---
kind: "section"
citation: "42 U.S.C. § 300mm–22"
title: "42"
title_heading: "The Public Health and Welfare"
number: "300mm–22"
heading: "Treatment of enrolled WTC responders for WTC-related health conditions"
release: "119-102"
date: "2026-07-12"
url: "https://uscodex.org/usc/42/300mm-22"
units:
  - "Chapter 6A — Public Health Service"
  - "Subchapter XXXI — World Trade Center Health Program"
  - "Part B — Program of Monitoring, Initial Health Evaluations, and Treatment"
  - "Subpart 1 — wtc responders"
---

# §300mm–22. Treatment of enrolled WTC responders for WTC-related health conditions

- (a) **WTC-related health condition defined—**
  - (1) **In general—** For purposes of this subchapter, the term “WTC-related health condition” means a condition that—
    - (A)
      - (i) is an illness or health condition for which exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the September 11, 2001, terrorist attacks, based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of WTC-related health conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition, as determined under [paragraph (2)](#a-2); or
      - (ii) is a mental health condition for which such attacks, based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of WTC-related health conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the condition, as determined under [paragraph (2)](#a-2); and
    - (B) is included in the applicable list of WTC-related health conditions or—
      - (i) with respect to a WTC responder, is provided certification of coverage under [subsection (b)(2)(B)(iii)](#b-2-B-iii); or
      - (ii) with respect to a screening-eligible WTC survivor or certified-eligible WTC survivor, is provided certification of coverage under [subsection (b)(2)(B)(iii)](#b-2-B-iii), as applied under [section 300mm–32(a) of this title](/usc/42/300mm–32.md?p=a).

    In the case of a WTC responder described in [section 300mm–21(a)(2)(A)(ii) of this title](/usc/42/300mm–21.md?p=a-2-A-ii) (relating to a surviving immediate [family member](/usc/42/300gg–91.md?p=d-15) of a firefighter), such term does not include an illness or health condition described in [subparagraph (A)(i)](#a-1-A-i).

