---
kind: "range"
citation: "42 U.S.C. §§ 300mm–300mm–61"
title: "42"
from: "300mm"
to: "300mm–61"
count: 17
release: "119-102"
url: "https://uscodex.org/usc/42/300mm..300mm-61"
---

# §300mm. Establishment of World Trade Center Health Program

- (a) **In general—** There is hereby established within the Department of Health and Human [Services](/usc/42/201.md?p=a) a [program](/usc/42/274l–1.md?p=4) to be known as the World Trade Center Health [Program](/usc/42/274l–1.md?p=4), which shall be administered by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A), to provide beginning on July 1, 2011—
  - (1) medical monitoring and [treatment](/usc/42/11851.md?p=11) benefits to eligible emergency responders and recovery and cleanup workers (including those who are Federal [employees](/usc/42/300gg–91.md?p=d-5)) who responded to the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12); and
  - (2) [initial health evaluation](/usc/42/300mm–5.md?p=6), monitoring, and [treatment](/usc/42/11851.md?p=11) benefits to residents and other [building](/usc/42/6881.md?p=i-3) occupants and area workers in New York [City](/usc/42/12902.md?p=11) who were directly impacted and adversely affected by such attacks.
- (b) **Components of program—** The [WTC Program](/usc/42/300mm–5.md?p=15) includes the following components:
  - (1) **Medical monitoring for responders—** Medical monitoring under [section 300mm–21 of this title](/usc/42/300mm–21.md), including clinical examinations and long-term health monitoring and analysis for [enrolled WTC responders](/usc/42/300mm–5.md?p=4) who were likely to have been exposed to airborne toxins that were released, or to other [hazards](/usc/42/5165f.md?p=a-3), as a result of the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12).
  - (2) **Initial health evaluation for survivors—** An [initial health evaluation](/usc/42/300mm–5.md?p=6) under [section 300mm–31 of this title](/usc/42/300mm–31.md), including an evaluation to determine eligibility for followup monitoring and [treatment](/usc/42/11851.md?p=11).
  - (3) **Followup monitoring and treatment for WTC-related health conditions for responders and survivors—** Provision under sections [300mm–22](/usc/42/300mm–22.md), [300mm–32](/usc/42/300mm–32.md), and [300mm–33](/usc/42/300mm–33.md) of this title of followup monitoring and [treatment](/usc/42/11851.md?p=11) and payment, subject to the provisions of [subsection (d)](#d), for all medically necessary health and mental health care expenses of an individual with respect to a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) (including necessary prescription [drugs](/usc/42/282.md?p=j-1-A-vii)).
  - (4) **Outreach—** Establishment under [section 300mm–2 of this title](/usc/42/300mm–2.md) of an education and outreach [program](/usc/42/274l–1.md?p=4) to potentially [eligible individuals](/usc/42/239.md?p=a-6) concerning the benefits under this subchapter.
  - (5) **Clinical data collection and analysis—** Collection and analysis under [section 300mm–3 of this title](/usc/42/300mm–3.md) of health and mental health data relating to individuals receiving monitoring or [treatment](/usc/42/11851.md?p=11) benefits in a uniform manner in collaboration with the collection of epidemiological data under [section 300mm–52 of this title](/usc/42/300mm–52.md).
  - (6) **Research on health conditions—** Establishment under part C of a research [program](/usc/42/274l–1.md?p=4) on health conditions resulting from the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12).
- (c) **No cost sharing—** Monitoring and [treatment](/usc/42/11851.md?p=11) benefits and [initial health evaluation](/usc/42/300mm–5.md?p=6) benefits are provided under part B without any deductibles, copayments, or other cost sharing to an [enrolled WTC responder](/usc/42/300mm–5.md?p=4) or [certified-eligible WTC survivor](/usc/42/300mm–5.md?p=2). [Initial health evaluation](/usc/42/300mm–5.md?p=6) benefits are provided under part B without any deductibles, copayments, or other cost sharing to a [screening-eligible WTC survivor](/usc/42/300mm–31.md?p=a-1-A).
- (d) **Preventing fraud and unreasonable administrative costs—**
  - (1) **Fraud—** The Inspector General of the Department of Health and Human [Services](/usc/42/201.md?p=a) shall develop and implement a [program](/usc/42/274l–1.md?p=4) to review the [WTC Program](/usc/42/300mm–5.md?p=15)’s health care expenditures to detect fraudulent or duplicate billing and payment for inappropriate [services](/usc/42/201.md?p=a). This subchapter is a Federal health care [program](/usc/42/274l–1.md?p=4) (as defined in [section 1320a–7b(f) of this title](/usc/42/1320a–7b.md?p=f)) and is a [health plan](/usc/42/300jj.md?p=6) (as defined in [section 1320a–7c(c) of this title](/usc/42/1320a–7c.md?p=c)) for purposes of applying [sections 1320a–7 through 1320a–7e](/usc/42/1320a–7..1320a–7e.md) of this title.
  - (2) **Unreasonable administrative costs—** The Inspector General of the Department of Health and Human [Services](/usc/42/201.md?p=a) shall develop and implement a [program](/usc/42/274l–1.md?p=4) to review the [WTC Program](/usc/42/300mm–5.md?p=15) for unreasonable administrative costs, including with respect to infrastructure, administration, and [claims](/usc/42/1320a–7a.md?p=i-2) processing.
- (e) **Quality assurance—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) working with the Clinical Centers of Excellence shall develop and implement a quality assurance [program](/usc/42/274l–1.md?p=4) for the monitoring and [treatment](/usc/42/11851.md?p=11) delivered by such Centers of Excellence and any other participating [health care providers](/usc/42/300jj.md?p=3). Such [program](/usc/42/274l–1.md?p=4) shall include—
  - (1) adherence to monitoring and [treatment](/usc/42/11851.md?p=11) protocols;
  - (2) appropriate diagnostic and [treatment](/usc/42/11851.md?p=11) referrals for [participants](/usc/42/300gg–91.md?p=d-11);
  - (3) prompt communication of test results to [participants](/usc/42/300gg–91.md?p=d-11); and
  - (4) such other elements as the [Administrator](/usc/42/4005.md?p=1) specifies in consultation with the Clinical Centers of Excellence.
- (f) **Annual program report—**
  - (1) **In general—** Not later than 6 months after the end of each fiscal year in which the [WTC Program](/usc/42/300mm–5.md?p=15) is in operation, the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall submit an annual report to the Congress on the operations of this subchapter for such fiscal year and for the entire period of operation of the [program](/usc/42/274l–1.md?p=4).
  - (2) **Contents included in report—** Each annual report under [paragraph (1)](#f-1) shall include at least the following:
    - (A) **Eligible individuals—** Information for each clinical [program](/usc/42/274l–1.md?p=4) described in [paragraph (3)](#f-3)—
      - (i) on the number of individuals who applied for certification under part B and the number of such individuals who were so certified;
      - (ii) of the individuals who were certified, on the number who received monitoring under the [program](/usc/42/274l–1.md?p=4) and the number of such individuals who received medical [treatment](/usc/42/11851.md?p=11) under the [program](/usc/42/274l–1.md?p=4);
      - (iii) with respect to individuals so certified who received such [treatment](/usc/42/11851.md?p=11), on the [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) for which they were treated; and
      - (iv) on the projected number of individuals who will be certified under part B in the succeeding fiscal year and the succeeding 10-year period.
    - (B) **Monitoring, initial health evaluation, and treatment costs—** For each clinical [program](/usc/42/274l–1.md?p=4) so described—
      - (i) information on the costs of monitoring and [initial health evaluation](/usc/42/300mm–5.md?p=6) and the costs of [treatment](/usc/42/11851.md?p=11) and on the estimated costs of such monitoring, evaluation, and [treatment](/usc/42/11851.md?p=11) in the succeeding fiscal year; and
      - (ii) an estimate of the cost of medical [treatment](/usc/42/11851.md?p=11) for [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) that have been paid for or reimbursed by workers’ compensation, by public or private [health plans](/usc/42/300jj.md?p=6), or by New York [City](/usc/42/12902.md?p=11) under [section 300mm–41 of this title](/usc/42/300mm–41.md).
    - (C) **Administrative costs—** Information on the cost of administering the [program](/usc/42/274l–1.md?p=4), including costs of [program](/usc/42/274l–1.md?p=4) support, data collection and analysis, and research conducted under the [program](/usc/42/274l–1.md?p=4).
    - (D) **Administrative experience—** Information on the administrative performance of the [program](/usc/42/274l–1.md?p=4), including—
      - (i) the performance of the [program](/usc/42/274l–1.md?p=4) in providing timely evaluation of and [treatment](/usc/42/11851.md?p=11) to [eligible individuals](/usc/42/239.md?p=a-6); and
      - (ii) a list of the Clinical Centers of Excellence and other providers that are participating in the [program](/usc/42/274l–1.md?p=4).
    - (E) **Scientific reports—** A summary of the findings of any new scientific reports or studies on the health effects associated with exposure described in [section 300mm–5(1) of this title](/usc/42/300mm–5.md?p=1), including the findings of research conducted under subsection (a) or (c) of [section 300mm–51 of this title](/usc/42/300mm–51.md).
    - (F) **Advisory Committee recommendations—** A list of recommendations by the [WTC Scientific/Technical Advisory Committee](/usc/42/300mm–5.md?p=19) on additional [WTC Program](/usc/42/300mm–5.md?p=15) eligibility criteria and on additional [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) and the action of the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) concerning each such recommendation.
  - (3) **Separate clinical programs described—** In [paragraph (2)](#f-2), each of the following shall be treated as a separate clinical [program](/usc/42/274l–1.md?p=4) of the [WTC Program](/usc/42/300mm–5.md?p=15):
    - (A) **Firefighters and related personnel—** The benefits provided for [enrolled WTC responders](/usc/42/300mm–5.md?p=4) described in [section 300mm–21(a)(2)(A) of this title](/usc/42/300mm–21.md?p=a-2-A).
    - (B) **Other WTC responders—** The benefits provided for [enrolled WTC responders](/usc/42/300mm–5.md?p=4) not described in [subparagraph (A)](#f-3-A).
    - (C) **WTC survivors—** The benefits provided for [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A) and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) in [section 300mm–31(a) of this title](/usc/42/300mm–31.md?p=a).
- (g) **Notification to Congress upon reaching 80 percent of eligibility numerical limits—** The [Secretary](/usc/42/201.md?p=c) shall promptly notify the Congress of each of the following:
  - (1) When the number of enrollments of [WTC responders](/usc/42/300mm–21.md?p=a-1) subject to the limit established under [section 300mm–21(a)(4) of this title](/usc/42/300mm–21.md?p=a-4) has reached 80 percent of such limit.
  - (2) When the number of certifications for [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) subject to the limit established under [section 300mm–31(a)(3) of this title](/usc/42/300mm–31.md?p=a-3) has reached 80 percent of such limit.
- (h) **Consultation—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall engage in ongoing outreach and consultation with relevant stakeholders, including the [WTC Health Program Steering Committees](/usc/42/300mm–5.md?p=14) and the [Advisory Committee](/usc/42/7703.md?p=9) under [section 300mm–1 of this title](/usc/42/300mm–1.md), regarding the implementation and improvement of [programs](/usc/42/274l–1.md?p=4) under this subchapter.
- (i) **GAO studies—**
  - (1) **Report—** Not later than 18 months after December 18, 2015, the Comptroller General of the [United States](/usc/42/403.md?p=k) shall submit to the Committee on [Energy](/usc/42/6311.md?p=7) and [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5) and the Committee on Health, Education, Labor, and Pensions of the Senate a report that assesses, with respect to the [WTC Program](/usc/42/300mm–5.md?p=15), the effectiveness of each of the following:
    - (A) The quality assurance [program](/usc/42/274l–1.md?p=4) developed and implemented under [subsection (e)](#e).
    - (B) The procedures for providing certifications of coverage of conditions as [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) for [enrolled WTC responders](/usc/42/300mm–5.md?p=4) under [section 300mm–22(b)(2)(B)(iii) of this title](/usc/42/300mm–22.md?p=b-2-B-iii) and for [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A) and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) under such section as applied under [section 300mm–32(a) of this title](/usc/42/300mm–32.md?p=a).
    - (C) Any action under the [WTC Program](/usc/42/300mm–5.md?p=15) to ensure appropriate payment (including the avoidance of improper payments), including determining the extent to which individuals enrolled in the [WTC Program](/usc/42/300mm–5.md?p=15) are eligible for workers compensation or sources of health coverage, ascertaining the liability of such compensation or sources of health coverage, and making recommendations for ensuring effective and efficient coordination of benefits for individuals enrolled in the [WTC Program](/usc/42/300mm–5.md?p=15) that does not place an undue burden on such individuals.
  - (2) **Subsequent assessments—** Not later than 6 years and 6 months after December 18, 2015, and every 5 years thereafter through fiscal year 2042, the Comptroller General of the [United States](/usc/42/403.md?p=k) shall—
    - (A) consult the Committee on [Energy](/usc/42/6311.md?p=7) and [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5) and the Committee on Health, Education, Labor, and Pensions of the Senate on the objectives in assessing the [WTC Program](/usc/42/300mm–5.md?p=15); and
    - (B) prepare and submit to such Committees a report that assesses the [WTC Program](/usc/42/300mm–5.md?p=15) for the applicable reporting period, including the objectives described in [subparagraph (A)](#i-2-A).
- (j) **Regulations—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) is authorized to promulgate such [regulations](/usc/42/201.md?p=d) as the [Administrator](/usc/42/4005.md?p=1) determines necessary to administer this subchapter.
- (k) **Termination—** The [WTC Program](/usc/42/300mm–5.md?p=15) shall terminate on October 1, 2090.

