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111th Congress                                            Rept. 111-560
                        HOUSE OF REPRESENTATIVES
 2d Session                                                      Part 2

======================================================================



 
         JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010

                                _______
                                

 July 22, 2010.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Conyers, from the Committee on the Judiciary, submitted the 
                               following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 847]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on the Judiciary, to whom was referred the bill 
(H.R. 847) to amend the Public Health Service Act to extend and 
improve protections and services to individuals directly 
impacted by the terrorist attack in New York City on September 
11, 2001, and for other purposes, having considered the same, 
reports favorably thereon with an amendment and recommends that 
the bill as amended do pass.

                                CONTENTS

                                                                   Page
The Amendment....................................................     3
Purpose and Summary..............................................    30
Background and Need for the Legislation..........................    30
Hearings.........................................................    34
Committee Consideration..........................................    35
Committee Votes..................................................    35
Committee Oversight Findings.....................................    36
New Budget Authority and Tax Expenditures........................    37
Congressional Budget Office Cost Estimate........................    37
Performance Goals and Objectives.................................    50
Constitutional Authority Statement...............................    50
Advisory on Earmarks.............................................    50
Section-by-Section Analysis......................................    50
Changes in Existing Law Made by the Bill, as Reported............    53
Dissenting Views.................................................    59

                             The Amendment

  The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``James Zadroga 9/11 
Health and Compensation Act of 2010''.
  (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Findings.

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

Sec. 101. World Trade Center Health Program.

             ``TITLE XXX--WORLD TRADE CENTER HEALTH PROGRAM

     ``Subtitle A--Establishment of Program; Advisory and Steering 
                               Committees

        ``Sec. 3001. Establishment of World Trade Center Health Program 
                        within NIOSH.
        ``Sec. 3002. WTC Health Program Scientific/Technical Advisory 
                        Committee.
        ``Sec. 3003. WTC Health Program Steering Committees.
        ``Sec. 3004. Community education and outreach.
        ``Sec. 3005. Uniform data collection.
        ``Sec. 3006. Centers of excellence.
        ``Sec. 3007. Entitlement authorities.
        ``Sec. 3008. Definitions.

 ``Subtitle B--Program of Monitoring, Initial Health Evaluations, and 
                               Treatment

                      ``Part 1--For WTC Responders

        ``Sec. 3011. Identification of eligible WTC responders and 
                        provision of WTC-related monitoring services.
        ``Sec. 3012. Treatment of certified eligible WTC responders for 
                        WTC-related health conditions.

                      ``Part 2--Community Program

        ``Sec. 3021. Identification and initial health evaluation of 
                        eligible WTC community members.
        ``Sec. 3022. Followup monitoring and treatment of certified 
                        eligible WTC community members for WTC-related 
                        health conditions.
        ``Sec. 3023. Followup monitoring and treatment of other 
                        individuals with WTC-related health conditions.

 ``Part 3--National Arrangement for Benefits for Eligible Individuals 
                            Outside New York

        ``Sec. 3031. National arrangement for benefits for eligible 
                        individuals outside New York.

                 ``Subtitle C--Research Into Conditions

        ``Sec. 3041. Research regarding certain health conditions 
                        related to September 11 terrorist attacks in 
                        New York City.

 ``Subtitle D--Programs of the New York City Department of Health and 
                             Mental Hygiene

        ``Sec. 3051. World Trade Center Health Registry.
        ``Sec. 3052. Mental health services.

       TITLE II--SEPTEMBER 11TH VICTIM COMPENSATION FUND OF 2001

Sec. 201. Definitions.
Sec. 202. Extended and expanded eligibility for compensation.
Sec. 203. Requirement to update regulations.
Sec. 204. Limited liability for certain claims.
Sec. 205. Funding; attorney fees.

SEC. 2. FINDINGS.

  Congress finds the following:
          (1) Thousands of rescue workers who responded to the areas 
        devastated by the terrorist attacks of September 11, local 
        residents, office and area workers, and school children 
        continue to suffer significant medical problems as a result of 
        compromised air quality and the release of other toxins from 
        the attack sites.
          (2) In a September 2006 peer-reviewed study conducted by the 
        World Trade Center Medical Monitoring Program, of 9,500 World 
        Trade Center responders, almost 70 percent of World Trade 
        Center responders had a new or worsened respiratory symptom 
        that developed during or after their time working at the World 
        Trade Center; among the responders who were asymptomatic before 
        9/11, 61 percent developed respiratory symptoms while working 
        at the World Trade Center; close to 60 percent still had a new 
        or worsened respiratory symptom at the time of their 
        examination; one-third had abnormal pulmonary function tests; 
        and severe respiratory conditions including pneumonia were 
        significantly more common in the 6 months after 9/11 than in 
        the prior 6 months.
          (3) An April 2006 study documented that, on average, a New 
        York City firefighter who responded to the World Trade Center 
        has experienced a loss of 12 years of lung capacity.
          (4) A peer-reviewed study of residents who lived near the 
        World Trade Center titled ``The World Trade Center Residents' 
        Respiratory Health Study: New Onset Respiratory Symptoms and 
        Pulmonary Function'', found that data demonstrated a three-fold 
        increase in new-onset, persistent lower respiratory symptoms in 
        residents near the former World Trade Center as compared to a 
        control population.
          (5) Previous research on the health impacts of the 
        devastation caused by the September 11 terrorist attacks has 
        shown relationships between the air quality from Ground Zero 
        and a host of health impacts, including lower pregnancy rates, 
        higher rates of respiratory and lung disorders, and a variety 
        of post-disaster mental health conditions (including 
        posttraumatic stress disorder) in workers and residents near 
        Ground Zero.
          (6) A variety of tests conducted by independent scientists 
        have concluded that significant WTC contamination settled in 
        indoor environments surrounding the disaster site. The 
        Environmental Protection Agency's (EPA) cleanup programs for 
        indoor residential spaces, in 2003 and 2005, though limited, 
        are an acknowledgment that indoor contamination continued after 
        the WTC attacks.
          (7) At the request of the Department of Energy, the Davis 
        DELTA Group at the University of California conducted outdoor 
        dust sampling in October 2001 at Varick and Houston Streets 
        (approximately 1.2 miles north of Ground Zero) and found that 
        the contamination from the World Trade Center ``outdid even the 
        worst pollution from the Kuwait oil fields fires''. Further, 
        the United States Geological Survey (USGS) reported on November 
        27, 2001, that dust samples collected from indoor surfaces 
        registered at levels that were ``as caustic as liquid drain 
        cleaners''.
          (8) According to both the EPA's own Inspector General's (EPA 
        IG) report of August 21, 2003 and General Accountability 
        Offices's (GAO) report of September 2007, no comprehensive 
        program has ever been conducted in order to characterize the 
        full extent of WTC contamination, and therefore the full impact 
        of that contamination--geographic or otherwise--remains 
        unknown.
          (9) Such reports found that there has never been a 
        comprehensive program to remediate WTC toxins from indoor 
        spaces. Thus, area residents, workers and students may continue 
        to be exposed to WTC contamination in their homes, workplaces 
        and schools.
          (10) Because of the failure to release federally appropriated 
        funds for community care, a lack of sufficient outreach, the 
        fact that many community members are receiving care from 
        physicians outside the current City-funded World Trade Center 
        Environmental Health Center program and thus fall outside data 
        collection efforts, and other factors, the number of community 
        members being treated at the World Trade Center Environmental 
        Health Center underrepresents the total number in the community 
        that have been affected by exposure to Ground Zero toxins.
          (11) Research by Columbia University's Center for Children's 
        Environmental Health has shown negative health effects on 
        babies born to women living within 2 miles of the World Trade 
        Center in the month following 9/11.
          (12) Federal funding allocated for the monitoring of rescue 
        workers' health is not sufficient to ensure the long-term study 
        of health impacts of September 11.
          (13) A significant portion of those who have developed health 
        problems as result of exposures to airborne toxins or other 
        hazards resulting from the September 11, 2001, attacks on the 
        World Trade Center have no health insurance, have lost their 
        health insurance as a result of the attacks, or have inadequate 
        health insurance.
          (14) The Federal program to provide medical treatments to 
        those who responded to the September 11 aftermath, and who 
        continue to experience health problems as a result, was finally 
        established more than five years after the attacks, but has no 
        certain long-term funding.
          (15) Rescue workers and volunteers seeking workers' 
        compensation have reported that their applications have been 
        denied, delayed for months, or redirected, instead of receiving 
        assistance in a timely and supportive manner.
          (16) A February 2007 report released by the City of New York 
        estimated that approximately 410,000 people were the most 
        heavily exposed to the environmental hazards and trauma of the 
        September 11 terrorist attacks. More than 30 percent of the 
        Fire Department of the City of New York first responders were 
        still experiencing some respiratory symptoms more than five 
        years after the attacks and according to the report, 59 percent 
        of those seen by the WTC Environmental Health Center at 
        Bellevue Hospital (which serves community members) are without 
        insurance and 65 percent have incomes less than $15,000 per 
        year. The report also found a need to continue and expand 
        mental health services.
          (17) Since the 5th anniversary of the attack (September 11, 
        2006), hundreds of workers a month have been signing up with 
        the monitoring and treatment programs.
          (18) In April 2008, the Department of Health and Human 
        Services reported to Congress that in fiscal year 2007 11,359 
        patients received medical treatment in the existing WTC 
        Responder Medical and Treatment program for WTC-related health 
        problems, and that number of responders who need treatment and 
        the severity of health problems is expected to increase.
          (19) The September 11 Victim Compensation Fund of 2001 was 
        established to provide compensation to individuals who were 
        physically injured or killed as a result of the terrorist-
        related aircraft crashes of September 11, 2001.
          (20) The deadline for filing claims for compensation under 
        the Victim Compensation Fund was December 22, 2003.
          (21) Some individuals did not know they were eligible to file 
        claims for compensation for injuries or did not know they had 
        suffered physical harm as a result of the terrorist-related 
        aircraft crashes until after the December 22, 2003, deadline.
          (22) Further research is needed to evaluate more 
        comprehensively the extent of the health impacts of September 
        11, including research for emerging health problems such as 
        cancer, which have been predicted.
          (23) Research is needed regarding possible treatment for the 
        illnesses and injuries of September 11.
          (24) The Federal response to medical and financial issues 
        arising from the September 11 response efforts needs a 
        comprehensive, coordinated long-term response in order to meet 
        the needs of all the individuals who were exposed to the toxins 
        of Ground Zero and are suffering health problems from the 
        disaster.
          (25) The failure to extend the appointment of Dr. John Howard 
        as Director of the National Institute for Occupational Safety 
        and Health in July 2008 is not in the interests of the 
        administration of such Institute nor the continued operation of 
        the World Trade Center Medical Monitoring and Treatment Program 
        which he has headed, and the Secretary of Health and Human 
        Services should reconsider extending such appointment.

               TITLE I--WORLD TRADE CENTER HEALTH PROGRAM

SEC. 101. WORLD TRADE CENTER HEALTH PROGRAM.

  The Public Health Service Act is amended by adding at the end the 
following new title:

             ``TITLE XXX--WORLD TRADE CENTER HEALTH PROGRAM

     ``Subtitle A--Establishment of Program; Advisory and Steering 
                               Committees

``SEC. 3001. ESTABLISHMENT OF WORLD TRADE CENTER HEALTH PROGRAM WITHIN 
                    NIOSH.

  ``(a) In General.--There is hereby established within the National 
Institute for Occupational Safety and Health a program to be known as 
the `World Trade Center Health Program' (in this title referred to as 
the `WTC program') to provide--
          ``(1) medical monitoring and treatment benefits to eligible 
        emergency responders and recovery and clean-up workers 
        (including those who are Federal employees) who responded to 
        the September 11, 2001, terrorist attacks on the World Trade 
        Center; and
          ``(2) initial health evaluation, monitoring, and treatment 
        benefits to residents and other building occupants and area 
        workers in New York City who were directly impacted and 
        adversely affected by such attacks.
  ``(b) Components of Program.--The WTC program includes the following 
components:
          ``(1) Medical monitoring for responders.--Medical monitoring 
        under section 3011, including clinical examinations and long-
        term health monitoring and analysis for individuals who were 
        likely to have been exposed to airborne toxins that were 
        released, or to other hazards, as a result of the September 11, 
        2001, terrorist attacks on the World Trade Center.
          ``(2) Initial health evaluation for community members.--An 
        initial health evaluation under section 3021, including an 
        evaluation to determine eligibility for followup monitoring and 
        treatment.
          ``(3) Follow-up monitoring and treatment for wtc-related 
        conditions for responders and community members.--Provision 
        under sections 3012, 3022, and 3023 of follow-up monitoring and 
        treatment and payment, subject to the provisions of subsection 
        (d), for all medically necessary health and mental health care 
        expenses (including necessary prescription drugs) of 
        individuals with a WTC-related health condition.
          ``(4) Outreach.--Establishment under section 3004 of an 
        outreach program to potentially eligible individuals concerning 
        the benefits under this title.
          ``(5) Uniform data collection.--Collection under section 3005 
        of health and mental health data on individuals receiving 
        monitoring or treatment benefits, using a uniform system of 
        data collection.
          ``(6) Research on wtc conditions.--Establishment under 
        subtitle C of a research program on health conditions resulting 
        from the September 11, 2001, terrorist attacks on the World 
        Trade Center.
  ``(c) No Cost-sharing.--Monitoring and treatment benefits and initial 
health evaluation benefits are provided under subtitle B without any 
deductibles, copayments, or other cost-sharing to an eligible WTC 
responder or any eligible WTC community member.
  ``(d) Payor.--
          ``(1) In general.--Except as provided in paragraphs (2) and 
        (3), the cost of monitoring and treatment benefits and initial 
        health evaluation benefits provided under subtitle B shall be 
        paid for by the WTC program.
          ``(2) Workers' compensation payment.--
                  ``(A) In general.--Except as provided in subparagraph 
                (B), payment for treatment under subtitle B of a WTC-
                related condition in an individual that is work-related 
                shall be reduced or recouped to the extent that the 
                Secretary determines that payment has been made, or can 
                reasonably be expected to be made, under a workers' 
                compensation law or plan of the United States or a 
                State, or other work-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 (42 U.S.C. 1395y(b)(2)) and 
                paragraph (3) of such section shall apply to the 
                recoupment under this paragraph 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.
                  ``(B) Exception.--If the WTC Program Administrator 
                certifies that the City of New York has contributed the 
                matching contribution required under section 3006(a)(3) 
                for a 12-month period (specified by the WTC Program 
                Administrator), subparagraph (A) shall not apply for 
                that 12-month period with respect to a workers' 
                compensation law or plan, including line of duty 
                compensation, to which the City is obligated to make 
                payments.
          ``(3) Health insurance coverage.--
                  ``(A) In general.--In the case of an individual who 
                has a WTC-related condition that is not work-related 
                and has health coverage for such condition through any 
                public or private health plan, the provisions of 
                section 1862(b) of the Social Security Act (42 U.S.C. 
                1395y(b)) shall apply to such a health plan and such 
                individual in the same manner as they apply to a group 
                health plan and an individual entitled to benefits 
                under title XVIII of such Act pursuant to section 
                226(a). Any costs for items and 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.
                  ``(B) Recovery by individual providers.--Nothing in 
                subparagraph (A) 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.
          ``(4) Work-related described.--For the purposes of this 
        subsection, a WTC-related condition shall be treated as a 
        condition that is work-related if--
                  ``(A) the condition is diagnosed in an eligible WTC 
                responder, or in an individual who qualifies as an 
                eligible WTC community member on the basis of being a 
                rescue, recovery, or clean-up worker; or
                  ``(B) 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.
  ``(e) Quality Assurance and Monitoring of Clinical Expenditures.--
          ``(1) Quality assurance.--The WTC Program Administrator 
        working with the Clinical Centers of Excellence shall develop 
        and implement a quality assurance program for the medical 
        monitoring and treatment delivered by such Centers of 
        Excellence and any other participating health care providers. 
        Such program shall include--
                  ``(A) adherence to medical monitoring and treatment 
                protocols;
                  ``(B) appropriate diagnostic and treatment referrals 
                for participants;
                  ``(C) prompt communication of test results to 
                participants; and
                  ``(D) such other elements as the Administrator 
                specifies in consultation with the Clinical Centers of 
                Excellence.
          ``(2) Fraud prevention.--The WTC Program Administrator shall 
        develop and implement a program to review the program's health 
        care expenditures to detect fraudulent or duplicate billing and 
        payment for inappropriate services. Such program shall be 
        similar to current methods used in connection with the Medicare 
        program under title XVIII of the Social Security Act. This 
        title is a Federal health care program (as defined in section 
        1128B(f) of such Act) and is a health plan (as defined in 
        section 1128C(c) of such Act) for purposes of applying sections 
        1128 through 1128E of such Act.
  ``(f) WTC Program Administration.--The WTC program shall be 
administered by the Director of the National Institute for Occupational 
Safety and Health, or a designee of such Director.
  ``(g) Annual Program Report.--
          ``(1) In general.--Not later than 6 months after the end of 
        each fiscal year in which the WTC program is in operation, the 
        WTC Program 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 of report.--Each annual report under paragraph 
        (1) shall include 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 medical 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.
                  ``(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 conditions that have 
                        been paid for or reimbursed by workers' 
                        compensation, by public or private health 
                        plans, or by the City of New York under section 
                        3012(c)(4).
                  ``(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 WTC center exposures, including 
                the findings of research conducted under section 
                3041(a).
                  ``(F) Advisory committee recommendations.--A list of 
                recommendations by the WTC Scientific/Technical 
                Advisory Committee on additional WTC program 
                eligibility criteria and on additional WTC-related 
                health conditions and the action of the WTC Program 
                Administrator concerning each such recommendation.
          ``(3) Separate clinical programs described.--In paragraph 
        (2), each of the following shall be treated as a separate 
        clinical program of the WTC program:
                  ``(A) FDNY responders.--The benefits provided for 
                eligible WTC responders described in section 
                3006(b)(1)(A).
                  ``(B) Other eligible wtc responders.--The benefits 
                provided for eligible WTC responders not described in 
                subparagraph (A).
                  ``(C) Eligible wtc community members.--The benefits 
                provided for eligible WTC community members in section 
                3006(b)(1)(C).
  ``(h) Notification to Congress When Reach 80 Percent of Eligibility 
Numerical Limits.--The WTC Program Administrator shall promptly notify 
the Congress--
          ``(1) when the number of certifications for eligible WTC 
        responders subject to the limit established under section 
        3011(a)(5) has reached 80 percent of such limit; and
          ``(2) when the number of certifications for eligible WTC 
        community members subject to the limit established under 
        section 3021(a)(5) has reached 80 percent of such limit.
  ``(i) GAO Report.--Not later than 3 years after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Congress a report on the costs of the monitoring 
and treatment programs provided under this title.
  ``(j) NYC Recommendations.--The City of New York may make 
recommendations to the WTC Program Administrator on ways to improve the 
monitoring and treatment programs under this title for both eligible 
WTC responders and eligible WTC community members.

``SEC. 3002. WTC HEALTH PROGRAM SCIENTIFIC/TECHNICAL ADVISORY 
                    COMMITTEE.

  ``(a) Establishment.--The WTC Program Administrator shall establish 
an advisory committee to be known as the WTC Health Program Scientific/
Technical Advisory Committee (in this section referred to as the 
`Advisory Committee') to review scientific and medical evidence and to 
make recommendations to the Administrator on additional WTC program 
eligibility criteria and on additional WTC-related health conditions.
  ``(b) Composition.--The WTC Program Administrator shall appoint the 
members of the Advisory Committee and shall include at least--
          ``(1) 4 occupational physicians, at least two of whom have 
        experience treating WTC rescue and recovery workers;
          ``(2) 1 physician with expertise in pulmonary medicine;
          ``(3) 2 environmental medicine or environmental health 
        specialists;
          ``(4) 2 representatives of eligible WTC responders;
          ``(5) 2 representatives of WTC community members;
          ``(6) an industrial hygienist;
          ``(7) a toxicologist;
          ``(8) an epidemiologist; and
          ``(9) a mental health professional.
  ``(c) Meetings.--The Advisory Committee shall meet at such frequency 
as may be required to carry out its duties.
  ``(d) Reports.--The WTC Program Administrator shall provide for 
publication of recommendations of the Advisory Committee on the public 
website established for the WTC program.
  ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary, not to exceed $100,000, for each fiscal year 
beginning with fiscal year 2009.
  ``(f) 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.
  ``(g) Application of FACA.--Except as otherwise specifically 
provided, the Advisory Committee shall be subject to the Federal 
Advisory Committee Act.

``SEC. 3003. WTC HEALTH PROGRAM STEERING COMMITTEES.

