Part A—Establishment of Program; Advisory Committee
§300mm. Establishment of World Trade Center Health Program
(a) In general
There is hereby established within the Department of Health and Human Services a program to be known as the World Trade Center Health Program, which shall be administered by the WTC Program Administrator, to provide beginning on July 1, 2011—
(1) medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers (including those who are Federal employees) who responded to the September 11, 2001, terrorist attacks; and
(2) initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers in New York City who were directly impacted and adversely affected by such attacks.
(b) Components of program
The WTC Program includes the following components:
(1) Medical monitoring for responders
Medical monitoring under
(2) Initial health evaluation for survivors
An initial health evaluation under
(3) Followup monitoring and treatment for WTC-related health conditions for responders and survivors
Provision under
(4) Outreach
Establishment under
(5) Clinical data collection and analysis
Collection and analysis under
(6) Research on health conditions
Establishment under part C of a research program on health conditions resulting from the September 11, 2001, terrorist attacks.
(c) No cost sharing
Monitoring and treatment benefits and initial health evaluation benefits are provided under part B without any deductibles, copayments, or other cost sharing to an enrolled WTC responder or certified-eligible WTC survivor. Initial health evaluation benefits are provided under part B without any deductibles, copayments, or other cost sharing to a screening-eligible WTC survivor.
(d) Preventing fraud and unreasonable administrative costs
(1) Fraud
The Inspector General of the Department of Health and Human Services shall develop and implement a program to review the WTC Program's health care expenditures to detect fraudulent or duplicate billing and payment for inappropriate services. This subchapter is a Federal health care program (as defined in
(2) Unreasonable administrative costs
The Inspector General of the Department of Health and Human Services shall develop and implement a program to review the WTC Program for unreasonable administrative costs, including with respect to infrastructure, administration, and claims processing.
(e) Quality assurance
The WTC Program Administrator working with the Clinical Centers of Excellence shall develop and implement a quality assurance program for the monitoring and treatment delivered by such Centers of Excellence and any other participating health care providers. Such program shall include—
(1) adherence to monitoring and treatment protocols;
(2) appropriate diagnostic and treatment referrals for participants;
(3) prompt communication of test results to participants; and
(4) such other elements as the Administrator specifies in consultation with the Clinical Centers of Excellence.
(f) Annual program report
(1) In general
Not later than 6 months after the end of each fiscal year in which the WTC Program is in operation, the WTC Program Administrator shall submit an annual report to the Congress on the operations of this subchapter for such fiscal year and for the entire period of operation of the program.
(2) Contents included in report
Each annual report under paragraph (1) shall include at least the following:
(A) Eligible individuals
Information for each clinical program described in paragraph (3)—
(i) on the number of individuals who applied for certification under 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 and the number of such individuals who received medical treatment under the program;
(iii) with respect to individuals so certified who received such treatment, on the WTC-related health conditions for which they were treated; and
(iv) on the projected number of individuals who will be certified under 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 so described—
(i) information on the costs of monitoring and initial health evaluation and the costs of treatment and on the estimated costs of such monitoring, evaluation, and treatment in the succeeding fiscal year; and
(ii) an estimate of the cost of medical treatment for WTC-related health conditions that have been paid for or reimbursed by workers' compensation, by public or private health plans, or by New York City under
(C) Administrative costs
Information on the cost of administering the program, including costs of program support, data collection and analysis, and research conducted under the program.
(D) Administrative experience
Information on the administrative performance of the program, including—
(i) the performance of the program in providing timely evaluation of and treatment to eligible individuals; and
(ii) a list of the Clinical Centers of Excellence and other providers that are participating in the program.
(E) Scientific reports
A summary of the findings of any new scientific reports or studies on the health effects associated with exposure described in
(F) Advisory Committee recommendations
A list of recommendations by the WTC Scientific/Technical Advisory Committee on additional WTC Program eligibility criteria and on additional WTC-related health conditions and the action of the WTC Program Administrator concerning each such recommendation.
(3) Separate clinical programs described
In paragraph (2), each of the following shall be treated as a separate clinical program of the WTC Program:
(A) Firefighters and related personnel
The benefits provided for enrolled WTC responders described in
(B) Other WTC responders
The benefits provided for enrolled WTC responders not described in subparagraph (A).