# §300mm–1. WTC Health Program Scientific/Technical Advisory Committee; WTC Health Program Steering Committees

- (a) **Advisory Committee—**
  - (1) **Establishment—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall establish an [advisory committee](/usc/42/7703.md?p=9) to be known as the WTC Health [Program](/usc/42/274l–1.md?p=4) Scientific/[Technical Advisory Committee](/usc/42/16121.md?p=5) (in this subsection referred to as the “[Advisory Committee](/usc/42/7703.md?p=9)”) to review scientific and medical evidence and to make recommendations to the [Administrator](/usc/42/4005.md?p=1) on additional [WTC Program](/usc/42/300mm–5.md?p=15) eligibility criteria and on additional [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1).
  - (2) **Composition—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall appoint the members of the [Advisory Committee](/usc/42/7703.md?p=9) and shall include at least—
    - (A) 4 occupational [physicians](/usc/42/1395cc–4.md?p=a-2-E), at least 2 of whom have experience treating WTC rescue and recovery workers;
    - (B) 1 [physician](/usc/42/1320a–7h.md?p=e-11) with expertise in pulmonary medicine;
    - (C) 2 environmental medicine or environmental health specialists;
    - (D) 2 [representatives](/usc/42/3058f.md?p=5) of [WTC responders](/usc/42/300mm–21.md?p=a-1);
    - (E) 2 [representatives](/usc/42/3058f.md?p=5) of [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2);
    - (F) an industrial hygienist;
    - (G) a toxicologist;
    - (H) an epidemiologist; and
    - (I) a mental health professional.
  - (3) **Meetings—** The [Advisory Committee](/usc/42/7703.md?p=9) shall meet at such frequency as may be required to carry out its duties.
  - (4) **Reports—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide for publication of recommendations of the [Advisory Committee](/usc/42/7703.md?p=9) on the public Web site established for the [WTC Program](/usc/42/300mm–5.md?p=15).
  - (5) **Duration—** Notwithstanding any other provision of law, the [Advisory Committee](/usc/42/7703.md?p=9) shall continue in operation during the period in which the [WTC Program](/usc/42/300mm–5.md?p=15) is in operation.
  - (6) **Application of chapter 10 of title 5—** Except as otherwise specifically provided, the [Advisory Committee](/usc/42/7703.md?p=9) shall be subject to Chapter[^1] 10 of [title 5](/usc/5.md).
- (b) **WTC Health Program Steering Committees—**
  - (1) **Consultation—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall consult with 2 steering committees (each in this section referred to as a “Steering Committee”) that are established as follows:
    - (A) **WTC Responders Steering Committee—** One Steering Committee, to be known as the [WTC Responders](/usc/42/300mm–21.md?p=a-1) Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of monitoring and [treatment](/usc/42/11851.md?p=11) [programs](/usc/42/274l–1.md?p=4) for the [enrolled WTC responders](/usc/42/300mm–5.md?p=4) under subpart 1 of part B.
    - (B) **WTC Survivors Steering Committee—** One Steering Committee, to be known as the WTC Survivors Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of [initial health evaluations](/usc/42/300mm–5.md?p=6), monitoring, and [treatment](/usc/42/11851.md?p=11) [programs](/usc/42/274l–1.md?p=4) for screening-eligible and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) under subpart 2 of part B.
  - (2) **Membership—**
    - (A) **WTC Responders Steering Committee—**
      - (i) **Representation—** The [WTC Responders](/usc/42/300mm–21.md?p=a-1) Steering Committee shall include—
        - (I) [representatives](/usc/42/3058f.md?p=5) of the Centers of Excellence providing [services](/usc/42/201.md?p=a) to [WTC responders](/usc/42/300mm–21.md?p=a-1);
        - (II) [representatives](/usc/42/3058f.md?p=5) of [labor organizations](/usc/42/2000ff.md?p=2-C) representing firefighters, police, other New York [City](/usc/42/12902.md?p=11) [employees](/usc/42/300gg–91.md?p=d-5), and recovery and cleanup workers who responded to the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12); and
        - (III) 3 [representatives](/usc/42/3058f.md?p=5) of New York [City](/usc/42/12902.md?p=11), 1 of whom will be selected by the police [commissioner](/usc/42/12302.md?p=1) of New York [City](/usc/42/12902.md?p=11), 1 by the health [commissioner](/usc/42/12302.md?p=1) of New York [City](/usc/42/12902.md?p=11), and 1 by the mayor of New York [City](/usc/42/12902.md?p=11).
      - (ii) **Initial membership—** The [WTC Responders](/usc/42/300mm–21.md?p=a-1) Steering Committee shall initially be composed of members of the WTC Monitoring and [Treatment](/usc/42/11851.md?p=11) [Program](/usc/42/274l–1.md?p=4) Steering Committee (as in existence on the day before January 2, 2011).
    - (B) **WTC Survivors Steering Committee—**
      - (i) **Representation—** The WTC Survivors Steering Committee shall include [representatives](/usc/42/3058f.md?p=5) of—
        - (I) the Centers of Excellence providing [services](/usc/42/201.md?p=a) to screening-eligible and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2);
        - (II) the population of residents, students, and area and other workers affected by the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12);
        - (III) screening-eligible and certified-eligible survivors receiving [initial health evaluations](/usc/42/300mm–5.md?p=6), monitoring, or [treatment](/usc/42/11851.md?p=11) under subpart 2 of part B and organizations advocating on their behalf; and
        - (IV) New York [City](/usc/42/12902.md?p=11).
      - (ii) **Initial membership—** The WTC Survivors Steering Committee shall initially be composed of members of the WTC Environmental Health Center Survivor [Advisory Committee](/usc/42/7703.md?p=9) (as in existence on the day before January 2, 2011).
    - (C) **Additional appointments—** Each Steering Committee may recommend, if approved by a majority of voting members of the Committee, additional members to the Committee.
    - (D) **Vacancies—** A vacancy in a Steering Committee shall be filled by an individual recommended by the Steering Committee.

# §300mm–2. Education and outreach


The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall institute a [program](/usc/42/274l–1.md?p=4) that provides education and outreach on the existence and availability of [services](/usc/42/201.md?p=a) under the [WTC Program](/usc/42/300mm–5.md?p=15). The outreach and education [program](/usc/42/274l–1.md?p=4)—

- (1) shall include—
  - (A) the establishment of a public Web site with information about the [WTC Program](/usc/42/300mm–5.md?p=15);
  - (B) meetings with potentially eligible populations;
  - (C) development and dissemination of outreach materials informing people about the [program](/usc/42/274l–1.md?p=4); and
  - (D) the establishment of phone information [services](/usc/42/201.md?p=a); 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.

# §300mm–3. Uniform data collection and analysis

- (a) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide for the uniform collection of data, including [claims](/usc/42/1320a–7a.md?p=i-2) data (and analysis of data and regular reports to the [Administrator](/usc/42/4005.md?p=1)) on the prevalence of [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) and the identification of new [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1). Such data shall be collected for all individuals provided monitoring or [treatment](/usc/42/11851.md?p=11) benefits under part B and regardless of their place of residence or [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) through which the benefits are provided. The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide, through the [Data Centers](/usc/42/300mm–4.md?p=b-2) or otherwise, for the integration of such data into the monitoring and [treatment](/usc/42/11851.md?p=11) [program](/usc/42/274l–1.md?p=4) activities under this subchapter.
- (b) **Coordinating through Centers of Excellence—** Each [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) shall collect data described in [subsection (a)](#a) and report such data to the corresponding [Data Center](/usc/42/300mm–4.md?p=b-2) for analysis by such [Data Center](/usc/42/300mm–4.md?p=b-2).
- (c) **Collaboration with WTC Health Registry—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide for collaboration between the [Data Centers](/usc/42/300mm–4.md?p=b-2) and the World Trade Center Health [Registry](/usc/42/6341.md?p=6) described in [section 300mm–52 of this title](/usc/42/300mm–52.md).
- (d) **Privacy—** The data collection and analysis under this section shall be conducted and maintained in a manner that protects the confidentiality of [individually identifiable health information](/usc/42/247d–11.md?p=g-1) consistent with applicable statutes and [regulations](/usc/42/201.md?p=d), including, as applicable, HIPAA privacy and security law (as defined in [section 300jj–19(a)(2) of this title](/usc/42/300jj–19.md?p=a-2)) and [section 552a of title 5](/usc/5/552a.md).