  ``(a) Establishment.--The WTC Program Administrator shall establish 
two steering committees (each in this section referred to as a 
`Steering Committee') as follows:
          ``(1) WTC responders steering committee.--One steering 
        committee, to be known as the WTC Responders Steering 
        Committee, for the purpose of facilitating the coordination of 
        medical monitoring and treatment programs for the eligible WTC 
        responders under part 1 of subtitle B.
          ``(2) WTC community program steering committee.--One steering 
        committee, to be known as the WTC Community Program Steering 
        Committee, for the purpose of facilitating the coordination of 
        initial health evaluations, monitoring, and treatment programs 
        for eligible WTC community members under part 2 of subtitle B.
  ``(b) Membership.--
          ``(1) Initial membership of wtc responders steering 
        committee.--The WTC Responders Steering Committee shall 
        initially be composed of members of the WTC Monitoring and 
        Treatment Program Steering Committee (as in existence on the 
        day before the date of the enactment of this title). In 
        addition, the committee membership shall include--
                  ``(A) a representative of the Police Commissioner of 
                the City of New York;
                  ``(B) a representative of the Department of Health of 
                the City of New York;
                  ``(C) a representative of another agency of the City 
                of New York, selected by the Mayor of New York City, 
                which had a large number of non-uniformed City workers 
                who responded to the WTC disaster; and
                  ``(D) three representatives of eligible WTC 
                responders;
        in order that eligible WTC responders constitute half the 
        members of the Steering Committee.
          ``(2) Initial membership of wtc community program steering 
        committee.--
                  ``(A) In general.--The WTC Community Program Steering 
                Committee shall initially be composed of members of the 
                WTC Environmental Health Center Community Advisory 
                Committee (as in existence on the day before the date 
                of the enactment of this title) and shall initially 
                have, as voting members, the following:
                          ``(i) 11 representatives of the affected 
                        populations of residents, students, area 
                        workers, and other community members.
                          ``(ii) The Medical Director of the WTC 
                        Environmental Health Center.
                          ``(iii) The Executive Director of the WTC 
                        Environmental Health Center.
                          ``(iv) Three physicians, one each 
                        representing the three WTC Environmental Health 
                        Center treatment sites of Bellevue Hospital 
                        Center, Gouverneur Healthcare Services, and 
                        Elmhurst Hospital Center.
                          ``(v) Five specialists with WTC related 
                        expertise or experience in treating non-
                        responder WTC diseases, such as a pediatrician, 
                        an epidemiologist, a psychiatrist or 
                        psychologist, an environmental/occupational 
                        specialists or a social worker from a WTC 
                        Environmental Health Center treatment site, or 
                        other relevant specialists.
                          ``(vi) A representative of the Department of 
                        Health and Mental Hygiene of the City of New 
                        York.
                  ``(B) Appointments.--
                          ``(i) WTC ehc community advisory committee.--
                        The WTC Environmental Health Center Community 
                        Advisory Committee as in existence on the date 
                        of the enactment of this title shall nominate 
                        members for positions described in subparagraph 
                        (A)(i).
                          ``(ii) NYC health and hospitals 
                        corporation.--The New York City Health and 
                        Hospitals Corporation shall nominate members 
                        for positions described in clauses (iv) and (v) 
                        of subparagraph (A).
                          ``(iii) Timing.--Nominations under clauses 
                        (i) and (ii) shall be recommended to the WTC 
                        Program Administrator not later than 60 days 
                        after the date of the enactment of this title.
                          ``(iv) Appointment.--The WTC Program 
                        Administrator shall appoint members of the WTC 
                        Community Program Steering Committee not later 
                        than 90 days after the date of the enactment of 
                        this title.
                          ``(v) General representatives.--Of the 
                        members appointed under subparagraph (A)(i)--
                                  ``(I) the representation shall 
                                reflect the broad and diverse WTC-
                                affected populations and constituencies 
                                and the diversity of impacted 
                                neighborhoods, including residents, 
                                hard-to-reach populations, students, 
                                area workers, school parents, 
                                community-based organizations, 
                                Community Boards, WTC Environmental 
                                Health Center patients, labor unions, 
                                and labor advocacy organizations; and
                                  ``(II) no one individual organization 
                                can have more than one representative.
          ``(3) Additional appointments.--Each Steering Committee may 
        appoint, if approved by a majority of voting members of the 
        Committee, additional members to the Committee.
          ``(4) Vacancies.--A vacancy in a Steering Committee shall be 
        filled by the Steering Committee, subject to the approval of 
        the WTC Program Administrator, so long as--
                  ``(A) in the case of the WTC Responders Steering 
                Committee, the composition of the Committee includes 
                representatives of eligible WTC responders and 
                representatives of each Clinical Center of Excellence 
                and each Coordinating Center of Excellence that serves 
                eligible WTC responders and such composition has 
                eligible WTC responders constituting half of the 
                membership of the Steering Committee; or
                  ``(B) in the case of the WTC Community Program 
                Steering Committee, the composition of the Committee 
                includes representatives of eligible WTC community 
                members and representatives of each Clinical Center of 
                Excellence and each Coordinating Center of Excellence 
                that serves eligible WTC community members and the 
                nominating process is consistent with paragraph (2)(B).
          ``(5) Co-chairs of wtc community program steering 
        committee.--The WTC Community Program Steering Committee shall 
        have two Co-Chairs as follows:
                  ``(A) Community/Labor co-chair.--A Community/Labor 
                Co-Chair who shall be chosen by the community and 
                labor-based members of the Steering Committee.
                  ``(B) Environmental health clinic co-chair.--A WTC 
                Environmental Health Clinic Co-Chair who shall be 
                chosen by the WTC Environmental Health Center members 
                on the Steering Committee.
  ``(c) Relation to FACA.--Each Steering Committee shall not be subject 
to the Federal Advisory Committee Act.
  ``(d) Meetings.--Each Steering Committee shall meet at such frequency 
necessary to carry out its duties, but not less than 4 times each 
calendar year and at least two such meetings each year shall be a joint 
meeting with the voting membership of the other Steering Committee for 
the purpose of exchanging information regarding the WTC program.
  ``(e) Duration.--Notwithstanding any other provision of law, each 
Steering Committee shall continue in operation during the period in 
which the WTC program is in operation.

``SEC. 3004. COMMUNITY EDUCATION AND OUTREACH.

  ``(a) In General.--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 website 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.
  ``(b) Partnerships.--To the greatest extent possible, in carrying out 
this section, the WTC Program Administrator shall enter into 
partnerships with local governments and organizations with experience 
performing outreach to the affected populations, including community 
and labor-based organizations.

``SEC. 3005. UNIFORM DATA COLLECTION.

  ``(a) In General.--The WTC Program Administrator shall provide for 
the uniform collection of data (and analysis of data and regular 
reports to the Administrator) on the utilization of monitoring and 
treatment benefits provided to eligible WTC responders and eligible WTC 
community members, the prevalence of WTC-related health conditions, and 
the identification of new WTC-related medical conditions. Such data 
shall be collected for all individuals provided monitoring or treatment 
benefits under subtitle B and regardless of their place of residence or 
Clinical Center of Excellence through which the benefits are provided.
  ``(b) Coordinating Through Centers of Excellence.--Each Clinical 
Center of Excellence shall collect data described in subsection (a) and 
report such data to the corresponding Coordinating Center of Excellence 
for analysis by such Coordinating Center of Excellence.
  ``(c) Privacy.--The data collection and analysis under this section 
shall be conducted in a manner that protects the confidentiality of 
individually identifiable health information consistent with applicable 
legal requirements.

``SEC. 3006. CENTERS OF EXCELLENCE.

  ``(a) In General.--
          ``(1) Contracts with clinical centers of excellence.--The WTC 
        Program Administrator shall enter into contracts with Clinical 
        Centers of Excellence specified in subsection (b)(1)--
                  ``(A) for the provision of monitoring and treatment 
                benefits and initial health evaluation benefits under 
                subtitle B;
                  ``(B) for the provision of outreach activities to 
                individuals eligible for such monitoring and treatment 
                benefits, for initial health evaluation benefits, and 
                for follow-up to individuals who are enrolled in the 
                monitoring program;
                  ``(C) for the provision of counseling for benefits 
                under subtitle B, with respect to WTC-related health 
                conditions, for individuals eligible for such benefits;
                  ``(D) for the provision of counseling for benefits 
                for WTC-related health conditions that 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 as for program participants who 
                are not English language proficient; and
                  ``(F) for the collection and reporting of data in 
                accordance with section 3005.
          ``(2) Contracts with coordinating centers of excellence.--The 
        WTC Program Administrator shall enter into contracts with 
        Coordinating Centers of Excellence specified in subsection 
        (b)(2)--
                  ``(A) for receiving, analyzing, and reporting to the 
                WTC Program Administrator on data, in accordance with 
                section 3005, that has been collected and reported to 
                such Coordinating Centers by the corresponding Clinical 
                Centers of Excellence under subsection (d)(3);
                  ``(B) for the development of medical monitoring, 
                initial health evaluation, and treatment protocols, 
                with respect to WTC-related health conditions;
                  ``(C) for coordinating the outreach activities 
                conducted under paragraph (1)(B) by each corresponding 
                Clinical Center of Excellence;
                  ``(D) for establishing criteria for the credentialing 
                of medical providers participating in the nationwide 
                network under section 3031;
                  ``(E) for coordinating and administrating the 
                activities of the WTC Health Program Steering 
                Committees established under section 3003(a); and
                  ``(F) for meeting periodically with the corresponding 
                Clinical Centers of Excellence to obtain input on the 
                analysis and reporting of data collected under 
                subparagraph (A) and on the development of medical 
                monitoring, initial health evaluation, and treatment 
                protocols under subparagraph (B).
        The medical providers under subparagraph (D) shall be selected 
        by the WTC Program Administrator on the basis of their 
        experience treating or diagnosing the medical conditions 
        included in the list of identified WTC-related conditions for 
        responders and of identified WTC-related conditions for 
        community members.
          ``(3) Required participation by new york city in monitoring 
        and treatment program and costs.--
                  ``(A) In general.--In order for New York City, any 
                agency or Department thereof, or the New York City 
                Health and Hospitals Corporation to qualify for a 
                contract for the provision of monitoring and treatment 
                benefits and other services under section 3006, New 
                York City is required to contribute a matching amount 
                of 10 percent of the amount of the covered monitoring 
                and treatment payment (as defined in subparagraph (B)).
                  ``(B) Covered monitoring and treatment payment 
                defined.--For the purposes of this paragraph, the term 
                `covered monitoring and treatment payment' means 
                payment under paragraphs (1) and (2), including under 
                such paragraph as applied under section 3021(b), 
                3022(a), and 3023, and reimbursement under 3006(c) for 
                items and services furnished by a Clinical Center of 
                Excellence or Coordinating Center of Excellence, and 
                providers designated by the WTC Program under section 
                3031, after the application of paragraphs (2) and (3) 
                of section 3001 (d).
                  ``(C) Payment of new york city share of monitoring 
                and treatment costs.--The WTC Program Administrator 
                shall--
                          ``(i) bill the amount specified in 
                        subparagraph (A) directly to New York City; and
                          ``(ii) certify periodically, for purposes of 
                        section 3001(d)(2), whether or not New York 
                        City has paid the amount so billed.
                  ``(D) Limitation on required amount.--In no case is 
                New York City required under this paragraph to 
                contribute more than a total of $500,000,000 over any 
                10-year period.
  ``(b) Centers of Excellence Defined.--
          ``(1) Clinical center of excellence.--In this title, the term 
        `Clinical Center of Excellence' means the following:
                  ``(A) For fdny responders.--With respect to an 
                eligible WTC responder who responded to the 9/11 
                attacks as an employee of the Fire Department of the 
                City of New York and who--
                          ``(i) is an active employee of such 
                        Department--
                                  ``(I) with respect to monitoring, 
                                such Fire Department; and
                                  ``(II) with respect to treatment, 
                                such Fire Department (or such entity as 
                                has entered into a contract with the 
                                Fire Department for treatment of such 
                                responders) or any other Clinical 
                                Center of Excellence described in 
                                subparagraph (B), (C), or (D); or
                          ``(ii) is not an active employee of such 
                        Department, such Fire Department (or such 
                        entity as has entered into a contract with the 
                        Fire Department for monitoring or treatment of 
                        such responders) or any other or any other 
                        Clinical Center of Excellence described in 
                        subparagraph (B), (C), or (D).
                  ``(B) Other eligible wtc responders.--With respect to 
                other eligible WTC responders, whether or not they 
                reside in the New York Metropolitan area, the Mt. Sinai 
                coordinated consortium, Queens College, State 
                University of New York at Stony Brook, University of 
                Medicine and Dentistry of New Jersey, and Bellevue 
                Hospital.
                  ``(C) WTC community members.--With respect to 
                eligible WTC community members, whether or not they 
                reside in the New York Metropolitan area, the World 
                Trade Center Environmental Health Center at Bellevue 
                Hospital and such hospitals or other facilities, 
                including but not limited to those within the New York 
                City Health and Hospitals Corporation, as are 
                identified by the WTC Program Administrator.
                  ``(D) All eligible wtc responders and eligible wtc 
                community members.--With respect to all eligible WTC 
                responders and eligible WTC community members, such 
                other hospitals or other facilities as are identified 
                by the WTC Program Administrator.
        The WTC Program Administrator shall limit the number of 
        additional Centers of Excellence identified under subparagraph 
        (D) to ensure that the participating centers have adequate 
        experience in the treatment and diagnosis of identified WTC-
        related medical conditions.
          ``(2) Coordinating center of excellence.--In this title, the 
        term `Coordinating Center of Excellence' means the following:
                  ``(A) For fdny responders.--With respect to an 
                eligible WTC responder who responded to the 9/11 
                attacks as an employee of the Fire Department of the 
                City of New York, such Fire Department.
                  ``(B) Other wtc responders.--With respect to other 
                eligible WTC responders, the Mt. Sinai coordinated 
                consortium.
                  ``(C) Wtc community members.--With respect to 
                eligible WTC community members, the World Trade Center 
                Environmental Health Center at Bellevue Hospital.
          ``(3) Corresponding centers.--In this title, a Clinical 
        Center of Excellence and a Coordinating Center of Excellence 
        shall be treated as `corresponding' to the extent that such 
        Clinical Center and Coordinating Center serve the same 
        population group.
  ``(c) Reimbursement for Non-treatment, Non-monitoring Program 
Costs.--A Clinical or Coordinating Center of Excellence with a contract 
under this section shall be reimbursed for the costs of such Center in 
carrying out the activities described in subsection (a), other than 
those described in subsection (a)(1)(A), subject to the provisions of 
section 3001(d), as follows:
          ``(1) Clinical centers of excellence.--For carrying out 
        subparagraphs (B) through (F) of subsection (a)(1)--
                  ``(A) Clinical center for fdny responders in new 
                york.--The Clinical Center of Excellence for FDNY 
                Responders in New York specified in subsection 
                (b)(1)(A) shall be reimbursed--
                          ``(i) in the first year of the contract under 
                        this section, $600 per certified eligible WTC 
                        responder in the medical treatment program, and 
                        $300 per certified eligible WTC responder in 
                        the monitoring program; and
                          ``(ii) in each subsequent contract year, 
                        subject to paragraph (3), at the rates 
                        specified in this subparagraph for the previous 
                        contract year adjusted by the WTC Program 
                        Administrator to reflect the rate of medical 
                        care inflation during the previous contract 
                        year.
                  ``(B) Clinical centers serving other eligible wtc 
                responders in new york.--A Clinical Center of 
                Excellence for other WTC responders in New York 
                specified in subsection (b)(1)(B) shall be reimbursed 
                the amounts specified in subparagraph (A).
                  ``(C) Clinical centers serving wtc community 
                members.--A Clinical Center of Excellence for eligible 
                WTC community members in New York specified in 
                subsection (b)(1)(C) shall be reimbursed--
                          ``(i) in the first year of the contract under 
                        this section, for each certified eligible WTC 
                        community member in a medical treatment program 
                        enrolled at a non-hospital-based facility, 
                        $600, and for each certified eligible WTC 
                        community member in a medical treatment program 
                        enrolled at a hospital-based facility, $300; 
                        and
                          ``(ii) in each subsequent contract year, 
                        subject to paragraph (3), at the rates 
                        specified in this subparagraph for the previous 
                        contract year adjusted by the WTC Program 
                        Administrator to reflect the rate of medical 
                        care inflation during the previous contract 
                        year.
                  ``(D) Other clinical centers.--A Clinical Center of 
                Excellence or other providers not described in a 
                previous subparagraph shall be reimbursed at a rate set 
                by the WTC Program Administrator.
                  ``(E) Reimbursement rules.--The reimbursement 
                provided under subparagraphs (A), (B) and (C) shall be 
                made for each certified eligible WTC responder and for 
                each WTC community member in the WTC program per year 
                that the member receives such services, regardless of 
                the volume or cost of services required.
          ``(2) Coordinating centers of excellence.--A Coordinating 
        Centers of Excellence specified in section (a)(2) shall be 
        reimbursed for the provision of services set forth in this 
        section at such levels as are established by the WTC Program 
        Administrator.
          ``(3) Review of rates.--
                  ``(A) Initial review.--Before the end of the third 
                contract year of the WTC program, the WTC Program 
                Administrator shall conduct a review to determine 
                whether the reimbursement rates set forth in this 
                subsection provide fair and appropriate reimbursement 
                for such program services. Based on such review, the 
                Administrator may, by rule beginning with the fourth 
                contract year, may modify such rates, taking into 
                account a reasonable and fair rate for the services 
                being provided.
                  ``(B) Subsequent reviews.--After the fourth contract 
                year, the WTC Program Administrator shall conduct 
                periodic reviews to determine whether the reimbursement 
                rates in effect under this subsection provide fair and 
                appropriate reimbursement for such program services. 
                Based upon such a review, the Administrator may by rule 
                modify such rates, taking into account a reasonable and 
                fair rate for the services being provided.
                  ``(C) GAO review.--The Comptroller General of the 
                United States shall review the WTC Program 
                Administrator's determinations regarding fair and 
                appropriate reimbursement for program services under 
                this paragraph.
  ``(d) Requirements.--The WTC Program Administrator shall not enter 
into a contract with a Clinical Center of Excellence under subsection 
(a)(1) unless--
          ``(1) the Center establishes 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;
          ``(2) the Center provides for the coordination of monitoring 
        and treatment benefits under subtitle B with routine medical 
        care provided for the treatment of conditions other than WTC-
        related health conditions;
          ``(3) the Center collects and reports to the corresponding 
        Coordinating Center of Excellence data in accordance with 
        section 3005;
          ``(4) the Center has in place safeguards against fraud that 
        are satisfactory to the Administrator;
          ``(5) the Center agrees to treat or refer for treatment all 
        individuals who are eligible WTC responders or eligible WTC 
        community members with respect to such Center who present 
        themselves for treatment of a WTC-related health condition;
          ``(6) the Center has in place safeguards to 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;
          ``(7) the Center provides assurances that the amounts paid 
        under subsection (c)(1) are used only for costs incurred in 
        carrying out the activities described in subsection (a), other 
        than those described in subsection (a)(1)(A); and
          ``(8) the Center agrees to meet all the other applicable 
        requirements of this title, including regulations implementing 
        such requirements.

``SEC. 3007. ENTITLEMENT AUTHORITIES.

  ``Subject to subsections (b)(4)(C) and (c)(5) of section 3012, 
subtitle B constitutes budget authority in advance of appropriations 
Acts and represents the obligation of the Federal Government to provide 
for the payment for monitoring, initial health evaluations, and 
treatment in accordance with such subtitle and section 3006(c) 
constitutes such budget authority and represents the obligation of the 
Federal Government to provide for the payment described in such 
section.

``SEC. 3008. DEFINITIONS.

  ``In this title:
          ``(1) The term `aggravating' means, with 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 on the World Trade Center 
        requires medical treatment that is (or will be) in addition to, 
        more frequent than, or of longer duration than the medical 
        treatment that would have been required for such condition in 
        the absence of such exposure.
          ``(2) The terms `certified eligible WTC responder' and 
        `certified eligible WTC community member' mean an individual 
        who has been certified as an eligible WTC responder under 
        section 3011(a)(4) or an eligible WTC community member under 
        section 3021(a)(4), respectively.
          ``(3) The terms `Clinical Center of Excellence' and 
        `Coordinating Center of Excellence' have the meanings given 
        such terms in section 3006(b).
          ``(4) The term `current consortium arrangements' means the 
        arrangements as in effect on the date of the enactment of this 
        title between the National Institute for Occupational Safety 
        and Health and the Mt. Sinai-coordinated consortium and the 
        Fire Department of the City of New York.
          ``(5) The terms `eligible WTC responder' and `eligible WTC 
        community member' are defined in sections 3011(a) and 3021(a), 
        respectively.
          ``(6) The term `initial health evaluation' 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.
          ``(7) The term `list of identified WTC-related health 
        conditions' means--
                  ``(A) for eligible WTC responders, the identified 
                WTC-related health condition for eligible WTC 
                responders under section 3012(a)(3) or 3012(a)(4); or
                  ``(B) for eligible WTC community members, the 
                identified WTC-related health condition for WTC 
                community members under section 3022(b)(1) or 
                3022(b)(2).
          ``(8) The term `Mt.-Sinai-coordinated consortium' means the 
        consortium coordinated by Mt. Sinai hospital in New York City 
        that coordinates the monitoring and treatment under the current 
        consortium arrangements for eligible WTC responders other than 
        with respect to those covered under the arrangement with the 
        Fire Department of the City of New York.
          ``(9) 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.
          ``(10) The term `New York metropolitan area' means an area, 
        specified by the WTC Program Administrator, within which 
        eligible WTC responders and eligible WTC community members 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 Centers of Excellence 
        described in subparagraphs (A), (B), or (C) of section 
        3006(b)(1).
          ``(11) Any reference to `September 11, 2001' shall be deemed 
        a reference to the period on such date subsequent to the 
        terrorist attacks on the World Trade Center on such date.
          ``(12) The term `September 11, 2001, terrorist attacks on the 
        World Trade Center' means the terrorist attacks that occurred 
        on September 11, 2001, in New York City and includes the 
        aftermath of such attacks.
          ``(13) The term `WTC Health Program Steering Committee' means 
        such a Steering Committee established under section 3003.
          ``(14) The term `WTC Program Administrator' means the 
        individual responsible under section 3001(f) for the 
        administration of the WTC program.
          ``(15) The term `WTC-related health condition' is defined in 
        section 3012(a).
          ``(16) The term `WTC Scientific/Technical Advisory Committee' 
        means such Committee established under section 3002.

 ``Subtitle B--Program of Monitoring, Initial Health Evaluations, and 
                               Treatment

                      ``PART 1--FOR WTC RESPONDERS

``SEC. 3011. IDENTIFICATION OF ELIGIBLE WTC RESPONDERS AND PROVISION OF 
                    WTC-RELATED MONITORING SERVICES.