(C) WTC survivors
The benefits provided for screening-eligible WTC survivors and certified-eligible WTC survivors in
(g) Notification to Congress upon reaching 80 percent of eligibility numerical limits
The Secretary shall promptly notify the Congress of each of the following:
(1) When the number of enrollments of WTC responders subject to the limit established under
(2) When the number of certifications for certified-eligible WTC survivors subject to the limit established under
(h) Consultation
The WTC Program Administrator shall engage in ongoing outreach and consultation with relevant stakeholders, including the WTC Health Program Steering Committees and the Advisory Committee under
(i) GAO studies
(1) Report
Not later than 18 months after December 18, 2015, the Comptroller General of the United States shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report that assesses, with respect to the WTC Program, the effectiveness of each of the following:
(A) The quality assurance program developed and implemented under subsection (e).
(B) The procedures for providing certifications of coverage of conditions as WTC-related health conditions for enrolled WTC responders under
(C) Any action under the WTC Program to ensure appropriate payment (including the avoidance of improper payments), including determining the extent to which individuals enrolled in the WTC Program 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 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 shall—
(A) consult the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate on the objectives in assessing the WTC Program; and
(B) prepare and submit to such Committees a report that assesses the WTC Program for the applicable reporting period, including the objectives described in subparagraph (A).
(j) Regulations
The WTC Program Administrator is authorized to promulgate such regulations as the Administrator determines necessary to administer this subchapter.
(k) Termination
The WTC Program shall terminate on October 1, 2090.
(July 1, 1944, ch. 373, title XXXIII, §3301, as added
Editorial Notes
Amendments
2022—Subsec. (f)(2)(E).
2015—Subsecs. (i) to (k).
§300mm–1. WTC Health Program Scientific/Technical Advisory Committee; WTC Health Program Steering Committees
(a) Advisory Committee
(1) Establishment
The WTC Program Administrator shall establish an advisory committee to be known as the WTC Health Program Scientific/Technical Advisory Committee (in this subsection referred to as the "Advisory Committee") to review scientific and medical evidence and to make recommendations to the Administrator on additional WTC Program eligibility criteria and on additional WTC-related health conditions.
(2) Composition
The WTC Program Administrator shall appoint the members of the Advisory Committee and shall include at least—
(A) 4 occupational physicians, at least 2 of whom have experience treating WTC rescue and recovery workers;
(B) 1 physician with expertise in pulmonary medicine;
(C) 2 environmental medicine or environmental health specialists;
(D) 2 representatives of WTC responders;
(E) 2 representatives of certified-eligible WTC survivors;
(F) an industrial hygienist;
(G) a toxicologist;
(H) an epidemiologist; and
(I) a mental health professional.
(3) Meetings
The Advisory Committee shall meet at such frequency as may be required to carry out its duties.
(4) Reports
The WTC Program Administrator shall provide for publication of recommendations of the Advisory Committee on the public Web site established for the WTC Program.
(5) Duration
Notwithstanding any other provision of law, the Advisory Committee shall continue in operation during the period in which the WTC Program is in operation.
(6) Application of chapter 10 of title 5
Except as otherwise specifically provided, the Advisory Committee shall be subject to Chapter 1 10 of title 5.
(b) WTC Health Program Steering Committees
(1) Consultation
The WTC Program Administrator shall consult with 2 steering committees (each in this section referred to as a "Steering Committee") that are established as follows:
(A) WTC Responders Steering Committee
One Steering Committee, to be known as the WTC Responders Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of monitoring and treatment programs for the enrolled WTC responders under 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, monitoring, and treatment programs for screening-eligible and certified-eligible WTC survivors under subpart 2 of part B.
(2) Membership
(A) WTC Responders Steering Committee
(i) Representation
The WTC Responders Steering Committee shall include—
(I) representatives of the Centers of Excellence providing services to WTC responders;
(II) representatives of labor organizations representing firefighters, police, other New York City employees, and recovery and cleanup workers who responded to the September 11, 2001, terrorist attacks; and
(III) 3 representatives of New York City, 1 of whom will be selected by the police commissioner of New York City, 1 by the health commissioner of New York City, and 1 by the mayor of New York City.