  - (2) **Determination—** The determination under [paragraph (1)](#a-1) or [subsection (b)](#b) of whether the September 11, 2001, terrorist attacks were substantially likely to be a significant factor in aggravating, contributing to, or causing an individual’s illness or health condition shall be made based on an assessment of the following:
    - (A) The individual’s exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the terrorist attacks. Such exposure shall be—
      - (i) evaluated and characterized through the use of a standardized, population-appropriate questionnaire approved by the [Director](/usc/42/11851.md?p=5) of the National Institute for Occupational Safety and Health; and
      - (ii) assessed and documented by a medical professional with experience in treating or diagnosing health conditions included on the list of WTC-related health conditions.
    - (B) The type of symptoms and temporal sequence of symptoms. Such symptoms shall be—
      - (i) assessed through the use of a standardized, population-appropriate medical questionnaire approved by the [Director](/usc/42/11851.md?p=5) 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)](#a-2-A-ii).
  - (3) **List of health conditions for WTC responders—** The list of health conditions for WTC responders consists of the following:
    - (A) **Aerodigestive disorders—**
      - (i) Interstitial lung diseases.
      - (ii) Chronic respiratory disorder—fumes/vapors.
      - (iii) Asthma.
      - (iv) Reactive airways dysfunction syndrome (RADS).
      - (v) WTC-exacerbated chronic obstructive pulmonary disease (COPD).
      - (vi) Chronic cough syndrome.
      - (vii) Upper airway hyperreactivity.
      - (viii) Chronic rhinosinusitis.
      - (ix) Chronic nasopharyngitis.
      - (x) Chronic laryngitis.
      - (xi) Gastroesophageal reflux disorder (GERD).
      - (xii) Sleep apnea exacerbated by or related to a condition described in a previous clause.
    - (B) **Mental health conditions—**
      - (i) Posttraumatic stress disorder (PTSD).
      - (ii) Major depressive disorder.
      - (iii) Panic disorder.
      - (iv) Generalized anxiety disorder.
      - (v) Anxiety disorder (not otherwise specified).
      - (vi) Depression (not otherwise specified).
      - (vii) Acute stress disorder.
      - (viii) Dysthymic disorder.
      - (ix) Adjustment disorder.
      - (x) Substance abuse.
    - (C) **Musculoskeletal disorders for certain WTC responders—** In the case of a WTC responder described in [paragraph (4)](#a-4), a condition described in such paragraph.
    - (D) **Additional conditions—** Any cancer (or type of cancer) or other condition added, pursuant to paragraph [(5)](#a-5) or [(6)](#a-6), to the list under this paragraph.
  - (4) **Musculoskeletal disorders—**
    - (A) **In general—** For purposes of this subchapter, in the case of a WTC responder who received any [treatment](/usc/42/11851.md?p=11) for a WTC-related musculoskeletal disorder on or before September 11, 2003, the list of health conditions in [paragraph (3)](#a-3) shall include:
      - (i) Low back pain.
      - (ii) Carpal tunnel syndrome (CTS).
      - (iii) Other musculoskeletal disorders.
    - (B) **Definition—** The term “WTC-related musculoskeletal disorder” means a chronic or recurrent disorder of the musculoskeletal system caused by heavy lifting or repetitive strain on the joints or musculoskeletal system occurring during rescue or recovery efforts in the New York City [disaster](/usc/42/5204.md?p=2) area in the aftermath of the September 11, 2001, terrorist attacks.
  - (5) **Cancer—**
    - (A) **In general—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall periodically conduct a review of all available scientific and medical evidence, including findings and recommendations of Clinical Centers of Excellence, published in peer-reviewed journals to determine if, based on such evidence, cancer or a certain type of cancer should be added to the applicable list of WTC-related health conditions. The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall conduct the first review under this subparagraph not later than 180 days after January 2, 2011.
    - (B) **Proposed regulations and rulemaking—** Based on the periodic reviews under [subparagraph (A)](#a-5-A), if the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) determines that cancer or a certain type of cancer should be added to such list of WTC-related health conditions, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall propose [regulations](/usc/42/201.md?p=d), through rulemaking, to add cancer or the certain type of cancer to such list.
    - (C) **Final regulations—** Based on all the available evidence in the rulemaking record, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall make a final determination of whether cancer or a certain type of cancer should be added to such list of WTC-related health conditions. If such a determination is made to make such an addition, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall by regulation add cancer or the certain type of cancer to such list.
    - (D) **Determinations not to add cancer or certain types of cancer—** In the case that the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) determines under subparagraph [(B)](#a-5-B) or [(C)](#a-5-C) that cancer or a certain type of cancer should not be added to such list of WTC-related health conditions, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall publish an explanation for such determination in the Federal Register. Any such determination to not make such an addition shall not preclude the addition of cancer or the certain type of cancer to such list at a later date.
  - (6) **Addition of health conditions to list for WTC responders—**
    - (A) **In general—** Whenever the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) determines that a proposed rule should be promulgated to add a health condition to the list of health conditions in [paragraph (3)](#a-3), the [Administrator](/usc/42/300bb–8.md?p=4) may request a recommendation of the [Advisory Committee](/usc/42/17061.md?p=2) or may publish such a proposed rule in the Federal Register in accordance with [subparagraph (D)](#a-6-D).
    - (B) **Administrator’s options after receipt of petition—** In the case that the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) receives a written petition by an interested party to add a health condition to the list of health conditions in [paragraph (3)](#a-3), not later than 90 days after the date of receipt of such petition the [Administrator](/usc/42/300bb–8.md?p=4) shall—
      - (i) request a recommendation of the [Advisory Committee](/usc/42/17061.md?p=2);
      - (ii) publish a proposed rule in the Federal Register to add such health condition, in accordance with [subparagraph (D)](#a-6-D);
      - (iii) publish in the Federal Register the [Administrator](/usc/42/300bb–8.md?p=4)’s determination not to publish such a proposed rule and the basis for such determination; or
      - (iv) publish in the Federal Register a determination that insufficient evidence exists to take action under clauses [(i)](#a-6-B-i) through [(iii)](#a-6-B-iii).
    - (C) **Action by Advisory Committee—** In the case that the [Administrator](/usc/42/300bb–8.md?p=4) requests a recommendation of the [Advisory Committee](/usc/42/17061.md?p=2) under this paragraph, with respect to adding a health condition to the list in [paragraph (3)](#a-3), the [Advisory Committee](/usc/42/17061.md?p=2) shall submit to the [Administrator](/usc/42/300bb–8.md?p=4) such recommendation not later than 90 days after the date of such request or by such date (not to exceed 180 days after such date of request) as specified by the [Administrator](/usc/42/300bb–8.md?p=4). Not later than 90 days after the date of receipt of such recommendation, the [Administrator](/usc/42/300bb–8.md?p=4) shall, in accordance with [subparagraph (D)](#a-6-D), publish in the Federal Register a proposed rule with respect to such recommendation or a determination not to propose such a proposed rule and the basis for such determination.
    - (D) **Publication—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall, with respect to any proposed rule under this paragraph—
      - (i) publish such proposed rule in accordance with [section 553 of title 5](/usc/5/553.md); and
      - (ii) provide interested parties a period of 30 days after such publication to submit written comments on the proposed rule.

