The amount of all available insurance identified
in schedule 2 of the WTC Captive Insurance Company
insurance policy.
‘‘(C) As it relates to the limitation of liability of the
City of New York, the amount that is the greater of the
City of New York’s insurance coverage or $350,000,000.
In determining the amount of the City’s insurance coverage
for purposes of the previous sentence, any amount described
in subparagraphs (A) and (B) shall not be included.
‘‘(D) As it relates to the limitation of liability of any
entity, including the Port Authority of New York and New
Jersey, with a property interest in the World Trade Center
on September 11, 2001 (whether fee simple, leasehold or
easement, or direct or indirect), the amount of all available
liability insurance coverage maintained by any such entity.
‘‘(E) As it relates to the limitation of liability of any
individual contractor or subcontractor, the amount of all
available liability insurance coverage maintained by such
contractor or subcontractor on September 11, 2001.
‘‘(5) PRIORITY OF CLAIMS PAYMENTS.—Payments to plaintiffs
who obtain a settlement or judgment with respect to a claim
or action to which paragraph (4) applies, shall be paid solely
from the following funds in the following order, as may be
applicable:
‘‘(A) The funds described in subparagraph (A) or (B)
of paragraph (4).

H. R. 847—42
‘‘(B) If there are no funds available as described in
subparagraph (A) or (B) of paragraph (4), the funds
described in subparagraph (C) of such paragraph.
‘‘(C) If there are no funds available as described in
subparagraph (A), (B), or (C) of paragraph (4), the funds
described in subparagraph (D) of such paragraph.
‘‘(D) If there are no funds available as described in
subparagraph (A), (B), (C), or (D) of paragraph (4), the
funds described in subparagraph (E) of such paragraph.
‘‘(6) DECLARATORY JUDGMENT ACTIONS AND DIRECT
ACTION.—Any claimant to a claim or action to which paragraph
(4) applies may, with respect to such claim or action, either
file an action for a declaratory judgment for insurance coverage
or bring a direct action against the insurance company involved,
except that no such action for declaratory judgment or direct
action may be commenced until after the funds available in
subparagraph (A), (B), (C), and (D) of paragraph (5) have been
exhausted consistent with the order described in such paragraph for payment.’’.
SEC. 205. FUNDING; ATTORNEY FEES.

Section 406 of the Air Transportation Safety and System Stabilization Act (49 U.S.C. 40101 note) is amended—
(1) in subsection (a), by striking ‘‘Not later than’’ and
inserting ‘‘Subject to the limitations under subsection (d), not
later than’’;
(2) in subsection (b)—
(A) by inserting ‘‘in the amounts provided under subsection (d)(1)’’ after ‘‘appropriations Acts’’; and
(B) by inserting ‘‘subject to the limitations under subsection (d)’’ before the period; and
(3) by adding at the end the following new subsections:
‘‘(d) LIMITATION.—
‘‘(1) IN GENERAL.—The total amount of Federal funds paid
for compensation under this title, with respect to claims filed
on or after the date on which the regulations are updated
under section 407(b), shall not exceed $2,775,000,000. Of such
amounts, not to exceed $875,000,000 shall be available to pay
such claims during the 5-year period beginning on such date.
‘‘(2) PRO-RATION AND PAYMENT OF REMAINING CLAIMS.—
‘‘(A) IN GENERAL.—The Special Master shall ratably
reduce the amount of compensation due claimants under
this title in a manner to ensure, to the extent possible,
that—
‘‘(i) all claimants who, before application of the
limitation under the second sentence of paragraph (1),
would have been determined to be entitled to a payment under this title during such 5-year period, receive
a payment during such period; and
‘‘(ii) the total amount of all such payments made
during such 5-year period do not exceed the amount
available under the second sentence of paragraph (1)
to pay claims during such period.
‘‘(B) PAYMENT OF REMAINDER OF CLAIM AMOUNTS.—
In any case in which the amount of a claim is ratably
reduced pursuant to subparagraph (A), on or after the
first day after the 5-year period described in paragraph