  ``(a) Eligible WTC Responder Defined.--
          ``(1) In general.--For purposes of this title, the term 
        `eligible WTC responder' means any of the following 
        individuals, subject to paragraph (5):
                  ``(A) Currently identified responder.--An individual 
                who has been identified as eligible for medical 
                monitoring under the current consortium arrangements 
                (as defined in section 3008(4)).
                  ``(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 on 
                        the World Trade Center, 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 on 
                        the World Trade Center as the WTC Program 
                        Administrator, after consultation with the WTC 
                        Responders Steering Committee and 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 certifications for eligible responders has 
                reached 80 percent of the limit described in paragraph 
                (5) or on or after the date that the number of 
                certifications for eligible community members has 
                reached 80 percent of the limit described in section 
                3021(a)(5).
          ``(2) Current eligibility criteria.--The eligibility criteria 
        described in this paragraph for an individual is that the 
        individual is described in either of the following categories:
                  ``(A) Fire fighters and related personnel.--The 
                individual--
                          ``(i) was a member of the Fire Department of 
                        the City of New York (whether fire or emergency 
                        personnel, active or retired) who participated 
                        at least one day in the rescue and recovery 
                        effort at any of the former World Trade sites 
                        (including Ground Zero, Staten Island land 
                        fill, and the NYC 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 the City of New York 
                        (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 mental health condition described in 
                        section 3012(a)(1)(B) on or before September 1, 
                        2008.
                  ``(B) Law enforcement officers and wtc rescue, 
                recovery, and clean-up workers.--The individual--
                          ``(i) worked or volunteered on-site 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 the City of New York (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 on-site in rescue, recovery, 
                        debris clean-up, 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 on-site in rescue, 
                        recovery, debris clean-up, or related services 
                        in 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 on-site in rescue, 
                        recovery, debris clean-up, or related services 
                        in lower Manhattan (south of Canal St.) for at 
                        least 24 hours during the period beginning on 
                        September 11, 2001, and ending on September 30, 
                        2001; or
                          ``(IV) participated on-site in rescue, 
                        recovery, debris clean-up, or related 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 the City of New York 
                        involved in the examination and handling of 
                        human remains from the World Trade Center 
                        attacks, or other morgue worker who performed 
                        similar post-September 11 functions for such 
                        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 on the 
                        World Trade Center during a duration and period 
                        described in subparagraph (A).
          ``(3) Application process.--The WTC Program Administrator in 
        consultation with the Coordinating Centers of Excellence shall 
        establish a process for individuals, other than eligible WTC 
        responders described in paragraph (1)(A), to apply to be 
        determined to be eligible WTC responders. Under such process--
                  ``(A) there shall be no fee charged to the applicant 
                for making an application for such determination;
                  ``(B) the Administrator shall make a determination on 
                such an application not later than 60 days after the 
                date of filing the application; and
                  ``(C) an individual who is determined not to be an 
                eligible WTC responder shall have an opportunity to 
                appeal such determination before an administrative law 
                judge in a manner established under such process.
          ``(4) Certification.--
                  ``(A) In general.--In the case of an individual who 
                is described in paragraph (1)(A) or who is determined 
                under paragraph (3) (consistent with paragraph (5)) to 
                be an eligible WTC responder, the WTC Program 
                Administrator shall provide an appropriate 
                certification of such fact and of eligibility for 
                monitoring and treatment benefits under this part. The 
                Administrator shall make determinations of eligibility 
                relating to an applicant's compliance with this title, 
                including the verification of information submitted in 
                support of the application, and shall not deny such a 
                certification to an individual unless the Administrator 
                determines that--
                          ``(i) based on the application submitted, the 
                        individual does not meet the eligibility 
                        criteria; or
                          ``(ii) the numerical limitation on eligible 
                        WTC responders set forth in paragraph (5) has 
                        been met.
                  ``(B) Timing.--
                          ``(i) Currently identified responders.--In 
                        the case of an individual who is described in 
                        paragraph (1)(A), the WTC Program Administrator 
                        shall provide the certification under 
                        subparagraph (A) not later than 60 days after 
                        the date of the enactment of this title.
                          ``(ii) Other responders.--In the case of 
                        another individual who is determined under 
                        paragraph (3) and consistent with paragraph (5) 
                        to be an eligible WTC responder, the WTC 
                        Program Administrator shall provide the 
                        certification under subparagraph (A) at the 
                        time of the determination.
          ``(5) Numerical limitation on eligible wtc responders.--
                  ``(A) In general.--The total number of individuals 
                not described in subparagraph (C) who may qualify as 
                eligible WTC responders for purposes of this title, and 
                be certified as eligible WTC responders under paragraph 
                (4), shall not exceed 15,000, subject to adjustment 
                under paragraph (6), of which no more than 2,500 may be 
                individuals certified based on modified eligibility 
                criteria established under paragraph (1)(C). In 
                applying the previous sentence, any individual who at 
                any time so qualifies as an eligible WTC responder 
                shall be counted against such numerical limitation.
                  ``(B) Process.--In implementing subparagraph (A), the 
                WTC Program Administrator shall--
                          ``(i) limit the number of certifications 
                        provided under paragraph (4) in accordance with 
                        such subparagraph; and
                          ``(ii) provide priority in such 
                        certifications in the order in which 
                        individuals apply for a determination under 
                        paragraph (3).
                  ``(C) Currently identified responders not counted.--
                Individuals described in this subparagraph are 
                individuals who are described in paragraph (1)(A).
          ``(6) Potential adjustment in numerical limitations dependent 
        upon actual spending relative to estimated spending.--
                  ``(A) Initial calculation for fiscal years 2009 
                through 2011.--If the WTC Program Administrator 
                determines as of December 1, 2011, that the WTC 
                expenditure-to-CBO-estimate percentage (as defined in 
                subparagraph (D)(iii)) for fiscal years 2009 through 
                2011 does not exceed 90 percent, then, effective 
                January 1, 2012, the WTC Program Administrator may 
                increase the numerical limitation under paragraph 
                (5)(A), the numerical limitation under section 
                3021(a)(5), or both, by a number of percentage points 
                not to exceed the number of percentage points specified 
                in subparagraph (C) for such period of fiscal years.
                  ``(B) Subsequent calculation for fiscal years 2009 
                through 2015.--If the Secretary determines as of 
                December 1, 2015, that the WTC expenditure-to-CBO-
                estimate percentages for fiscal years 2009 through 2015 
                and for fiscal years 2012 through 2015 do not exceed 90 
                percent, then, effective January 1, 2015, the WTC 
                Program Administrator may increase the numerical 
                limitation under paragraph (5)(A), the numerical 
                limitation under section 3021(a)(5), or both, as in 
                effect after the application of subparagraph (A), by a 
                number of percentage points not to exceed twice the 
                lesser of--
                          ``(i) the number of percentage points 
                        specified in subparagraph (C) for fiscal years 
                        2009 through 2012, or
                          ``(ii) the number of percentage points 
                        specified in subparagraph (C) for fiscal years 
                        2012 through 2015.
                  ``(C) Maximum percentage increase in numerical 
                limitations for period of fiscal years.--The number of 
                percentage points specified in this clause for a period 
                of fiscal years is--
                          ``(i) 100 percentage points, multiplied by
                          ``(ii) one minus a fraction the numerator of 
                        which is the net Federal WTC spending for such 
                        period, and the denominator of which is the CBO 
                        WTC spending estimate under this title for such 
                        period.
                  ``(D) Definitions.--For purposes of this paragraph:
                          ``(i) Net federal spending.--The term `net 
                        Federal WTC spending' means, with respect to a 
                        period of fiscal years, the net Federal 
                        spending under this title for such fiscal 
                        years.
                          ``(ii) CBO wtc spending estimate under this 
                        title.--The term `CBO WTC medical spending 
                        estimate under this title' means, with respect 
                        to--
                                  ``(I) fiscal years 2009 through 2011, 
                                $900,000,000;
                                  ``(II) fiscal years 2012 through 
                                2015, $1,890,000,000; and
                                  ``(III) fiscal years 2009 through 
                                2015, the sum of the amounts specified 
                                in subclauses (I) and (II).
                          ``(iii) WTC expenditure-to-cbo-estimate 
                        percentage.--The term `WTC expenditure-to-
                        estimate percentage' means, with respect to a 
                        period of fiscal years, the ratio (expressed as 
                        a percentage) of--
                                  ``(I) the net Federal WTC spending 
                                for such period, to
                                  ``(II) the CBO WTC spending estimate 
                                under this title for such period.
  ``(b) Monitoring Benefits.--
          ``(1) In general.--In the case of an eligible WTC responder 
        under section 3011(a)(4) (other than one described in 
        subsection (a)(2)(A)(ii)), the WTC program shall provide for 
        monitoring benefits that include medical 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 eligible WTC responder who is 
        an active member of the Fire Department of the City of New 
        York, 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 
        3031.

``SEC. 3012. TREATMENT OF CERTIFIED ELIGIBLE 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) 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 on the World Trade Center, 
                based on an examination by a medical professional with 
                experience in treating or diagnosing the medical 
                conditions included in the applicable list of 
                identified WTC-related 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
                  ``(B) a mental health condition for which such 
                attacks, based on an examination by a medical 
                professional with experience in treating or diagnosing 
                the medical conditions included in the applicable list 
                of identified WTC-related conditions, is substantially 
                likely be a significant factor in aggravating, 
                contributing to, or causing the condition, as 
                determined under paragraph (2).
        In the case of an eligible WTC responder described in section 
        3011(a)(2)(A)(ii), such term only includes the mental health 
        condition described in subparagraph (B).
          ``(2) Determination.--The determination of whether the 
        September 11, 2001, terrorist attacks on the World Trade Center 
        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 medical conditions included on the 
                        list of identified WTC-related 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 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 identified wtc-related health conditions for 
        certified eligible wtc responders.--For purposes of this title, 
        the term `identified WTC-related health condition for eligible 
        WTC responders' means any of the following health conditions:
                  ``(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) Gastro-esophageal reflux disorder 
                        (GERD).
                          ``(xii) Sleep apnea exacerbated by or related 
                        to a condition described in a previous clause.
                  ``(B) Mental health conditions.--
                          ``(i) Post traumatic stress disorder (PTSD).
                          ``(ii) Major depressive disorder.
                          ``(iii) Panic disorder.
                          ``(iv) Generalized anxiety disorder.
                          ``(v) Anxiety disorder (not otherwise 
                        specified).
                          ``(vi) Depression (not otherwise specified).
                          ``(vii) Acute stress disorder.
                          ``(viii) Dysthymic disorder.
                          ``(ix) Adjustment disorder.
                          ``(x) Substance abuse.
                          ``(xi) V codes (treatments not specifically 
                        related to psychiatric disorders, such as 
                        marital problems, parenting problems etc.), 
                        secondary to another identified WTC-related 
                        health condition for WTC eligible responders.
                  ``(C) Musculoskeletal disorders.--
                          ``(i) Low back pain.
                          ``(ii) Carpal tunnel syndrome (CTS).
                          ``(iii) Other musculoskeletal disorders.
          ``(4) Addition of identified wtc-related health conditions 
        for eligible wtc responders.--
                  ``(A) In general.--The WTC Program Administrator may 
                promulgate regulations to add an illness or health 
                condition not described in paragraph (3) to be added to 
                the list of identified WTC-related conditions for 
                eligible WTC responders. In promulgating such 
                regulations, the Secretary shall provide for notice and 
                opportunity for a public hearing and at least 90 days 
                of public comment. In promulgating such regulations, 
                the WTC Program Administrator shall take into account 
                the findings and recommendations of Clinical Centers of 
                Excellence published in peer reviewed journals in the 
                determination of whether an additional illness or 
                health condition, such as cancer, should be added to 
                the list of identified WTC-related health conditions 
                for eligible WTC responders.
                  ``(B) Petitions.--Any person (including the WTC 
                Health Program Scientific/Technical Advisory Committee) 
                may petition the WTC Program Administrator to propose 
                regulations described in subparagraph (A). Unless 
                clearly frivolous, or initiated by such Committee, any 
                such petition shall be referred to such Committee for 
                its recommendations. Following--
                          ``(i) receipt of any recommendation of the 
                        Committee; or
                          ``(ii) 180 days after the date of the 
                        referral to the Committee,
                whichever occurs first, the WTC Program Administrator 
                shall conduct a rulemaking proceeding on the matters 
                proposed in the petition or publish in the Federal 
                Register a statement of reasons for not conducting such 
                proceeding.
                  ``(C) Effectiveness.--Any addition under subparagraph 
                (A) of an illness or health condition shall apply only 
                with respect to applications for benefits under this 
                title which are filed after the effective date of such 
                regulation.
                  ``(D) Role of advisory committee.--Except with 
                respect to a regulation recommended by the WTC Health 
                Program Scientific/Technical Advisory Committee), the 
                WTC Program Administrator may not propose a regulation 
                under this paragraph, unless the Administrator has 
                first provided to the Committee a copy of the proposed 
                regulation, requested recommendations and comments by 
                the Committee, and afforded the Committee at least 90 
                days to make such recommendations.
  ``(b) Coverage of Treatment for WTC-Related Health Conditions.--
          ``(1) Determination based on an identified wtc-related health 
        condition for certified eligible wtc responders.--
                  ``(A) In general.--If a physician at a Clinical 
                Center of Excellence that is providing monitoring 
                benefits under section 3011 for a certified eligible 
                WTC responder determines that the responder has an 
                identified WTC-related health condition, and the 
                physician makes a clinical determination that exposure 
                to airborne toxins, other hazards, or adverse 
                conditions resulting from the 9/11 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) of a 
                        WTC-related health condition.
                          ``(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 an identified WTC-
                        related health condition or that exposure to 
                        airborne toxins, other hazards, or adverse 
                        conditions resulting from the 9/11 terrorist 
                        attacks is not substantially likely to be a 
                        significant factor in significantly 
                        aggravating, contributing to, or causing the 
                        condition.
                          ``(iii) Appeal process.--The Administrator 
                        shall provide a process for the appeal of 
                        determinations under clause (ii) before an 
                        administrative law judge.
          ``(2) Determination based on other wtc-related health 
        condition.--
                  ``(A) In general.--If a physician at a Clinical 
                Center of Excellence determines pursuant to subsection 
                (a) that the certified eligible WTC responder has a 
                WTC-related health condition that is not an identified 
                WTC-related health condition for eligible WTC 
                responders--
                          ``(i) the physician shall promptly transmit 
                        such determination to the WTC Program 
                        Administrator and provide the Administrator 
                        with the facts supporting such determination; 
                        and
                          ``(ii) the Administrator shall make a 
                        determination under subparagraph (B) with 
                        respect to such physician's determination.
                  ``(B) Review; certification.--
                          ``(i) Use of physician panel.--With respect 
                        to each determination relating to a WTC-related 
                        health condition transmitted under subparagraph 
                        (A)(i), the WTC Program Administrator shall 
                        provide for the review of the condition to be 
                        made by a physician panel with appropriate 
                        expertise appointed by the WTC Program 
                        Administrator. Such a panel shall make 
                        recommendations to the Administrator on the 
                        evidence supporting such determination.
                          ``(ii) Review of recommendations of panel; 
                        certification.--The Administrator, based on 
                        such recommendations shall determine, within 60 
                        days after the date of the transmittal under 
                        subparagraph (A)(i), whether or not the 
                        condition is a WTC-related health condition 
                        and, if it is, provide for a certification 
                        under paragraph (1)(B)(ii) of coverage of such 
                        condition. The Administrator shall provide a 
                        process for the appeal of determinations that 
                        the responder's condition is not a WTC-related 
                        health condition before an administrative law 
                        judge.
          ``(3) Requirement of medical necessity.--
                  ``(A) In general.--In providing treatment for a WTC-
                health condition, a physician shall provide treatment 
                that is medically necessary and in accordance with 
                medical protocols established under subsection (d).
                  ``(B) Medically necessary standard.--For the purpose 
                of this title, health care services shall be treated as 
                medically necessary for an individual if a physician, 
                exercising prudent clinical judgment, would consider 
                the services to be medically necessary for the 
                individual for the purpose of evaluating, diagnosing, 
                or treating an illness, injury, disease or its 
                symptoms, and that are--
                          ``(i) in accordance with the generally 
                        accepted standards of medical practice;
                          ``(ii) clinically appropriate, in terms of 
                        type, frequency, extent, site, and duration, 
                        and considered effective for the individual's 
                        illness, injury, or disease; and
                          ``(iii) not primarily for the convenience of 
                        the patient or physician, or another physician, 
                        and not more costly than an alternative service 
                        or sequence of services at least as likely to 
                        produce equivalent therapeutic or diagnostic 
                        results as to the diagnosis or treatment of the 
                        individual's illness, injury, or disease.
                  ``(C) Determination of medical necessity.--
                          ``(i) Review of medical necessity.--As part 
                        of the reimbursement payment process under 
                        subsection (c), the WTC Program Administrator 
                        shall review claims for reimbursement for the 
                        provision of medical treatment to determine if 
                        such treatment is medically necessary.
                          ``(ii) Withholding of payment for medically 
                        unnecessary treatment.--The Administrator may 
                        withhold such payment for treatment that the 
                        Administrator determines is not medically 
                        necessary.
                          ``(iii) Review of determinations of medical 
                        necessity.--The Administrator shall provide a 
                        process for providers to appeal a determination 
                        under clause (ii) that medical treatment is not 
                        medically necessary. Such appeals shall be 
                        reviewed through the use of a physician panel 
                        with appropriate expertise.
          ``(4) Scope of treatment covered.--
                  ``(A) In general.--The scope of treatment covered 
                under such paragraphs 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.--To the extent 
                provided in advance in appropriations Acts, the WTC 
                Program Administrator may provide for necessary and 
                reasonable transportation and expenses incident to the 
                securing of medically necessary treatment 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.--In the 
        case of a certified eligible WTC responder who has been 
        determined by an examining physician under subsection (b)(1) to 
        have an identified WTC-related health condition, but for whom a 
        certification of the determination has not yet been made by the 
        WTC Program Administrator, medical treatment may be provided 
        under this subsection, subject to paragraph (6), until the 
        Administrator makes a decision on such certification. Medical 
        treatment provided under this paragraph shall be considered to 
        be medical treatment for which payment may be made under 
        subsection (c).
          ``(6) Prior approval process for non-certified non-emergency 
        inpatient hospital services.--Non-emergency inpatient hospital 
        services for a WTC-related health condition identified by an 
        examining physician under paragraph (b)(1) that is not 
        certified under paragraph (1)(B)(ii) is not covered unless the 
        services have been determined to be medically necessary and 
        approved through a process established by the WTC Program 
        Administrator. Such process shall provide for a decision on a 
        request for such services within 15 days of the date of receipt 
        of the request. The WTC Administrator shall provide a process 
        for the appeal of a decision that the services are not 
        medically necessary.
  ``(c) Payment for Initial Health Evaluation, Medical Monitoring, and 
Treatment of WTC-Related Health Conditions.--
          ``(1) Medical treatment.--
                  ``(A) Use of feca payment rates.--Subject to 
                subparagraph (B), 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.
                  ``(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 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 
                        select a separate vendor to provide 
                        pharmaceutical benefits to certified eligible 
                        WTC responders for whom the Clinical Center of 
                        Excellence is described in section 
                        3006(b)(1)(A) if such an arrangement is deemed 
                        necessary and beneficial to the program by the 
                        WTC Program Administrator.
                  ``(C) Other treatment.--For treatment not covered 
                under a preceding subparagraph, the WTC Program 
                Administrator shall designate a reimbursement rate for 
                each such service.
          ``(2) Medical monitoring and initial health evaluation.--The 
        WTC Program Administrator shall reimburse the costs of medical 
        monitoring and the costs of an initial health evaluation 
        provided under this title at a rate set by the Administrator.
          ``(3) 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 this section.
          ``(4) Claims processing subject to appropriations.--The 
        payment by the WTC Program Administrator for the processing of 
        claims under this title is limited to the amounts provided in 
        advance in appropriations Acts.
  ``(d) Medical Treatment Protocols.--
          ``(1) Development.--The Coordinating Centers of Excellence 
        shall develop medical treatment protocols for the treatment of 
        certified eligible WTC responders and certified eligible WTC 
        community members for identified WTC-related health conditions.
          ``(2) Approval.--The WTC Program Administrator shall approve 
        the medical treatment protocols, in consultation with the WTC 
        Health Program Steering Committees.

                      ``PART 2--COMMUNITY PROGRAM

``SEC. 3021. IDENTIFICATION AND INITIAL HEALTH EVALUATION OF ELIGIBLE 
                    WTC COMMUNITY MEMBERS.

  ``(a) Eligible WTC Community Member Defined.--
          ``(1) In general.--In this title, the term `eligible WTC 
        community member' means, subject to paragraphs (3) and (5), an 
        individual who claims symptoms of a WTC-related health 
        condition and is described in any of the following 
        subparagraphs:
                  ``(A) Currently identified community member.--An 
                individual, including an eligible WTC responder, who 
                has been identified as eligible for medical treatment 
                or monitoring by the WTC Environmental Health Center as 
                of the date of enactment of this title.
                  ``(B) Community member who meets current eligibility 
                criteria.--An individual who is not an eligible WTC 
                responder and meets any of the current eligibility 
                criteria described in a subparagraph of paragraph (2).
                  ``(C) Community member who meets modified eligibility 
                criteria.--An individual who is not an eligible WTC 
                responder and meets such eligibility criteria relating 
                to exposure to airborne toxins, other hazards, or 
                adverse conditions resulting from the September 11, 
                2001, terrorist attacks on the World Trade Center as 
                the WTC Administrator determines eligible, after 
                consultation with the WTC Community Program Steering 
                Committee, Coordinating Centers of Excellence described 
                in section 3006(b)(1)(C), and the WTC Scientific/
                Technical Advisory Committee.
        The Administrator shall not modify such criteria under 
        subparagraph (C) on or after the date that the number of 
        certifications for eligible community members has reached 80 
        percent of the limit described in paragraph (5) or on or after 
        the date that the number of certifications for eligible 
        responders has reached 80 percent of the limit described in 
        section 3021(a)(5).
          ``(2) Current eligibility criteria.--The eligibility criteria 
        described in this paragraph for an individual are that the 
        individual is described in any of the following subparagraphs:
                  ``(A) A person who was present in the New York City 
                disaster area in the dust or dust cloud on September 
                11, 2001.
                  ``(B) A person who worked, resided or attended 
                school, child care or adult day care in the New York 
                City disaster area for--
                          ``(i) at least four 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.
                  ``(C) Any person who worked as a clean-up 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.
                  ``(D) 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.
                  ``(E) 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 on the World Trade 
                        Center.
          ``(3) Application process.--The WTC Program Administrator in 
        consultation with the Coordinating Centers of Excellence shall 
        establish a process for individuals, other than individuals 
        described in paragraph (1)(A), to be determined eligible WTC 
        community member. Under such process--
                  ``(A) there shall be no fee charged to the applicant 
                for making an application for such determination;
                  ``(B) the Administrator shall make a determination on 
                such an application not later than 60 days after the 
                date of filing the application; and
                  ``(C) an individual who is determined not to be an 
                eligible WTC community member shall have an opportunity 
                to appeal such determination before an administrative 
                law judge in a manner established under such process.
          ``(4) Certification.--
                  ``(A) In general.--In the case of an individual who 
                is described in paragraph (1)(A) or who is determined 
                under paragraph (3) (consistent with paragraph (5)) to 
                be an eligible WTC community member, the WTC Program 
                Administrator shall provide an appropriate 
                certification of such fact and of eligibility for 
                followup monitoring and treatment benefits under this 
                part. The Administrator shall make determinations of 
                eligibility relating to an applicant's compliance with 
                this title, including the verification of information 
                submitted in support of the application and shall not 
                deny such a certification to an individual unless the 
                Administrator determines that--
                          ``(i) based on the application submitted, the 
                        individual does not meet the eligibility 
                        criteria; or
                          ``(ii) the numerical limitation on 
                        certification of eligible WTC community members 
                        set forth in paragraph (5) has been met.
                  ``(B) Timing.--
                          ``(i) Currently identified community 
                        members.--In the case of an individual who is 
                        described in paragraph (1)(A), the WTC Program 
                        Administrator shall provide the certification 
                        under subparagraph (A) not later than 60 days 
                        after the date of the enactment of this title.
                          ``(ii) Other members.--In the case of another 
                        individual who is determined under paragraph 
                        (3) and consistent with paragraph (5) to be an 
                        eligible WTC community member, the WTC Program 
                        Administrator shall provide the certification 
                        under subparagraph (A) at the time of such 
                        determination.
          ``(5) Numerical limitation on certification of eligible wtc 
        community members.--
                  ``(A) In general.--The total number of individuals 
                not described in subparagraph (C) who may be certified 
                as eligible WTC community members under paragraph (4) 
                shall not exceed 15,000. In applying the previous 
                sentence, any individual who at any time so qualifies 
                as an eligible WTC community member shall be counted 
                against such numerical limitation.
                  ``(B) Process.--In implementing subparagraph (A), the 
                WTC Program Administrator shall--
                          ``(i) limit the number of certifications 
                        provided under paragraph (4) in accordance with 
                        such subparagraph; and
                          ``(ii) provide priority in such 
                        certifications in the order in which 
                        individuals apply for a determination under 
                        paragraph (4).
                  ``(C) Individuals currently receiving treatment not 
                counted.--Individuals described in this subparagraph 
                are individuals who--
                          ``(i) are described in paragraph (1)(A); or
                          ``(ii) before the date of the enactment of 
                        this title, have received monitoring or 
                        treatment at the World Trade Center 
                        Environmental Health Center at Bellevue 
                        Hospital Center, Gouverneur Health Care 
                        Services, or Elmhurst Hospital Center.
                The New York City Health and Hospitals Corporation 
                shall, not later than 6 months after the date of 
                enactment of this title, enter into arrangements with 
                the Mt. Sinai Data and Clinical Coordination Center for 
                the reporting of medical data concerning eligible WTC 
                responders described in paragraph (1)(A), as determined 
                by the WTC Program Administrator and consistent with 
                applicable Federal and State laws and regulations 
                relating to confidentiality of individually 
                identifiable health information.
                  ``(D) Report to congress if numerical limitation to 
                be reached.--If the WTC Program Administrator 
                determines that the number of individuals subject to 
                the numerical limitation of subparagraph (A) is likely 
                to exceed such numerical limitation, the Administrator 
                shall submit to Congress a report on such 
                determination. Such report shall include an estimate of 
                the number of such individuals in excess of such 
                numerical limitation and of the additional expenditures 
                that would result under this title if such numerical 
                limitation were removed.
  ``(b) Initial Health Evaluation To Determine Eligibility for Followup 
Monitoring or Treatment.--
          ``(1) In general.--In the case of a certified eligible WTC 
        community member, the WTC program shall provide for an initial 
        health evaluation to determine if the member has a WTC-related 
        health condition and is eligible for followup monitoring and 
        treatment benefits under the WTC program. Initial health 
        evaluation protocols shall be approved by the WTC Program 
        Administrator, in consultation with the World Trade Center 
        Environmental Health Center at Bellevue Hospital and the WTC 
        Community Program Steering Committee.
          ``(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 initial health evaluation under this part for an 
        eligible WTC community member 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.