      The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) may extend the period described in [clause (ii)](#a-6-D-ii) upon a finding of good cause. In the case of such an extension, the [Administrator](/usc/42/300bb–8.md?p=4) shall publish such extension in the Federal Register.

    - (E) **Interested party defined—** For purposes of this paragraph, the term “interested party” includes a representative of any organization representing WTC responders, a nationally recognized medical association, a Clinical or Data Center, a [State](/usc/42/201.md?p=f) or political subdivision, or any other interested person.
    - (F) **Independent peer reviews—** Prior to issuing a final rule to add a health condition to the list in [paragraph (3)](#a-3), the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall provide for an independent peer review of the scientific and technical evidence that would be the basis for issuing such final rule.
    - (G) **Additional advisory committee recommendations—**
      - (i) **Program policies—**
        - (I) **Existing policies—** Not later than 1 year after December 18, 2015, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall request the [Advisory Committee](/usc/42/17061.md?p=2) to review and evaluate the policies and procedures, in effect at the time of the review and evaluation, that are used to determine whether sufficient evidence exists to support adding a health condition to the list in [paragraph (3)](#a-3).
        - (II) **Subsequent policies—** Prior to establishing any substantive new policy or procedure used to make the determination described in [subclause (I)](#a-6-G-i-I) or prior to making any substantive amendment to any policy or procedure described in such subclause, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall request the [Advisory Committee](/usc/42/17061.md?p=2) to review and evaluate such substantive policy, procedure, or amendment.
      - (ii) **Identification of individuals conducting independent peer reviews—** Not later than 1 year after December 18, 2015, and not less than every 2 years thereafter, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall seek recommendations from the [Advisory Committee](/usc/42/17061.md?p=2) regarding the identification of individuals to conduct the independent peer reviews under [subparagraph (F)](#a-6-F).
- (b) **Coverage of treatment for WTC-related health conditions—**
  - (1) **Determination for enrolled WTC responders based on a WTC-related health condition—**
    - (A) **In general—** If a physician at a Clinical Center of Excellence that is providing monitoring benefits under [section 300mm–21 of this title](/usc/42/300mm–21.md) for an enrolled WTC responder makes a determination that the responder has a WTC-related health condition that is in the list in [subsection (a)(3)](#a-3) and that exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 1, 2001, terrorist attacks is substantially likely to be a significant factor in aggravating, contributing to, or causing the condition—
      - (i) the physician shall promptly transmit such determination to the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) and provide the [Administrator](/usc/42/300bb–8.md?p=4) with the medical facts supporting such determination; and
      - (ii) on and after the date of such transmittal and subject to [subparagraph (B)](#b-1-B), the WTC [Program](/usc/42/274l–1.md?p=4) shall provide for payment under [subsection (c)](#c) for medically necessary [treatment](/usc/42/11851.md?p=11) for such condition.
    - (B) **Review; certification; appeals—**
      - (i) **Review—** A Federal [employee](/usc/42/300gg–91.md?p=d-5) designated by the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall review determinations made under [subparagraph (A)](#b-1-A).
      - (ii) **Certification—** The [Administrator](/usc/42/300bb–8.md?p=4) shall provide a certification of such condition based upon reviews conducted under [clause (i)](#b-1-B-i). Such a certification shall be provided unless the [Administrator](/usc/42/300bb–8.md?p=4) determines that the responder’s condition is not a WTC-related health condition in the list in [subsection (a)(3)](#a-3) or that exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 1, 2001, terrorist attacks is not substantially likely to be a significant factor in aggravating, contributing to, or causing the condition.