# §300mm–4. Clinical Centers of Excellence and Data Centers

- (a) **In general—**
  - (1) **Contracts with Clinical Centers of Excellence—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall, subject to [subsection (b)(1)(B)](#b-1-B), enter into contracts with Clinical Centers of Excellence (as defined in [subsection (b)(1)(A)](#b-1-A))—
    - (A) for the provision of monitoring and [treatment](/usc/42/11851.md?p=11) benefits and [initial health evaluation](/usc/42/300mm–5.md?p=6) benefits under part B;
    - (B) for the provision of outreach and retention activities to individuals eligible for such monitoring and [treatment](/usc/42/11851.md?p=11) benefits, for [initial health evaluation](/usc/42/300mm–5.md?p=6) benefits, and for followup to individuals who are enrolled in the monitoring [program](/usc/42/274l–1.md?p=4);
    - (C) for the provision of counseling for benefits under part B, with respect to [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1), for individuals eligible for such benefits;
    - (D) for the provision of counseling for benefits for [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) that may be available under workers’ compensation or other benefit [programs](/usc/42/274l–1.md?p=4) for work-related injuries or illnesses, health insurance, disability insurance, or other insurance plans or through public or private social [service](/usc/42/201.md?p=a) agencies and assisting [eligible individuals](/usc/42/239.md?p=a-6) in applying for such benefits;
    - (E) for the provision of translational and interpretive [services](/usc/42/201.md?p=a) for [program](/usc/42/274l–1.md?p=4) [participants](/usc/42/300gg–91.md?p=d-11) who are not English language proficient; and
    - (F) for the collection and reporting of data, including [claims](/usc/42/1320a–7a.md?p=i-2) data, in accordance with [section 300mm–3 of this title](/usc/42/300mm–3.md).
  - (2) **Contracts with Data Centers—**
    - (A) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall enter into contracts with one or more [Data Centers](#b-2) (as defined in [subsection (b)(2)](#b-2))—
      - (i) for receiving, analyzing, and reporting to the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) on data, in accordance with [section 300mm–3 of this title](/usc/42/300mm–3.md), that have been collected and reported to such [Data Centers](#b-2) by the corresponding Clinical Centers of Excellence under [subsection (b)(1)(B)(iii)](#b-1-B-iii);
      - (ii) for the development of monitoring, [initial health evaluation](/usc/42/300mm–5.md?p=6), and [treatment](/usc/42/11851.md?p=11) protocols, with respect to [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1);
      - (iii) for coordinating the outreach and retention activities conducted under [paragraph (1)(B)](#a-1-B) by each corresponding [Clinical Center of Excellence](#b-1-A);
      - (iv) for establishing criteria for the credentialing of medical providers participating in the nationwide network under [section 300mm–23 of this title](/usc/42/300mm–23.md);
      - (v) for coordinating and administering the activities of the [WTC Health Program Steering Committees](/usc/42/300mm–5.md?p=14) established under [section 300mm–1(b)](/usc/42/300mm–1.md?p=b)[^1] of this title; and
      - (vi) for meeting periodically with the corresponding Clinical Centers of Excellence to obtain input on the analysis and reporting of data collected under [clause (i)](#a-2-A-i) and on the development of monitoring, [initial health evaluation](/usc/42/300mm–5.md?p=6), and [treatment](/usc/42/11851.md?p=11) protocols under [clause (ii)](#a-2-A-ii).
    - (B) **Medical provider selection—** The medical providers under [subparagraph (A)(iv)](#a-2-A-iv) shall be selected by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) on the basis of their experience treating or diagnosing the health conditions included in the [list of WTC-related health conditions](/usc/42/300mm–5.md?p=7).
    - (C) **Clinical discussions—** In carrying out [subparagraph (A)(ii)](#a-2-A-ii), a [Data Center](#b-2) shall engage in clinical discussions across the [WTC Program](/usc/42/300mm–5.md?p=15) to guide [treatment](/usc/42/11851.md?p=11) approaches for individuals with a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1).
    - (D) **Transparency of data—** A contract entered into under this subsection with a [Data Center](#b-2) shall require the [Data Center](#b-2) to make any data collected and reported to such Center under [subsection (b)(1)(B)(iii)](#b-1-B-iii) available to health researchers and others as provided in the CDC/ATSDR Policy on Releasing and Sharing Data.
  - (3) **Authority for contracts to be class specific—** A contract entered into under this subsection with a [Clinical Center of Excellence](#b-1-A) or a [Data Center](#b-2) may be with respect to one or more class of [enrolled WTC responders](/usc/42/300mm–5.md?p=4), [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A), or [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2).
  - (4) **Use of cooperative agreements—** Any contract under this subchapter between the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) and a [Data Center](#b-2) or a [Clinical Center of Excellence](#b-1-A) may be in the form of a cooperative [agreement](/usc/42/1320b–8.md?p=a-3-A).
  - (5) **Review on feasibility of consolidating Data Centers—** Not later than July 1, 2011, the Comptroller General of the [United States](/usc/42/403.md?p=k) shall submit to the Committee on [Energy](/usc/42/6311.md?p=7) and [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5) and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the feasibility of consolidating [Data Centers](#b-2) into a [single](/usc/42/2304.md?p=m) [Data Center](#b-2).
- (b) **Centers of Excellence—**
  - (1) **Clinical Centers of Excellence—**
    - (A) **Definition—** For purposes of this subchapter, the term “Clinical Center of Excellence” means a Center that demonstrates to the satisfaction of the [Administrator](/usc/42/4005.md?p=1) that the Center—
      - (i) uses an integrated, centralized [health care provider](/usc/42/300jj.md?p=3) approach to create a comprehensive suite of health [services](/usc/42/201.md?p=a) under this subchapter that are accessible to [enrolled WTC responders](/usc/42/300mm–5.md?p=4), [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A), or [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2);
      - (ii) has experience in caring for [WTC responders](/usc/42/300mm–21.md?p=a-1) and [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A) or includes [health care providers](/usc/42/300jj.md?p=3) who have been trained pursuant to [section 300mm–23(c) of this title](/usc/42/300mm–23.md?p=c);
      - (iii) employs [health care provider](/usc/42/300jj.md?p=3) staff with expertise that includes, at a minimum, occupational medicine, environmental medicine, trauma-related psychiatry and psychology, and social [services](/usc/42/201.md?p=a) counseling; and
      - (iv) meets such other requirements as specified by the [Administrator](/usc/42/4005.md?p=1).
    - (B) **Contract requirements—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall not enter into a contract with a [Clinical Center of Excellence](#b-1-A) under [subsection (a)(1)](#a-1) unless the Center agrees to do each of the following:
      - (i) Establish a formal mechanism for consulting with and receiving input from [representatives](/usc/42/3058f.md?p=5) of eligible populations receiving monitoring and [treatment](/usc/42/11851.md?p=11) benefits under part B from such Center.
      - (ii) Coordinate monitoring and [treatment](/usc/42/11851.md?p=11) benefits under part B with routine [medical care](/usc/42/300gg–91.md?p=a-2) provided for the [treatment](/usc/42/11851.md?p=11) of conditions other than [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1).
      - (iii) Collect and report to the corresponding [Data Center](#b-2) data, including [claims](/usc/42/1320a–7a.md?p=i-2) data, in accordance with [section 300mm–3(b) of this title](/usc/42/300mm–3.md?p=b).
      - (iv) Have in place safeguards against fraud that are satisfactory to the [Administrator](/usc/42/4005.md?p=1), in consultation with the Inspector General of the Department of Health and Human [Services](/usc/42/201.md?p=a).
      - (v) Treat or refer for [treatment](/usc/42/11851.md?p=11) all individuals who are [enrolled WTC responders](/usc/42/300mm–5.md?p=4) or [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) with respect to such Center who present themselves for [treatment](/usc/42/11851.md?p=11) of a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1).
      - (vi) Have in place safeguards, consistent with [section 300mm–3(d) of this title](/usc/42/300mm–3.md?p=d), to ensure the confidentiality of an individual’s [individually identifiable health information](/usc/42/247d–11.md?p=g-1), including requiring that such information not be disclosed to the individual’s [employer](/usc/42/300gg–91.md?p=d-6) without the [authorization](/usc/42/4370m.md?p=3) of the individual.
      - (vii) Use amounts paid under [subsection (c)(1)](#c-1) only for costs incurred in carrying out the activities described in [subsection (a)](#a), other than those described in [subsection (a)(1)(A)](#a-1-A).
      - (viii) Utilize [health care providers](/usc/42/300jj.md?p=3) with occupational and environmental medicine expertise to conduct physical and mental health assessments, in accordance with protocols developed under [subsection (a)(2)(A)(ii)](#a-2-A-ii).
      - (ix) Communicate with [WTC responders](/usc/42/300mm–21.md?p=a-1) and screening-eligible and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) in appropriate languages and conduct outreach activities with relevant stakeholder worker or community associations.
      - (x) Meet all the other applicable requirements of this subchapter, including [regulations](/usc/42/201.md?p=d) implementing such requirements.
    - (C) **Transition rule to ensure continuity of care—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall to the maximum extent feasible ensure continuity of care in any period of transition from monitoring and [treatment](/usc/42/11851.md?p=11) of an [enrolled WTC responder](/usc/42/300mm–5.md?p=4) or [certified-eligible WTC survivor](/usc/42/300mm–5.md?p=2) by a provider to a [Clinical Center of Excellence](#b-1-A) or a [health care provider](/usc/42/300jj.md?p=3) participating in the nationwide network under [section 300mm–23 of this title](/usc/42/300mm–23.md).
  - (2) **Data Centers—** For purposes of this subchapter, the term “Data Center” means a Center that the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) determines has the capacity to carry out the responsibilities for a Data Center under [subsection (a)(2)](#a-2).
  - (3) **Corresponding centers—** For purposes of this subchapter, a [Clinical Center of Excellence](#b-1-A) and a [Data Center](#b-2) shall be treated as “corresponding” to the extent that such Clinical Center and [Data Center](#b-2) serve the same population group.
- (c) **Payment for infrastructure costs—**
  - (1) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall reimburse a [Clinical Center of Excellence](#b-1-A) for the [fixed infrastructure costs](#c-2) of such Center in carrying out the activities described in part B at a rate negotiated by the [Administrator](/usc/42/4005.md?p=1) and such Centers. Such negotiated rate shall be fair and appropriate and take into account the number of [enrolled WTC responders](/usc/42/300mm–5.md?p=4) receiving [services](/usc/42/201.md?p=a) from such Center under this subchapter.
  - (2) **Fixed infrastructure costs—** For purposes of [paragraph (1)](#c-1), the term “fixed infrastructure costs” means, with respect to a [Clinical Center of Excellence](#b-1-A), the costs incurred by such Center that are not otherwise reimbursable by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) under [section 300mm–22(c) of this title](/usc/42/300mm–22.md?p=c) for patient evaluation, monitoring, or [treatment](/usc/42/11851.md?p=11) but which are needed to operate the [WTC program](/usc/42/300mm–5.md?p=15) such as the costs involved in outreach to [participants](/usc/42/300gg–91.md?p=d-11) or recruiting [participants](/usc/42/300gg–91.md?p=d-11), data collection and analysis, social [services](/usc/42/201.md?p=a) for counseling patients on other available assistance outside the [WTC program](/usc/42/300mm–5.md?p=15), and the development of [treatment](/usc/42/11851.md?p=11) protocols. Such term does not include costs for new [construction](/usc/42/7479.md?p=2-C) or other capital costs.
- (d) **GAO analysis—** Not later than July 1, 2011, the Comptroller General shall submit to the Committee on [Energy](/usc/42/6311.md?p=7) and [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5) and the Committee on Health, Education, Labor, and Pensions of the Senate an analysis on whether Clinical Centers of Excellence with which the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) enters into a contract under this section have financial systems that will allow for the timely submission of [claims](/usc/42/1320a–7a.md?p=i-2) data for purposes of [section 300mm–3 of this title](/usc/42/300mm–3.md) and subsections [(a)(1)(F)](#a-1-F) and [(b)(1)(B)(iii)](#b-1-B-iii).

# §300mm–5. Definitions


In this subchapter:

- (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](/usc/42/5165f.md?p=a-3), or any other adverse condition resulting from the [September 11, 2001, terrorist attacks](#12), requires medical [treatment](/usc/42/11851.md?p=11) that is (or will be) in addition to, more frequent than, or of longer duration than the medical [treatment](/usc/42/11851.md?p=11) that would have been required for such condition in the absence of such exposure.
- (2) The term “certified-eligible WTC survivor” has the meaning given such term in [section 300mm–31(a)(2) of this title](/usc/42/300mm–31.md?p=a-2).
- (3) The terms “[Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A)” and “[Data Center](/usc/42/300mm–4.md?p=b-2)” have the meanings given such terms in [section 300mm–4 of this title](/usc/42/300mm–4.md).
- (4) The term “enrolled WTC responder” means a [WTC responder](/usc/42/300mm–21.md?p=a-1) enrolled under [section 300mm–21(a)(3) of this title](/usc/42/300mm–21.md?p=a-3).
- (5) The term “Federal agency” means an agency, [office](/usc/42/3058f.md?p=1), or other establishment in the executive, legislative, or judicial branch of the Federal Government.
- (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](/usc/42/300mm–22.md?p=a-1) and is eligible for [treatment](/usc/42/11851.md?p=11) under the [WTC Program](#15).
- (7) The term “list of WTC-related health conditions” means—
  - (A) for [WTC responders](/usc/42/300mm–21.md?p=a-1), the health conditions listed in [section 300mm–22(a)(3) of this title](/usc/42/300mm–22.md?p=a-3); and
  - (B) for screening-eligible and [certified-eligible WTC survivors](#2), the health conditions listed in [section 300mm–32(b) of this title](/usc/42/300mm–32.md?p=b).
- (8) The term “New York City disaster area” means the area within New York [City](/usc/42/12902.md?p=11) 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.
- (9) The term “New York metropolitan area” means an area, specified by the [WTC Program Administrator](#16-A), within which [WTC responders](/usc/42/300mm–21.md?p=a-1) and eligible WTC screening-eligible survivors who reside in such area are reasonably able to access monitoring and [treatment](/usc/42/11851.md?p=11) benefits and [initial health evaluation](#6) benefits under this subchapter through a [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) described in subparagraphs (A), (B), or (C) of [section 300mm–4(b)(1) of this title](/usc/42/300mm–4.md?p=b-1).
- (10) The term “[screening-eligible WTC survivor](/usc/42/300mm–31.md?p=a-1-A)” has the meaning given such term in [section 300mm–31(a)(1) of this title](/usc/42/300mm–31.md?p=a-1).
- (11) Any reference to “September 11, 2001” shall be deemed a reference to the period on such date subsequent to the terrorist attacks at the World Trade Center, Shanksville, Pennsylvania, or the Pentagon, as applicable, on such date.
- (12) The term “September 11, 2001, terrorist attacks” means the terrorist attacks that occurred on September 11, 2001, in New York [City](/usc/42/12902.md?p=11), in Shanksville, Pennsylvania, and at the Pentagon, and includes the aftermath of such attacks.
- (13) The term “uniformed services” has the meaning given the term in [section 101(a) of title 10](/usc/10/101.md?p=a).
- (14) The term “WTC Health Program Steering Committee” means such a Steering Committee established under [section 300mm–1(b) of this title](/usc/42/300mm–1.md?p=b).
- (15) The term “WTC Program” means the Word Trade Center Health [Program](/usc/42/274l–1.md?p=4) established under [section 300mm(a) of this title](/usc/42/300mm.md?p=a).
- (16)
  - (A) The term “WTC Program Administrator” means—
    - (i) subject to [subparagraph (B)](#16-B), with respect to paragraphs (3) and (4) of [section 300mm–21(a) of this title](/usc/42/300mm–21.md?p=a) (relating to enrollment of [WTC responders](/usc/42/300mm–21.md?p=a-1)), [section 300mm–22(c) of this title](/usc/42/300mm–22.md?p=c) and the corresponding provisions of [section 300mm–32 of this title](/usc/42/300mm–32.md) (relating to payment for [initial health evaluation](#6), monitoring, and [treatment](/usc/42/11851.md?p=11),[^1] paragraphs (1)(C), (2)(B), and (3) of [section 300mm–31(a) of this title](/usc/42/300mm–31.md?p=a) (relating to determination or certification of screening-eligible or certified-eligible [WTC responders](/usc/42/300mm–21.md?p=a-1)), and subpart 3 of part B (relating to payor provisions), an official in the Department of Health and Human [Services](/usc/42/201.md?p=a), to be designated by the [Secretary](/usc/42/201.md?p=c); and
    - (ii) with respect to any other provision of this subchapter, the [Director](/usc/42/5061.md?p=1) of the National Institute for Occupational Safety and Health, or a designee of such [Director](/usc/42/5061.md?p=1).
  - (B) In no case may the [Secretary](/usc/42/201.md?p=c) designate under [subparagraph (A)(i)](#16-A-i) the [Director](/usc/42/5061.md?p=1) of the National Institute for Occupational Safety and Health or a designee of such [Director](/usc/42/5061.md?p=1) with respect to [section 300mm–32 of this title](/usc/42/300mm–32.md) (relating to payment for [initial health evaluation](#6), monitoring, and [treatment](/usc/42/11851.md?p=11)).
- (17) The term “[WTC-related health condition](/usc/42/300mm–22.md?p=a-1)” is defined in [section 300mm–22(a) of this title](/usc/42/300mm–22.md?p=a).
- (18) The term “[WTC responder](/usc/42/300mm–21.md?p=a-1)” is defined in [section 300mm–21(a) of this title](/usc/42/300mm–21.md?p=a).
- (19) The term “WTC Scientific/Technical Advisory Committee” means such Committee established under [section 300mm–1(a) of this title](/usc/42/300mm–1.md?p=a).

# §300mm–21. Identification of WTC responders and provision of WTC-related monitoring services

- (a) **WTC responder defined—**
  - (1) **In general—** For purposes of this subchapter, the term “WTC responder” means any of the following individuals, subject to [paragraph (4)](#a-4):
    - (A) **Currently identified responder—** An individual who has been identified as eligible for monitoring under the arrangements as in effect on January 2, 2011, between the National Institute for Occupational Safety and Health and—
      - (i) the [consortium](/usc/42/16282.md?p=d-4) coordinated by Mt. Sinai [Hospital](/usc/42/1395dd.md?p=e-5) in New York [City](/usc/42/12902.md?p=11) that coordinates the monitoring and [treatment](/usc/42/11851.md?p=11) for [enrolled WTC responders](/usc/42/300mm–5.md?p=4) other than with respect to those covered under the arrangement with the Fire Department of New York [City](/usc/42/12902.md?p=11); or
      - (ii) the Fire Department of New York [City](/usc/42/12902.md?p=11).
    - (B) **Responder who meets current eligibility criteria—** An individual who meets the current eligibility criteria described in [paragraph (2)](#a-2).
    - (C) **Responder who meets modified eligibility criteria—** An individual who—
      - (i) performed rescue, recovery, demolition, debris cleanup, or other related [services](/usc/42/201.md?p=a) in the [New York City disaster area](/usc/42/300mm–5.md?p=8) in response to the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12), regardless of whether such [services](/usc/42/201.md?p=a) were performed by a [State](/usc/42/300gg–91.md?p=d-14) or Federal [employee](/usc/42/300gg–91.md?p=d-5) or member of the National Guard or otherwise; and
      - (ii) meets such eligibility criteria relating to exposure to airborne toxins, other [hazards](/usc/42/5165f.md?p=a-3), or adverse conditions resulting from the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12) as the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A), after consultation with the [WTC Scientific/Technical Advisory Committee](/usc/42/300mm–5.md?p=19), determines appropriate.