``SEC. 3022. FOLLOWUP MONITORING AND TREATMENT OF CERTIFIED ELIGIBLE 
                    WTC COMMUNITY MEMBERS FOR WTC-RELATED HEALTH 
                    CONDITIONS.

  ``(a) In General.--Subject to subsection (b), the provisions of 
sections 3011 and 3012 shall apply to followup monitoring and treatment 
of WTC-related health conditions for certified eligible WTC community 
members in the same manner as such provisions apply to the monitoring 
and treatment of identified WTC-related health conditions for certified 
eligible WTC responders, except that such monitoring shall only be 
available to those certified as eligible for treatment under this 
title. Under section 3006(a)(3), the City of New York is required to 
contribute a share of the costs of such treatment.
  ``(b) List of Identified WTC-related Health Conditions for WTC 
Community Members.--
          ``(1) Identified wtc-related health conditions for wtc 
        community members.--For purposes of this title, the term 
        `identified WTC-related health conditions for WTC community 
        members' means any of the following health conditions:
                  ``(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) Gastro-esophageal reflux disorder 
                        (GERD).
                          ``(xii) Sleep apnea exacerbated by or related 
                        to a condition described in a previous clause.
                  ``(B) Mental health conditions.--
                          ``(i) Post traumatic stress disorder (PTSD).
                          ``(ii) Major depressive disorder.
                          ``(iii) Panic disorder.
                          ``(iv) Generalized anxiety disorder.
                          ``(v) Anxiety disorder (not otherwise 
                        specified).
                          ``(vi) Depression (not otherwise specified).
                          ``(vii) Acute stress disorder.
                          ``(viii) Dysthymic disorder.
                          ``(ix) Adjustment disorder.
                          ``(x) Substance abuse.
                          ``(xi) V codes (treatments not specifically 
                        related to psychiatric disorders, such as 
                        marital problems, parenting problems etc.), 
                        secondary to another identified WTC-related 
                        health condition for WTC community members.
          ``(2) Additions to identified wtc-related health conditions 
        for wtc community members.--The provisions of paragraph (4) of 
        section 3012(a) shall apply with respect to an addition to the 
        list of identified WTC-related conditions for eligible WTC 
        community members under paragraph (1) in the same manner as 
        such provisions apply to an addition to the list of identified 
        WTC-related conditions for eligible WTC responders under 
        section 3012(a)(3).

``SEC. 3023. FOLLOWUP MONITORING AND TREATMENT OF OTHER INDIVIDUALS 
                    WITH WTC-RELATED HEALTH CONDITIONS.

  ``(a) In General.--Subject to subsection (c), the provisions of 
section 3022 shall apply to the followup monitoring and treatment of 
WTC-related health conditions for eligible WTC community members 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 WTC community members. Under section 
3006(a)(3), the City of New York is required to contribute a share of 
the costs of such monitoring and treatment.
  ``(b) Individuals Described.--An individual described in this 
subsection is an individual who, regardless of location of residence--
          ``(1) is not a eligible WTC responder or an eligible WTC 
        community member; and
          ``(2) is diagnosed at a Clinical Center of Excellence (with 
        respect to an eligible WTC community member) with an identified 
        WTC-related health condition for WTC community members.
  ``(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) fiscal year 2009 is $20,000,000; or
                  ``(B) 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--NATIONAL ARRANGEMENT FOR BENEFITS FOR ELIGIBLE INDIVIDUALS 
                            OUTSIDE NEW YORK

``SEC. 3031. 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 eligible WTC responders or 
eligible WTC community members 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 
        Coordinating Centers of Excellence;
          ``(2) follow the monitoring, initial health evaluation, and 
        treatment protocols developed under section 3006(a)(2)(B);
          ``(3) collect and report data in accordance with section 
        3005; and
          ``(4) meet such fraud, quality assurance, and other 
        requirements as the WTC Program Administrator establishes.

                 ``Subtitle C--Research Into Conditions

``SEC. 3041. RESEARCH REGARDING CERTAIN HEALTH CONDITIONS RELATED TO 
                    SEPTEMBER 11 TERRORIST ATTACKS IN NEW YORK CITY.

  ``(a) In General.--With respect to individuals, including eligible 
WTC responders and eligible WTC community members, 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 3051), through a Clinical Center of 
Excellence, or through a Coordinating Center of Excellence.
  ``(b) Types of Research.--The research under subsection (a)(1) shall 
include epidemiologic and other research studies on WTC-related 
conditions or emerging conditions--
          ``(1) among WTC responders and community members under 
        treatment; and
          ``(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 Health Program Steering 
Committees and 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 otherwise conducted by the National Institutes of Health.
  ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated $15,000,000 
for each fiscal year, in addition to any other authorizations of 
appropriations that are available for such purpose.

 ``Subtitle D--Programs of the New York City Department of Health and 
                             Mental Hygiene

``SEC. 3051. WORLD TRADE CENTER HEALTH REGISTRY.

  ``(a) Program Extension.--For the purpose of ensuring on-going data 
collection for victims of the September 11, 2001, terrorist attacks on 
the World Trade Center, the WTC Program Administrator, shall extend and 
expand the arrangements in effect as of January 1, 2008, with the New 
York City Department of Health and Mental Hygiene that provide for the 
World Trade Center Health Registry.
  ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated $7,000,000 for each fiscal year to carry out this section.

``SEC. 3052. MENTAL HEALTH SERVICES.

  ``(a) In General.--The WTC Program Administrator may make grants to 
the New York City Department of Health and Mental Hygiene to provide 
mental health services to address mental health needs relating to the 
September 11, 2001, terrorist attacks on the World Trade Center.
  ``(b) Authorization of Appropriations.--There are authorized to be 
appropriated $8,500,000 for each fiscal year to carry out this 
section.''.

       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'' 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 August 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
          (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 December 22, 2031.''.
  (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.
                          ``(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) Authority to reinstitute certain lawsuits.--Such section, 
        as so redesignated, is further amended by adding at the end the 
        following new clause:
                          ``(iii) Authority to reinstitute certain 
                        lawsuits.--In the case of a claimant who was a 
                        party to a civil action described in clause 
                        (i), who withdrew from such action pursuant to 
                        clause (ii), and who is subsequently determined 
                        to not be an eligible individual for purposes 
                        of this subsection, such claimant may 
                        reinstitute such action without prejudice 
                        during the 90-day period beginning after the 
                        date of such ineligibility determination.''.

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 90 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 
        through December 22, 2031) 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 clauses (i) and (ii) 
                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)(A) applies, shall be paid solely 
        from the following funds in the following order, as may be 
        applicable:
                  ``(A) The funds described in clause (i) or (ii) of 
                paragraph (4)(A).
                  ``(B) If there are no funds available as described in 
                clause (i) or (ii) of paragraph (4)(A), the funds 
                described in clause (iii) of such paragraph.
                  ``(C) If there are no funds available as described in 
                clause (i), (ii), or (iii) of paragraph (4)(A), the 
                funds described in clause (iv) of such paragraph.
                  ``(D) If there are no funds available as described in 
                clause (i), (ii), (iii), or (iv) of paragraph (4)(A), 
                the funds described in clause (v) of such paragraph.
          ``(6) Declaratory judgment actions and direct action.--Any 
        party to a claim or action to which paragraph (4)(A) 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.''.

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 subsection (d), not later than'';
          (2) in subsection (b), by striking ``This title'' and 
        inserting ``Subject to subsection (d), this title''; and
          (3) by adding at the end the following new subsections:
  ``(d) Limitation.--The total payment of amounts 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 $8,400,000,000.
  ``(e) Attorney Fees.--
          ``(1) In general.--Notwithstanding any contract, and except 
        as provided in paragraph (2), 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) Exception.--With respect to a claim made on behalf of 
        an individual for whom a lawsuit was filed in the Southern 
        District of New York prior to January 1, 2009, in the event 
        that the representative believes in good faith that the fee 
        limit set by paragraph (1) will not provide adequate 
        compensation for services rendered in connection with such 
        claim because of the substantial amount of legal work provided 
        on behalf of the claimant (including work performed before the 
        enactment of this legislation), application for greater 
        compensation may be made to the Special Master. Upon such 
        application, the Special Master may, in his or her discretion, 
        award as reasonable compensation for services rendered an 
        amount greater than that allowed for in paragraph (1). Such fee 
        award will be final, binding, and non-appealable.''.

                          Purpose and Summary

    H.R. 847 establishes the World Trade Center Health Program 
to provide medical monitoring and treatment benefits to 
emergency responders, recovery and cleanup workers, area 
residents, and others who were directly impacted by the attacks 
of September 11, 2001. The bill also reopens the September 11 
Victim Compensation Fund of 2001 to provide compensation to 
anyone who was injured in the aftermath of the attacks, 
including persons who were injured during debris removal at the 
September 11 crash sites. The bill extends the deadline for 
making claims under the fund, and it provides certain liability 
protections for the City of New York and other entities that 
engaged in recovery efforts and debris removal following the 
September 11 attacks.

                Background and Need for the Legislation

                  SEPTEMBER 11, 2001 AND ITS AFTERMATH

    On September 11, 2001, terrorists flew two hijacked 
commercial jets into the World Trade Center towers in New York 
City. Almost 3,000 people were killed in the collapse of the 
towers, including hundreds of first responders, police 
officers, and firefighters. Beyond this immediate loss of life, 
thousands of other persons are now suffering debilitating and 
even deadly illnesses due to their proximity to the World Trade 
Center site in the aftermath of the attacks.
    It is now well documented that the collapse of the World 
Trade Center towers and the adjacent buildings released 
numerous hazardous substances into the environment. These 
substances included hundreds of tons of asbestos, nearly half a 
million pounds of lead, and large amounts of glass fibers, 
various heavy metals, dioxin, benzene, polychlorinated 
biphenyls (PCBs) and other potentially deadly chemicals and 
materials.\1\ These substances formed a large cloud of toxic 
dust and smoke, which blanketed parts of New York City and New 
Jersey and spread into many of the surrounding office 
buildings, schools, and residences. All together, the collapse 
of the towers dispersed about one million tons of dust on the 
area around Lower Manhattan.
---------------------------------------------------------------------------
    \1\See ``World Trade Center USGS Bulk Chemistry Results,'' U.S. 
Geological Survey, Open-File Report 01-0429, available at: 
pubs.usgs.gov/of/2001/ofr-01-0429/chem1/index.html; ``Characterization 
of the Dust/Smoke Aerosol that Settled East of the World Trade Center 
(WTC) in Lower Manhattan after the Collapse of the WTC 11 September 
2001,'' 110 Environmental Health Perspectives 7 (July 2002), available 
at: www.ehponline.org/members/2002/110p703-714lioy/lioy-full.html; 
Office of Inspector General, Environmental Protection Agency, EPA's 
Response to the World Trade Center Collapse: Challenges, Successes, and 
Areas for Improvement, Rpt. No. 2003-P-00012, at 65 (Aug. 21, 2003).
---------------------------------------------------------------------------
    Many of those who worked and lived in this area are now 
experiencing serious and life-threatening illnesses due to 
their exposure to ``World Trade Center dust.'' Evidence 
accumulated since the collapse of the World Trade Center 
buildings indicates that the air in Lower Manhattan was 
hazardous, notwithstanding safety assurances from the 
Environmental Protection Agency (EPA), and that exposure to 
World Trade Center dust has caused adverse health effects in 
thousands of responders, recovery workers, and others at or 
near Ground Zero in the immediate aftermath of the September 11 
attacks.\2\ Such effects include pulmonary fibrosis, 
sarcoidosis, interstitial lung disease, chronic sinusitis, 
severe asthma and other conditions resulting in significant 
loss of lung function.\3\ There is also growing evidence that 
exposure to World Trade Center dust is resulting in other 
serious diseases, including respiratory tract cancer, lymphoma, 
and a range of blood cell cancers.\4\ Medical monitoring has 
been put in place for thousands of workers at the World Trade 
Center site to track cancer rates among this population into 
the future.
---------------------------------------------------------------------------
    \2\See Id.; Megan Nordgren, Eric Goldstein, and Mark Izeman, The 
Environmental Impacts of the World Trade Center Attacks, Natural 
Resources Defense Council, at 3 (2002); Office of the Inspector 
General, Federal Emergency Management Agency, FEMA's Delivery of 
Individual Assistance Program, at 25 (Dec. 18, 2002).
    \3\Levin, S.M., Physical Health Status of World Trade Center Rescue 
and Recovery Workers and Volunteers--New York City, July 2002--August 
2004, Centers for Disease Control and Prevention (Sept. 10, 2004); Mt. 
Sinai WTC Medical Monitoring Program, The World Trade Center Disaster 
and the Health of Workers: Five-Year Assessment of a Unique Medical 
Screening Program (Sept. 6, 2006).
    \4\See, e.g., Cancer may be ``third wave'' of WTC illnesses, 
Associated Press (May 31, 2007), available at: http://
www.msnbc.msn.com/id/18969197/; Gabriel Izbicki, M.D., et al., World 
Trade Center ``Sarcoid-Like'' Granulomatous Pulmonary Disease in New 
York City Fire Depart-
ment Rescue Workers, Chest Journal (Jan. 26, 2007), abstract available 
at: 
http://www.chestjournal.org/content/131/5/1414.abstract; Jonathan M. 
Samet, M.D., et al., The Legacy of World Trade Center Dust, The New 
England Journal of Medicine (May 31, 2007), available at: http://
content.nejm.org/cgi/content/full/356/22/2233.
---------------------------------------------------------------------------
    Such illnesses have caused major financial strains on those 
who, exposed to the toxins during the aftermath of the 
September 11 attacks, are no longer able to work, and face the 
high price of health care without assistance. While some of the 
above diseases can improve with medical treatment, the ultimate 
medical outcome for people currently being treated or who will 
become ill in the future is uncertain. In many cases, 
individuals suffer from progressive loss of pulmonary capacity, 
resulting in incapacitation, and an inability to perform job 
duties or everyday activities. Many others suffer from 
recurrent episodes of lung infections leading to frequent 
hospitalizations.

           THE SEPTEMBER 11 VICTIM COMPENSATION FUND OF 2001

    In the immediate aftermath of the September 11 terrorist 
attacks, Congress created the September 11 Victim Compensation 
Fund (VCF), a unique program designed to compensate people for 
losses sustained as a result of the attacks on the World Trade 
Center and other 9/11 crash sites. The VCF provided aid to the 
families of September 11 victims and to individuals who 
suffered personal injury. In return for accepting VCF funds, 
recipients relinquished their right to sue the airlines, whose 
liability was limited to the value of their insurance. Victims 
or their personal representatives were offered the choice to 
seek no-fault compensation through the VCF or to bring a civil 
tort action against an airline or other parties. For those who 
chose to enter the fund, the VCF required that applications be 
filed before December 22, 2003.
    The special master of the VCF, Kenneth Feinberg, was given 
wide latitude to determine eligibility and the amount of 
compensation to be paid individuals on a case-by-case basis. 
Over a 33-month period, the VCF distributed over $7 billion to 
the surviving family members of 2,880 of those who were killed 
on September 11 and to 2,680 of those who were injured in the 
attacks or the immediate rescue efforts. Families of the 
deceased were paid in amounts ranging from $800,000 to $6.5 
million. People who had sustained physical injuries were paid 
amounts ranging from $500 for a broken finger to $7.1 million 
for severe burns over 85% of the victim's body. Awards were 
reduced to offset other forms of compensation such as workers 
compensation, pension awards and life insurance.
    The VCF provided an attractive alternative to the 
uncertainty and delay of litigation, and the program was widely 
considered to be a success. Most families of deceased victims 
chose to participate in the VCF, and 97% of those who submitted 
claims received compensation through the program.
    While the VCF did an excellent job in handling claims 
involving people who died or had an immediate and easily 
diagnosable ailment (such as a broken leg), the fund was not as 
suitable for dealing with other kinds of injuries. The Fund's 
regulations, for example, limited compensation to workers who 
were injured in the ``immediate aftermath'' of the attacks, 
which was defined as the 96-hour time period immediately 
following the attacks. This time-frame was sufficient to deal 
with workers who suffered immediate injuries. However, it left 
no recourse for individuals with late-onset injuries or for 
those who arrived after September 15, 2001 to assist in 
recovery and cleanup efforts and are now suffering injuries as 
a result of those efforts.
    Additionally, some injured persons either did not know they 
were eligible to file claims or were unaware of ailments that 
had yet to manifest prior to expiration of the deadline. Such 
persons include thousands of first responders, construction 
workers, local residents and other individuals who are now 
developing a range of diseases because of their exposure to 
World Trade Center toxins. Many of these individuals are now 
developing career-ending injuries, such as pulmonary and 
respiratory ailments, but are not eligible to receive 
assistance because their symptoms developed after the VCF 
filing deadline had passed.

       THE JAMES ZADROGA 9/11 HEALTH AND COMPENSATION ACT OF 2010

    The James Zadroga 9/11 Health and Compensation Act of 2010 
addresses the above concerns by establishing a program to 
provide health care to those injured during recovery and 
cleanup efforts at September 11 crash sites and by reopening 
the September 11 Victim Compensation Fund to provide 
compensation for such injured individuals.
    Specifically, title I of the bill amends the Public Health 
Service Act to establish the World Trade Center Health Program 
within the National Institute for Occupational Safety and 
Health. This program will provide medical monitoring and 
treatment benefits to eligible emergency responders and 
recovery and cleanup workers who worked at the World Trade 
Center crash site. It will also provide initial health 
evaluation, monitoring, and treatment benefits to residents and 
other building occupants and area workers who were directly 
impacted and adversely affected by the September 11 attacks. 
The program will ensure that every person at risk of illness 
from exposure to World Trade Center toxins can obtain medical 
monitoring and that all those who are injured or sick as a 
result of such exposure can obtain treatment.
    Title II of the bill reopens the VCF to provide 
compensation for economic damages and losses to persons injured 
during recovery efforts and debris removal, including workers 
and area residents injured by toxins released during the 
collapse of the World Trade Center towers. To this end, the 
bill redefines a number of terms in the original VCF 
legislation so as to expand coverage to persons exposed to 
World Trade Center toxins. The bill expands coverage to all 
injuries occurring during recovery efforts and debris removal, 
including injuries occurring near the World Trade Center site 
and along the routes used to remove debris from that site. The 
bill defines ``debris removal'' comprehensively, so as to 
include the wide range of activities performed at the World 
Trade Center site and debris-removal routes, including, but not 
limited to, the assessment of damaged structures and the debris 
pile, the development of temporary stabilization procedures and 
mechanisms, demolition of unsafe structures, and removal of the 
debris pile. The bill also defines the term ``immediate 
aftermath'' as any period beginning with the terrorist-related 
aircraft crashes of September 11, 2001 and ending on August 30, 
2002.
    The bill reopens the VCF until December 22, 2031, allowing 
individuals who did not previously file a claim, or who became 
ill after the original December 22, 2003 deadline, to be 
compensated for economic damages and losses stemming from their 
injuries. The purpose behind reopening the fund for over 20 
years is to protect to the greatest extent possible those 
persons who were exposed to World Trade Center toxins during 
recovery and cleanup efforts but whose resulting injuries are 
latent and will manifest over the next two decades.
    While extending protection to injured individuals, the bill 
also provides protection from liability to certain entities 
that participated in recovery efforts and debris removal. The 
bill provides that their liability for all claims and actions 
arising from, or related to, recovery efforts and debris 
removal (including claims and actions previously resolved, 
currently pending, or filed through December 22, 2031) is 
limited to the amount of funds held by the World Trade Center 
Captive Insurance Company, the amount of available insurance 
coverage identified by the Captive Insurance Company, and the 
amount of insurance coverage held by certain other entities.
    The bill provides that the liability of the City of New 
York is limited to the City's insurance coverage or 
$350,000,000, whichever is greater. It further provides that 
the liability of the Port Authority of New York and New Jersey, 
and any other entity with a property interest in the World 
Trade Center on September 11, 2001, is limited to the amount of 
all available insurance coverage maintained by any such entity. 
The bill also limits liability of any individual contractor or 
subcontractor that participated in recovery efforts and debris 
removal to the amount of available liability insurance 
maintained by such contractor or subcontractor.
    The bill establishes a priority of funds from which 
plaintiffs may satisfy judgments or settlements obtained in 
civil claims or actions related to recovery and cleanup 
efforts. The priority requires exhaustion of amounts held by 
the Captive Insurance Company and identified insurance 
policies, followed by exhaustion of the amount for which the 
City of New York is liable, followed by exhaustion of the 
available insurance coverage maintained by the Port Authority 
and other entities with a property interest in the World Trade 
Center on September 11, 2001, followed by exhaustion of the 
available insurance coverage maintained by individual 
contractors and subcontractors.
    As amended in Committee, the bill caps the total amount of 
new compensation that could be awarded by the VCF to $8.4 
billion. The bill also caps the amount of such compensation 
that could be used to pay attorney's fees at 10 percent, except 
that the Special Master is given the discretion to raise this 
percentage for certain cases filed in the Southern District of 
New York prior to January 1, 2009. This discretion is provided 
to the Special Master to address cases where the 10 percent cap 
on attorney's fees may not provide adequate compensation for 
services rendered in connection with a claim because of the 
substantial amount of legal work expended on that claim during 
the period after which the initial period for filing claims 
under the VCF expired.
    The bill also requires the Special Master to update 
regulations consistent with revisions to the Victim 
Compensation Fund under this bill.

