- § 300mm-21. Identification of WTC responders and provision of WTC-related monitoring services
- § 300mm-22. Treatment of enrolled WTC responders for WTC-related health conditions
- § 300mm-23. National arrangement for benefits for eligible individuals outside New York
§ 300mm–21. Identification of WTC responders and provision of WTC-related monitoring services
(a) WTC responder defined
(1) In generalFor purposes of this subchapter, the term “WTC responder” means any of the following individuals, subject to paragraph (4):
(A) Currently identified responderAn 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 coordinated by Mt. Sinai Hospital in New York City that coordinates the monitoring and treatment for enrolled WTC responders other than with respect to those covered under the arrangement with the Fire Department of New York City; or
(ii) the Fire Department of New York City.
(B) Responder who meets current eligibility criteria
(C) Responder who meets modified eligibility criteriaAn individual who—
(i) performed rescue, recovery, demolition, debris cleanup, or other related services in the New York City disaster area in response to the September 11, 2001, terrorist attacks, regardless of whether such services were performed by a State or Federal employee or member of the National Guard or otherwise; and
(ii) meets such eligibility criteria relating to exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, terrorist attacks as the WTC Program Administrator, after consultation with the WTC Scientific/Technical Advisory Committee, determines appropriate.
The WTC Program Administrator shall not modify such eligibility criteria on or after the date that the number of enrollments of WTC responders has reached 80 percent of the limit described in paragraph (4) or on or after the date that the number of certifications for certified-eligible WTC survivors under section 300mm–31(a)(2)(B) of this title has reached 80 percent of the limit described in section 300mm–31(a)(3) of this title.
(2) Current eligibility criteriaThe eligibility criteria described in this paragraph for an individual is that the individual is described in any of the following categories:
(A) Firefighters and related personnelThe individual—
(i) was a member of the Fire Department of New York City (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 Chief Medical Examiner’s Office) for any time during the period beginning on September 11, 2001, and ending on July 31, 2002; or
(ii)(I) is a surviving immediate family member of an individual who was a member of the Fire Department of New York City (whether fire or emergency personnel, active or retired) and was killed at the World Trade site on September 11, 2001; and(II) received any treatment for a WTC-related health condition described in section 300mm–22(a)(1)(A)(ii) of this title (relating to mental health conditions) on or before September 1, 2008.
(B) Law enforcement officers and WTC rescue, recovery, and cleanup workersThe individual—
(i) worked or volunteered onsite in rescue, recovery, debris cleanup, or related support services in lower Manhattan (south of Canal St.), the Staten Island Landfill, or the barge loading piers, for at least 4 hours during the period beginning on September 11, 2001, and ending on September 14, 2001, for at least 24 hours during the period beginning on September 11, 2001, and ending on September 30, 2001, or for at least 80 hours during the period beginning on September 11, 2001, and ending on July 31, 2002;
(ii)(I) was a member of the Police Department of New York City (whether active or retired) or a member of the Port Authority Police of the Port Authority of New York and New Jersey (whether active or retired) who participated onsite in rescue, recovery, debris cleanup, or related services in lower Manhattan (south of Canal St.), including Ground Zero, the Staten Island Landfill, or the barge loading piers, for at least 4 hours during the period beginning September 11, 2001, and ending on September 14, 2001;(II) participated onsite in rescue, recovery, debris cleanup, or related services at Ground Zero, the Staten Island Landfill, or the barge loading piers, for at least one day during the period beginning on September 11, 2001, and ending on July 31, 2002;(III) participated onsite in rescue, recovery, debris cleanup, or related services in lower Manhattan (south of Canal St.) for at least 24 hours during the period beginning on September 11, 2001, and ending on September 30, 2001; or(IV) participated onsite in rescue, recovery, debris cleanup, or related services in lower Manhattan (south of Canal St.) for at least 80 hours during the period beginning on September 11, 2001, and ending on July 31, 2002;
(iii) was an employee of the Office of the Chief Medical Examiner of New York City involved in the examination and handling of human remains from the World Trade Center attacks, or other morgue worker who performed similar post-September 11 functions for such Office staff, during the period beginning on September 11, 2001, and ending on July 31, 2002;
(iv) was a worker in the Port Authority Trans-Hudson Corporation Tunnel for at least 24 hours during the period beginning on
(v) was a vehicle-maintenance worker who was exposed to debris from the former World Trade Center while retrieving, driving, cleaning, repairing, and maintaining vehicles contaminated by airborne toxins from the September 11, 2001, terrorist attacks during a duration and period described in subparagraph (A).