      The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall not modify such eligibility criteria on or after the date that the number of enrollments of [WTC responders](#a-1) has reached 80 percent of the limit described in [paragraph (4)](#a-4) or on or after the date that the number of certifications for [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) under [section 300mm–31(a)(2)(B) of this title](/usc/42/300mm–31.md?p=a-2-B) has reached 80 percent of the limit described in [section 300mm–31(a)(3) of this title](/usc/42/300mm–31.md?p=a-3).

  - (2) **Current eligibility criteria—** The eligibility criteria described in this paragraph for an individual is that the individual is described in any of the following [categories](/usc/42/1395w–4.md?p=j-1):
    - (A) **Firefighters and related personnel—** The individual—
      - (i) was a member of the Fire Department of New York [City](/usc/42/12902.md?p=11) (whether fire or emergency personnel, active or retired) who participated at least one day in the rescue and recovery effort at any of the former World Trade Center sites (including Ground Zero, Staten Island Landfill, and the New York [City](/usc/42/12902.md?p=11) Chief Medical Examiner’s [Office](/usc/42/3058f.md?p=1)) 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](/usc/42/300gg–91.md?p=d-15) of an individual who was a member of the Fire Department of New York [City](/usc/42/12902.md?p=11) (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](/usc/42/11851.md?p=11) for a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) described in [section 300mm–22(a)(1)(A)(ii) of this title](/usc/42/300mm–22.md?p=a-1-A-ii) (relating to mental health conditions) on or before September 1, 2008.
    - (B) **Law enforcement officers and WTC rescue, recovery, and cleanup workers—** The individual—
      - (i) worked or volunteered onsite in rescue, recovery, debris cleanup, or related support [services](/usc/42/201.md?p=a) in lower Manhattan (south of Canal St.), the Staten Island Landfill, or the barge loading piers, for at least 4 hours during the period beginning on September 11, 2001, and ending on September 14, 2001, for at least 24 hours during the period beginning on September 11, 2001, and ending on September 30, 2001, or for at least 80 hours during the period beginning on September 11, 2001, and ending on July 31, 2002;
      - (ii)
        - (I) was a member of the Police Department of New York [City](/usc/42/12902.md?p=11) (whether active or retired) or a member of the Port Authority Police of the Port Authority of New York and New Jersey (whether active or retired) who participated onsite in rescue, recovery, debris cleanup, or related [services](/usc/42/201.md?p=a) in lower Manhattan (south of Canal St.), including Ground Zero, the Staten Island Landfill, or the barge loading piers, for at least 4 hours during the period beginning September 11, 2001, and ending on September 14, 2001;
        - (II) participated onsite in rescue, recovery, debris cleanup, or related [services](/usc/42/201.md?p=a) at Ground Zero, the Staten Island Landfill, or the barge loading piers, for at least one day during the period beginning on September 11, 2001, and ending on July 31, 2002;
        - (III) participated onsite in rescue, recovery, debris cleanup, or related [services](/usc/42/201.md?p=a) 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 onsite in rescue, recovery, debris cleanup, or related [services](/usc/42/201.md?p=a) 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](/usc/42/300gg–91.md?p=d-5) of the [Office](/usc/42/3058f.md?p=1) of the Chief Medical Examiner of New York [City](/usc/42/12902.md?p=11) 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](/usc/42/3058f.md?p=1) 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](/usc/42/2296b–7.md?p=1) 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](/usc/42/300mm–5.md?p=12) during a duration and period described in [subparagraph (A)](#a-2-A).
    - (C) **Responders to the September 11 attacks at the Pentagon and Shanksville, Pennsylvania—** The individual—
      - (i)
        - (I) was a member of a fire or police department (whether fire or emergency personnel, active or retired), worked for a recovery or cleanup contractor, or was a volunteer; and performed rescue, recovery, demolition, debris cleanup, or other related [services](/usc/42/201.md?p=a) at the Pentagon site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A);
        - (II) was a member of a fire or police department (whether fire or emergency personnel, active or retired), worked for a recovery or cleanup contractor, or was a volunteer; and performed rescue, recovery, demolition, debris cleanup, or other related [services](/usc/42/201.md?p=a) at the Shanksville, Pennsylvania, site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A);
        - (III) was an [employee](/usc/42/300gg–91.md?p=d-5) of the Department of Defense or any other [Federal agency](/usc/42/300mm–5.md?p=5), worked during the period beginning on September 11, 2001, and ending on September 18, 2001, for a contractor of the Department of Defense or any other [Federal agency](/usc/42/300mm–5.md?p=5), or was a member of a regular or reserve component of the [uniformed services](/usc/42/300mm–5.md?p=13); and performed rescue, recovery, demolition, debris cleanup, or other related [services](/usc/42/201.md?p=a) at the Pentagon site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A); or
        - (IV) was an [employee](/usc/42/300gg–91.md?p=d-5) of the Department of Defense or any other [Federal agency](/usc/42/300mm–5.md?p=5), worked during the period beginning on September 11, 2001, and ending on September 18, 2001, for a contractor of the Department of Defense or any other [Federal agency](/usc/42/300mm–5.md?p=5), or was a member of a regular or reserve component of the [uniformed services](/usc/42/300mm–5.md?p=13); and performed rescue, recovery, demolition, debris cleanup, or other related [services](/usc/42/201.md?p=a) at the Shanksville, Pennsylvania, site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A); and
      - (ii) is determined by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) to be at an increased risk of developing a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) as a result of exposure to airborne toxins, other [hazards](/usc/42/5165f.md?p=a-3), or adverse conditions resulting from the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12), and meets such eligibility criteria related to such exposures, as the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) determines are appropriate, after consultation with the [WTC Scientific/Technical Advisory Committee](/usc/42/300mm–5.md?p=19).
  - (3) **Enrollment process—**
    - (A) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall establish a process for enrolling [WTC responders](#a-1) in the [WTC Program](/usc/42/300mm–5.md?p=15). Under such process—
      - (i) [WTC responders](#a-1) described in [paragraph (1)(A)](#a-1-A) shall be deemed to be enrolled in such [Program](/usc/42/274l–1.md?p=4);
      - (ii) subject to [clause (iii)](#a-3-A-iii), the [Administrator](/usc/42/4005.md?p=1) shall enroll in such [program](/usc/42/274l–1.md?p=4) individuals who are determined to be [WTC responders](#a-1);
      - (iii) the [Administrator](/usc/42/4005.md?p=1) shall deny such enrollment to an individual if the [Administrator](/usc/42/4005.md?p=1) determines that the numerical limitation in [paragraph (4)](#a-4) on enrollment of [WTC responders](#a-1) has been met;
      - (iv) there shall be no fee charged to the applicant for making an application for such enrollment;
      - (v) the [Administrator](/usc/42/4005.md?p=1) shall make a determination on such an application not later than 60 days after the date of filing the application; and
      - (vi) an individual who is denied enrollment in such [Program](/usc/42/274l–1.md?p=4) shall have an opportunity to appeal such determination in a manner established under such process.
    - (B) **Timing—**
      - (i) **Currently identified responders—** In accordance with [subparagraph (A)(i)](#a-3-A-i), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall enroll an individual described in [paragraph (1)(A)](#a-1-A) in the [WTC Program](/usc/42/300mm–5.md?p=15) not later than July 1, 2011.
      - (ii) **Other responders—** In accordance with [subparagraph (A)(ii)](#a-3-A-ii) and consistent with [paragraph (4)](#a-4), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall enroll any other individual who is determined to be a [WTC responder](#a-1) in the [WTC Program](/usc/42/300mm–5.md?p=15) at the time of such determination.
  - (4) **Numerical limitation on eligible WTC responders—**
    - (A) **Limit—**
      - (i) **In general—** The total number of individuals not described in paragraph [(1)(A)](#a-1-A) or [(2)(A)(ii)](#a-2-A-ii) or subclause [(III)](#a-2-C-i-III) or [(IV)](#a-2-C-i-IV) of paragraph (2)(C)(i) who may be enrolled under [paragraph (3)(A)(ii)](#a-3-A-ii) shall not exceed 75,000 at any time, of which no more than 2,500 may be individuals enrolled based on [modified](/usc/42/7501.md?p=4) eligibility criteria established under [paragraph (1)(C)](#a-1-C).
      - (ii) **Certain responders to the September 11 attacks at the Pentagon and Shanksville, Pennsylvania—** The total number of individuals who may be enrolled under [paragraph (3)(A)(ii)](#a-3-A-ii) based on eligibility criteria described in subclause [(III)](#a-2-C-i-III) or [(IV)](#a-2-C-i-IV) of paragraph (2)(C)(i) shall not exceed 500 at any time.
    - (B) **Process—** In implementing [subparagraph (A)](#a-4-A), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall—
      - (i) limit the number of enrollments made under [paragraph (3)](#a-3)—
        - (I) in accordance with such subparagraph; and
        - (II) to such number, as determined by the [Administrator](/usc/42/4005.md?p=1) based on the best available information and subject to amounts available under this subchapter, that will ensure sufficient [funds](/usc/42/12854.md?p=3) will be available to provide [treatment](/usc/42/11851.md?p=11) and monitoring benefits under this subchapter, with respect to all individuals who are enrolled; and
      - (ii) provide priority (subject to [paragraph (3)(A)(i)](#a-3-A-i)) in such enrollments in the order in which individuals apply for enrollment under [paragraph (3)](#a-3).
  - (5) **Disqualification of individuals on terrorist watch list—** No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify as an eligible [WTC responder](#a-1). Before enrolling any individual as a [WTC responder](#a-1) in the [WTC Program](/usc/42/300mm–5.md?p=15) under [paragraph (3)](#a-3), the [Administrator](/usc/42/4005.md?p=1), in consultation with the [Secretary](/usc/42/201.md?p=c) of Homeland Security, shall determine whether the individual is on such list.
- (b) **Monitoring benefits—**
  - (1) **In general—** In the case of an [enrolled WTC responder](/usc/42/300mm–5.md?p=4) (other than one described in [subsection (a)(2)(A)(ii)](#a-2-A-ii)), the [WTC Program](/usc/42/300mm–5.md?p=15) shall provide for monitoring benefits that include monitoring consistent with protocols approved by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) and including clinical examinations and long-term health monitoring and analysis. In the case of an [enrolled WTC responder](/usc/42/300mm–5.md?p=4) who is an active member of the Fire Department of New York [City](/usc/42/12902.md?p=11), 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)](#b-1) shall be provided through the [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) for the type of individual involved or, in the case of an individual residing outside the [New York metropolitan area](/usc/42/300mm–5.md?p=9), under an arrangement under [section 300mm–23 of this title](/usc/42/300mm–23.md).

# §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](/usc/42/5165f.md?p=a-3), or any other adverse condition resulting from the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12), 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](/usc/42/300mm–5.md?p=7), is substantially likely to be a significant factor in [aggravating](/usc/42/300mm–5.md?p=1), 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](/usc/42/300mm–5.md?p=7), is substantially likely to be a significant factor in [aggravating](/usc/42/300mm–5.md?p=1), 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](/usc/42/300mm–5.md?p=7) or—
      - (i) with respect to a [WTC responder](/usc/42/300mm–21.md?p=a-1), 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](/usc/42/300mm–31.md?p=a-1-A) or [certified-eligible WTC survivor](/usc/42/300mm–5.md?p=2), 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](/usc/42/300mm–21.md?p=a-1) 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](/usc/42/300mm–5.md?p=12) were substantially likely to be a significant factor in [aggravating](/usc/42/300mm–5.md?p=1), 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](/usc/42/5165f.md?p=a-3), 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/42/5061.md?p=1) 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](/usc/42/300mm–5.md?p=7).
    - (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/42/5061.md?p=1) 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](/usc/42/300mm–21.md?p=a-1) 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](/usc/42/300mm–21.md?p=a-1) 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](/usc/42/300mm–21.md?p=a-1) who received any [treatment](/usc/42/11851.md?p=11) for a [WTC-related musculoskeletal disorder](#a-4-B) 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 area](/usc/42/300mm–5.md?p=8) in the aftermath of the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12).
  - (5) **Cancer—**
    - (A) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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](/usc/42/300mm–5.md?p=7). The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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 Administrator](/usc/42/300mm–5.md?p=16-A) determines that cancer or a certain type of cancer should be added to such [list of WTC-related health conditions](/usc/42/300mm–5.md?p=7), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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 Administrator](/usc/42/300mm–5.md?p=16-A) 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](/usc/42/300mm–5.md?p=7). If such a determination is made to make such an addition, the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall by regulation add cancer or the certain type of cancer to such list.
    - (D) **Determinations not to add cancer or certain types of cancer—** In the case that the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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](/usc/42/300mm–5.md?p=7), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall publish an explanation for such determination in the Federal Register. Any such determination to not make such an addition shall not preclude the addition of cancer or the certain type of cancer to such list at a later date.
  - (6) **Addition of health conditions to list for WTC responders—**
    - (A) **In general—** Whenever the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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/42/4005.md?p=1) may request a recommendation of the [Advisory Committee](/usc/42/7703.md?p=9) 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 Administrator](/usc/42/300mm–5.md?p=16-A) receives a written petition by an [interested party](#a-6-E) 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/42/4005.md?p=1) shall—
      - (i) request a recommendation of the [Advisory Committee](/usc/42/7703.md?p=9);
      - (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/42/4005.md?p=1)’s determination not to publish such a proposed rule and the basis for such determination; or
      - (iv) publish in the Federal Register a determination that insufficient evidence exists to take action under [clauses (i) through (iii)](#a-6-B-i..a-6-B-iii).
    - (C) **Action by Advisory Committee—** In the case that the [Administrator](/usc/42/4005.md?p=1) requests a recommendation of the [Advisory Committee](/usc/42/7703.md?p=9) under this paragraph, with respect to adding a health condition to the list in [paragraph (3)](#a-3), the [Advisory Committee](/usc/42/7703.md?p=9) shall submit to the [Administrator](/usc/42/4005.md?p=1) 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/42/4005.md?p=1). Not later than 90 days after the date of receipt of such recommendation, the [Administrator](/usc/42/4005.md?p=1) 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 Administrator](/usc/42/300mm–5.md?p=16-A) 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-6-E) a period of 30 days after such publication to submit written comments on the proposed rule.