                                Hearings

    The Committee's Subcommittee on Immigration, Citizenship, 
Refugees, Border Security, and International Law and 
Subcommittee on the Constitution, Civil Rights, and Civil 
Liberties held a joint hearing on H.R. 847 on March 31, 2009. 
Testimony was received from Kenneth R. Feinberg, former Special 
Master, Victim Compensation Fund; Barbara Burnette, former 
Detective, New York City Police Department; James Melius, MD., 
Administrator, New York State Laborers' Health and Safety Trust 
Fund; Christine LaSala, Chief Executive Officer, World Trade 
Center Captive Insurance Fund; Michael A. Cardozo, Corporation 
Counsel, City of New York; Theodore H. Frank, American 
Enterprise Institute; and Richard Wood, President, Plaza 
Construction Corporation. Additional materials were submitted 
by the Associated Builders and Contractors (ABC) and Christine 
C. Quinn, Speaker, New York City Council.

                        Committee Consideration

    On July 29, 2009, the Committee met in open session and 
ordered the bill H.R. 847 favorably reported with an amendment, 
by a rollcall vote of 22 to 9, a quorum being present.

                            Committee Votes

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
following rollcall vote occurred during the Committee's 
consideration of H.R. 847:
    1. An amendment by Mr. Smith to: (a) reduce the life of the 
Victim Compensation Fund from 22 to 5 years; (b) reduce the cap 
on the Fund from $8.4 billion to $5.5 billion; and (c) strike 
several provisions intended to expand eligibility under the VCF 
to first responders, recovery workers, and others injured as a 
result of exposure to World Trade Center toxins during recovery 
efforts and debris removal. Defeated 9 to 21.

                                                 ROLLCALL NO. 1
----------------------------------------------------------------------------------------------------------------
                                                                       Ayes            Nays           Present
----------------------------------------------------------------------------------------------------------------
Mr. Conyers, Jr., Chairman......................................                              X
Mr. Berman......................................................
Mr. Boucher.....................................................
Mr. Nadler......................................................                              X
Mr. Scott.......................................................                              X
Mr. Watt........................................................                              X
Ms. Lofgren.....................................................                              X
Ms. Jackson Lee.................................................                              X
Ms. Waters......................................................
Mr. Delahunt....................................................
Mr. Wexler......................................................                              X
Mr. Cohen.......................................................                              X
Mr. Johnson.....................................................                              X
Mr. Pierluisi...................................................                              X
Mr. Quigley.....................................................                              X
Mr. Gutierrez...................................................
Mr. Sherman.....................................................                              X
Ms. Baldwin.....................................................                              X
Mr. Gonzalez....................................................                              X
Mr. Weiner......................................................                              X
Mr. Schiff......................................................                              X
Ms. Sanchez.....................................................                              X
Ms. Wasserman Schultz...........................................
Mr. Maffei......................................................                              X
Mr. Smith, Ranking Member.......................................              X
Mr. Sensenbrenner, Jr...........................................              X
Mr. Coble.......................................................              X
Mr. Gallegly....................................................
Mr. Goodlatte...................................................
Mr. Lungren.....................................................                              X
Mr. Issa........................................................              X
Mr. Forbes......................................................              X
Mr. King........................................................              X
Mr. Franks......................................................              X
Mr. Gohmert.....................................................              X
Mr. Jordan......................................................              X
Mr. Poe.........................................................                              X
Mr. Chaffetz....................................................
Mr. Rooney......................................................                              X
Mr. Harper......................................................
                                                                 -----------------------------------------------
    Total.......................................................              9              21
----------------------------------------------------------------------------------------------------------------

    2. Motion to order the bill favorably reported as amended. 
Approved 22-9.

                                                 ROLLCALL NO. 2
----------------------------------------------------------------------------------------------------------------
                                                                       Ayes            Nays           Present
----------------------------------------------------------------------------------------------------------------
Mr. Conyers, Jr., Chairman......................................              X
Mr. Berman......................................................
Mr. Boucher.....................................................
Mr. Nadler......................................................              X
Mr. Scott.......................................................              X
Mr. Watt........................................................              X
Ms. Lofgren.....................................................              X
Ms. Jackson Lee.................................................              X
Ms. Waters......................................................
Mr. Delahunt....................................................
Mr. Wexler......................................................              X
Mr. Cohen.......................................................              X
Mr. Johnson.....................................................              X
Mr. Pierluisi...................................................              X
Mr. Quigley.....................................................              X
Mr. Gutierrez...................................................
Mr. Sherman.....................................................              X
Ms. Baldwin.....................................................              X
Mr. Gonzalez....................................................              X
Mr. Weiner......................................................              X
Mr. Schiff......................................................              X
Ms. Sanchez.....................................................              X
Ms. Wasserman Schultz...........................................              X
Mr. Maffei......................................................              X
Mr. Smith, Ranking Member.......................................                              X
Mr. Sensenbrenner, Jr...........................................                              X
Mr. Coble.......................................................                              X
Mr. Gallegly....................................................
Mr. Goodlatte...................................................
Mr. Lungren.....................................................              X
Mr. Issa........................................................                              X
Mr. Forbes......................................................                              X
Mr. King........................................................                              X
Mr. Franks......................................................                              X
Mr. Gohmert.....................................................
Mr. Jordan......................................................                              X
Mr. Poe.........................................................              X
Mr. Chaffetz....................................................                              X
Mr. Rooney......................................................              X
Mr. Harper......................................................
                                                                 -----------------------------------------------
    Total.......................................................             22               9
----------------------------------------------------------------------------------------------------------------

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

               New Budget Authority and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the House 
of Representatives, the Committee adopts the estimate prepared 
by the Director of the Congressional Budget Office printed 
below.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the House 
of Representatives, the Committee sets forth, with respect to 
the bill, H.R. 847, the following estimate and comparison 
prepared by the Director of the Congressional Budget Office 
under section 402 of the Congressional Budget Act of 1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 25, 2010.
Hon. John Conyers, Jr., Chairman,
Committee on the Judiciary,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 847, the ``James 
Zadroga 9/11 Health and Compensation Act of 2010.'' As you 
requested, CBO has completed an estimate that reflects Title I 
of the bill as ordered reported by the Committee on Energy and 
Commerce and Title II as ordered reported by the Committee on 
the Judiciary.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts are Stephanie 
Cameron (Title I), who can be reached at 226-9010, and Leigh 
Angres (Title II), who can be reached at 226-2700.
            Sincerely,
                                      Douglas W. Elmendorf,
                                                  Director.

Enclosure

cc:
        Honorable Lamar S. Smith.
        Ranking Member

Identical letter sent to the Honorable Henry A. Waxman.

H.R. 847--James Zadroga 9/11 Health and Compensation Act of 2010.

    Title I as ordered reported by the House Committee on 
Energy and Commerce on May 25, 2010, and

    Title II as ordered reported by the House Committee on the 
Judiciary on July 29, 2009.

                                SUMMARY

    H.R. 847 would establish the World Trade Center (WTC) 
Health Program and extend and expand eligibility for 
compensation under the September 11th Victim Compensation Fund 
(VCF) of 2001. Specifically, H.R. 847 would provide:

         LHealth care benefits for eligible emergency 
        personnel who responded to the September 11, 2001, 
        terrorist attacks (the terrorist attacks) in New York 
        City, the Pentagon, and Shanksville, Pennsylvania, and 
        for workers who participated in recovery and cleanup 
        following the attacks (collectively referred to as 
        responders in this estimate);

         LHealth care benefits for eligible residents 
        and others present in the area of New York City near 
        the World Trade Center (defined as survivors under the 
        bill); and

         LMonetary compensation to individuals eligible 
        under the bill to submit claims for death and physical 
        injury claims resulting from the attacks.

    CBO estimates that enacting H.R. 847 would increase direct 
spending by $7.2 billion over the 2011-2015 period and $10.5 
billion over the 2011-2020 period. Pay-as-you-go procedures 
apply because enacting the legislation would affect direct 
spending.
    In addition, we estimate that, subject to appropriation of 
the necessary amounts, administering the VCF awards process 
would cost $514 million over the next 10 years. However, 
assuming appropriation actions consistent with title I of the 
bill, CBO estimates a $688 million reduction in discretionary 
outlays over the 2011-2020 period because some spending that is 
currently funded by annual appropriations would become direct 
spending under the bill. On balance, CBO estimates that 
discretionary spending would decrease by $174 million over 10 
years.
    H.R. 847 contains no intergovernmental mandates as defined 
in the Unfunded Mandates Reform Act (UMRA).
    H.R. 847 would impose a private-sector mandate as defined 
in UMRA. The bill would impose a mandate on individuals seeking 
compensatory damages or other relief arising from or related to 
debris removal from sites of the terrorist attacks by limiting 
the liability of entities from which individuals might win 
compensation. CBO cannot determine whether the aggregate cost 
of complying with that mandate would exceed the threshold 
established by UMRA for private-sector mandates in 2011 ($141 
million in 2010, adjusted annually for inflation).

                ESTIMATED COST TO THE FEDERAL GOVERNMENT

    The estimated budgetary impact of H.R. 847 is shown in the 
following table. The costs of this legislation fall within 
budget functions 550 (health), 570 (Medicare), and 750 
(administration of justice).

                           BASIS OF ESTIMATE

    For this estimate, CBO assumes that H.R. 847 will be 
enacted by the end of fiscal year 2010. H.R. 847 would provide 
health benefits and compensation to those who qualify based on 
a combination of factors, including where they were exposed to 
hazardous conditions following the terrorist attacks, and their 
current and expected future health conditions. CBO's estimate 
is based on an analysis of the size of the potentially affected 
populations, the prevalence of certain health conditions in 
those populations, the propensity to seek health services or 
compensation from the program, and the monetary damages 
previously awarded by the VCF through 2004.
    Under H.R. 847, spending for the WTC Health Program and VCF 
awards would increase direct spending, while the administrative 
costs associated with the VCF would be subject to future 
appropriations. Expenditures related to the WTC Health Program 
would be subject to annual spending caps totaling about $4.6 
billion through 2020, when the program would sunset. Award 
payments under the VCF would be subject to a lifetime spending 
cap of $8.4 billion through 2032, when the program would cease 
operation.


    On June 10, 2010, a Federal district court judge approved a 
settlement between firefighters, police, contractors, and 
others who worked at the World Trade Center site, and New York 
City and its contractors for claims of injuries associated with 
their rescue and cleanup work. To become final, the settlement 
requires the participation of 95 percent of the plaintiffs, who 
have yet to agree to the terms. Should that settlement become 
final, CBO expects that the number and value of compensation 
awards provided through the VCF would be lower than presented 
in this cost estimate for H.R. 847.
Eligible Population
    CBO's analysis focused on two populations--responders and 
survivors. The responder population includes those who were 
involved in the rescue, recovery, and cleanup efforts following 
the terrorist attacks in 2001. Survivors include commuters, 
residents, ``passers-by,'' and students who were in the New 
York City (NYC) disaster area around the time of the attacks 
and in the months following. Under H.R. 847, CBO estimates that 
roughly 650,000 individuals from the NYC disaster area--
approximately 75,000 responders and 575,000 survivors--would 
meet the exposure requirements specified in the legislation, 
along with potentially another 10,000 responders from the 
Pentagon and Shanksville, Pennsylvania, sites. Although many of 
those individuals may have or develop health conditions related 
to the terrorist attacks, CBO estimates that only a portion 
would participate in the WTC Health Program and apply for an 
award under the VCF. Overall, CBO expects that of the total 
population that meets the exposure requirements, slightly less 
than 15 percent would enroll in the WTC Health Program by 2020 
and slightly more than 5 percent would receive awards from the 
VCF. Those estimated participation rates reflect people's 
willingness to enroll in government programs as well as 
additional requirements that would have to be met to receive a 
VCF award.

    Geographic and Time-Period Requirements. Title I specifies 
that individuals must have been present in the following 
locations following the terrorist attacks to be eligible for 
the new health program: NYC disaster area, the Pentagon site, 
and the Shanksville, Pennsylvania, site. Title II would give 
discretion to the VCF Special Master (appointed by the U.S. 
Attorney General to administer the fund) to define the 
geographic area for awards from that fund; for this estimate, 
CBO assumes that the geographic areas of exposure specified in 
title I would also be used as the criteria for compensation 
payments under title II. Title I defines the NYC disaster area 
as the part of Manhattan that is south of Houston Street and 
any block in Brooklyn that is wholly or partially contained 
within a 1.5-mile radius of the former World Trade Center site. 
H.R. 847 would also base eligibility on the amount of time an 
individual spent in the specified region. Based on those 
requirements, CBO estimates that about 75,000 responders and 
575,000 survivors from the NYC disaster area would meet the 
geographic-eligibility and time-period requirements specified 
in H.R. 847, as well as potentially another 10,000 responders 
from the Pentagon and Shanksville, Pensylvania, sites.
    Those estimates are based on information collected by 
certain hospitals (known as the Centers of Excellence) in the 
NYC area that are treating responders, New York City's 
Department of Health and Mental Hygiene, the U.S. Department of 
Health and Human Services, Research Triangle International, and 
New York State Laborers' Tri-Fund. In particular, CBO's 
analysis relies heavily on the WTC Health Registry which was 
developed by New York City's Department of Health and Mental 
Hygiene and the U.S. Department of Health and Human Services 
(HHS) to document and evaluate the short- and long-term 
physical and mental health issues associated with the terrorist 
attacks and recovery efforts. The Registry established 
eligibility criteria that considered an individual's residence, 
location at the time of attacks, and intensity and duration of 
exposure to hazardous conditions. About 71,000 individuals 
enrolled voluntarily in this Registry before it closed in 
November 2004.

    Diseases. The bill would require a determination that the 
terrorist attacks were substantially likely to be a significant 
factor in aggravating, contributing to, or causing the 
condition or illness prior to receiving treatment through the 
WTC Health Program. Title I would specify certain physical and 
mental health conditions deemed WTC-related for both responders 
and survivors. Title II would give discretion to the Special 
Master to determine what physical conditions would be eligible 
for an award; for this estimate, CBO assumes that the diseases 
specified in title I would also be used as criteria for 
compensation payments.
    In general, individuals whose health conditions developed 
or were aggravated as a result of the terrorist attacks cannot 
easily be distinguished from individuals whose conditions would 
have developed or worsened in the absence of those attacks. 
Therefore, CBO considered the entire population that may 
develop and seek treatment for eligible physical and mental 
health conditions that might be associated with the aftermath 
of the terrorist attacks. The existence of a causal 
relationship between the attacks and specific diseases 
generally would be difficult to establish or disprove.
    CBO analyzed more than a dozen studies on the incidence and 
prevalence of the WTC-related health conditions in both 
responders and survivors. We also analyzed data collected in 
the Morbidity and Mortality Weekly Report (MMWR) and population 
level data collected by the Medical Expenditure Panel Survey 
(MEPS). The MEPS collects annual data pertaining to the use of 
health care services, sources of payment for those services, 
and health insurance coverage. Based on those analyses, CBO 
estimates that about 280,000 of the individuals (about 40 
percent) who meet the exposure criteria defined in the 
legislation have or will develop a health condition that meets 
the criteria set in the bill.
    Responders who meet the geographic-eligibility criteria and 
survivors who both meet the geographic-eligibility criteria and 
develop a qualifying physical or mental health condition, as 
defined in the bill, would be eligible to enroll in the WTC 
Health Program. CBO estimates that about 50,000 responders and 
230,000 survivors would develop at least one qualifying 
physical or mental health condition. That estimate reflects the 
prevalence of the eligible conditions among the general 
population as well as the increase in prevalence attributable 
to the attacks themselves.
    Eligibility for an award under the VCF would differ from 
that for the WTC Health Program. The VCF would only compensate 
individuals with physical health conditions who have received 
treatment. CBO estimates that about 100,000 responders and 
survivors would meet those criteria.
Direct Spending
    CBO estimates that enacting H.R. 847 would increase direct 
spending by $10.5 billion over the 2011-2020 period. About $4.2 
billion of that amount would result from spending for health 
care benefits provided under title I. The remaining $6.3 
billion would be spent on compensation payments provided under 
title II.

    Title I: Health Care Benefits. Under current law, the 
National Institute of Occupational Safety and Health (NIOSH) 
provides funding to several programs that offer medical 
monitoring and treatment to responders and survivors with 
conditions associated with the September 11, 2001, terrorist 
attacks under the umbrella of the WTC Medical Monitoring and 
Treatment Program. Those programs treat or have enrolled 
approximately 60,000 individuals: about 40,000 in the Mt. Sinai 
Coordinated Consortium Responder Heath Program and the National 
Responder Program; about 16,000 in the Fire Department City of 
New York Responder Health Program; and about 4,600 survivors in 
the WTC Environmental Health Center Program. Funding for those 
programs is subject to annual appropriation. For 2010, $70 
million was appropriated to NIOSH through the Centers for 
Disease Control and Prevention (CDC) to support those programs.
    H.R. 847 would establish the WTC Health Program within HHS 
to replace and expand the NIOSH programs. The WTC Health 
Program would provide monitoring and treatment benefits for 
qualifying health conditions to individuals who were engaged in 
emergency response, recovery, and cleanup operations related to 
the terrorist attacks. It also would provide monitoring and 
treatment benefits to certain residents and others with a 
qualifying health condition who were working, visiting, or 
residing near the WTC during the year following the attacks. 
H.R 847 would replace annual appropriations for the NIOSH 
programs with mandatory funding for the WTC Health Program. (An 
estimated reduction in authorized discretionary spending is 
discussed below under ``Spending Subject to Appropriation.'')
    CBO estimates that, if unconstrained, the WTC Health 
Program would cost between $5 billion and $6 billion over the 
2011-2020 period. In contrast, the cap on Federal spending 
specified in H.R. 847 is about $4.6 billion over that same 
period. Taking that spending cap into consideration, CBO 
estimates that gross spending would total $4.4 billion over the 
2011-2020 period. The WTC Health Program also would result in 
some savings for Medicare and Medicaid, yielding a net increase 
in direct spending of $4.2 billion over the 2011-2020 period, 
as shown in the table on page 3. CBO also estimates that New 
York City would contribute $0.5 billion to the WTC Health 
Program over the 2011-2020 period.
    Program Participation. The WTC Health Program would cover 
individuals enrolled in the existing programs as of the date of 
enactment and would allow up to an additional 25,000 responders 
and 25,000 survivors to enroll in the program. H.R. 847 defines 
exposure and health criteria for an eligible WTC responder and 
an eligible WTC survivor. The program's administrator would be 
allowed to expand those eligibility criteria until 80 percent 
of the numerical limitation is reached.
    CBO estimates that about 65,000 of the approximately 85,000 
responders at the various sites who would meet the exposure 
criteria would enroll in the WTC Health Program and that about 
20 percent of those enrollees would receive treatment through 
the program in a given year. We estimate that about 250,000 
individuals, or roughly 40 percent of the approximately 575,000 
survivors who would meet those criteria, would also meet the 
health condition criteria specified in title I of H.R. 847. CBO 
expects that less than 10 percent of those individuals would 
enroll in the WTC Health Program by 2020. In part, this 
estimate reflects the expectation that most individuals will 
continue to receive care from providers who are not affiliated 
with a Center of Excellence or the WTC Health Program. CBO 
further expects that, in a given year, slightly less than half 
of the enrolled survivors would receive treatment through the 
WTC Health Program.