(ii) Initial membership
The WTC Responders Steering Committee shall initially be composed of members of the WTC Monitoring and Treatment Program Steering Committee (as in existence on the day before January 2, 2011).
(B) WTC Survivors Steering Committee
(i) Representation
The WTC Survivors Steering Committee shall include representatives of—
(I) the Centers of Excellence providing services to screening-eligible and certified-eligible WTC survivors;
(II) the population of residents, students, and area and other workers affected by the September 11, 2001, terrorist attacks;
(III) screening-eligible and certified-eligible survivors receiving initial health evaluations, monitoring, or treatment under subpart 2 of part B and organizations advocating on their behalf; and
(IV) New York City.
(ii) Initial membership
The WTC Survivors Steering Committee shall initially be composed of members of the WTC Environmental Health Center Survivor Advisory Committee (as in existence on the day before 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.
(July 1, 1944, ch. 373, title XXXIII, §3302, as added
Editorial Notes
Amendments
2022—Subsec. (a)(6).
1 So in original. Probably should not be capitalized.
§300mm–2. Education and outreach
The WTC Program Administrator shall institute a program that provides education and outreach on the existence and availability of services under the WTC Program. The outreach and education program—
(1) shall include—
(A) the establishment of a public Web site with information about the WTC Program;
(B) meetings with potentially eligible populations;
(C) development and dissemination of outreach materials informing people about the program; and
(D) the establishment of phone information services; and
(2) shall be conducted in a manner intended—
(A) to reach all affected populations; and
(B) to include materials for culturally and linguistically diverse populations.
(July 1, 1944, ch. 373, title XXXIII, §3303, as added
§300mm–3. Uniform data collection and analysis
(a) In general
The WTC Program Administrator shall provide for the uniform collection of data, including claims data (and analysis of data and regular reports to the Administrator) on the prevalence of WTC-related health conditions and the identification of new WTC-related health conditions. Such data shall be collected for all individuals provided monitoring or treatment benefits under part B and regardless of their place of residence or Clinical Center of Excellence through which the benefits are provided. The WTC Program Administrator shall provide, through the Data Centers or otherwise, for the integration of such data into the monitoring and treatment program activities under this subchapter.
(b) Coordinating through Centers of Excellence
Each Clinical Center of Excellence shall collect data described in subsection (a) and report such data to the corresponding Data Center for analysis by such Data Center.
(c) Collaboration with WTC Health Registry
The WTC Program Administrator shall provide for collaboration between the Data Centers and the World Trade Center Health Registry described in
(d) Privacy
The data collection and analysis under this section shall be conducted and maintained in a manner that protects the confidentiality of individually identifiable health information consistent with applicable statutes and regulations, including, as applicable, HIPAA privacy and security law (as defined in
(July 1, 1944, ch. 373, title XXXIII, §3304, as added
§300mm–4. Clinical Centers of Excellence and Data Centers
(a) In general
(1) Contracts with Clinical Centers of Excellence
The WTC Program Administrator shall, subject to subsection (b)(1)(B), enter into contracts with Clinical Centers of Excellence (as defined in subsection (b)(1)(A))—
(A) for the provision of monitoring and treatment benefits and initial health evaluation benefits under part B;
(B) for the provision of outreach and retention activities to individuals eligible for such monitoring and treatment benefits, for initial health evaluation benefits, and for followup to individuals who are enrolled in the monitoring program;
(C) for the provision of counseling for benefits under part B, with respect to WTC-related health conditions, for individuals eligible for such benefits;
(D) for the provision of counseling for benefits for WTC-related health conditions that may be available under workers' compensation or other benefit programs for work-related injuries or illnesses, health insurance, disability insurance, or other insurance plans or through public or private social service agencies and assisting eligible individuals in applying for such benefits;
(E) for the provision of translational and interpretive services for program participants who are not English language proficient; and
(F) for the collection and reporting of data, including claims data, in accordance with
(2) Contracts with Data Centers
(A) In general
The WTC Program Administrator shall enter into contracts with one or more Data Centers (as defined in subsection (b)(2))—
(i) for receiving, analyzing, and reporting to the WTC Program Administrator on data, in accordance with
(ii) for the development of monitoring, initial health evaluation, and treatment protocols, with respect to WTC-related health conditions;
(iii) for coordinating the outreach and retention activities conducted under paragraph (1)(B) by each corresponding Clinical Center of Excellence;
(iv) for establishing criteria for the credentialing of medical providers participating in the nationwide network under
(v) for coordinating and administering the activities of the WTC Health Program Steering Committees established under section 300mm–1(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) and on the development of monitoring, initial health evaluation, and treatment protocols under clause (ii).