      The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) may extend the period described in [clause (ii)](#a-6-D-ii) upon a finding of good [cause](/usc/42/9908.md?p=c-2). In the case of such an extension, the [Administrator](/usc/42/4005.md?p=1) shall publish such extension in the Federal Register.

    - (E) **Interested party defined—** For purposes of this paragraph, the term “interested party” includes a [representative](/usc/42/3058f.md?p=5) of any organization representing [WTC responders](/usc/42/300mm–21.md?p=a-1), a nationally recognized medical association, a Clinical or [Data Center](/usc/42/300mm–4.md?p=b-2), a [State](/usc/42/300gg–91.md?p=d-14) or political subdivision, or any other interested [person](/usc/42/1320a–7k.md?p=d-4-C-i).
    - (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 Administrator](/usc/42/300mm–5.md?p=16-A) 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 Administrator](/usc/42/300mm–5.md?p=16-A) shall request the [Advisory Committee](/usc/42/7703.md?p=9) 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 Administrator](/usc/42/300mm–5.md?p=16-A) shall request the [Advisory Committee](/usc/42/7703.md?p=9) 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 Administrator](/usc/42/300mm–5.md?p=16-A) shall seek recommendations from the [Advisory Committee](/usc/42/7703.md?p=9) 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](/usc/42/1320a–7h.md?p=e-11) at a [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) that is providing monitoring benefits under [section 300mm–21 of this title](/usc/42/300mm–21.md) for an [enrolled WTC responder](/usc/42/300mm–5.md?p=4) makes a determination that the responder has a [WTC-related health condition](#a-1) that is in the list in [subsection (a)(3)](#a-3) and that exposure to airborne toxins, other [hazards](/usc/42/5165f.md?p=a-3), or adverse conditions resulting from the September 1, 2001, terrorist attacks is substantially likely to be a significant factor in [aggravating](/usc/42/300mm–5.md?p=1), contributing to, or causing the condition—
      - (i) the [physician](/usc/42/1320a–7h.md?p=e-11) shall promptly transmit such determination to the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) and provide the [Administrator](/usc/42/4005.md?p=1) 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/42/300mm–5.md?p=15) 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 Administrator](/usc/42/300mm–5.md?p=16-A) shall review determinations made under [subparagraph (A)](#b-1-A).
      - (ii) **Certification—** The [Administrator](/usc/42/4005.md?p=1) 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/42/4005.md?p=1) determines that the responder’s condition is not a [WTC-related health condition](#a-1) in the list in [subsection (a)(3)](#a-3) or that exposure to airborne toxins, other [hazards](/usc/42/5165f.md?p=a-3), or adverse conditions resulting from the September 1, 2001, terrorist attacks is not substantially likely to be a significant factor in [aggravating](/usc/42/300mm–5.md?p=1), contributing to, or causing the condition.
      - (iii) **Appeal process—** The [Administrator](/usc/42/4005.md?p=1) 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](/usc/42/1320a–7h.md?p=e-11) at a [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) determines pursuant to [subsection (a)](#a) that the [enrolled WTC responder](/usc/42/300mm–5.md?p=4) 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](#a-1)—
      - (i) the [physician](/usc/42/1320a–7h.md?p=e-11) shall promptly transmit such determination to the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) and provide the [Administrator](/usc/42/4005.md?p=1) with the facts supporting such determination; and
      - (ii) the [Administrator](/usc/42/4005.md?p=1) shall make a determination under [subparagraph (B)](#b-2-B) with respect to such [physician](/usc/42/1320a–7h.md?p=e-11)’s determination.
    - (B) **Procedures for review, certification, and appeal—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall, by rule, establish procedures for the review and certification of [physician](/usc/42/1320a–7h.md?p=e-11) determinations under [subparagraph (A)](#b-2-A). Such rule shall provide for—
      - (i) the timely review of such a determination by a [physician](/usc/42/1320a–7h.md?p=e-11) [panel](/usc/42/10362.md?p=16) with appropriate expertise for the condition and recommendations to the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A);
      - (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 Administrator](/usc/42/300mm–5.md?p=16-A) 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](#a-1);
      - (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](#a-1); and
      - (iv) a process for appeals of determinations relating to such conditions.
    - (C) **Inclusion in list of health conditions—** If the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) provides certification under [subparagraph (B)(iii)](#b-2-B-iii) for coverage of a condition, the [Administrator](/usc/42/4005.md?p=1) 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 Administrator](/usc/42/300mm–5.md?p=16-A) 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 Administrator](/usc/42/300mm–5.md?p=16-A) 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-1), a [physician](/usc/42/1320a–7h.md?p=e-11) or other provider 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 Administrator](/usc/42/300mm–5.md?p=16-A) shall issue [regulations](/usc/42/201.md?p=d) specifying a [standard](/usc/42/1320d.md?p=7) for determining medical necessity with respect to health care [services](/usc/42/201.md?p=a) 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](/usc/42/1320d.md?p=7) (including any prior [authorization](/usc/42/4370m.md?p=3) 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](/usc/42/1395cc–4.md?p=a-2-E) and other [health care providers](/usc/42/300jj.md?p=3), diagnostic and [laboratory](/usc/42/300jj.md?p=10) tests, prescription [drugs](/usc/42/282.md?p=j-1-A-vii), inpatient and outpatient [hospital](/usc/42/1395dd.md?p=e-5) [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/42/282.md?p=j-1-A-vii), such [drugs](/usc/42/282.md?p=j-1-A-vii) shall be provided, under arrangements made by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A), directly through participating Clinical Centers of Excellence or through one or more outside vendors.
    - (C) **Transportation expenses for nationwide network—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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](/usc/42/300mm–5.md?p=4) for whom a determination is made by an examining [physician](/usc/42/1320a–7h.md?p=e-11) under paragraph [(1)](#b-1) or [(2)](#b-2), but for whom the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) has not yet determined whether to certify the determination, the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) may establish by rule a process through which the [Administrator](/usc/42/4005.md?p=1) 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](#a-1) (under such terms and conditions as the [Administrator](/usc/42/4005.md?p=1) may provide) until the [Administrator](/usc/42/4005.md?p=1) 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 Administrator](/usc/42/300mm–5.md?p=16-A) shall reimburse costs for medically necessary [treatment](/usc/42/11851.md?p=11) under this subchapter for [WTC-related health conditions](#a-1) 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](/usc/42/11049.md?p=4) 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)](#c-1-A-i) or [subparagraph (B)](#c-1-B), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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](/usc/42/3058f.md?p=1) 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 Administrator](/usc/42/300mm–5.md?p=16-A) 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](#a-1) through one or more contracts with outside vendors.
      - (ii) **Competitive bidding—** Under such [program](/usc/42/274l–1.md?p=4) the [Administrator](/usc/42/4005.md?p=1) 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/42/300mm–5.md?p=15).
      - (iii) **Treatment of FDNY participants—** Under such [program](/usc/42/274l–1.md?p=4) the [Administrator](/usc/42/4005.md?p=1) may enter into an [agreement](/usc/42/1320b–8.md?p=a-3-A) with a separate vendor to provide pharmaceutical benefits to [enrolled WTC responders](/usc/42/300mm–5.md?p=4) for whom the [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) is described in [section 300mm—4](/usc/42/300mm..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 Administrator](/usc/42/300mm–5.md?p=16-A).
      - (iv) **Pharmaceuticals—** Not later than July 1, 2011, the Comptroller General of the [United States](/usc/42/403.md?p=k) shall submit to the Committee on [Energy](/usc/42/6311.md?p=7) and [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5) 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/42/300mm–5.md?p=15).
    - (C) **Improving quality and efficiency through modification of payment amounts and methodologies—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) may modify the amounts and methodologies for making payments for [initial health evaluations](/usc/42/300mm–5.md?p=6), 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/42/4005.md?p=1) determines that a bundling, capitation, pay for performance, or other payment methodology would better ensure high quality and efficient delivery of [initial health evaluations](/usc/42/300mm–5.md?p=6), monitoring, or [treatment](/usc/42/11851.md?p=11) to an [enrolled WTC responder](/usc/42/300mm–5.md?p=4), [screening-eligible WTC survivor](/usc/42/300mm–31.md?p=a-1-A), or [certified-eligible WTC survivor](/usc/42/300mm–5.md?p=2).
  - (2) **Monitoring and initial health evaluation—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall reimburse the costs of monitoring and the costs of an [initial health evaluation](/usc/42/300mm–5.md?p=6) provided under this subchapter at a rate set by the [Administrator](/usc/42/4005.md?p=1) by regulation.
  - (3) **Determination of medical necessity—**
    - (A) **Review of medical necessity and protocols—** As part of the process for reimbursement or payment under this subsection, the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide for the review of [claims](/usc/42/1320a–7a.md?p=i-2) 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/42/4005.md?p=1) shall withhold such reimbursement or payment for [treatment](/usc/42/11851.md?p=11) that the [Administrator](/usc/42/4005.md?p=1) 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](/usc/42/300mm–4.md?p=b-2) shall develop medical [treatment](/usc/42/11851.md?p=11) protocols for the [treatment](/usc/42/11851.md?p=11) of [enrolled WTC responders](/usc/42/300mm–5.md?p=4) and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) for health conditions included in the applicable [list of WTC-related health conditions](/usc/42/300mm–5.md?p=7).
  - (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 Administrator](/usc/42/300mm–5.md?p=16-A).

# §300mm–23. National arrangement for benefits for eligible individuals outside New York

- (a) **In general—** In order to ensure reasonable access to benefits under this part for individuals who are [enrolled WTC responders](/usc/42/300mm–5.md?p=4), [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A), or [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) and who reside in any [State](/usc/42/300gg–91.md?p=d-14), as defined in [section 201(f) of this title](/usc/42/201.md?p=f), outside the [New York metropolitan area](/usc/42/300mm–5.md?p=9), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall establish a nationwide network of [health care providers](/usc/42/300jj.md?p=3) to provide monitoring and [treatment](/usc/42/11851.md?p=11) benefits and [initial health evaluations](/usc/42/300mm–5.md?p=6) near such individuals’ areas of residence in such [States](/usc/42/300gg–91.md?p=d-14). Nothing in this subsection shall be construed as preventing such individuals from being provided such monitoring and [treatment](/usc/42/11851.md?p=11) benefits or [initial health evaluation](/usc/42/300mm–5.md?p=6) through any [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A).
- (b) **Network requirements—** Any [health care provider](/usc/42/300jj.md?p=3) participating in the network under [subsection (a)](#a) shall—
  - (1) meet criteria for credentialing established by the [Data Centers](/usc/42/300mm–4.md?p=b-2);
  - (2) follow the monitoring, [initial health evaluation](/usc/42/300mm–5.md?p=6), and [treatment](/usc/42/11851.md?p=11) protocols developed under [section 300mm–4(a)(2)(A)(ii) of this title](/usc/42/300mm–4.md?p=a-2-A-ii);
  - (3) collect and report data in accordance with [section 300mm–3 of this title](/usc/42/300mm–3.md); and
  - (4) meet such fraud, quality assurance, and other requirements as the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) establishes, including [sections 1320a–7 through 1320a–7e](/usc/42/1320a–7..1320a–7e.md) of this title, as applied by [section 300mm(d) of this title](/usc/42/300mm.md?p=d).
- (c) **Training and technical assistance—** The [WTC Program](/usc/42/300mm–5.md?p=15) Administer[^1] may provide, including through contract, for the provision of [training](/usc/42/285e–2.md?p=b-2) and technical assistance to [health care providers](/usc/42/300jj.md?p=3) participating in the network under [subsection (a)](#a).
- (d) **Provision of services through the VA—**
  - (1) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) may enter into an [agreement](/usc/42/1320b–8.md?p=a-3-A) with the [Secretary](/usc/42/201.md?p=c) of Veterans Affairs for the [Secretary](/usc/42/201.md?p=c) to provide [services](/usc/42/201.md?p=a) under this section through [facilities](/usc/42/11049.md?p=4) of the Department of Veterans Affairs.
  - (2) **National program—** Not later than July 1, 2011, the Comptroller General of the [United States](/usc/42/403.md?p=k) shall submit to the Committee on [Energy](/usc/42/6311.md?p=7) and [Commerce](/usc/42/6311.md?p=7) of the House of [Representatives](/usc/42/3058f.md?p=5) and the Committee on Health, Education, Labor, and Pensions of the Senate a report on whether the Department of Veterans Affairs can provide monitoring and [treatment services](/usc/42/300x–34.md?p=7) to individuals under this section more efficiently and effectively than through the nationwide network to be established under [subsection (a)](#a).