    Survivor and Responder Health Benefits. H.R. 847 would 
provide for health benefits, including monitoring and medically 
necessary follow-up treatment for enrolled responders. 
Survivors would receive an initial health evaluation to 
determine program eligibility. Once eligibility is determined, 
H.R. 847 would provide for monitoring and medically necessary 
follow-up treatment for survivors. Monitoring, initial health 
evaluations, and medically necessary follow-up would only be 
covered when provided by Centers of Excellence or by providers 
who participate in the nationwide network established by the 
WTC program administrator. The WTC Health Program would also 
provide funding for coordination and administrative expenses 
for the Centers of Excellence. CBO estimates that the cost of 
the health benefits program (including initial health 
evaluations, monitoring, treatment, and administration) would 
total up to $4.5 billion over the 2011-2020 period. That amount 
comprises about $4.2 billion for monitoring and medically 
necessary treatment and $0.3 billion for administrative costs.
    The WTC Health Program would pay for the monitoring and 
medically necessary treatment costs associated with a 
qualifying health condition that are not covered by a patient's 
primary insurer, including deductibles, copayments, 
coinsurance, and other cost-sharing requirements. (As a 
practical matter, the WTC Health Program would be the primary 
insurer for individuals covered by Medicare.) H.R. 847 
specifies a series of WTC-related health conditions; however, 
H.R. 847 would authorize the administrator to approve 
conditions and illnesses not specified in the legislation but 
deemed to be a WTC-related health condition for treatment. The 
administrator could also add illnesses and conditions to the 
list of WTC-related health conditions through the rulemaking 
process, which might include requesting a recommendation of the 
Advisory Panel. In addition, for an individual, a condition not 
on the list would be deemed to be WTC-related if a physician 
determines that it was likely to have been caused or aggravated 
by exposure to the terrorist attacks.
    CBO estimated the cost of treatment for WTC-related health 
conditions using data from MEPS, Medicare, and the Federal 
Employees Compensation Act (FECA) program. CBO analyzed MEPS 
data to estimate the national average cost of treating 
qualifying conditions. Those costs were then adjusted to 
reflect the relative costs in New York City--spending per 
Medicare enrollee is about 20 percent higher in New York City 
than the national average--and to account for differences 
between payment rates in the FECA program and those underlying 
our estimate of national average cost. Those costs were then 
projected based on CBO's estimates of growth in per capita 
health spending. The administrator would be required to 
establish a program for necessary outpatient prescription 
pharmaceuticals prescribed under this title through contracts 
with one or more vendors. Separately, CBO estimated the cost of 
outpatient prescription drugs and assumed that those payment 
amounts would be comparable to prices paid in the private 
market.
    The WTC Health Program would be the secondary payer for 
survivors with private insurance or Medicaid coverage and for 
responders receiving benefits from a non-NYC worker's 
compensation or other work-related injury or illness benefit 
plan. For those individuals, the program would pay the 
difference between FECA payment rates and the amounts paid by 
the primary insurer; the individual would have no out-of-pocket 
obligation.\1\ CBO estimates that primary insurers would cover 
about 60 percent of the cost of treating WTC-related health 
conditions for those individuals, with the WTC Health Program 
paying the rest.
---------------------------------------------------------------------------
    \1\For responders employed by New York City, all WTC-related 
conditions would be considered work-related. The legislation would 
relieve the city's worker's compensation program or other work-related 
injury or illness benefit plan of the obligation to pay for those 
conditions in return for the city's participation in the financing of 
the WTC Health Program.
---------------------------------------------------------------------------
    CBO estimates that Federal spending for Medicaid would be 
reduced by about $30 million over the 2011-2020 period. Those 
savings would occur largely because, in some cases, providers 
would bill the WTC Health Program instead of Medicaid to avoid 
the administrative cost of dealing with two payers.
    The WTC Health Program would reduce Medicare spending 
because it would replace Medicare as the primary payer for 
individuals enrolled in Medicare. CBO estimates that Medicare 
savings would total about $155 million over the 2011-2020 
period.
    CBO estimates that costs incurred to administer health 
evaluations, monitor, and provide treatment would total up to 
$0.3 billion over the 2011-2020 period. H.R. 847 would direct 
the administrator to enter into contracts with Clinical Centers 
of Excellence to provide monitoring and treatment benefits and 
initial health evaluations, counseling, outreach, translational 
and interpretive services, and to collect and report on 
utilization, incidence, and prevalence data.
    Other Health Benefits and Program Funding. H.R. 847 would 
provide funding for:

         LMental health benefits for surviving family 
        members of responders who died at the WTC site on 
        September 11, 2001;

         LCreation of a scientific committee and 
        technical advisory committee;

         LEducation and outreach;

         LUniform data collection;

         LResearch pertaining to conditions related to 
        the September 11, 2001, terrorist attacks; and

         LMaintaining ongoing data collection through 
        the WTC health registry.

    The bill specifies a maximum amount for each of those 
activities. CBO estimates that the costs of those activities 
would total up to $0.5 billion over the 2011-2020 period. In 
addition, H.R. 847 would provide funding for training and 
technical assistance, transportation expenses, and claims 
processing. CBO estimates that the costs of those activities 
would total an additional $0.2 billion over the 2011-2020 
period. Thus, the total cost of other activities would total up 
to $0.7 billion over the 2011-2020 period.
    World Trade Center Health Program Fund. H.R. 847 would 
establish the WTC Health Program Fund to pay for the benefits 
included under title I. New York City and the Federal 
Government would contribute to the fund based on percentages 
and amounts provided in the legislation.
    The legislation would authorize implementation of the WTC 
Health Program only if New York City enters into a contract 
with the WTC program administrator in which the city agrees to 
pay 10 percent of program costs. This estimate assumes that the 
city would enter into that contract and that the city would 
reimburse the WTC Health Program within six to nine months. 
(Alternatively, if the city would not enter into a contract 
with the administrator, CBO expects that no payments would be 
made from the WTC Health Program Fund, resulting in no increase 
in direct spending over the 2011-2020 period.)
    The Federal Government would be required to contribute the 
lesser of 90 percent of the program expenditures or an annual 
amount specified in the legislation. That cap on Federal 
spending would rise from $71 million in 2011 to $743 million in 
2020 and would total about $4.6 billion over the 2011-2020 
period.
    In the absence of a cap, CBO estimates that the Federal 
share of annual expenditures for the WTC Health Program would 
probably be about 1 percent to 5 percent higher than the annual 
caps. However, CBO's cost estimate targets the midpoint of a 
distribution of likely spending outcomes. Establishing a cap on 
annual spending truncates that distribution of likely outcomes 
by eliminating the potential for spending above the cap. 
Therefore, the middle of the truncated range of likely spending 
outcomes would be slightly below the cap. As a result, CBO 
estimates that Federal spending would total about $4.4 billion 
over the 2011-2020 period.
    H.R. 847 would require New York City to cover 10 percent of 
the expenditures for carrying out title I. If the city pays its 
share, the WTC Health Program would assume responsibility for 
treatment costs for responders that would under current law be 
the responsibility of the city's worker's compensation or other 
work-related injury or illness benefit plan. Late payments from 
the city would accrue interest on the unpaid amount. For the 
purpose of our estimate, we assume that New York City would 
make payments on time. If the city fails to pay pursuant to its 
contract with the administrator and interest accrues on the 
unpaid amount, the Federal expenditures would reach the cap 
more quickly.
    CBO estimates that the city of New York would contribute 
about $0.5 billion over the 2011-2020 period.

    Title II: Compensation Payments. Title II would reopen the 
September 11, 2001, Victim Compensation Fund, which provided 
compensation to any individual (or relatives of a deceased 
individual) who was physically injured or killed as a result of 
the terrorist attacks. The VCF, which terminated operations in 
2004, was established by the Air Transportation Safety and 
System Stabilization Act (Public Law 107-42) as an 
administrative alternative to litigation. That act created a 
Special Master, who determined the compensation levels based on 
specified eligibility criteria and subsequent regulations. 
Through 2004, the VCF made 2,880 death and 2,680 injury awards, 
totaling more than $7 billion (about $6 billion was for death 
awards). Public Law 107-42 did not cap the number or amount of 
awards that could be issued by the Special Master.
    H.R. 847 would establish broader eligibility rules for 
compensation than those established for the VCF under Public 
Law 107-42. Under the bill, total payments would be capped at 
$8.4 billion through 2032. CBO estimates that compensation 
payments would total $6.3 billion over the 2011-2020 period, 
with about 90 percent ($5.7 billion) of those payments made in 
the first five years following enactment. Most of the awards 
would be for physical injuries associated with the attacks or 
with debris removal and response activities following the 
attacks. CBO estimates that the VCF would make additional 
payments totalling about $300 million after 2020.
    CBO's estimate of those payments is based on a number of 
assumptions and projections regarding eligibility, average 
award amounts, and attorneys' fees.
    Changes in Eligibility. Title II would make many more 
individuals who were involved in the rescue, recovery, and 
cleanup efforts potentially eligible for compensation. Based on 
information provided by the previous Special Master of the VCF, 
CBO assumes that the VCF would be administered in the same 
manner as it was previously but would reflect new regulations 
written after the bill's enactment. Those regulations would 
reflect the following changes made by the bill:

         LTime Present at Site: Eligibility would be 
        determined in part based on the time an individual was 
        present or near the sites of the terrorist attacks. 
        Specifically, the bill would require that an eligible 
        individual must have been at those sites some time 
        during the period beginning on September 11, 2001, and 
        ending on August 30, 2002. Prior to the sunset of the 
        original VCF, the implementing regulations required 
        that an individual had to have been present at those 
        sites during the 12 hours immediately following the 
        attacks, or for responders, 96 hours after the attacks.

         LGeographical Expansion: Based on regulations 
        promulgated under Public Law 107-42, the Special Master 
        originally defined the crash site as a zone bounded by 
        specific streets very close to the WTC area. H.R. 847 
        would expand the definition of the crash site to 
        include routes related to debris removal (such as 
        barges and landfills). Although the bill does not 
        specify other changes to the site definition, the 
        Special Master would have discretion to expand the site 
        if it is determined that there was demonstrable risk of 
        physical harm in adjacent areas. For this estimate, CBO 
        assumes that the new regulations would extend the 
        boundaries to be the same as those defined for 
        eligibility for the health care benefits authorized in 
        title I of the bill.

         LExtended Claims Filing Deadlines: Generally, 
        the filing deadline under the bill would depend 
        primarily on when the Special Master determines that a 
        claimant realizes that he or she suffered some form of 
        physical harm resulting from the terrorist attacks or 
        associated debris removal. If the Special Master 
        determines that a claimant was aware (or should have 
        been aware) of such an injury by the time the 
        regulations are promulgated, the claimant would have 
        two years to file from that time (roughly by the end of 
        December 2012). For all others, if a claimant realizes 
        such an injury after the new regulations are finalized, 
        the claimant would have two years from when the Special 
        Master determines that the claimant should have been 
        aware of such injury. All claims would have to be filed 
        by December 22, 2031.

    Awards and Average Award Amount. CBO expects that the 
bill's expanded eligibility criteria would significantly 
increase the number of individuals who could seek compensation 
from the VCF. CBO expects that most of the awards would be for 
injuries associated with the attacks, and therefore our 
analysis focused on those claims. Further, the bill would not 
provide compensation for mental health conditions although it 
would provide treatment for mental illnesses under title I. 
Over the next 10 years, CBO estimates that about 35,000 awards 
would be made, with an average award amount of about $180,000.

         LNumber of Awards: CBO expects that the number 
        awards would depend largely on the estimated number of 
        responders and survivors who have or will have health 
        conditions or symptoms associated with the terrorist 
        attacks and recovery efforts, and are being treated for 
        such conditions. Under H.R. 847, the VCF would require 
        that all claimants prove they were treated by medical 
        professionals and provide contemporaneous medical 
        records to verify that treatment. CBO estimates that 
        about 100,000 individuals--nearly 25,000 responders and 
        more than 75,000 survivors--would meet that additional 
        eligibility requirement.
          L  CBO estimated the proportion of those individuals 
        who would file a claim by reviewing studies on the 
        propensity of individuals to seek legal remedy for 
        injuries. Although CBO estimates that the overall claim 
        rate would be a bit under 50 percent, we expect that 
        responders would have a much higher filing rate than 
        survivors because of their involvement in the existing 
        treatment programs at the Centers of Excellence and 
        because of the efforts by certain union organizations 
        to publicize the possible health issues associated with 
        the cleanup efforts.
          L  Taking into account the VCF's previous approval 
        rate and the approval rates of other compensation 
        programs, CBO estimates that about 35,000 awards would 
        be made, including payments to nearly 20,000 responders 
        and 15,000 survivors. CBO expects that the number of 
        death claims would be very small because there is 
        little evidence that many individuals have died from 
        injuries caused by the 2001 terrorist attacks after 
        compensation benefits were first awarded.

         LAverage Award Amount: Under the bill, award 
        amounts would be determined in the same way as they 
        were before the sunset of the original VCF. Awards 
        would comprise two parts--economic and noneconomic 
        loss--adjusted for collateral offsets such as pensions. 
        For injury victims, economic loss would reflect the 
        actual lost income or expenses incurred as a direct 
        result of the injury and future lost income and costs 
        due to those injuries. Noneconomic loss would reflect 
        compensation for pain and suffering due to injuries 
        associated with the attacks. Awards, which would be 
        provided in one payment, would be determined within 120 
        days of filing the claim and paid within 20 days of 
        such determination.
          L  Based on information provided by administrators of 
        the previous VCF program, CBO estimates that the 
        average injury award would be about $180,000. (For 
        death claims, the average award would be about $2 
        million, the same amount provided under the original 
        VCF.) CBO estimated the average injury award by 
        considering the characteristics of the current 
        population enrolled in WTC Medical Monitoring and 
        Treatment Programs, including average age, extent of 
        disability, estimated income, and employer-provided 
        benefits such as pensions and health insurance. CBO 
        estimates that the average award would be higher for 
        responders--about $240,000 per claim--because we expect 
        that a greater proportion of responders have more 
        serious injuries. In contrast, we estimate that awards 
        for survivors would average about $100,000. The award 
        estimates also were adjusted to account for certain 
        health care benefits provided under title I.

    Attorneys' Fees. This estimate does not include any 
significant additional costs for attorneys' compensation that 
the Special Master could award under the bill. The bill would 
give the Special Master discretion to provide compensation to 
attorneys for services rendered on cases filed in district 
court for injuries associated with the terrorist attacks, but 
CBO expects that this authority would be used sparingly, based 
on the historical experience of the VCF. Previously, attorneys 
provided free legal assistance to claimants.
Spending Subject to Appropriation
    CBO estimates that implementing H.R. 847 would decrease 
discretionary spending by $174 million over the 2011-2020 
period.

    Administering VCF Awards. Under H.R. 847, additional 
funding would be required to administer the VCF. The original 
compensation program was administered by the Department of 
Justice's (DOJ's) Civil Division. About $87 million was spent 
to process about 7,400 claims, and the average administrative 
cost per claim was about $11,500. Under the bill, CBO assumes 
that DOJ would again administer and oversee the program.
    Based on information provided by DOJ, CBO estimates that 
the average cost to process a claim under H.R. 847 would be 
about $10,000. CBO expects that the average cost would be lower 
than under the original program because the administrative 
infrastructure already exists and because we assume that 
certain efficiencies would be achieved with a larger number of 
claims. In total, CBO estimates that, assuming appropriation of 
the necessary amounts, administrative costs for the program 
would total $483 million over 2011-2015 period and $514 million 
over the 2011-2020 period to process an estimated 50,000 
claims, including many from individuals who would not qualify 
for an award. Most of that amount would be for salaries of 
hundreds of individuals to process millions of documents, 
operate a claims management system, and manage 20 to 30 claims-
assistance sites around the country. Compensation also would be 
provided for DOJ attorneys, administrative law judges, and 
support staff.

    NOISH World Trade Center Health Program. As discussed 
above, the enactment of H.R. 847 would replace annual 
appropriations with mandatory funding for NIOSH through CDC. 
Under the current-law baseline, CBO projects that discretionary 
appropriations will continue at the current level of funding 
adjusted annually for anticipated inflation. Assuming 
appropriation actions consistent with the bill, CBO estimates 
that appropriations for NIOSH would be reduced by $71 million 
in 2011 and increasing amounts in subsequent years because that 
baseline spending would be replaced by new direct spending 
under H.R. 847. We estimate that the reduction in 
appropriations would total $764 million over the 2011-2020 
period, resulting in a corresponding reduction in outlays of 
$688 million over the same period.

                      PAY-AS-YOU-GO CONSIDERATIONS

    The Statutory Pay-As-You-Go Act of 2010 establishes budget 
reporting and enforcement procedures for legislation affecting 
direct spending or revenues. The net changes in outlays that 
are subject to those pay-as-you-go procedures are shown in the 
following table.


        ESTIMATED IMPACT ON STATE, LOCAL, AND TRIBAL GOVERNMENTS

    H.R. 847 contains no intergovernmental mandates as defined 
in UMRA. The bill would place conditions on the city of New 
York for participating in the health program authorized by the 
bill, but those conditions would not be intergovernmental 
mandates as defined in UMRA.

                 ESTIMATED IMPACT ON THE PRIVATE SECTOR

    H.R. 847 would impose a private-sector mandate as defined 
in UMRA by limiting the liability of New York City, any entity 
with a property interest in the World Trade Center on September 
11, 2001, and any contractors and subcontractors thereof. 
Liability would be limited to the total amount of available 
insurance coverage of those entities for compensatory damages 
or other relief arising from or related to debris removal from 
sites of the terrorist attacks. By limiting the liability of 
those entities, the bill would impose a mandate on individuals 
seeking compensatory damages or other relief. Because of 
uncertainty about the potential amount of the awards and the 
ability of the city of New York and other entities whose 
liability would be limited to pay for any awards in excess of 
the liability limit, CBO cannot determine the costs the mandate 
would impose on the affected individuals.

                         ESTIMATE PREPARED BY:

Federal Costs: Stephanie Cameron, Leigh Angres, and Chapin 
    White
Impact on State, Local, and Tribal Governments: Lisa Ramirez-
    Branum
Impact on the Private Sector: Sarah Axeen

                         ESTIMATE APPROVED BY:

Holly Harvey, Deputy Assistant Director for Budget Analysis

                    Performance Goals and Objectives

    The Committee states that pursuant to clause 3(c)(4) of 
rule XIII of the Rules of the House of Representatives, H.R. 
847 will establish a program to provide health care monitoring 
and treatment to persons injured during recovery efforts and 
debris removal at September 11, 2001 crash sites, and it will 
reopen the September 11 Victim Compensation Fund to provide 
compensation for such injured individuals.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in article I, section 8, clause 3 of the 
Constitution.

                          Advisory on Earmarks

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 847 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as defined in clause 9(d), 9(e), or 9(f) of Rule XXI.

                      Section-by-Section Analysis

    The following discussion describes the bill as reported by 
the Committee.
    Sec. 1. Short Title; Table of Contents. Section 1 sets 
forth the short title of the bill as the ``James Zadroga 9/11 
Health and Compensation Act of 2010.'' The section also sets 
forth the table of contents of the bill.
    Sec. 2. Findings. Section 2 sets forth several findings of 
Congress.
    Sec. 101. World Trade Center Health Program. Section 101 
amends the Public Health Service Act to establish the World 
Trade Center Health Program (WTC program) within the National 
Institute for Occupational Safety and Health to provide medical 
monitoring and treatment benefits to emergency responders, 
recovery and cleanup workers, area residents and others who 
were directly impacted and adversely affected by the attacks of 
September 11, 2001.
    Sec. 201. Definitions. Section 201 amends the original 
Victim Compensation Fund provisions within the Air 
Transportation Safety and System Stabilization Act as follows:

         Lamends the definition of ``collateral 
        source'' by including payments related to debris 
        removal;

         Ldefines ``contractor and subcontractor'' to 
        mean any entity that participated in debris removal at 
        any September 11 crash site, except for any such entity 
        with a property interest in the World Trade Center on 
        September 11, 2001;

         Ldefines ``debris removal'' to mean rescue and 
        recovery efforts, removal of debris, cleanup, 
        remediation, and response during the immediate 
        aftermath of the September 11 attacks;

         Ldefines ``immediate aftermath'' to mean any 
        period beginning with the terrorist-related aircraft 
        crashes of September 11, 2001, and ending on August 30, 
        2002; and

         Ldefines ``9/11 crash site'' to mean: (1) the 
        World Trade Center, Pentagon, and Shanksville, 
        Pennsylvania crash sites; (2) the buildings or portions 
        of buildings destroyed as a result of the September 11 
        aircraft crashes; (3) any areas contiguous to the site 
        of such crashes that the Special Master determines are 
        sufficiently close to the site so that there was a 
        demonstrable risk of physical harm resulting from the 
        impact of the aircraft or any subsequent fire, 
        explosions, or building collapses; and (4) any area 
        related to, or along, routes of debris removal, such as 
        barges and Fresh Kills.

    Sec. 202. Extended and Expanded Eligibility for 
Compensation. Section 202 amends the Air Transportation Safety 
and System Stabilization Act to generally extend and expand 
eligibility for compensation under the Victim Compensation 
Fund.
    Subsection (a) requires that the eligibility claim form for 
compensation benefits be amended to also request information 
concerning physical harm or death resulting from debris removal 
related to the September 11 attacks.
    Subsection (b) provides new deadlines for claims related to 
physical harm or death from debris removal at the crash sites 
that would extend to December 22, 2031.
    Subsection (c) establishes timing and proof requirements 
for claims filed during the extended filing period.
    Subsection (d) makes a technical correction to the original 
Victims Compensation Fund to clarify that claimants may include 
individuals who were present at other September 11 aircraft 
crash sites at the time of, or in the immediate aftermath of, 
the aircraft crashes.
    Subsection (e) amends the eligibility requirements for 
claimants to include individuals who suffered physical harm 
resulting from debris removal.
    Subsection (f) requires an individual filing a claim for 
compensation related to debris removal to waive his or her 
right to file a civil action or be party to such action in any 
Federal or state court for damages sustained as the result of 
the September 11 terrorist attacks. Any individual who was a 
party to such action, withdrew from such action in order to 
submit a claim for compensation, and was found ineligible for 
compensation, is permitted to reinstitute the civil action 
without prejudice during the 90-day period after ineligibility 
is determined.
    Sec. 203. Requirement to Update Regulations. Section 203 
amends the Air Transportation Safety and System Stabilization 
Act to require the Special Master to update, within 90 days of 
enactment, VCF regulations to reflect the changes made by this 
Act.
    Sec. 204. Limited Liability for Certain Claims. Section 204 
amends the Air Transportation Safety and System Stabilization 
Act to limit the liability of certain entities for civil claims 
and actions arising from or related to debris removal, 
including claims or actions previously resolved, currently 
pending, and that may be filed through December 22, 2031. 
Liability for such claims or actions is limited to the amount 
of funds held by the World Trade Center Captive Insurance 
Company, the amount of available insurance coverage identified 
in schedule 2 of the Captive Insurance Company insurance 
policy, and the amount of insurance coverage held by the City 
of New York, by entities with a property interest in the World 
Trade Center on September 11, 2001, and by contractors and 
subcontractors that participated in debris removal.
    Section 204 specifically provides that the individual 
liability of the City of New York is limited to the City's 
insurance coverage or $350,000,000, whichever is greater. The 
liability of the Port Authority of New York and New Jersey and 
any other entity with a property interest in the World Trade 
Center on September 11, 2001 is limited to the amount of all 
available insurance coverage maintained by any such entity. The 
liability of any contractor or subcontractor that participated 
in debris removal is limited to the amount of available 
liability insurance maintained by such contractor or 
subcontractor.
    Section 204 also establishes a priority of funds from which 
plaintiffs may satisfy judgments or settlements obtained for 
civil claims or actions related to debris removal. The priority 
requires exhaustion of amounts held by the Captive Insurance 
Company and identified insurance policies, followed by 
exhaustion of the amount for which the City of New York is 
liable, followed by exhaustion of the available insurance 
coverage maintained by the Port Authority and other entities 
with a property interest in the World Trade Center on September 
11, 2001, followed by exhaustion of the available insurance 
coverage maintained by contractors and subcontractors. In 
addition, section 204 specifies that any party to a claim or 
action can file an action for a declaratory judgment for 
insurance coverage or bring a direct action against the 
insurance company involved.
    Sec. 205. Funding; Attorney Fees. Section 205 amends the 
Air Transportation Safety and System Stabilization Act to cap 
the total payment of amounts for compensation from the VCF to 
$8.4 billion with respect to claims filed on or after the 
Special Master updates the Fund's regulations. Section 205 
would also cap at 10 percent the percentage of compensation 
that attorneys could receive in fees, except that the Special 
Master is given the discretion to raise this percentage for 
certain cases filed in the Southern District of New York prior 
to January 1, 2009. This discretion is provided to the Special 
Master to address cases where the 10 percent cap on attorneys' 
fees may not provide adequate compensation for services 
rendered in connection with a claim because of the substantial 
amount of legal work expended on that claim during the period 
after which the initial period for filing claims under the VCF 
expired.