(B) Medical provider selection
The medical providers under subparagraph (A)(iv) shall be selected by the WTC Program Administrator on the basis of their experience treating or diagnosing the health conditions included in the list of WTC-related health conditions.
(C) Clinical discussions
In carrying out subparagraph (A)(ii), a Data Center shall engage in clinical discussions across the WTC Program to guide treatment approaches for individuals with a WTC-related health condition.
(D) Transparency of data
A contract entered into under this subsection with a Data Center shall require the Data Center to make any data collected and reported to such Center under subsection (b)(1)(B)(iii) available to health researchers and others as provided in the CDC/ATSDR Policy on Releasing and Sharing Data.
(3) Authority for contracts to be class specific
A contract entered into under this subsection with a Clinical Center of Excellence or a Data Center may be with respect to one or more class of enrolled WTC responders, screening-eligible WTC survivors, or certified-eligible WTC survivors.
(4) Use of cooperative agreements
Any contract under this subchapter between the WTC Program Administrator and a Data Center or a Clinical Center of Excellence may be in the form of a cooperative agreement.
(5) Review on feasibility of consolidating Data Centers
Not later than July 1, 2011, the Comptroller General of the United States shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on the feasibility of consolidating Data Centers into a single Data Center.
(b) Centers of Excellence
(1) Clinical Centers of Excellence
(A) Definition
For purposes of this subchapter, the term "Clinical Center of Excellence" means a Center that demonstrates to the satisfaction of the Administrator that the Center—
(i) uses an integrated, centralized health care provider approach to create a comprehensive suite of health services under this subchapter that are accessible to enrolled WTC responders, screening-eligible WTC survivors, or certified-eligible WTC survivors;
(ii) has experience in caring for WTC responders and screening-eligible WTC survivors or includes health care providers who have been trained pursuant to
(iii) employs health care provider staff with expertise that includes, at a minimum, occupational medicine, environmental medicine, trauma-related psychiatry and psychology, and social services counseling; and
(iv) meets such other requirements as specified by the Administrator.
(B) Contract requirements
The WTC Program Administrator shall not enter into a contract with a Clinical Center of Excellence under subsection (a)(1) unless the Center agrees to do each of the following:
(i) Establish a formal mechanism for consulting with and receiving input from representatives of eligible populations receiving monitoring and treatment benefits under part B from such Center.
(ii) Coordinate monitoring and treatment benefits under part B with routine medical care provided for the treatment of conditions other than WTC-related health conditions.
(iii) Collect and report to the corresponding Data Center data, including claims data, in accordance with
(iv) Have in place safeguards against fraud that are satisfactory to the Administrator, in consultation with the Inspector General of the Department of Health and Human Services.
(v) Treat or refer for treatment all individuals who are enrolled WTC responders or certified-eligible WTC survivors with respect to such Center who present themselves for treatment of a WTC-related health condition.
(vi) Have in place safeguards, consistent with
(vii) Use amounts paid under subsection (c)(1) only for costs incurred in carrying out the activities described in subsection (a), other than those described in subsection (a)(1)(A).
(viii) Utilize health care providers with occupational and environmental medicine expertise to conduct physical and mental health assessments, in accordance with protocols developed under subsection (a)(2)(A)(ii).
(ix) Communicate with WTC responders and screening-eligible and certified-eligible WTC survivors in appropriate languages and conduct outreach activities with relevant stakeholder worker or community associations.
(x) Meet all the other applicable requirements of this subchapter, including regulations implementing such requirements.
