[United States Statutes at Large, Volume 124, 111th Congress, 2nd Session]
[From the U.S. Government Printing Office, www.gpo.gov]


Public Law 111-347
111th Congress

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 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.

[[Page 3624]]

``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 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.

[[Page 3625]]

``(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 wtc-related
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 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 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

[[Page 3626]]

``(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

[[Page 3627]]

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.

[[Page 3628]]

``(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.--
``(i) Representation.--The WTC Survivors
Steering Committee shall include representatives
of--
``(I) the Centers of Excellence
providing services to screening-eligible
and certified-eligible WTC survivors;

[[Page 3629]]

``(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

[[Page 3630]]

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 work-related 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;

[[Page 3631]]

``(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, 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 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);

[[Page 3632]]

``(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

[[Page 3633]]

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.

[[Page 3634]]

``(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 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.

[[Page 3635]]

``(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

[[Page 3636]]

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 fireor 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

[[Page 3637]]

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
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 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 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
Administrator to be at an increased risk of
developing a WTC-related health condition as a
result of exposure to airborne toxins, other
hazards, or adverse conditions resulting from the
September 11, 2001, 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.

[[Page 3638]]

``(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

[[Page 3639]]

``(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 long-term
health monitoring and analysis. In the case of an enrolled WTC
responder who is an active member of the Fire Department of New
York City, the responder shall receive such benefits as part of
the 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
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 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 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

[[Page 3640]]

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).

[[Page 3641]]

``(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 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. 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

[[Page 3642]]

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

[[Page 3643]]

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 wtc-
related 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

[[Page 3644]]

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 WTC-
related health condition;
``(iii) certification in accordance with
paragraph (1)(B)(ii) of coverage of such condition
if determined to be described in subsection
(a)(1)(A) and medically 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 WTC-
related health condition, a physician or other provider
shall provide treatment that is medically necessary and
in accordance with medical treatment protocols
established under subsection (d).
``(B) Regulations relating to medical necessity.--
For the purpose of this title, the 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).

[[Page 3645]]

``(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

[[Page 3646]]

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

[[Page 3647]]

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

[[Page 3648]]

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.

``(a) Identification of Screening-Eligible WTC Survivors and
Certified-Eligible WTC Survivors.--
``(1) Screening-eligible wtc survivors.--
``(A) Definition.--In this title, the term
`screening-eligible WTC survivor' means, subject to
subparagraph (C) and paragraph (3), an 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.

[[Page 3649]]

``(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

[[Page 3650]]

``(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 screening-
eligibility.--
``(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.

[[Page 3651]]

``(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 certified-eligible 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.

[[Page 3652]]

``SEC. 3322. <> FOLLOWUP MONITORING AND
TREATMENT OF CERTIFIED-ELIGIBLE 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

[[Page 3653]]

``(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 WTC-related
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),

[[Page 3654]]

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

[[Page 3655]]

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.

[[Page 3656]]

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 certified-
eligible 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 work-related
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 WTC-related health
conditions or emerging conditions--
``(1) among enrolled WTC responders and certified-eligible
WTC survivors under treatment; and

[[Page 3657]]

``(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--

[[Page 3658]]

``(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 12-month 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 12-month period ending with March of
the previous year.
``(3) Education and outreach.--For the purpose of carrying
out section 3303--

[[Page 3659]]

``(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 12-month 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 12-month 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 12-month 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 12-month 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,

[[Page 3660]]

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

[[Page 3661]]

(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
terrorist-related 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.

[[Page 3662]]

``(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.''.

[[Page 3663]]

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).

[[Page 3664]]

``(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

[[Page 3665]]

(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:

[[Page 3666]]

``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.

[[Page 3667]]

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.

Approved January 2, 2011.

LEGISLATIVE HISTORY--H.R. 847:
---------------------------------------------------------------------------

HOUSE REPORTS: No. 111-560, Pt. 1 (Comm. on Energy and Commerce) and
Pt. 2 (Comm. on the Judiciary).
CONGRESSIONAL RECORD, Vol. 156 (2010):
July 29, considered and failed House.
Sept. 29, considered and passed House.
Dec. 22, considered and passed Senate, amended. House
concurred in Senate amendment.
DAILY COMPILATION OF PRESIDENTIAL DOCUMENTS (2011):
Jan. 2, Presidential statement.