         Changes in Existing Law Made by the Bill, as Reported

  The bill was referred to this committee for consideration of 
such provisions of the bill as fall within the jurisdiction of 
this committee pursuant to clause 2 of rule XII of the Rules of 
the House of Representatives. In compliance with clause 3(e) of 
rule XIII of the Rules of the House of Representatives, changes 
in existing law made by the bill, as reported, are shown as 
follows (existing law proposed to be omitted is enclosed in 
black brackets, new matter is printed in italics, existing law 
in which no change is proposed is shown in roman):

         AIR TRANSPORTATION SAFETY AND SYSTEM STABILIZATION ACT

TITLE IV--VICTIM COMPENSATION

           *       *       *       *       *       *       *


SEC. 402. DEFINITIONS.

  In this title, the following definitions apply:
          (1) * * *

           *       *       *       *       *       *       *

          (6) Collateral source.--The term ``collateral 
        source'' means all collateral sources, including life 
        insurance, pension funds, death benefit programs, and 
        payments by Federal, State, or local governments 
        related to the terrorist-related aircraft crashes of 
        September 11, 2001, or debris removal, including under 
        the World Trade Center Health Program established under 
        section 3001 of the Public Health Service Act.
          (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.
          [(7)] (9) Economic loss.--The term ``economic loss'' 
        means any pecuniary loss resulting from harm (including 
        the loss of earnings or other benefits related to 
        employment, medical expense loss, replacement services 
        loss, loss due to death, burial costs, and loss of 
        business or employment opportunities) to the extent 
        recovery for such loss is allowed under applicable 
        State law.
          [(8)] (10) Eligible individual.--The term ``eligible 
        individual'' means an individual determined to be 
        eligible for compensation under section 405(c).
          (11) Immediate aftermath.--The term ``immediate 
        aftermath'' means any period beginning with the 
        terrorist-related aircraft crashes of September 11, 
        2001, and ending on August 30, 2002.
          [(9)] (12) Noneconomic losses.--The term 
        ``noneconomic losses'' means losses for physical and 
        emotional pain, suffering, inconvenience, physical 
        impairment, mental anguish, disfigurement, loss of 
        enjoyment of life, loss of society and companionship, 
        loss of consortium (other than loss of domestic 
        service), hedonic damages, injury to reputation, and 
        all other nonpecuniary losses of any kind or nature.
          [(10)] (13) Special master.--The term ``Special 
        Master'' means the Special Master appointed under 
        section 404(a).
          (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. 405. DETERMINATION OF ELIGIBILITY FOR COMPENSATION.

  (a) Filing of Claim.--
          (1) * * *
          (2) Claim form.--
                  (A) * * *
                  (B) Contents.--The form developed under 
                subparagraph (A) shall request--
                          (i) information from the claimant 
                        concerning the physical harm that the 
                        claimant suffered, or in the case of a 
                        claim filed on behalf of a decedent 
                        information confirming the decedent's 
                        death, as a result of the terrorist-
                        related aircraft crashes of September 
                        11, 2001, or debris removal during the 
                        immediate aftermath;
                          (ii) information from the claimant 
                        concerning any possible economic and 
                        noneconomic losses that the claimant 
                        suffered as a result of such crashes or 
                        debris removal during the immediate 
                        aftermath; and
                          (iii) information regarding 
                        collateral sources of compensation the 
                        claimant has received or is entitled to 
                        receive as a result of such crashes or 
                        debris removal during the immediate 
                        aftermath.
          [(3) Limitation.--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.]
          (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 December 22, 2031.

           *       *       *       *       *       *       *

  (c) Eligibility.--
          (1) * * *
          (2) Individuals.--A claimant is an individual 
        described in this paragraph if the claimant is--
                  (A) an individual who--
                          (i) was present at the World Trade 
                        Center, (New York, New York), the 
                        Pentagon (Arlington, Virginia), [or the 
                        site of the aircraft crash at 
                        Shanksville, Pennsylvania] the site of 
                        the aircraft crash at Shanksville, 
                        Pennsylvania, or any other 9/11 crash 
                        site at the time, or in the immediate 
                        aftermath, of the terrorist-related 
                        aircraft crashes of September 11, 2001; 
                        and
                          (ii) suffered physical harm or death 
                        as a result of such an air crash or 
                        debris removal;

           *       *       *       *       *       *       *

          (3) Requirements.--
                  (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.
                          (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).
                  [(A)] (B) Single claim.--Not more than one 
                claim may be submitted under this title by an 
                individual or on behalf of a deceased 
                individual.
                  [(B)] (C) Limitation on civil action.--
                          (i) In general.--Upon the submission 
                        of a claim under this title, the 
                        claimant waives the right to file a 
                        civil action (or to be a party to an 
                        action) in any Federal or State court 
                        for damages sustained as a result of 
                        the terrorist-related aircraft crashes 
                        of September 11, 2001, or for damages 
                        arising from or related to debris 
                        removal. The preceding sentence does 
                        not apply to a civil action to recover 
                        collateral source obligations, or to a 
                        civil action against any person who is 
                        a knowing participant in any conspiracy 
                        to hijack any aircraft or commit any 
                        terrorist act.
                          [(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 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.]
                          (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).
                          (iii) Authority to reinstitute 
                        certain lawsuits.--In the case of a 
                        claimant who was a party to a civil 
                        action described in clause (i), who 
                        withdrew from such action pursuant to 
                        clause (ii), and who is subsequently 
                        determined to not be an eligible 
                        individual for purposes of this 
                        subsection, such claimant may 
                        reinstitute such action without 
                        prejudice during the 90-day period 
                        beginning after the date of such 
                        ineligibility determination.

SEC. 406. PAYMENTS TO ELIGIBLE INDIVIDUALS.

  (a) In General.--[Not later than] Subject to subsection (d), 
not later than 20 days after the date on which a determination 
is made by the Special Master regarding the amount of 
compensation due a claimant under this title, the Special 
Master shall authorize payment to such claimant of the amount 
determined with respect to the claimant.
  (b) Payment Authority.--[This title] Subject to subsection 
(d), this title constitutes budget authority in advance of 
appropriations Acts and represents the obligation of the 
Federal Government to provide for the payment of amounts for 
compensation under this title.

           *       *       *       *       *       *       *

  (d) Limitation.--The total payment of amounts 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 $8,400,000,000.
  (e) Attorney Fees.--
          (1) In general.--Notwithstanding any contract, and 
        except as provided in paragraph (2), 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) Exception.--With respect to a claim made on 
        behalf of an individual for whom a lawsuit was filed in 
        the Southern District of New York prior to January 1, 
        2009, in the event that the representative believes in 
        good faith that the fee limit set by paragraph (1) will 
        not provide adequate compensation for services rendered 
        in connection with such claim because of the 
        substantial amount of legal work provided on behalf of 
        the claimant (including work performed before the 
        enactment of this legislation), application for greater 
        compensation may be made to the Special Master. Upon 
        such application, the Special Master may, in his or her 
        discretion, award as reasonable compensation for 
        services rendered an amount greater than that allowed 
        for in paragraph (1). Such fee award will be final, 
        binding, and non-appealable.

SEC. 407. REGULATIONS.

  [Not later than] (a) In General._Not later than 90 days after 
the date of enactment of this Act, the Attorney General, in 
consultation with the Special Master, shall promulgate 
regulations to carry out this title, including regulations with 
respect to--
          (1) * * *

           *       *       *       *       *       *       *

  (b) Updated Regulations.--Not later than 90 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. 408. LIMITATION ON LIABILITY.

  (a) In General.--
          (1) * * *

           *       *       *       *       *       *       *

          (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 through December 22, 2031) 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 clauses (i) and (ii) 
                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)(A) 
        applies, shall be paid solely from the following funds 
        in the following order, as may be applicable:
                  (A) The funds described in clause (i) or (ii) 
                of paragraph (4)(A).
                  (B) If there are no funds available as 
                described in clause (i) or (ii) of paragraph 
                (4)(A), the funds described in clause (iii) of 
                such paragraph.
                  (C) If there are no funds available as 
                described in clause (i), (ii), or (iii) of 
                paragraph (4)(A), the funds described in clause 
                (iv) of such paragraph.
                  (D) If there are no funds available as 
                described in clause (i), (ii), (iii), or (iv) 
                of paragraph (4)(A), the funds described in 
                clause (v) of such paragraph.
          (6) Declaratory judgment actions and direct action.--
        Any party to a claim or action to which paragraph 
        (4)(A) 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.

           *       *       *       *       *       *       *


                            Dissenting Views

          Despite its success, the fund has not set a 
        precedent. Congress has not authorized similar 
        compensation for the thousands of victims of Hurricane 
        Katrina, for those injured by other natural disasters 
        or for the families of those killed in such tragedies. 
        Nor has Congress exhibited such generosity toward U.S. 
        soldiers wounded, or the families of those killed, in 
        Iraq and Afghanistan.
          The same is true of victims of terrorist attacks that 
        took place before Sept. 11, 2001. The Navy personnel 
        who died in the suicide attack on the USS Cole and the 
        victims of the Oklahoma City bombing received no such 
        public compensation. Even the victims of the first 
        terrorist attack on the World Trade Center, in 1993, 
        were denied. Cold though it may sound, this is as it 
        should be.
          Bad things happen to good people every day; Congress 
        does not come to their financial rescue with generous, 
        tax-free checks. In our free society, based on notions 
        of limited government and equal protection of the laws, 
        we simply do not expect the government to step in 
        whenever misfortune strikes. This is not out of concern 
        about bankrupting the Treasury. It is because our 
        heritage teaches that we all must take our chances in 
        life.
                                                --Kenneth R. 
                                        Feinberg\1\
---------------------------------------------------------------------------
    \1\Kenneth R. Feinberg, 9/11 Fund: Once Was Enough, Wash. Post, 
September 11, 2008, at A17. Kenneth R. Feinberg was the Special Master 
of the September 11th Victim Compensation Fund.

                              INTRODUCTION

    Eight years ago, just 11 days after the terrorist attacks 
of September 11th, Congress passed the Air Transportation 
Safety and System Stability Act,\2\ which created the September 
11th Victim Compensation Fund, and President Bush quickly 
signed it into law. This bipartisan bill was one-of-a-kind 
legislation, providing generous public compensation to the 
physically injured and to the families of the dead. The 
original 9/11 Fund successfully served its purpose by 
effectively and efficiently providing a short-term, 
administrative, no-fault alternative to tort litigation to 
compensate the victims. The Fund paid out over $7 billion in 
taxpayer dollars to 5,560 eligible claimants.
---------------------------------------------------------------------------
    \2\Pub. L. No. 107-42 (2001), 115 Stat. 230 (2001) (codified at 49 
U.S.C. Sec. 40101 note).
---------------------------------------------------------------------------
    The original fund reflected national solidarity towards the 
victims and expressed a national sense of compassion not only 
to the victims, but to the rest of the world. It was ``an 
expression of the best in the American character.''\3\ The 
question H.R. 847 raises is whether Congress should pass a new 
9/11 Fund, with different terms than the original fund, or 
whether the original fund should be considered a unique, 
singular response to an unprecedented tragedy. The answer to 
that question--at least with regard to H.R. 847 in its current 
form--is that a new 9/11 Fund should not be enacted.
---------------------------------------------------------------------------
    \3\H.R. 847, the ``James Zadroga 9/11 Health and Compensation Act 
of 2009'': Joint Hearing Before the Subcomm. on the Constitution and 
the Subcomm. on Immigration of the House Comm. on the Judiciary, 111th 
Cong. (2009) (statement of Kenneth R. Feinberg).
---------------------------------------------------------------------------
    The approach H.R. 847 takes ``does not have the advantages 
that made the [original 9/11 Fund] successful, and magnifies 
the disadvantages and fairness problems of the [original 9/11 
Fund].''\4\ Three of the main problems with H.R. 847 are that 
(1) it leaves the fund open for 22 years, well beyond what is 
needed to take care of any latent claims; (2) gives the Special 
Master virtually unbounded authority, that will not work for a 
long-term (22 years) compensation program involving a 
substantially larger set of potential claimants than the 
original 9/11 Fund with injuries of more ambiguous causation; 
and (3) the nature of the fund will make it highly susceptible 
to waste, fraud, and abuse.
---------------------------------------------------------------------------
    \4\H.R. 847, the ``James Zadroga 9/11 Health and Compensation Act 
of 2009'': Joint Hearing Before the Subcomm. on the Constitution and 
the Subcomm. on Immigration of the House Comm. on the Judiciary, 111th 
Cong. (2009) (statement of Theodore H. Frank) (``Frank testimony'') .
---------------------------------------------------------------------------
    In short, while there is a sympathetic and potentially 
deserving class of claimants and while there is good reason to 
give the construction contractors that aided after 9/11 in the 
recovery and cleanup efforts liability protection, the fund 
that will be created by H.R. 847 is not narrowly and 
appropriately tailored towards those ends. Accordingly, 
Congress should not create the new 9/11 Fund contained in H.R. 
847.

                               BACKGROUND

    Title II of H.R. 847 will create a new September 11th 
Victim Compensation Fund (``VCF''), which will be open until 
December 22, 2031, to provide compensation for individuals who 
did not file before, or became ill after, the December 22, 2003 
filing deadline for the original fund. In addition, Title II 
will limit the liability of defendants--including the 
contractors and subcontractors that aided in the rescue, 
recovery, and cleanup efforts--for lawsuits previously 
resolved, currently pending, or filed through December 22, 
2031, related to the rescue, recovery, and cleanup efforts at 
the World Trade Center site.
A. LOriginal Victim Compensation Fund
    Eleven days after the terrorist attacks on September 11, 
2001, Congress passed the Air Transportation Safety and 
Stabilization Act to protect air carriers from tort lawsuits 
that threatened to cripple air travel in the United States. The 
Act capped damages against the airlines at their pre-existing 
liability insurance limits and limited jurisdiction for tort 
claims to the U.S. District Court for the Southern District of 
New York. Moreover, the Act established the 9/11 Victim 
Compensation Fund, through which victims of the attacks could 
opt to waive all federal and state tort claims and receive 
administrative relief through a predetermined formula, under 
the discretion of the Fund's Special Master.
    The VCF limited recovery to a discrete class of victims, 
determined by time and place. To be eligible for recovery under 
the Fund, victims had to have been on the flights or at the 
World Trade Center or Pentagon sites ``within 12 hours of the 
attacks, suffered a physical injury, and been treated by a 
medical professional within 24 hours of the injury, within 24 
hours of rescue, or within 72 hours of injury or rescue for 
those victims who were unable to realize immediately the extent 
of their injuries or for whom treatment by a medical 
professional was not available on September 11.''\5\ Those who 
died in the attacks and rescue workers who were at the site 
within 96 hours of the attacks were eligible. The VCF thus had 
a clearly defined class of victims whose death or injuries did 
not present complex questions of causation.
---------------------------------------------------------------------------
    \5\Lloyd Dixon and Rachel Kaganoff Stern, ``Compensation for Losses 
from the 9/11 Attacks'' (The Rand Institute for Civil Justice: 2004) at 
121.
---------------------------------------------------------------------------
    The VCF granted awards for economic loss based on the 
victim's annual income prior to the attack. Awards for non-
economic losses for death cases were set at $250,000 per victim 
and $100,000 for a spouse and each dependent child; those who 
did not believe that these levels provided adequate 
compensation for non-economic damages could petition for a 
hearing.\6\ The VCF deducted from awards all collateral-source 
benefits, including ``life insurance, pension funds, death 
benefit programs, and payments by Federal, State, or local 
governments related to the terrorist-related aircraft crashes 
of September 11, 2001.''\7\
---------------------------------------------------------------------------
    \6\See 67 Fed. Reg. 11,239 (Mar. 13, 2002).
    \7\Pub. L. No. 107-42 (2001), 115 Stat. 230 (2001) (codified at 49 
U.S.C. Sec. 40101 note).
---------------------------------------------------------------------------
B. LCurrent Situation
    Immediately after the terrorist attacks on 9/11, large 
private contracting firms were asked by the City of New York to 
immediately begin cleanup efforts at Ground Zero. They did so 
heroically and in strained circumstances, even though they were 
unable to secure the liability insurance they would normally 
obtain before starting a project. They were unable to obtain 
such insurance because the unprecedented nature of the disaster 
site (containing some 20 stories of debris) caused insurance 
markets to be incapable of pricing such an insurance product.
    Since then, many people who worked and lived in and around 
the cleanup site have developed medical problems alleged to 
have been caused by the toxic particulates in the air around 
the site and by the alleged negligence of the cleanup companies 
to ensure that their workers and those in the area were not 
exposed to such contaminants. The alleged victims of this 
alleged negligence have filed lawsuits (over 10,000 claimants 
so far) which now proceed for huge demands of damages. The 
contractors claim that the vast majority of claimants are not 
contractor employees, but New York City employees such as 
firemen. These lawsuits place the solvency of these firms in 
jeopardy.
    Other major entities affected by the 9/11 attacks, 
including the airlines, the owner of the World Trade Center, 
and the Port Authority of New York and New Jersey, were 
protected from excessive liability exposure following the 
attacks by federal legislation. Unfortunately, the cleanup 
firms, whose liability issues did not arise until many months 
after the attacks, were not. While approximately a billion 
dollars have been appropriated to help pay for the medical 
expenses of those affects by the contaminants in the areas 
around the World Trade Center site, the administrative 
compensation program created to help the immediate victims of 
9/11 (the VCF) did not cover those exposed to subsequent site 
contaminants, and the liability protections passed after 9/11 
do not cover the cleanup and recovery firms.

                               DISCUSSION

    Title II of H.R. 847 creates a new September 11th Victim 
Compensation Fund to provide compensation to those who were 
injured by air contaminants as a result of rescue, recovery, 
and cleanup efforts following 9/11 but were ineligible for 
compensation under the VCF because their injuries did not 
manifest themselves by the fund's December 22, 2003 filing 
deadline. However, the structure of the original 9/11 Fund, 
which H.R. 847 incorporates, intended for compensating a 
limited set of claimants in time and place with relatively 
uncontroversial claims in a non-adversarial setting, will not 
work for the significantly longer-term fund created by H.R. 847 
involving a substantially larger set of claimants with injuries 
of more ambiguous causation.
    Under the original 9/11 Fund, there was, in general, no 
ambiguity with regard to causation. Someone who was on one of 
the planes or was killed in the World Trade Center or at the 
Pentagon clearly was entitled to compensation from the Fund. 
Accordingly, determining who was eligible for compensation was 
for the most part a ministerial function, which did not require 
adjudication. Moreover, as the number of potential claimants to 
the original fund was limited to several thousand, the Fund was 
able to be administered effectively and efficiently with a 
structure that was relatively thin for a government 
bureaucracy. However, ``[a] longer-term and larger compensation 
fund could not possibly vest that much discretionary authority 
in a single individual, and would need to craft `rigidly 
standardized rules' that the current statutory structure of the 
Fund would not permit.''\8\ Yet, H.R. 847 makes no changes to 
the original Fund's structure to account for the long-term 
nature and increased size and complexity of the new Fund.
---------------------------------------------------------------------------
    \8\Frank testimony at 3.
---------------------------------------------------------------------------
    Thus, while enacting a new 9/11 Fund is in some ways an 
attractive proposition, the Fund that will be created by H.R. 
847 is highly problematic.
A. LH.R. 847 extends the 9/11 Compensation Fund over 30 years beyond 
        September 11, 2001.
    Under H.R. 847, a claim may be filed at any time during the 
period that begins on the date the Special Master updates the 
VCF regulations and ends on December 22, 2031. The Special 
Master is required to update the regulations within 90 days of 
enactment of H.R. 847. Thus, under this bill, the Fund will be 
open from at least 2010 to 2031--a period of over 21 years and 
over 30 years beyond September 11, 2001.
    The sponsors of the legislation want to leave the VCF open 
for such a long period of time to address potential latent 
claims. However, according to Kenneth Feinberg, Special Master 
of the original VCF, ``no latent claims need such an extended 
date.'' As the original 9/11 Fund paid over $1 billion to 2,680 
eligible physical injury claimants the majority of whom were 
suffering from respiratory ailments, former Special Master 
Feinberg has firsthand knowledge of the types of claims that 
can be expected for the new Fund.
    Based on his experience, Mr. Feinberg has suggested that 
``Congress could simply reopen the 9/11 Fund to encompass all 
such claims during a `window' of 5 years during which time all 
September 11 related respiratory physical injuries could be 
evaluated and processed.''\9\ Moreover, if latent claims 
present a problem at a later date, victims can sue the 
contractors and the city assuming the liability cap has not 
been reached. Or, if a shorter period (e.g., 5 years) does not 
end up being long enough, Congress could once again consider 
the issue and reenact the fund. This is an obvious solution as 
that is exactly the situation that is occurring here: according 
to the bill's sponsors the original fund was not open long 
enough so this legislation would reenact it.
---------------------------------------------------------------------------
    \9\Paying With Their Lives: The Status of Compensation for 9/11 
Health Effects: Joint Hearing Before the Subcomm. on the Constitution 
and the Subcomm. on Immigration of the House Comm. on the Judiciary, 
110th Cong. (2008) (statement of Kenneth R. Feinberg).
---------------------------------------------------------------------------
    What is more, the bill extends the time period for when an 
individual's injuries had to have been sustained from the 96 
hours after the 9/11 attacks contained in the original fund to 
almost a full year after September 11, 2001. That is to say, 
claimants will be eligible for the Fund if they were present in 
a covered area between September 11, 2001 and August 30, 2002. 
Inexplicably, however, the last three months of this nearly 
additional year of coverage fall after the cleanup of Ground 
Zero ended on May 30, 2002. Why should taxpayers be providing 
compensation for injuries that were sustained up to three 
months after the cleanup ended?
B. LH.R. 847 gives the Special Master unchecked and unreviewable 
        discretionary power that is inappropriate for the compensation 
        fund it creates.
    The compensation fund that will be created by H.R. 847, 
like the original 9/11 Fund, vests tremendous unchecked and 
unreviewable discretionary power in the Fund's special master. 
This may have been acceptable for the original 9/11 Fund, with 
its limited set of claimants in time and place with relatively 
uncontroversial claims. But it is inappropriate for the longer-
term compensation program created by H.R. 847 involving a 
substantially larger set of potential claimants with injuries 
of more ambiguous causation.
    The country was tremendously lucky that Special Master 
Feinberg exercised the discretion he was given under the 
original fund so ably. The compensation fund that will be 
created by H.R. 847, however, is greater in scope and is of a 
significantly longer duration than the original fund. Thus it 
is highly problematic that H.R. 847 contains very few, if any, 
constraints on the new Special Master's discretion to disburse 
compensation to the tens of thousands of potential claimants. 
This is especially true with regard to medical causation and 
non-economic damages.
    In terms of medical causation, if the Fund is to be anymore 
than a giveaway of taxpayer money to anyone who is suffering a 
respiratory problem and was in the appropriate geographic area, 
the cooperative non-adversarial structure of the original 9/11 
Fund will necessarily have to change. This cooperative non-
adversarial structure was advantageous in the original fund as 
there was no dispute as to causation and there were a 
relatively limited number of claimants. This structure, which 
H.R. 847 leaves unaltered, however, is not appropriate for the 
type or scope of claims that will be covered by the new fund or 
the larger number of claims that can be expected.
    With regard to non-economic damages, the discretion given 
to the Special Master under H.R. 847 is also problematic. Non-
economic damages are highly subjective. The original 9/11 Fund 
had a regulatory limitation on presumed non-economic damages, 
but the Special Master could exceed that limitation in 
exceptional cases and ``[a] different Special Master could undo 
those regulatory limitations, and open the Treasury to 
arbitrary non-economic damages awards to thousands of 
claimants.''\10\
---------------------------------------------------------------------------
    \10\Frank testimony at 4.
---------------------------------------------------------------------------
    In other words, H.R. 847 simply puts too much discretion in 
the hands of what will likely be several Special Masters over 
the duration of the 22-year fund. Although Mr. Feinberg did an 
exceptional job with the original fund, Congress should not 
leave to chance that there will be as able a set of Special 
Masters over the course of the fund created by H.R. 847. Nor 
should Congress treat this larger, more complex and longer-
lasting fund as though it is simply a carbon copy of the 
original Fund.
C. LFund will be susceptible to fraud, waste, error, and abuse
    The original 9/11 Fund was designed for a select group of 
claimants who, for the most part, were unquestionably the 
intended recipients and eligible for benefits. In general, this 
narrow focus allowed for a non-adversarial process, involving a 
limited number of claimants, without dispute over causation. 
Indeed, as Special Master Feinberg has noted, ``Claimants did 
not need to present detailed computations or analyses. Instead, 
they only needed to supply the fund easily obtained data.''\11\
---------------------------------------------------------------------------
    \11\Kenneth R. Feinberg, 1 Final Report of the Special Master of 
the September 11th Victim Compensation Fund 7 (2004).
---------------------------------------------------------------------------
    However, the structure of the original fund, ``left 
unchanged in H.R. 847, is inappropriate for either the broader 
scope of the new Fund or the larger volume of claims the Fund 
can anticipate.''\12\ In order to avoid waste, fraud, and abuse 
of taxpayer dollars, Ted Frank of the American Enterprise 
Institute, a witness at the Committee's hearing on this 
legislation, explained in his written testimony that:
---------------------------------------------------------------------------
    \12\Frank testimony at 5.