# §300mm–31. Identification and initial health evaluation of screening-eligible and certified-eligible WTC survivors

- (a) **Identification of screening-eligible WTC survivors and certified-eligible WTC survivors—**
  - (1) **Screening-eligible WTC survivors—**
    - (A) **Definition—** In this subchapter, the term “screening-eligible WTC survivor” means, subject to [subparagraph (C)](#a-1-C) and [paragraph (3)](#a-3), an individual who is described in any of the following clauses:
      - (i) **Currently identified survivor—** An individual, including a [WTC responder](/usc/42/300mm–21.md?p=a-1), who has been identified as eligible for medical [treatment](/usc/42/11851.md?p=11) and monitoring by the WTC Environmental Health Center as of January 2, 2011.
      - (ii) **Survivor who meets current eligibility criteria—** An individual who is not a [WTC responder](/usc/42/300mm–21.md?p=a-1), for purposes of the [initial health evaluation](/usc/42/300mm–5.md?p=6) under [subsection (b)](#b), [claims](/usc/42/1320a–7a.md?p=i-2) symptoms of a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) and meets any of the current eligibility criteria described in [subparagraph (B)](#a-1-B).
      - (iii) **Survivor who meets modified eligibility criteria—** An individual who is not a [WTC responder](/usc/42/300mm–21.md?p=a-1), for purposes of the [initial health evaluation](/usc/42/300mm–5.md?p=6) under [subsection (b)](#b), [claims](/usc/42/1320a–7a.md?p=i-2) symptoms of a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) and meets such eligibility criteria relating to exposure to airborne toxins, other [hazards](/usc/42/5165f.md?p=a-3), or adverse conditions resulting from the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12) as the WTC [Administrator](/usc/42/4005.md?p=1) determines, after consultation with the [Data Centers](/usc/42/300mm–4.md?p=b-2) described in [section 300mm–4 of this title](/usc/42/300mm–4.md) and the [WTC Scientific/Technical Advisory Committee](/usc/42/300mm–5.md?p=19) and [WTC Health Program Steering Committees](/usc/42/300mm–5.md?p=14) under [section 300mm–1 of this title](/usc/42/300mm–1.md).

      The [Administrator](/usc/42/4005.md?p=1) shall not modify such criteria under [clause (iii)](#a-1-A-iii) on or after the date that the number of certifications for [certified-eligible WTC survivors](#a-2-A) under [paragraph (2)(B)](#a-2-B) has reached 80 percent of the limit described in [paragraph (3)](#a-3) or on or after the date that the number of enrollments of [WTC responders](/usc/42/300mm–21.md?p=a-1) has reached 80 percent of the limit described in [section 300mm–21(a)(4) of this title](/usc/42/300mm–21.md?p=a-4).

    - (B) **Current eligibility criteria—** The eligibility criteria described in this subparagraph for an individual are that the individual is described in any of the following clauses:
      - (i) A [person](/usc/42/1320a–7k.md?p=d-4-C-i) who was present in the [New York City disaster area](/usc/42/300mm–5.md?p=8) in the dust or dust cloud on September 11, 2001.
      - (ii) A [person](/usc/42/1320a–7k.md?p=d-4-C-i) who worked, resided, or attended [school](/usc/42/6372.md?p=1), childcare, or adult daycare in the [New York City disaster area](/usc/42/300mm–5.md?p=8) for—
        - (I) at least 4 days during the 4-month period beginning on September 11, 2001, and ending on January 10, 2002; or
        - (II) at least 30 days during the period beginning on September 11, 2001, and ending on July 31, 2002.
      - (iii) Any [person](/usc/42/1320a–7k.md?p=d-4-C-i) who worked as a cleanup worker or performed maintenance work in the [New York City disaster area](/usc/42/300mm–5.md?p=8) during the 4-month period described in [subparagraph (B)(i)](#a-1-B-i) and had extensive exposure to WTC dust as a result of such work.
      - (iv) A [person](/usc/42/1320a–7k.md?p=d-4-C-i) who was deemed eligible to receive a grant from the Lower Manhattan Development [Corporation](/usc/42/2296b–7.md?p=1) Residential Grant [Program](/usc/42/274l–1.md?p=4), who possessed a lease for a residence or purchased a residence in the [New York City disaster area](/usc/42/300mm–5.md?p=8), and who resided in such residence during the period beginning on September 11, 2001, and ending on May 31, 2003.
      - (v) A [person](/usc/42/1320a–7k.md?p=d-4-C-i) 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](/usc/42/300mm–5.md?p=8); and
        - (II) was deemed eligible to receive a grant from the Lower Manhattan Development [Corporation](/usc/42/2296b–7.md?p=1) WTC Small Firms Attraction and Retention Act [program](/usc/42/274l–1.md?p=4) or other government incentive [program](/usc/42/274l–1.md?p=4) designed to revitalize the lower Manhattan economy after the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12).
    - (C) **Application and determination process for screening eligibility—**
      - (i) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) in consultation with the [Data Centers](/usc/42/300mm–4.md?p=b-2) shall establish a process for individuals, other than individuals described in [subparagraph (A)(i)](#a-1-A-i), to be determined to be [screening-eligible WTC survivors](#a-1-A). Under such process—
        - (I) there shall be no fee charged to the applicant for making an application for such determination;
        - (II) the [Administrator](/usc/42/4005.md?p=1) shall make a determination on such an application not later than 60 days after the date of filing the application;
        - (III) the [Administrator](/usc/42/4005.md?p=1) shall make such a determination relating to an applicant’s compliance with this subchapter and shall not determine that an individual is not so eligible or deny written documentation under [clause (ii)](#a-1-C-ii) to such individual unless the [Administrator](/usc/42/4005.md?p=1) determines that—
          - (aa) based on the application submitted, the individual does not meet the eligibility criteria; or
          - (bb) the numerical limitation on certifications of [certified-eligible WTC survivors](#a-2-A) set forth in [paragraph (3)](#a-3) has been met; and
        - (IV) an individual who is determined not to be a [screening-eligible WTC survivor](#a-1-A) shall have an opportunity to appeal such determination in a manner established under such process.
      - (ii) **Written documentation of screening-eligibility—**
        - (I) **In general—** In the case of an individual who is described in [subparagraph (A)(i)](#a-1-A-i) or who is determined under [clause (i)](#a-1-C-i) (consistent with [paragraph (3)](#a-3)) to be a [screening-eligible WTC survivor](#a-1-A), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide an appropriate written documentation of such fact.
        - (II) **Timing—**
          - (aa) **Currently identified survivors—** In the case of an individual who is described in [subparagraph (A)(i)](#a-1-A-i), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide the written documentation under [subclause (I)](#a-1-C-ii-I) not later than July 1, 2011.
          - (bb) **Other members—** In the case of another individual who is determined under [clause (i)](#a-1-C-i) and consistent with [paragraph (3)](#a-3) to be a [screening-eligible WTC survivor](#a-1-A), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide the written documentation under [subclause (I)](#a-1-C-ii-I) at the time of such determination.
  - (2) **Certified-eligible WTC survivors—**
    - (A) **Definition—** The term “certified-eligible WTC survivor” means, subject to [paragraph (3)](#a-3), a [screening-eligible WTC survivor](#a-1-A) who the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) certifies under [subparagraph (B)](#a-2-B) to be eligible for followup monitoring and [treatment](/usc/42/11851.md?p=11) under this subpart.
    - (B) **Certification of eligibility for monitoring and treatment—**
      - (i) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall establish a certification process under which the [Administrator](/usc/42/4005.md?p=1) shall provide appropriate certification to [screening-eligible WTC survivors](#a-1-A) who, pursuant to the [initial health evaluation](/usc/42/300mm–5.md?p=6) under [subsection (b)](#b), are determined to be eligible for followup monitoring and [treatment](/usc/42/11851.md?p=11) under this subpart.
      - (ii) **Timing—**
        - (I) **Currently identified survivors—** In the case of an individual who is described in [paragraph (1)(A)(i)](#a-1-A-i), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide the certification under [clause (i)](#a-2-B-i) not later than July 1, 2011.
        - (II) **Other members—** In the case of another individual who is determined under [clause (i)](#a-2-B-i) to be eligible for followup monitoring and [treatment](/usc/42/11851.md?p=11), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall provide the certification under such clause at the time of such determination.
  - (3) **Numerical limitation on certified-eligible WTC survivors—**
    - (A) **In general—** The total number of individuals not described in [paragraph (1)(A)(i)](#a-1-A-i) who may be certified as [certified-eligible WTC survivors](#a-2-A) under [paragraph (2)(B)](#a-2-B) shall not exceed 75,000 at any time.
    - (B) **Process—** In implementing [subparagraph (A)](#a-3-A), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall—
      - (i) limit the number of certifications provided under [paragraph (2)(B)](#a-2-B)—
        - (I) in accordance with such subparagraph; and
        - (II) to such number, as determined by the [Administrator](/usc/42/4005.md?p=1) based on the best available information and subject to amounts made available under this subchapter, that will ensure sufficient [funds](/usc/42/12854.md?p=3) will be available to provide [treatment](/usc/42/11851.md?p=11) and monitoring benefits under this subchapter, with respect to all individuals receiving such certifications; and
      - (ii) provide priority in such certifications in the order in which individuals apply for a determination under [paragraph (2)(B)](#a-2-B).
  - (4) **Disqualification of individuals on terrorist watch list—** No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify as a [screening-eligible WTC survivor](#a-1-A) or a [certified-eligible WTC survivor](#a-2-A). Before determining any individual to be a [screening-eligible WTC survivor](#a-1-A) under [paragraph (1)](#a-1) or certifying any individual as a certified eligible[^1] WTC survivor under [paragraph (2)](#a-2), the [Administrator](/usc/42/4005.md?p=1), in consultation with the [Secretary](/usc/42/201.md?p=c) of Homeland Security, shall determine whether the individual is on such list.
- (b) **Initial health evaluation to determine eligibility for followup monitoring or treatment—**
  - (1) **In general—** In the case of a [screening-eligible WTC survivor](#a-1-A), the [WTC Program](/usc/42/300mm–5.md?p=15) shall provide for an [initial health evaluation](/usc/42/300mm–5.md?p=6) to determine if the survivor has a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) and is eligible for followup monitoring and [treatment](/usc/42/11851.md?p=11) benefits under the [WTC Program](/usc/42/300mm–5.md?p=15). [Initial health evaluation](/usc/42/300mm–5.md?p=6) protocols under [section 300mm–4(a)(2)(A)(ii) of this title](/usc/42/300mm–4.md?p=a-2-A-ii) shall be subject to approval by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A).
  - (2) **Initial health evaluation providers—** The [initial health evaluation](/usc/42/300mm–5.md?p=6) described in [paragraph (1)](#b-1) shall be provided through a [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) with respect to the individual involved.
  - (3) **Limitation on initial health evaluation benefits—** Benefits for an [initial health evaluation](/usc/42/300mm–5.md?p=6) under this subpart for a [screening-eligible WTC survivor](#a-1-A) shall consist only of a [single](/usc/42/2304.md?p=m) medical [initial health evaluation](/usc/42/300mm–5.md?p=6) consistent with [initial health evaluation](/usc/42/300mm–5.md?p=6) protocols described in [paragraph (1)](#b-1). Nothing in this paragraph shall be construed as preventing such an individual from seeking additional medical [initial health evaluations](/usc/42/300mm–5.md?p=6) at the expense of the individual.

# §300mm–32. Followup monitoring and treatment of certified-eligible WTC survivors for WTC-related health conditions

- (a) **In general—** Subject to [subsection (b)](#b), the provisions of sections [300mm–21](/usc/42/300mm–21.md) and [300mm–22](/usc/42/300mm–22.md) of this title shall apply to followup monitoring and [treatment](/usc/42/11851.md?p=11) of [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) for [certified-eligible WTC survivors](/usc/42/300mm–31.md?p=a-2-A) in the same manner as such provisions apply to the monitoring and [treatment](/usc/42/11851.md?p=11) of [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) for [enrolled WTC responders](/usc/42/300mm–5.md?p=4).
- (b) **List of WTC-related health conditions for survivors—** The list of health conditions for [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A) and [certified-eligible WTC survivors](/usc/42/300mm–31.md?p=a-2-A) consists of the following:
  - (1) **Aerodigestive disorders—**
    - (A) Interstitial lung diseases.
    - (B) Chronic respiratory disorder—fumes/vapors.
    - (C) Asthma.
    - (D) Reactive airways dysfunction syndrome (RADS).
    - (E) WTC-exacerbated chronic obstructive pulmonary disease (COPD).
    - (F) Chronic cough syndrome.
    - (G) Upper airway hyperreactivity.
    - (H) Chronic rhinosinusitis.
    - (I) Chronic nasopharyngitis.
    - (J) Chronic laryngitis.
    - (K) Gastroesophageal reflux disorder (GERD).
    - (L) Sleep apnea exacerbated by or related to a condition described in a previous clause.
  - (2) **Mental health conditions—**
    - (A) Posttraumatic stress disorder (PTSD).
    - (B) Major depressive disorder.
    - (C) Panic disorder.
    - (D) Generalized anxiety disorder.
    - (E) Anxiety disorder (not otherwise specified).
    - (F) Depression (not otherwise specified).
    - (G) Acute stress disorder.
    - (H) Dysthymic disorder.
    - (I) Adjustment disorder.
    - (J) Substance abuse.
  - (3) **Additional conditions—** Any cancer (or type of cancer) or other condition added to the list in [section 300mm–22(a)(3) of this title](/usc/42/300mm–22.md?p=a-3) pursuant to paragraph (5) or (6) of [section 300mm–22(a) of this title](/usc/42/300mm–22.md?p=a), as such provisions are applied under [subsection (a)](#a) with respect to [certified-eligible WTC survivors](/usc/42/300mm–31.md?p=a-2-A).