(C) Transition rule to ensure continuity of care
The WTC Program Administrator shall to the maximum extent feasible ensure continuity of care in any period of transition from monitoring and treatment of an enrolled WTC responder or certified-eligible WTC survivor by a provider to a Clinical Center of Excellence or a health care provider participating in the nationwide network under
(2) Data Centers
For purposes of this subchapter, the term "Data Center" means a Center that the WTC Program Administrator determines has the capacity to carry out the responsibilities for a Data Center under subsection (a)(2).
(3) Corresponding centers
For purposes of this subchapter, a Clinical Center of Excellence and a Data Center shall be treated as "corresponding" to the extent that such Clinical Center and Data Center serve the same population group.
(c) Payment for infrastructure costs
(1) In general
The WTC Program Administrator shall reimburse a Clinical Center of Excellence for the fixed infrastructure costs of such Center in carrying out the activities described in part B at a rate negotiated by the Administrator and such Centers. Such negotiated rate shall be fair and appropriate and take into account the number of enrolled WTC responders receiving services from such Center under this subchapter.
(2) Fixed infrastructure costs
For purposes of paragraph (1), the term "fixed infrastructure costs" means, with respect to a Clinical Center of Excellence, the costs incurred by such Center that are not otherwise reimbursable by the WTC Program Administrator under
(d) GAO analysis
Not later than July 1, 2011, the Comptroller General shall submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate an analysis on whether Clinical Centers of Excellence with which the WTC Program Administrator enters into a contract under this section have financial systems that will allow for the timely submission of claims data for purposes of
(July 1, 1944, ch. 373, title XXXIII, §3305, as added
Editorial Notes
References in Text
Amendments
2015—Subsec. (a)(1)(B).
Subsec. (a)(2)(A)(iii).
Subsec. (b)(1)(B)(vi).
1 See References in Text note below.
§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, or any other adverse condition resulting from the September 11, 2001, terrorist attacks, requires medical treatment that is (or will be) in addition to, more frequent than, or of longer duration than the medical treatment that would have been required for such condition in the absence of such exposure.
(2) The term "certified-eligible WTC survivor" has the meaning given such term in
(3) The terms "Clinical Center of Excellence" and "Data Center" have the meanings given such terms in
(4) The term "enrolled WTC responder" means a WTC responder enrolled under
(5) The term "Federal agency" means an agency, office, 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 and is eligible for treatment under the WTC Program.
(7) The term "list of WTC-related health conditions" means—
(A) for WTC responders, the health conditions listed in
(B) for screening-eligible and certified-eligible WTC survivors, the health conditions listed in
(8) The term "New York City disaster area" means the area within New York City that is—
(A) the area of Manhattan that is south of Houston Street; and
(B) any block in Brooklyn that is wholly or partially contained within a 1.5-mile radius of the former World Trade Center site.
(9) The term "New York metropolitan area" means an area, specified by the WTC Program Administrator, within which WTC responders and eligible WTC screening-eligible survivors who reside in such area are reasonably able to access monitoring and treatment benefits and initial health evaluation benefits under this subchapter through a Clinical Center of Excellence described in subparagraphs (A), (B), or (C) of
(10) The term "screening-eligible WTC survivor" has the meaning given such term in
(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, 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
(14) The term "WTC Health Program Steering Committee" means such a Steering Committee established under
(15) The term "WTC Program" means the Word Trade Center Health Program established under
(16)(A) The term "WTC Program Administrator" means—
(i) subject to subparagraph (B), with respect to paragraphs (3) and (4) of
(ii) with respect to any other provision of this subchapter, the Director of the National Institute for Occupational Safety and Health, or a designee of such Director.
(B) In no case may the Secretary designate under subparagraph (A)(i) the Director of the National Institute for Occupational Safety and Health or a designee of such Director with respect to
(17) The term "WTC-related health condition" is defined in
(18) The term "WTC responder" is defined in
(19) The term "WTC Scientific/Technical Advisory Committee" means such Committee established under
(July 1, 1944, ch. 373, title XXXIII, §3306, as added
Editorial Notes
Amendments
2023—Pars. (5) to (19).
1 So in original. A closing parenthesis probably should precede the comma.