      - (iii) **Appeal process—** The [Administrator](/usc/42/300bb–8.md?p=4) shall establish, by rule, a process for the appeal of determinations under [clause (ii)](#b-1-B-ii).
  - (2) **Determination based on medically associated WTC-related health conditions—**
    - (A) **In general—** If a physician at a Clinical Center of Excellence determines pursuant to [subsection (a)](#a) that the enrolled WTC responder has a health condition described in [subsection (a)(1)(A)](#a-1-A) that is not in the list in [subsection (a)(3)](#a-3) but which is medically associated with a WTC-related health condition—
      - (i) the physician shall promptly transmit such determination to the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) and provide the [Administrator](/usc/42/300bb–8.md?p=4) with the facts supporting such determination; and
      - (ii) the [Administrator](/usc/42/300bb–8.md?p=4) shall make a determination under [subparagraph (B)](#b-2-B) with respect to such physician’s determination.
    - (B) **Procedures for review, certification, and appeal—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall, by rule, establish procedures for the review and certification of physician determinations under [subparagraph (A)](#b-2-A). Such rule shall provide for—
      - (i) the timely review of such a determination by a physician panel with appropriate expertise for the condition and recommendations to the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4);
      - (ii) not later than 60 days after the date of the transmittal under [subparagraph (A)(i)](#b-2-A-i), a determination by the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) on whether or not the condition involved is described in [subsection (a)(1)(A)](#a-1-A) and is medically associated with a WTC-related health condition;
      - (iii) certification in accordance with [paragraph (1)(B)(ii)](#b-1-B-ii) of coverage of such condition if determined to be described in [subsection (a)(1)(A)](#a-1-A) and medically associated with a WTC-related health condition; and
      - (iv) a process for appeals of determinations relating to such conditions.
    - (C) **Inclusion in list of health conditions—** If the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) provides certification under [subparagraph (B)(iii)](#b-2-B-iii) for coverage of a condition, the [Administrator](/usc/42/300bb–8.md?p=4) may, pursuant to [subsection (a)(6)](#a-6), add the condition to the list in [subsection (a)(3)](#a-3).
    - (D) **Conditions already declined for inclusion in list—** If the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) publishes a determination under [subsection (a)(6)(B)](#a-6-B) not to include a condition in the list in [subsection (a)(3)](#a-3), the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall not provide certification under [subparagraph (B)(iii)](#b-2-B-iii) for coverage of the condition. In the case of an individual who is certified under [subparagraph (B)(iii)](#b-2-B-iii) with respect to such condition before the date of the publication of such determination the previous sentence shall not apply.
  - (3) **Requirement of medical necessity—**
    - (A) **In general—** In providing [treatment](/usc/42/11851.md?p=11) for a WTC-related health condition, a physician or other [provider](/usc/42/299b–21.md?p=8) shall provide [treatment](/usc/42/11851.md?p=11) that is medically necessary and in accordance with medical [treatment](/usc/42/11851.md?p=11) protocols established under [subsection (d)](#d).
    - (B) **Regulations relating to medical necessity—** For the purpose of this subchapter, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall issue [regulations](/usc/42/201.md?p=d) specifying a standard for determining medical necessity with respect to health [care services](/usc/42/300z–1.md?p=a-7) and prescription pharmaceuticals, a process for determining whether [treatment](/usc/42/11851.md?p=11) furnished and pharmaceuticals prescribed under this subchapter meet such standard (including any prior authorization requirement), and a process for appeal of a determination under [subsection (c)(3)](#c-3).
  - (4) **Scope of treatment covered—**