# §300mm–33. Followup monitoring and treatment of other individuals with WTC-related health conditions

- (a) **In general—** Subject to [subsection (c)](#c), the provisions of [section 300mm–32 of this title](/usc/42/300mm–32.md) shall apply to the followup monitoring and [treatment](/usc/42/11851.md?p=11) of [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) in the case of individuals described in [subsection (b)](#b) in the same manner as such provisions apply to the followup monitoring and [treatment](/usc/42/11851.md?p=11) of [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) for [certified-eligible WTC survivors](/usc/42/300mm–31.md?p=a-2-A).
- (b) **Individuals described—** An individual described in this subsection is an individual who, regardless of location of residence—
  - (1) is not an [enrolled WTC responder](/usc/42/300mm–5.md?p=4) or a [certified-eligible WTC survivor](/usc/42/300mm–31.md?p=a-2-A); and
  - (2) is diagnosed at a [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A) with a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) for [certified-eligible WTC survivors](/usc/42/300mm–31.md?p=a-2-A).
- (c) **Limitation—**
  - (1) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall limit benefits for any fiscal year under [subsection (a)](#a) in a manner so that payments under this section for such fiscal year do not exceed the amount specified in [paragraph (2)](#c-2) for such fiscal year.
  - (2) **Limitation—** The amount specified in this paragraph for—
    - (A) the last calendar quarter of fiscal year 2011 is $5,000,000;
    - (B) fiscal year 2012 is $20,000,000; or
    - (C) a succeeding fiscal year is the amount specified in this paragraph for the previous fiscal year increased by the annual percentage increase in the [medical care](/usc/42/300gg–91.md?p=a-2) component of the consumer price index for all urban consumers.

# §300mm–41. Payment of claims

- (a) **In general—** Except as provided in subsections [(b)](#b) and [(c)](#c), the cost of monitoring and [treatment](/usc/42/11851.md?p=11) benefits and [initial health evaluation](/usc/42/300mm–5.md?p=6) benefits provided under subparts 1 and 2 of this part shall be paid for by the [WTC Program](/usc/42/300mm–5.md?p=15) from (as applicable) the [Funds](/usc/42/12854.md?p=3) established under sections [300mm–61](/usc/42/300mm–61.md), [300mm–62](/usc/42/300mm–62.md), [300mm–63](/usc/42/300mm–63.md), and [300mm–64](/usc/42/300mm–64.md) of this title.
- (b) **Workers’ compensation payment—**
  - (1) **In general—** Subject to [paragraph (2)](#b-2), payment for [treatment](/usc/42/11851.md?p=11) under subparts 1 and 2 of this part of a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) of an individual that is work-related shall be reduced or recouped to the extent that the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) 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](/usc/42/403.md?p=k), a [State](/usc/42/300gg–91.md?p=d-14), or a locality, or other work-related injury or illness benefit plan of the [employer](/usc/42/300gg–91.md?p=d-6) of such individual, for such [treatment](/usc/42/11851.md?p=11). 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)](/usc/42/1395y.md?p=b)] and paragraphs [(3)](/usc/42/1395y.md?p=b-3) and [(4)](/usc/42/1395y.md?p=b-4) of such section shall apply to the recoupment under this subsection of a payment to the [WTC Program](/usc/42/300mm–5.md?p=15) (with respect to a workers’ compensation law or plan, or other work-related injury or illness plan of the [employer](/usc/42/300gg–91.md?p=d-6) involved, and such individual) in the same manner as such provisions apply to the reimbursement of a payment under [section 1862(b)(2)](/usc/42/1862.md) of such Act [[42 U.S.C. 1395y(b)(2)](/usc/42/1395y.md?p=b-2)] to the [Secretary](/usc/42/201.md?p=c) (with respect to such a law or plan and an individual entitled to benefits under title XVIII of such Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.]) except that any reference in such paragraph (4) to payment rates under title XVIII of the Social Security Act shall be deemed a reference to payment rates under this subchapter.
  - (2) **Exception—** [Paragraph (1)](#b-1) shall not apply for any quarter, with respect to any workers’ compensation law or plan, including line of duty compensation, to which New York [City](/usc/42/12902.md?p=11) is obligated to make payments, if, in accordance with terms specified under the contract under [subsection (d)(1)(A)](#d-1-A), New York [City](/usc/42/12902.md?p=11) has made the full payment required under such contract for such quarter.
  - (3) **Rules of construction—** Nothing in this subchapter shall be construed to affect, modify, or relieve any obligations under a worker’s compensation law or plan, other work-related injury or illness benefit plan of an [employer](/usc/42/300gg–91.md?p=d-6), or any health insurance plan.
- (c) **Health insurance coverage—**
  - (1) **In general—** In the case of an individual who has a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) that is not work-related and has health coverage for such condition through any public or private [health plan](/usc/42/300jj.md?p=6) (including health benefits under title XVIII, XIX, or XXI of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq., 1396 et seq., 1397aa et seq.]) the provisions of section 1862(b) of the Social Security Act [[42 U.S.C. 1395y(b)](/usc/42/1395y.md?p=b)] shall apply to such a [health plan](/usc/42/300jj.md?p=6) and such individual in the same manner as they apply to group[^1] [health plan](/usc/42/300jj.md?p=6) and an individual entitled to benefits under title XVIII of such Act pursuant to section 226(a) of such Act [[42 U.S.C. 426(a)](/usc/42/426.md?p=a)]. Any costs for items and [services](/usc/42/201.md?p=a) covered under such plan that are not reimbursed by such [health plan](/usc/42/300jj.md?p=6), due to the application of deductibles, copayments, coinsurance, other cost sharing, or otherwise, are reimbursable under this subchapter to the extent that they are covered under the [WTC Program](/usc/42/300mm–5.md?p=15). The [program](/usc/42/274l–1.md?p=4) under this subchapter shall not be treated as a legally liable party for purposes of applying section 1902(a)(25) of the Social Security Act [[42 U.S.C. 1396a(a)(25)](/usc/42/1396a.md?p=a-25)].
  - (2) **Recovery by individual providers—** Nothing in [paragraph (1)](#c-1) shall be construed as requiring an entity providing monitoring and [treatment](/usc/42/11851.md?p=11) under this subchapter to seek reimbursement under a [health plan](/usc/42/300jj.md?p=6) with which the entity has no contract for reimbursement.
  - (3) **Maintenance of required minimum essential coverage—** No payment may be made for monitoring and [treatment](/usc/42/11851.md?p=11) under this subchapter for an individual for a month (beginning with July 2014) if with respect to such month the individual—
    - (A) is an applicable individual (as defined in subsection (d) of [section 5000A of title 26](/usc/26/5000A.md)) for whom the exemption under [subsection (e)](/usc/26/5000A.md?p=e) of such section does not apply; and
    - (B) is not covered under minimum essential coverage, as required under [subsection (a)](#a) of such section.
- (d) **Required contribution by New York City in program costs—**
  - (1) **Contract requirement—**
    - (A) **In general—** No [funds](/usc/42/12854.md?p=3) may be disbursed from the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) under [section 300mm–61 of this title](/usc/42/300mm–61.md) or the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Special [Fund](/usc/42/12854.md?p=3) under [section 300mm–63 of this title](/usc/42/300mm–63.md) unless New York [City](/usc/42/12902.md?p=11) has entered into a contract with the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) under which New York [City](/usc/42/12902.md?p=11) agrees, in a form and manner specified by the [Administrator](/usc/42/4005.md?p=1), to pay the full contribution described in [subparagraph (B)](#d-1-B) in accordance with this subsection on a timely basis, plus any interest owed pursuant to [subparagraph (E)(i)](#d-1-E-i). Such contract shall specify the terms under which New York [City](/usc/42/12902.md?p=11) shall be considered to have made the full payment required for a quarter for purposes of [subsection (b)(2)](#b-2).
    - (B) **Full contribution amount—** Under such contract, with respect to each calendar quarter of fiscal year 2016 and of each subsequent fiscal year through fiscal year 2090, the full contribution amount under this subparagraph shall be equal to 10 percent of the expenditures in carrying out this subchapter for the respective quarter (excluding any expenditures from amounts in the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Supplemental [Fund](/usc/42/12854.md?p=3) under [section 300mm–62 of this title](/usc/42/300mm–62.md) or the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) for Certain [WTC Responders](/usc/42/300mm–21.md?p=a-1) at the Pentagon and Shanksville, Pennsylvania under [section 300mm–64 of this title](/usc/42/300mm–64.md)).
    - (C) **Satisfaction of payment obligation—** The payment obligation under such contract may not be satisfied through any of the following:
      - (i) An amount derived from Federal sources.
      - (ii) An amount paid before January 2, 2011.
      - (iii) An amount paid to satisfy a judgment or as part of a settlement related to injuries or illnesses arising out of the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12).
    - (D) **Timing of contribution—** The payment obligation under such contract for a calendar quarter in a fiscal year shall be paid not later than the last day of the second succeeding calendar quarter.
    - (E) **Compliance—**
      - (i) **Interest for late payment—** If New York [City](/usc/42/12902.md?p=11) fails to pay to the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) pursuant to such contract the amount required for any calendar quarter by the day specified in [subparagraph (D)](#d-1-D), interest shall accrue on the amount not so paid at the rate (determined by the [Administrator](/usc/42/4005.md?p=1)) based on the average yield to maturity, plus 1 percentage point, on outstanding municipal bonds issued by New York [City](/usc/42/12902.md?p=11) with a remaining maturity of at least 1 year.
      - (ii) **Recovery of amounts owed—** The amounts owed to the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) under such contract shall be recoverable by the [United States](/usc/42/403.md?p=k) in an action in the same manner as payments made under title XVIII of the Social Security Act [[42 U.S.C. 1395](/usc/42/1395.md) et seq.] may be recoverable in an action brought under [section 1862(b)(2)(B)(iii)](/usc/42/1862.md) of such Act [[42 U.S.C. 1395y(b)(2)(B)(iii)](/usc/42/1395y.md?p=b-2-B-iii)].
    - (F) **Deposit in fund—** The [WTC Program](/usc/42/300mm–5.md?p=15) Administer shall deposit amounts paid under such contract into the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) under [section 300mm–61 of this title](/usc/42/300mm–61.md).
  - (2) **Payment of New York City share of monitoring and treatment costs—** With respect to each calendar quarter for which a contribution is required by New York [City](/usc/42/12902.md?p=11) under the contract under [paragraph (1)](#d-1), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall—
    - (A) provide New York [City](/usc/42/12902.md?p=11) with an estimate of such amount of the required contribution at the beginning of such quarter and with an updated estimate of such amount at the beginning of each of the subsequent 2 quarters;
    - (B) bill such amount directly to New York [City](/usc/42/12902.md?p=11); and
    - (C) certify periodically, for purposes of this subsection, whether or not New York [City](/usc/42/12902.md?p=11) has paid the amount so billed.

    Such amount shall initially be estimated by the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) and shall be subject to adjustment and reconciliation based upon actual expenditures in carrying out this subchapter (excluding any expenditures from amounts in the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Supplemental [Fund](/usc/42/12854.md?p=3) under [section 300mm–62 of this title](/usc/42/300mm–62.md) or the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) for Certain [WTC Responders](/usc/42/300mm–21.md?p=a-1) at the Pentagon and Shanksville, Pennsylvania under [section 300mm–64 of this title](/usc/42/300mm–64.md)).

  - (3) **Rule of construction—** Nothing in this subsection shall be construed as authorizing the WTC [Administrator](/usc/42/4005.md?p=1), with respect to a fiscal year, to reduce the numerical limitation under section [300mm–21(a)(4)](/usc/42/300mm–21.md?p=a-4) or [300mm–31(a)(3)](/usc/42/300mm–31.md?p=a-3) of this title for such fiscal year if New York [City](/usc/42/12902.md?p=11) fails to comply with [paragraph (1)](#d-1) for a calendar quarter in such fiscal year.
- (e) **Work-related described—** For the purposes of this section, a [WTC-related health condition](/usc/42/300mm–22.md?p=a-1) shall be treated as a condition that is work-related if—
  - (1) the condition is diagnosed in an [enrolled WTC responder](/usc/42/300mm–5.md?p=4), or in an individual who qualifies as a [certified-eligible WTC survivor](/usc/42/300mm–5.md?p=2) on the basis of being a rescue, recovery, or cleanup worker; or
  - (2) with respect to the condition the individual has filed and had established a [claim](/usc/42/1320a–7a.md?p=i-2) under a workers’ compensation law or plan of the [United States](/usc/42/403.md?p=k) or a [State](/usc/42/300gg–91.md?p=d-14), or other work-related injury or illness benefit plan of the [employer](/usc/42/300gg–91.md?p=d-6) of such individual.

# §300mm–42. Administrative arrangement authority


The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) may enter into arrangements with other government agencies, insurance companies, or other third-party [administrators](/usc/42/4005.md?p=1) to provide for timely and accurate processing of [claims](/usc/42/1320a–7a.md?p=i-2) under sections [300mm–22](/usc/42/300mm–22.md), [300mm–23](/usc/42/300mm–23.md), [300mm–32](/usc/42/300mm–32.md), and [300mm–33](/usc/42/300mm–33.md) of this title.