        If the Fund is to be aimed at a specific set of victims 
        of terrorist attack, rather than simply a giveaway of 
        taxpayer money to a geographic area and to trial 
        lawyers, Section 405 will need to be amended to both 
        require the Fund to establish neutral medical criteria 
        for demonstrating causation, and to have a more 
        realistic timeframe for adjudication of potentially 
        controversial claims for compensation. Congress should 
        require the Fund to establish appropriate burdens of 
        proof and permit for independent medical review to 
        ensure that, if taxpayers are to be responsible for 
        compensation for injuries caused in the aftermath of 
        the September 11 attacks, they are responsible for that 
        amount and no more.\13\
---------------------------------------------------------------------------
    \13\Frank testimony at 5-6.

    For an example of the potential for fraud, waste, and 
abuse, one need look no further than the namesake of H.R. 847, 
James Zadroga. Detective Zadroga died from pulmonary disease 
and respiratory failure allegedly caused by exposure to dust at 
Ground Zero. The chief New York City medical examiner, however, 
concluded that, ``[i]t is our unequivocal opinion, with 
certainty beyond doubt, that the foreign material in [Detective 
Zadroga's] lungs did not get there as the result of inhaling 
dust at the World Trade Center or elsewhere.''\14\ Although 
Zadroga's family disputes the medical examiner's finding, the 
simple fact that this controversy exists demonstrates that the 
non-adversarial structure of the original fund cannot be 
retained without opening the new Fund up to fraud, waste, and 
abuse.
---------------------------------------------------------------------------
    \14\Bill Hutchinson, Coroner Says Hero James Zadroga Didn't Die 
From WTC Dust, N.Y. Daily News (Oct. 19, 2007).
---------------------------------------------------------------------------
    As Ted Frank further explained in his written testimony,

          The danger here is not simply the occasional false 
        positive of unmerited compensation, but the creation of 
        a compensation structure that will be subject to 
        pervasive fraud. History has shown in the asbestos and 
        silicosis mass tort litigations that claims of lung 
        ailments are especially susceptible to fraud. . . .
          The only hurdle the bill creates is Section 
        405(c)(3)(A)(ii)--proof that one contemporaneously 
        sought medical treatment. This may succeed in winnowing 
        out especially meritless claims that have already been 
        brought, but the bar is quite low for future claimants.
          Even legitimate medical facilities have a danger of 
        suffering from confirmation bias and exaggerating the 
        scope of pulmonary injuries, given the millions of 
        dollars of federal money at stake. Many of the most 
        sensational reports, including congressional testimony, 
        have come from the Irving J. Selikoff Center for 
        Occupational and Environmental Medicine. . . . But 
        critics have complained that ``doctors at the clinic, 
        which has strong historical ties to labor unions, have 
        allowed their advocacy for workers to trump their 
        science by making statements that go beyond what their 
        studies have confirmed''; and they have presented 
        findings in ``scientifically questionable ways.''\15\
---------------------------------------------------------------------------
    \15\Frank testimony at 7 (citations omitted).

    Moreover, as Mr. Frank explains, a fund like the one 
created in H.R. 847 will invariably suffer from the Field of 
Dreams problem: ``if you build it they will come.''\16\ In 
other words, ``[i]f Congress creates a compensation system 
where geographic proximity and a diagnosis are the only 
prerequisites for a large government check and an attorney's 
contingent fee, attorneys will have every incentive to 
manufacture such diagnoses, and have done so in the past, often 
with the cooperation of unions.''\17\ In the case of a new 9/11 
Fund, this concern is more than hypothetical. ``Thousands of 
lawsuits in the September 11 litigation in [federal] court 
alleging pulmonary injury have been filed by Napoli, Kaiser & 
Bern LLP, which was responsible for massive fraud in the fen-
phen litigation.''\18\
---------------------------------------------------------------------------
    \16\Id. at 8 (citing Richard A. Nagareda, Mass Torts in a World of 
Settlement 143 (2007).
    \17\Id. at 8.
    \18\Id.
---------------------------------------------------------------------------
    What will stop this same type of fraud from seeping into 
the new 9/11 Fund that is to be created by H.R. 847? As Mr. 
Frank points out, it likely will not be the structure of the 
Fund as it currently stands:

        Given the likely volume of claims and the complexity of 
        the underlying causation and timeliness issues, it will 
        be extraordinarily unlikely that the next Special 
        Master will be able to adequately review claims for 
        merit. Without firm medical criteria and the 
        opportunity of scrutiny of claims on the front end and 
        the promise of criminal penalties for fraud on the back 
        end, the reopening of the VCF will be subject to 
        substantial fraud and abuse.\19\
---------------------------------------------------------------------------
    \19\Id. at 9.
---------------------------------------------------------------------------
D. LThe manager's amendment's $8.4 billion cap is an invitation to 
        spend $8.4 billion
    Through the manager's amendment that was adopted in 
Committee, expenditures from the fund will be capped at $8.4 
billion. There are several problems with this cap. First, at 
base, a cap of $8.4 billion is nothing more than an invitation 
for the Fund's Special Master to spend $8.4 billion. Second, it 
is unclear where this $8.4 billion figure came from. The 
Congressional Budget Office (CBO) scored the first 10 years of 
the new Fund at $6.4 billion, but extrapolating CBO's 10-year 
numbers out for a 22-year long fund comes to no more than $7.6 
billion.\20\ Additionally, Special Master Feinberg, who 
probably has as good a grasp on the scope of these claims as 
anyone, has indicated that all existing claims could be settled 
for $1.5 billion.\21\ If $1.5 billion is anywhere close to 
being correct, why then is the cap set at $8.4 billion? It 
should not be. Third, an $8.4 billion cap in H.R. 847 does 
nothing to prevent a future Congress from increasing the cap. 
For instance, if the Special Master pays out $8.4 billion in 
the first 10 years of the Fund, is a future Congress not going 
to be at least tempted to authorize an increase in the cap? Of 
course it will. If a future Congress can increase the cap, why 
then not limit the initial cap to the $1.5 billion figure 
suggested for Mr. Feinberg? The bill's sponsors do not explain 
why they have not chosen that route.
---------------------------------------------------------------------------
    \20\The Congressional Budget Office only calculated the cost of an 
uncapped fund for the first 10 years the Fund would be opened. However, 
CBO determined that claims for compensation from the Fund would 
decrease over time. According to CBO's cost estimate, in year 10 annual 
payouts from the fund would only be $100 million. Thus, even assuming 
$100 million in payouts per year for the remaining 12 years the Fund 
will be open, the overall cost only gets to $7.6 billion. It is likely 
though that this number would be lower than $7.6 billion as it does not 
account for a further annual drop in payouts over the remaining 12 
years.
    \21\See, e.g., Feinberg testimony at 8-10.
---------------------------------------------------------------------------
    In other words, the $8.4 billion cap has little real 
effect. Had the proponents of H.R. 847 really wanted to put 
safeguards in the legislation to protect taxpayer money, they 
would have eliminated or capped the amount of highly subjective 
non-economic damages that could be awarded; limited the 
duration of the fund; and put in place some concrete rules on 
medical causation. Simply put, the $8.4 billion cap will do 
little, if anything, to protect taxpayers. While the victims 
and the parties that are being sued in federal court are worthy 
of protection, so too are taxpayers.
E. LA new Fund may reduce Congress' ability to provide funding for 
        future disasters or terrorist attacks.
    As the nonpartisan Rand Institute for Civil Justice pointed 
out in 2004, in its report on the original VCF, 
``precommitments by government programs . . . reduce the 
ability of government, and society more generally, to allocate 
resources to meet the most pressing needs after an 
attack.''\22\ And the Government Accountability Office, in 
2005, also cautioned, in a study of four federal compensation 
programs, that ``the federal role in all four programs has 
expanded significantly over time . . . As might be expected, as 
the federal role for those four programs has grown, so have 
their costs . . . [B]ecause these programs may expand 
significantly beyond the initial cost estimates, policymakers 
must carefully consider the cost and precedent-setting 
implications of establishing any new federal compensation 
programs, particularly in light of the current federal 
deficit.''\23\
---------------------------------------------------------------------------
    \22\Lloyd Dixon and Rachel Kaganoff Stern, ``Compensation for 
Losses from the 9/11 Attacks'' (The Rand Institute for Civil Justice: 
2004) at 143.
    \23\Government Accountability Office, ``Federal Compensation 
Programs: Perspectives on Four Programs (November 2005) at 4-5 
(analyzing the Black Lung Program, the Vaccine Injury Compensation 
Program, the Radiation Exposure Compensation Program, and the Energy 
Employees Occupational Illness Compensation Program).
---------------------------------------------------------------------------
F. LH.R. 847 allows attorneys to collect taxpayer funded fees for work 
        not directly related to recovery from the Victim Compensation 
        Fund.
    Because the 9/11 Fund is a no-fault, administrative scheme 
that does not involve the kind of risks and expense that would 
justify significant contingency fees, attorneys' fees should be 
limited. The entire purpose of the compensation fund is to 
provide victims with compensation without requiring them to 
prove complex legal concepts such as negligence, products 
liability, or other tort theories. Indeed, when Congress was 
considering the original VCF, the Association of Trial Lawyers 
of America sent a letter to Congress stating that ``ATLA 
believes that 100% of the compensation from the fund should go 
directly to these families.''\24\
---------------------------------------------------------------------------
    \24\Letter from Leo V. Boyle, President, Association of Trial 
Lawyers of America, to Congressional Leaders reprinted in 147 Cong. 
Rec. H5914 (daily ed. Sept. 21, 2001) (statement of Rep. Delahunt); 147 
Cong. Rec. S9599 (daily ed. Sept. 21, 2001) (statement of Mr. Reid).
---------------------------------------------------------------------------
    Through the manager's amendment, the bill will include a 
cap on attorneys' fees; however, the cap is poorly crafted if 
it is truly intended to maximize victims' recoveries by 
limiting attorneys to reasonable fees. What is more, the fee 
cap has an exception that will swallow the rule by allowing 
attorneys to receive fees for work that is not directly related 
to a victim's recovery under the VCF. A true fee cap would have 
given the Special Master the discretion to award less than 10 
percent attorneys' fees depending on the facts of the claim and 
the amount of work the attorney truly put in on that particular 
claim. Indeed, under the first 9/11 Fund, the Special Master 
had a non-binding guideline of 5 percent attorneys' fees and 
many attorneys worked pro bono. It is truly ironic that not 
giving the Special Master the discretion to award less than 10 
percent attorneys' fees is the one area that H.R. 847 puts 
limits on the Special Master's discretion. Surely, taxpayers 
who are providing the money for the new Fund would appreciate 
more meaningful limits on the Special Master's nearly unbounded 
discretion.
    Second, the attorneys' fee cap has an exception that 
provides that attorneys who have worked on civil litigation for 
a claimant prior to January 1, 2009, arising out of the cleanup 
efforts at the Ground Zero, will not be bound by the manager's 
amendment's 10 percent attorneys' fee cap. Essentially, this 
means that some attorneys will be compensated for work that is 
not directly related to filing a claim under the new 9/11 Fund. 
In other words, attorneys will be, for instance, compensated 
with taxpayer dollars for having filed motions in federal 
district court that are wholly unrelated to the no-fault, 
administrative compensation being provided for under the Fund. 
Why should taxpayers be paying attorneys for work that is not 
directly related to a claim under the Fund? The vast majority 
of the money from the Fund should go to the victims, not to 
attorneys that they may have hired. When these attorneys took 
on the civil litigation the manager's amendment intends to 
compensate them for, they did so at the risk (as is the case 
with all contingent fee litigation) that they would receive 
nothing for their work. Why now should Congress offset that 
risk?
    Simply put, the attorneys' fee cap in the manager's 
amendment to H.R. 847 is really not much of a cap at all. 
Attorneys representing World Trade Center cleanup-related 
victims should remember the sentiments of the ATLA right after 
the attacks and not seek fees, or anything more than minimal 
fees, for their representations of victims before the 9/11 
Fund. And Congress should not step in with this so-called 
attorneys' fees cap and invite attorneys to take money from the 
victims for work they did in civil litigation.
G. LOther disaster victims do not receive this type of federal 
        compensation.
    There is also the question of why Congress should reopen 
the 9/11 Fund, providing billions in additional federal 
compensation to the physical injury victims of the 9/11 
attacks, while no such fund exists for the victims of the 
Oklahoma City bombing, the victims of the U.S. embassy 
bombings, the victims of the first World Trade Center Attack in 
1993, or the victims of the unprecedented disaster associated 
with Hurricane Katrina. If this entitlement is approved, how 
does Congress say ``no'' to the victims of future tragedies, 
whether as a result of natural disasters or terrorist attacks? 
Congress must stop and think of the precedent this bill sets 
for future disasters. As former Special Master Feinberg has 
written,

        Why should Congress, which has already enacted 
        legislation authorizing over $7 billion in public 
        compensation to the families of those who died on 
        September 11, or who were physically injured as a 
        result of the attacks, now authorize additional 
        millions or even billions in compensation for the 
        remaining September 11 victims, while failing to do 
        anything similar to the other victims of life's 
        misfortunes? It is a fundamental question posed to our 
        elected officials in a free democratic society. Why 
        some victims but not others? On what basis should such 
        distinctions be made? Are some victims more ``worthy'' 
        than others?\25\
---------------------------------------------------------------------------
    \25\Feinberg testimony at 7.

    Moreover, it is not just that the VCF compensates the 
victims of one set of terrorist attacks but not victims of 
other terrorist attacks on American and foreign soil. It is 
also that the VCF ``compensates the 9/11 victims while most 
other innocent victims of crime, intentional wrongdoing, or 
negligence must suffer without remedy unless they are `lucky' 
enough to have been injured by someone who can be held liable 
under the tort system's peculiar, often arbitrary rules and who 
is also sufficiently insured or secure financially to pay the 
judgment.''\26\
---------------------------------------------------------------------------
    \26\Peter Schuck, Special Dispensation, Am. Lawyer, June 2004.
---------------------------------------------------------------------------
H. LH.R. 847 contains a partially self-defeating provision that allows 
        for the reinstatement of lawsuits if a claimant is ineligible 
        under the VCF.
    Section 202, paragraph 3 of H.R. 847 provides that if a 
claimant is determined to be ineligible for the compensation 
fund, he may reinstitute his lawsuit. One of the arguments, 
however, for reenacting the Fund is to bring a close to 
litigation against the City and its contractors. If ineligible 
claimants can reinstitute their lawsuits, this legislation is 
providing an avenue for lawsuits to move forward even after the 
Special Master has determined that they do not have an eligible 
claim. Moreover, the bill's limitation of liability provisions 
may not serve to discourage litigation. Those that seek 
compensation in the fund but are denied compensation not only 
will be able to reinstitute their tort cases in federal court; 
the liability caps actually may serve to create an 
approximately $2 billion incentive to sue in federal court 
rather than go through the fund. In other words, creation of 
the Fund may not have the anticipated impact on ending the 
litigation.

                         REPUBLICAN AMENDMENTS

    Republican Members offered two amendments to Title II of 
H.R. 847 at the Committee markup. Neither of the Republican 
amendments was adopted:

         LSmith Amendment. Ranking Member Smith offered 
        an amendment, based on the recommendation of former 
        Special Master Feinberg, to limit reopening of the fund 
        to 5 years on the Fund's original terms. As Special 
        Master Feinberg wrote in his written testimony at a 
        Judiciary Committee hearing on reenacting the 9/11 
        Fund, ``any attempt to reenact and extend the 9/11 Fund 
        should be initiated with the understanding that there 
        would be no changes in the rules and regulations 
        governing the original Fund, that the new law would 
        simply be a `one line' extension of reaffirmation of 
        the law which established the original 9/11 Fund.''\27\ 
        According to Special Master Feinberg, ``Congress could 
        simply reopen the 9/11 Fund to encompass all such 
        claims during a `window' of 5 years during which time 
        all September 11 related respiratory injuries could be 
        evaluated and processed.''\28\ Ranking Member Smith's 
        amendment would have accomplished Special Master 
        Feinberg's recommendation of a ``one-line,'' 5-year 
        extension of the original 9/11 Fund. This amendment 
        would have, in a very simple manner, addressed many of 
        the concerns expressed above with regards to the new 
        Fund that will be created by H.R. 847. Unfortunately, 
        Ranking Member Smith's amendment was not adopted.
---------------------------------------------------------------------------
    \27\Feinberg testimony at 6.
    \28\Feinberg testimony at 5.

         LKing Amendment. Mr. King offered an amendment 
        to remove the exception in the attorneys' fee cap for 
        attorneys who had filed a lawsuit on behalf of a victim 
        in federal court prior to January 1, 2009. This 
        exception swallows the rule. Had Mr. King's amendment 
        been adopted it would have ensured that more of the 
        compensation under the Fund would have gone to the 
        victims and not to any attorneys they may have hired. 
        Given that the VCF is a no-fault, administrative 
        scheme, there is no justification for high attorneys' 
        fees. Nor is there any reason to provide attorneys with 
        compensation under the VCF for work they performed for 
        litigation in federal court--the VCF is wholly a 
        separate system from that litigation. When attorneys 
        took on that representation in that litigation they did 
        so at the risk that they would receive no compensation 
        at all if the plaintiff lost--such is the nature of a 
        contingency fee. Mr. King's amendment was not adopted.

                               CONCLUSION

    Consideration of creating the new Victim Compensation Fund 
contained in Title II of H.R. 847 raises two questions. First, 
why should Congress reenact and expand the 9/11 Fund, providing 
millions in additional public compensation to the physical 
injury victims of the September 11 attacks, while no such Fund 
exists at all for the victims of the Oklahoma City bombing, the 
victims of the African Embassy bombing, the victims of the 
first World Trade Center attack in 1993 or, for that matter, 
the victims of the unprecedented disaster associated with 
Hurricane Katrina? Underlying this question is the issue of 
whether the federal government, i.e., the taxpayers of the 
United States, are to become in perpetuity the guarantors of 
last resort for all the tragedies that beset people over their 
lives. Members will have to make their own philosophical 
decision as to this first question.
    The second question is whether the 9/11 Fund that will be 
created by H.R. 847 is written in such a manner that it will 
safeguard valuable taxpayer dollars while appropriately 
compensating only the actual victims of the aftermath of the 9/
11 attacks. The answer to the second question is much more 
clear--the Fund that will be created by H.R. 847 is open for 
much longer than is necessary (at least 21 years); gives far 
too much discretion to the Special Master considering the long-
term nature of the Fund, which will have a larger set of 
claimants with claims of much more ambiguous causation than 
under the original Fund; and the size and unstructured nature 
of the Fund will make it highly susceptible to waste, fraud, 
and abuse. Simply put, the structure of the original 9/11 Fund 
will not work for the Fund that will be created by H.R. 847.
    There may be a deserving class of claimants who are 
suffering respiratory and other physical ailments as a result 
of their work at Ground Zero. And it may be that the original 
9/11 Fund should be reopened for a limited period of time in 
order to compensate those individuals. But the Fund created in 
H.R. 847 is not the original 9/11 Fund, nor is it being re-
opened for a brief window. We are unable to support enactment 
of this legislation.

                                   Lamar Smith.
                                   F. James Sensenbrenner, Jr.
                                   Bob Goodlatte.
                                   Gregg Harper.