    - (A) **In general—** The scope of [treatment](/usc/42/11851.md?p=11) covered under this subsection includes [services](/usc/42/201.md?p=a) of physicians and other [health care providers](/usc/42/300aa–33.md?p=1), diagnostic and laboratory tests, prescription [drugs](/usc/42/11851.md?p=4), inpatient and outpatient [hospital](/usc/42/300s–3.md?p=1) [services](/usc/42/201.md?p=a), and other medically necessary [treatment](/usc/42/11851.md?p=11).
    - (B) **Pharmaceutical coverage—** With respect to ensuring coverage of medically necessary outpatient prescription [drugs](/usc/42/11851.md?p=4), such [drugs](/usc/42/11851.md?p=4) shall be provided, under arrangements made by the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4), directly through participating Clinical Centers of Excellence or through one or more outside vendors.
    - (C) **Transportation expenses for nationwide network—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) may provide for necessary and reasonable transportation and expenses incident to the securing of medically necessary [treatment](/usc/42/11851.md?p=11) through the nationwide network under [section 300mm–23 of this title](/usc/42/300mm–23.md) 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](/usc/42/201.md?p=a) involving travel of more than 250 miles under [regulations](/usc/42/201.md?p=d) implementing [section 7384t(c) of this title](/usc/42/7384t.md?p=c).
  - (5) **Provision of treatment pending certification—** With respect to an enrolled WTC responder for whom a determination is made by an examining physician under paragraph [(1)](#b-1) or [(2)](#b-2), but for whom the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) has not yet determined whether to certify the determination, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) may establish by rule a process through which the [Administrator](/usc/42/300bb–8.md?p=4) may approve the provision of medical [treatment](/usc/42/11851.md?p=11) under this subsection (and payment under [subsection (c)](#c)) with respect to such responder and such responder’s WTC-related health condition (under such terms and conditions as the [Administrator](/usc/42/300bb–8.md?p=4) may provide) until the [Administrator](/usc/42/300bb–8.md?p=4) makes a decision on whether to certify the determination.
- (c) **Payment for initial health evaluation, monitoring, and treatment of WTC-related health conditions—**
  - (1) **Medical treatment—**
    - (A) **Use of FECA payment rates—**
      - (i) **In general—** Subject to [clause (ii)](#c-1-A-ii):
        - (I) Subject to subparagraphs [(B)](#c-1-B) and [(C)](#c-1-C), the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall reimburse costs for medically necessary [treatment](/usc/42/11851.md?p=11) under this subchapter for WTC-related health conditions according to the payment rates that would apply to the provision of such [treatment](/usc/42/11851.md?p=11) and [services](/usc/42/201.md?p=a) by the facility under the Federal [Employees](/usc/42/300gg–91.md?p=d-5) Compensation Act.
        - (II) For [treatment](/usc/42/11851.md?p=11) not covered under subclause (i) or [subparagraph (B)](#c-1-B), the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall establish by regulation a reimbursement rate for such [treatment](/usc/42/11851.md?p=11).
      - (ii) **Exception—** In no case shall payments for products or [services](/usc/42/201.md?p=a) under [clause (i)](#c-1-A-i) be made at a rate higher than the Office of Worker’s Compensation [Programs](/usc/42/274l–1.md?p=4) in the Department[^1] Labor would pay for such products or [services](/usc/42/201.md?p=a) rendered at the time such products or [services](/usc/42/201.md?p=a) were provided.
    - (B) **Pharmaceuticals—**
      - (i) **In general—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall establish a [program](/usc/42/274l–1.md?p=4) for paying for the medically necessary outpatient prescription pharmaceuticals prescribed under this subchapter for WTC-related health conditions through one or more contracts with outside vendors.
      - (ii) **Competitive bidding—** Under such [program](/usc/42/274l–1.md?p=4) the [Administrator](/usc/42/300bb–8.md?p=4) 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](/usc/42/300gg–91.md?p=d-11) in the WTC [Program](/usc/42/274l–1.md?p=4).