# §300mm–51. Research regarding certain health conditions related to September 11 terrorist attacks

- (a) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall conduct or support—
  - (1) research on physical and mental health conditions that may be related to the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12);
  - (2) research on diagnosing [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1), in the case of conditions for which there has been diagnostic uncertainty; and
  - (3) research on treating [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1), in the case of conditions for which there has been [treatment](/usc/42/11851.md?p=11) uncertainty.

  The [Administrator](/usc/42/4005.md?p=1) may provide such support through continuation and expansion of research that was initiated before January 2, 2011, and through the World Trade Center Health [Registry](/usc/42/6341.md?p=6) (referred to in [section 300mm–52 of this title](/usc/42/300mm–52.md)), through a [Clinical Center of Excellence](/usc/42/300mm–4.md?p=b-1-A), or through a [Data Center](/usc/42/300mm–4.md?p=b-2).

- (b) **Types of research—** The research under [subsection (a)(1)](#a-1) shall include epidemiologic and other research studies on [WTC-related health conditions](/usc/42/300mm–22.md?p=a-1) or emerging conditions—
  - (1) among [enrolled WTC responders](/usc/42/300mm–5.md?p=4) and [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2) under [treatment](/usc/42/11851.md?p=11) and individuals who were exposed within a [geographic area](/usc/42/11360.md?p=9) related to the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12) in a manner similar to the exposure within such [geographic area](/usc/42/11360.md?p=9) experienced by individuals meeting the eligibility criteria under section [300mm–21(a)(2)](/usc/42/300mm–21.md?p=a-2) or [300mm–31(a)(1)(B)](/usc/42/300mm–31.md?p=a-1-B) of this title; and
  - (2) in sampled populations outside the [New York City disaster area](/usc/42/300mm–5.md?p=8) 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) **Research cohort for emerging health impacts on youth—**
  - (1) **In general—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A), in consultation with the [Secretary](/usc/42/201.md?p=c) of Education, shall establish a research cohort of sufficient size to conduct future research studies on the health and educational impacts of exposure to airborne toxins, or any other [hazard](/usc/42/5165f.md?p=a-3) or adverse condition, resulting from the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12), including on the population of individuals who were 21 years of age or younger at the time of exposure, including such individuals who are [screening-eligible WTC survivors](/usc/42/300mm–31.md?p=a-1-A) or [certified-eligible WTC survivors](/usc/42/300mm–5.md?p=2).
  - (2) **Populations studied—** The research cohort under [paragraph (1)](#c-1) may include—
    - (A) individuals who, on September 11, 2001, were 21 years of age or younger and were—
      - (i) outside the [New York City disaster area](/usc/42/300mm–5.md?p=8); and
      - (ii) in—
        - (I) the area of Manhattan not further north than 14th Street; or
        - (II) Brooklyn; and
    - (B) control populations, including populations of individuals who, on September 11, 2001, were 21 years of age or younger.
- (d) **Consultation—** The [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall carry out this section in consultation with the [WTC Scientific/Technical Advisory Committee](/usc/42/300mm–5.md?p=19).
- (e) **Application of privacy and human subject protections—** The privacy and human subject protections applicable to research conducted under this section shall not be less than such protections applicable to research conducted or funded by the Department of Health and Human [Services](/usc/42/201.md?p=a).

# §300mm–52. World Trade Center Health Registry


For the purpose of ensuring ongoing data collection relating to victims of the [September 11, 2001, terrorist attacks](/usc/42/300mm–5.md?p=12), the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) shall ensure that a [registry](/usc/42/6341.md?p=6) of such victims is maintained that is at least as comprehensive as the World Trade Center Health [Registry](/usc/42/6341.md?p=6) maintained under the arrangements in effect as of January 1, 2015, with the New York [City](/usc/42/12902.md?p=11) Department of Health and Mental Hygiene.


# §300mm–61. World Trade Center Health Program Fund

- (a) **Establishment of Fund—**
  - (1) **In general—** There is established a [fund](/usc/42/12854.md?p=3) to be known as the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) (referred to in this section as the “[Fund](/usc/42/12854.md?p=3)”).
  - (2) **Funding—** Out of any money in the Treasury not otherwise appropriated, there shall be deposited into the [Fund](/usc/42/12854.md?p=3) for fiscal year 2016 and each subsequent fiscal year through fiscal year 2090—
    - (A) the Federal share, consisting of an amount equal to—
      - (i) for fiscal year 2016, $330,000,000;
      - (ii) for fiscal year 2017, $345,610,000;
      - (iii) for fiscal year 2018, $380,000,000;
      - (iv) for fiscal year 2019, $440,000,000;
      - (v) for fiscal year 2020, $485,000,000;
      - (vi) for fiscal year 2021, $501,000,000;
      - (vii) for fiscal year 2022, $518,000,000;
      - (viii) for fiscal year 2023, $535,000,000;
      - (ix) for fiscal year 2024, $552,000,000;
      - (x) for fiscal year 2025, $570,000,000;
      - (xi) for each of fiscal years 2026 through 2040—
        - (I) the amount determined under this subparagraph for the previous fiscal year multiplied by 1.07; multiplied by
        - (II) the ratio of—
          - (aa) the total number of individuals enrolled in the [WTC Program](/usc/42/300mm–5.md?p=15) on July 1 of such previous fiscal year; to
          - (bb) the total number of individuals so enrolled on July 1 of the fiscal year prior to such previous fiscal year; and
      - (xii) for each subsequent fiscal year through fiscal year 2090, the amount specified under this subparagraph for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/403.md?p=k) [city](/usc/42/12902.md?p=11) average) as estimated by the [Secretary](/usc/42/201.md?p=c) for the 12-month period ending with March of the previous year; plus
    - (B) the New York [City](/usc/42/12902.md?p=11) share, consisting of the amount contributed under the contract under [section 300mm–41(d) of this title](/usc/42/300mm–41.md?p=d).
  - (3) **Contract requirement—**
    - (A) **In general—** No [funds](/usc/42/12854.md?p=3) may be disbursed from the [Fund](/usc/42/12854.md?p=3) unless New York [City](/usc/42/12902.md?p=11) has entered into a contract with the [WTC Program Administrator](/usc/42/300mm–5.md?p=16-A) under [section 300mm–41(d)(1) of this title](/usc/42/300mm–41.md?p=d-1).
    - (B) **Breach of contract—** In the case of a failure to pay the amount so required under the contract—
      - (i) the amount is recoverable under subparagraph (E)(ii) of such section;
      - (ii) such failure shall not affect the disbursement of amounts from the [Fund](/usc/42/12854.md?p=3); and
      - (iii) the Federal share described in [paragraph (2)(A)](#a-2-A) shall not be increased by the amount so unpaid.
  - (4) **Amounts from prior fiscal years—** Amounts that were deposited, or identified for deposit, into the [Fund](/usc/42/12854.md?p=3) for any fiscal year under [paragraph (2)](#a-2), as such paragraph was in effect on the day before December 18, 2015, that were not expended in carrying out this subchapter for any such fiscal year, shall remain deposited, or be deposited, as the case may be, into the [Fund](/usc/42/12854.md?p=3).
  - (5) **Amounts to remain available until expended—** Amounts deposited into the [Fund](/usc/42/12854.md?p=3) under this subsection, including amounts deposited under [paragraph (2)](#a-2) as in effect on the day before December 18, 2015, for a fiscal year shall remain available, for the purposes described in this subchapter, until expended for such fiscal year and any subsequent fiscal year through fiscal year 2090.
- (b) **Mandatory funds for monitoring, initial health evaluations, treatment, and claims processing—**
  - (1) **In general—** The amounts deposited into the [Fund](/usc/42/12854.md?p=3) under [subsection (a)(2)](#a-2) shall be available, without further appropriation, consistent with [paragraph (2)](#b-2) and [subsection (c)](#c), to carry out part B and sections [300mm(e)](/usc/42/300mm.md?p=e), [300mm(f)](/usc/42/300mm.md?p=f), [300mm–1(a)](/usc/42/300mm–1.md?p=a), [300mm–1(b)](/usc/42/300mm–1.md?p=b), [300mm–2](/usc/42/300mm–2.md), [300mm–3](/usc/42/300mm–3.md), [300mm–4(a)(1)](/usc/42/300mm–4.md?p=a-1), [300mm–4(a)(2)](/usc/42/300mm–4.md?p=a-2), [300mm–4(c)](/usc/42/300mm–4.md?p=c), [300mm–51](/usc/42/300mm–51.md), and [300mm–52](/usc/42/300mm–52.md) of this title.
  - (2) **Limitation on mandatory funding—** This subchapter does not establish any Federal obligation for payment of amounts in excess of the amounts available from the [Fund](/usc/42/12854.md?p=3) for such purpose or as available from the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Supplemental [Fund](/usc/42/12854.md?p=3) under [section 300mm–62 of this title](/usc/42/300mm–62.md), the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Special [Fund](/usc/42/12854.md?p=3) under [section 300mm–63 of this title](/usc/42/300mm–63.md), or the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) for Certain [WTC Responders](/usc/42/300mm–21.md?p=a-1) at the Pentagon and Shanksville, Pennsylvania under [section 300mm–64 of this title](/usc/42/300mm–64.md).
  - (3) **Limitation on authorization for further appropriations—** This subchapter does not establish any [authorization](/usc/42/4370m.md?p=3) for appropriation of amounts in excess of the amounts available from the [Fund](/usc/42/12854.md?p=3) under [paragraph (1)](#b-1) or as available from the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Supplemental [Fund](/usc/42/12854.md?p=3) under [section 300mm–62 of this title](/usc/42/300mm–62.md), the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) Special [Fund](/usc/42/12854.md?p=3) under [section 300mm–63 of this title](/usc/42/300mm–63.md), or the World Trade Center Health [Program](/usc/42/274l–1.md?p=4) [Fund](/usc/42/12854.md?p=3) for Certain [WTC Responders](/usc/42/300mm–21.md?p=a-1) at the Pentagon and Shanksville, Pennsylvania under [section 300mm–64 of this title](/usc/42/300mm–64.md).
  - (4) **Limitation for research cohort for emerging health impacts on youth—** Notwithstanding [paragraph (1)](#b-1), the amounts made available under such paragraph may not be used for fiscal years 2023 through 2032 to carry out subsection (c) of [section 300mm–51 of this title](/usc/42/300mm–51.md).
- (c) **Limits on spending for certain purposes—** Of the amounts made available under [subsection (b)(1)](#b-1), not more than each of the following amounts may be available for each of the following purposes:
  - (1) **Surviving immediate family members of firefighters—** For the purposes of carrying out part B with respect to [WTC responders](/usc/42/300mm–21.md?p=a-1) described in [section 300mm–21(a)(2)(A)(ii) of this title](/usc/42/300mm–21.md?p=a-2-A-ii)—
    - (A) for fiscal year 2016, the amount determined for such fiscal year under subparagraph (C)[^1] as in effect on the day before December 18, 2015; and
    - (B) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/403.md?p=k) [city](/usc/42/12902.md?p=11) average) as estimated by the [Secretary](/usc/42/201.md?p=c) for the 12-month period ending with March of the previous year.
  - (2) **WTC Health Program Scientific/Technical Advisory Committee—** For the purpose of carrying out [section 300mm–1(a) of this title](/usc/42/300mm–1.md?p=a)—
    - (A) for fiscal year 2016, $200,000;[^2]
    - (B) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/403.md?p=k) [city](/usc/42/12902.md?p=11) average) as estimated by the [Secretary](/usc/42/201.md?p=c) for the 12-month period ending with March of the previous year.
  - (3) **Education and outreach—** For the purpose of carrying out [section 300mm–2 of this title](/usc/42/300mm–2.md), for fiscal year 2016 and each subsequent fiscal year, $750,000.
  - (4) **Uniform data collection—** For the purpose of carrying out [section 300mm–3 of this title](/usc/42/300mm–3.md) and for reimbursing [Data Centers](/usc/42/300mm–4.md?p=b-2) (as defined in [section 300mm–4(b)(2) of this title](/usc/42/300mm–4.md?p=b-2)) for the costs incurred by such Centers in carrying out activities under contracts entered into under [section 300mm–4(a)(2) of this title](/usc/42/300mm–4.md?p=a-2)—
    - (A) for fiscal year 2016, the amount determined for such fiscal year under [subparagraph (C)](#c-4-C) as in effect on the day before December 18, 2015;
    - (B) for fiscal year 2017, $15,000,000; and
    - (C) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/403.md?p=k) [city](/usc/42/12902.md?p=11) average) as estimated by the [Secretary](/usc/42/201.md?p=c) for the 12-month period ending with March of the previous year.
  - (5) **Research regarding certain health conditions—** For the purpose of carrying out [section 300mm–51 of this title](/usc/42/300mm–51.md)—
    - (A) for fiscal year 2016, the amount determined for such fiscal year under subparagraph (C)[^1] as in effect on the day before December 18, 2015; and
    - (B) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/403.md?p=k) [city](/usc/42/12902.md?p=11) average) as estimated by the [Secretary](/usc/42/201.md?p=c) for the 12-month period ending with March of the previous year.
  - (6) **World Trade Center Health Registry—** For the purpose of carrying out [section 300mm–52 of this title](/usc/42/300mm–52.md)—
    - (A) for fiscal year 2016, the amount determined for such fiscal year under subparagraph (C)[^1] as in effect on the day before December 18, 2015; and
    - (B) for each subsequent fiscal year, the amount specified under this paragraph for the previous fiscal year increased by the percentage increase in the consumer price index for all urban consumers (all items; [United States](/usc/42/403.md?p=k) [city](/usc/42/12902.md?p=11) average) as estimated by the [Secretary](/usc/42/201.md?p=c) for the 12-month period ending with March of the previous year.