H. R. 847—43
(1), but in no event later than 1 year after such 5-year
period, the Special Master shall pay to the claimant the
amount that is equal to the difference between—
‘‘(i) the amount that the claimant would have been
paid under this title during such period without regard
to the limitation under the second sentence of paragraph (1) applicable to such period; and
‘‘(ii) the amount the claimant was paid under this
title during such period.
‘‘(C) TERMINATION.—Upon completion of all payments
pursuant to this subsection, the Victim’s Compensation
Fund shall be permanently closed.
‘‘(e) ATTORNEY FEES.—
‘‘(1) IN GENERAL.—Notwithstanding any contract, the representative of an individual may not charge, for services rendered in connection with the claim of an individual under
this title, more than 10 percent of an award made under
this title on such claim.
‘‘(2) LIMITATION.—
‘‘(A) IN GENERAL.—Except as provided in subparagraph
(B), in the case of an individual who was charged a legal
fee in connection with the settlement of a civil action
described in section 405(c)(3)(C)(iii), the representative of
the individual may not charge any amount for compensation for services rendered in connection with a claim filed
under this title.
‘‘(B) EXCEPTION.—If the legal fee charged in connection
with the settlement of a civil action described in section
405(c)(3)(C)(iii) of an individual is less than 10 percent
of the aggregate amount of compensation awarded to such
individual through such settlement, the representative of
such individual may charge an amount for compensation
for services rendered to the extent that such amount
charged is not more than—
‘‘(i) 10 percent of such aggregate amount through
the settlement, minus
‘‘(ii) the total amount of all legal fees charged
for services rendered in connection with such settlement.
‘‘(3) DISCRETION TO LOWER FEE.—In the event that the
special master finds that the fee limit set by paragraph (1)
or (2) provides excessive compensation for services rendered
in connection with such claim, the Special Master may, in
the discretion of the Special Master, award as reasonable compensation for services rendered an amount lesser than that
permitted for in paragraph (1).’’.

TITLE III—REVENUE RELATED
PROVISIONS
SEC. 301. EXCISE TAX ON CERTAIN FOREIGN PROCUREMENT.

(a) IMPOSITION OF TAX.—
(1) IN GENERAL.—Subtitle D of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
chapter:

H. R. 847—44
‘‘CHAPTER 50—FOREIGN PROCUREMENT
‘‘Sec. 5000C. Imposition of tax on certain foreign procurement.
‘‘SEC. 5000C. IMPOSITION OF TAX ON CERTAIN FOREIGN PROCUREMENT.

‘‘(a) IMPOSITION OF TAX.—There is hereby imposed on any foreign person that receives a specified Federal procurement payment
a tax equal to 2 percent of the amount of such specified Federal
procurement payment.
‘‘(b) SPECIFIED FEDERAL PROCUREMENT PAYMENT.—For purposes of this section, the term ‘specified Federal procurement payment’ means any payment made pursuant to a contract with the
Government of the United States for—
‘‘(1) the provision of goods, if such goods are manufactured
or produced in any country which is not a party to an international procurement agreement with the United States, or
‘‘(2) the provision of services, if such services are provided
in any country which is not a party to an international procurement agreement with the United States.
‘‘(c) FOREIGN PERSON.—For purposes of this section, the term
‘foreign person’ means any person other than a United States person.
‘‘(d) ADMINISTRATIVE PROVISIONS.—
‘‘(1) WITHHOLDING.—The amount deducted and withheld
under chapter 3 shall be increased by the amount of tax
imposed by this section on such payment.
‘‘(2) OTHER ADMINISTRATIVE PROVISIONS.—For purposes of
subtitle F, any tax imposed by this section shall be treated
as a tax imposed by subtitle A.’’.
(2) CLERICAL AMENDMENT.—The table of chapters for subtitle D of the Internal Revenue Code of 1986 is amended by
adding at the end the following new item:
‘‘CHAPTER 50—FOREIGN PROCUREMENT’’.

(3) EFFECTIVE DATE.—The amendments made by this subsection shall apply to payments received pursuant to contracts
entered into on and after the date of the enactment of this
Act.
(b) PROHIBITION ON REIMBURSEMENT OF FEES.—
(1) IN GENERAL.—The head of each executive agency shall
take any and all measures necessary to ensure that no funds
are disbursed to any foreign contractor in order to reimburse
the tax imposed under section 5000C of the Internal Revenue
Code of 1986.
(2) ANNUAL REVIEW.—The Administrator for Federal
Procurement Policy shall annually review the contracting activities of each executive agency to monitor compliance with the
requirements of paragraph (1).
(3) EXECUTIVE AGENCY.—For purposes of this subsection,
the term ‘‘executive agency’’ has the meaning given the term
in section 4 of the Office of Federal Procurement Policy Act
(41 U.S.C. 403).
(c) APPLICATION.—This section and the amendments made by
this section shall be applied in a manner consistent with United
States obligations under international agreements.

H. R. 847—45
SEC. 302. RENEWAL OF FEES FOR VISA-DEPENDENT EMPLOYERS.

Subsections (a), (b), and (c) of section 402 of Public Law 111–
230 are amended by striking ‘‘2014’’ each place that such appears
and inserting ‘‘2015’’.

TITLE IV—BUDGETARY EFFECTS
SEC. 401. COMPLIANCE WITH STATUTORY PAY-AS-YOU-GO ACT OF 2010.

The budgetary effects of this Act, for the purpose of complying
with the Statutory Pay-As-You-Go Act of 2010, shall be determined
by reference to the latest statement titled ‘‘Budgetary Effects of
PAYGO Legislation’’ for this Act, submitted for printing in the
Congressional Record by the Chairman of the Senate Budget Committee, provided that such statement has been submitted prior
to the vote on passage.

Speaker of the House of Representatives.

Vice President of the United States and
President of the Senate.