Zadroga_Act.pdf

H. R. 847

One Hundred Eleventh Congress of the

United States of America

AT THE SECOND SESSION

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 con-ditions.

‘‘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 sur-vivors for WTC-related health conditions.

‘‘Sec. 3323. Followup monitoring and treatment of other individuals with WTC-related health conditions.

‘‘PART 3—PAYOR PROVISIONS

‘‘Sec. 3331. Payment of claims.

‘‘Sec. 3332. Administrative arrangement authority.

‘‘Subtitle C—Research Into Conditions ‘‘Sec. 3341. Research regarding certain health conditions related to 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. 201. Definitions.

Sec. 202. Extended and expanded eligibility for compensation.

Sec. 203. Requirement to update regulations.

Sec. 204. Limited liability for certain claims.

Sec. 205. Funding; attorney fees.

TITLE III—REVENUE RELATED PROVISIONS

Sec. 301. Excise tax on foreign procurement.

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 PRO-

GRAM.

‘‘(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 adminis-tered 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 mon-itoring 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 ini-tial health evaluation under section 3321, including an evalua-tion to determine eligibility for followup monitoring and treat-ment.

‘‘(3) FOLLOWUP MONITORING AND TREATMENT FOR WTC-

RELATED HEALTH CONDITIONS FOR RESPONDERS AND SUR-

VIVORS.—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 individ-uals 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. Ini-tial health evaluation benefits are provided under subtitle B without any deductibles, copayments, or other cost sharing to a screening-eligible 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 pro-gram (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 clin-ical 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 med-ical 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, evalua-tion, 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 con-ducted 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 individ-uals; and

‘‘(ii) a list of the Clinical Centers of Excellence and other providers that are participating in the pro-gram.

‘‘(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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‘‘(3) SEPARATE CLINICAL PROGRAMS DESCRIBED.—In para-graph (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 stake-holders, 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 COMMIT-

TEES.

‘‘(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 rec-ommendations to the Administrator on additional WTC Pro-gram 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 sur-vivors;

‘‘(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 pro-vide for publication of recommendations of the Advisory Com-mittee 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 Fed-eral 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 Excel-lence providing services to WTC responders;

‘‘(II) representatives of labor organizations rep-resenting 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 commis-sioner of New York City, 1 by the health commis-sioner of New York City, and 1 by the mayor of New York City.

‘‘(ii) INITIAL MEMBERSHIP.—The WTC Responders

Steering Committee shall initially be composed of members of the WTC Monitoring and Treatment Pro-gram Steering Committee (as in existence on the day before the date of the enactment of this title).

‘‘(B) WTC SURVIVORS STEERING COMMITTEE.—

‘‘(i) REPRESENTATION.—The WTC Survivors Steering Committee shall include representatives of—

‘‘(I) the Centers of Excellence providing serv-ices 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, mon-itoring, 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 Com-mittee 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 avail-ability 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 mate-rials 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 linguis-tically diverse populations.

‘‘SEC. 3304. UNIFORM DATA COLLECTION AND ANALYSIS.

‘‘(a) IN GENERAL.—The WTC Program Administrator shall pro-vide 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 Cen-ters or otherwise, for the integration of such data into the moni-toring and treatment program activities under this title.

‘‘(b) COORDINATING THROUGH CENTERS OF EXCELLENCE.—Each Clinical Center of Excellence shall collect data described in sub-section (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 sec-tion 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 Excel-lence (as defined in subsection (b)(1)(A))—

‘‘(A) for the provision of monitoring and treatment benefits and initial health evaluation benefits under sub-title B;

‘‘(B) for the provision of outreach activities to individ-uals eligible for such monitoring and treatment benefits, for initial health evaluation benefits, and for followup to individuals who are enrolled in the monitoring program;

‘‘(C) for the provision of counseling for benefits under subtitle B, with respect to WTC-related health conditions, for individuals eligible for such benefits;

‘‘(D) for the provision of counseling for benefits for WTC-related health conditions that may be available under workers’ compensation or other benefit programs for work-related injuries or illnesses, health insurance, disability insurance, or other insurance plans or through public or private social service agencies and assisting eligible individ-uals in applying for such benefits;

‘‘(E) for the provision of translational and interpretive services for program participants who are not English lan-guage 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 con-ducted 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 activi-ties of the WTC Health Program Steering Committees established under section 3002(b); and

‘‘(vi) for meeting periodically with the cor-responding 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 pro-viders under subparagraph (A)(iv) shall be selected by the WTC Program Administrator on the basis of their experi-ence treating or diagnosing the health conditions included in the list of WTC-related health conditions.