      - (iii) **Treatment of FDNY participants—** Under such [program](/usc/42/274l–1.md?p=4) the [Administrator](/usc/42/300bb–8.md?p=4) may enter into an agreement with a separate vendor to provide pharmaceutical benefits to enrolled WTC responders for whom the Clinical Center of Excellence is described in [section 300mm](/usc/42/300mm.md)—[4](/usc/42/4.md) of this title if such an arrangement is deemed necessary and beneficial to the [program](/usc/42/274l–1.md?p=4) by the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4).
      - (iv) **Pharmaceuticals—** Not later than July 1, 2011, the [Comptroller General](/usc/42/300x–64.md?p=b-1) of the United States shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on whether existing Federal pharmaceutical purchasing [programs](/usc/42/274l–1.md?p=4) can provide pharmaceutical benefits more efficiently and effectively than through the WTC [program](/usc/42/274l–1.md?p=4).
    - (C) **Improving quality and efficiency through modification of payment amounts and methodologies—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) may modify the amounts and methodologies for making payments for initial health evaluations, monitoring, or [treatment](/usc/42/11851.md?p=11), if, taking into account utilization and quality data furnished by the Clinical Centers of Excellence under [section 300mm–4(b)(1)(B)(iii) of this title](/usc/42/300mm–4.md?p=b-1-B-iii), the [Administrator](/usc/42/300bb–8.md?p=4) determines that a bundling, capitation, pay for performance, or other payment methodology would better ensure high quality and efficient delivery of initial health evaluations, monitoring, or [treatment](/usc/42/11851.md?p=11) to an enrolled WTC responder, screening-eligible WTC survivor, or certified-eligible WTC survivor.
  - (2) **Monitoring and initial health evaluation—** The WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall reimburse the costs of monitoring and the costs of an initial health evaluation provided under this subchapter at a rate set by the [Administrator](/usc/42/300bb–8.md?p=4) by regulation.
  - (3) **Determination of medical necessity—**
    - (A) **Review of medical necessity and protocols—** As part of the process for reimbursement or payment under this subsection, the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4) shall provide for the review of claims for reimbursement or payment for the provision of medical [treatment](/usc/42/11851.md?p=11) to determine if such [treatment](/usc/42/11851.md?p=11) is medically necessary and in accordance with medical [treatment](/usc/42/11851.md?p=11) protocols established under [subsection (d)](#d).
    - (B) **Withholding of payment for medically unnecessary treatment—** The [Administrator](/usc/42/300bb–8.md?p=4) shall withhold such reimbursement or payment for [treatment](/usc/42/11851.md?p=11) that the [Administrator](/usc/42/300bb–8.md?p=4) determines is not medically necessary or is not in accordance with such medical [treatment](/usc/42/11851.md?p=11) protocols.
- (d) **Medical treatment protocols—**
  - (1) **Development—** The Data Centers shall develop medical [treatment](/usc/42/11851.md?p=11) protocols for the [treatment](/usc/42/11851.md?p=11) of enrolled WTC responders and certified-eligible WTC survivors for health conditions included in the applicable list of WTC-related health conditions.
  - (2) **Approval—** The medical [treatment](/usc/42/11851.md?p=11) protocols developed under [paragraph (1)](#d-1) shall be subject to approval by the WTC [Program](/usc/42/274l–1.md?p=4) [Administrator](/usc/42/300bb–8.md?p=4).

## Footnotes

[^1]: So in original. The word “of” probably should appear.

## Source credit

(July 1, 1944, ch. 373, title XXXIII, § 3312, as added Pub. L. 111–347, title I, § 101, Jan. 2, 2011, 124 Stat. 3639; amended Pub. L. 114–113, div. O, title III, § 302(e), Dec. 18, 2015, 129 Stat. 2999.)

## Notes

### Editorial Notes

### References in Text

The Federal Employees Compensation Act, referred to in subsec. (c)(1)(A)(i)(I), is act Sept. 7, 1916, ch. 458, 39 Stat. 742. The act was repealed, and the provisions thereof were reenacted as subchapter I (§ 8101 et seq.) of chapter 81 of Title 5, Government Organization and Employees, by Pub. L. 89–554, Sept. 6, 1966, 80 Stat. 378.

### Amendments

2015—Subsec. (a)(6)(B). Pub. L. 114–113, § 302(e)(1)(A), substituted “90 days” for “60 days” in introductory provisions.

Subsec. (a)(6)(C). Pub. L. 114–113, § 302(e)(1)(B), substituted “90 days” for “60 days” in two places.

Subsec. (a)(6)(F), (G). Pub. L. 114–113, § 302(e)(2), added subpars. (F) and (G).