‘‘(C) CLINICAL DISCUSSIONS.—In carrying out subpara-graph (A)(ii), a Data Center shall engage in clinical discus-sions 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, screening-eligible 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 CEN-

TERS.—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 Com-mittee 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 dem-onstrates to the satisfaction of the Administrator that the Center—

‘‘(i) uses an integrated, centralized health care pro-vider approach to create a comprehensive suite of health services under this title that are accessible to enrolled WTC responders, screening-eligible WTC sur-vivors, or certified-eligible WTC survivors;

‘‘(ii) has experience in caring for WTC responders and screening-eligible WTC 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 exper-tise that includes, at a minimum, occupational medi-cine, environmental medicine, trauma-related psychi-atry 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 treat-ment 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 sec-tion 3304(c), to ensure the confidentiality of an individ-ual’s individually identifiable health information, including requiring that such information not be dis-closed 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 occupa-tional 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 activi-ties 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 max-imum 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 Adminis-trator determines has the capacity to carry out the responsibil-ities 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 infra-structure 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 appro-priate and take into account the number of enrolled WTC responders receiving services from such Center under this title.

‘‘(2) FIXED INFRASTRUCTURE COSTS.—For purposes of para-graph (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 collec-tion 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 Comp-troller General shall submit to the Committee on Energy and Com-merce 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 sur-vivors 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 ter-rorist attacks at the World Trade Center, Shanksville, Pennsyl-vania, 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 para-graphs (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 deter-mination or certification of screening-eligible or certified-eligible 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.

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‘‘(B) In no case may the Secretary designate under subpara-graph (A)(i) the Director of the National Institute for Occupa-tional 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 Com-mittee’ 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 indi-vidual 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 Hos-pital 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 CRI-

TERIA.—An individual who meets the current eligibility criteria described in paragraph (2).

‘‘(C) RESPONDER WHO MEETS MODIFIED ELIGIBILITY CRI-

TERIA.—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 expo-sure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, ter-rorist 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 indi-vidual 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 Depart-ment 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 Sep-tember 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 Sep-tember 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 Sep-tember 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 Trans- Hudson 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 begin-ning 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 terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the WTC Program Administrator; and

‘‘(ii) is determined by the WTC Program Adminis-trator to be at an increased risk of developing a WTC-related health condition as a result of exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, 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 enroll-ment 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 Pro-gram 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 individ-uals enrolled based on modified eligibility criteria estab-lished 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 informa-tion and subject to amounts available under sec-tion 3351, that will ensure sufficient funds will be available to provide treatment and monitoring benefits under this title, with respect to all individ-uals 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 Sec-retary of Homeland Security, shall determine whether the indi-vidual 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 mon-itoring consistent with protocols approved by the WTC Program Administrator and including clinical examinations and long-term health monitoring and analysis. In the case of an enrolled WTC responder who is an active member of the Fire Depart-ment of New York City, the responder shall receive such bene-fits 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 WTC-

RELATED HEALTH CONDITIONS.

‘‘(a) WTC-RELATED HEALTH CONDITION DEFINED.— ‘‘(1) IN GENERAL.—For purposes of this title, the term ‘WTC-related health condition’ means a condition that— ‘‘(A)(i) is an illness or health condition for which expo-sure 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 WTC-related health conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition, as determined under para-graph (2); or

‘‘(ii) is a mental health condition for which such attacks, based on an examination by a medical professional with experience in treating or diagnosing the health condi-tions 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 sur-vivor 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, ter-rorist attacks were substantially likely to be a significant factor in aggravating, contributing to, or causing an individual’s ill-ness or health condition shall be made based on an assessment of the following:

‘‘(A) The individual’s exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the terrorist attacks. Such exposure shall be—

‘‘(i) evaluated and characterized through the use of a standardized, population-appropriate question-naire approved by the Director of the National Institute for Occupational Safety and Health; and

‘‘(ii) assessed and documented by a medical profes-sional 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 Occupa-tional 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 pul-monary 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 Sep-tember 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 musculo-skeletal 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 recommenda-tions of Clinical Centers of Excellence, published in peer-reviewed journals to determine if, based on such evidence, cancer or a certain type of cancer should be added to the applicable list of WTC-related health conditions.