(C) Responders to the September 11 attacks at the Pentagon and Shanksville, PennsylvaniaThe individual—
(i)(I) was a member of a fire or police department (whether fire or emergency personnel, active or retired), worked for a recovery or cleanup contractor, or was a volunteer; and performed rescue, recovery, demolition, debris cleanup, or other related services at the Pentagon site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the WTC Program Administrator;(II) was a member of a fire or police department (whether fire or emergency personnel, active or retired), worked for a recovery or cleanup contractor, or was a volunteer; and performed rescue, recovery, demolition, debris cleanup, or other related services at the Shanksville, Pennsylvania, site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the WTC Program Administrator;(III) was an employee of the Department of Defense or any other Federal agency, 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, or was a member of a regular or reserve component of the uniformed services; and performed rescue, recovery, demolition, debris cleanup, or other related services at the Pentagon site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the WTC Program Administrator; or(IV) was an employee of the Department of Defense or any other Federal agency, 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, or was a member of a regular or reserve component of the uniformed services; and performed rescue, recovery, demolition, debris cleanup, or other related services at the Shanksville, Pennsylvania, site of the terrorist-related aircraft crash of September 11, 2001, during the period beginning on September 11, 2001, and ending on the date on which the cleanup of the site was concluded, as determined by the WTC Program Administrator; and
(ii) is determined by the WTC Program Administrator to be at an increased risk of developing a WTC-related health condition as a result of exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 11, 2001, terrorist attacks, and meets such eligibility criteria related to such exposures, as the WTC Program Administrator determines are appropriate, after consultation with the WTC Scientific/Technical Advisory Committee.
(3) Enrollment process
(A) In generalThe WTC Program Administrator shall establish a process for enrolling WTC responders in the WTC Program. Under such process—
(i) WTC responders described in paragraph (1)(A) shall be deemed to be enrolled in such Program;
(ii) subject to clause (iii), the Administrator shall enroll in such program individuals who are determined to be WTC responders;
(iii) the Administrator shall deny such enrollment to an individual if the Administrator determines that the numerical limitation in paragraph (4) on enrollment of WTC responders has been met;
(iv) there shall be no fee charged to the applicant for making an application for such enrollment;
(v) the Administrator shall make a determination on such an application not later than 60 days after the date of filing the application; and
(vi) an individual who is denied enrollment in such Program shall have an opportunity to appeal such determination in a manner established under such process.
(B) Timing
(i) Currently identified responders
(ii) Other responders
(4) Numerical limitation on eligible WTC responders
(A) Limit
(i) In general
(ii) Certain responders to the September 11 attacks at the Pentagon and Shanksville, Pennsylvania
(B) ProcessIn implementing subparagraph (A), the WTC Program Administrator shall—
(i) limit the number of enrollments made under paragraph (3)—(I) in accordance with such subparagraph; and(II) to such number, as determined by the Administrator based on the best available information and subject to amounts available under this subchapter, that will ensure sufficient funds will be available to provide treatment and monitoring benefits under this subchapter, with respect to all individuals who are enrolled; and
(ii) provide priority (subject to paragraph (3)(A)(i)) in such enrollments in the order in which individuals apply for enrollment under paragraph (3).
(5) Disqualification of individuals on terrorist watch list
(b) Monitoring benefits
(1) In general
(2) Provision of monitoring benefits
(July 1, 1944, ch. 373, title XXXIII, § 3311, as added Pub. L. 111–347, title I, § 101, Jan. 2, 2011, 124 Stat. 3635; amended Pub. L. 114–113, div. O, title III, § 302(d), Dec. 18, 2015, 129 Stat. 2999; Pub. L. 116–59, div. B, title VI, § 1602(a), Sept. 27, 2019, 133 Stat. 1107; Pub. L. 117–328, div. FF, title VII, § 7701(b)(1), Dec. 29, 2022, 136 Stat. 5965; Pub. L. 118–31, div. A, title XVIII, § 1851(a)(2), (c)(1), Dec. 22, 2023, 137 Stat. 706, 708.)
§ 300mm–22. Treatment of enrolled WTC responders for WTC-related health conditions
(a) WTC-related health condition defined
(1) In generalFor purposes of this subchapter, the term “WTC-related health condition” means a condition that—
(A)
(i) is an illness or health condition for which exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the September 11, 2001, terrorist attacks, based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of WTC-related health conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the illness or health condition, as determined under paragraph (2); or
(ii) is a mental health condition for which such attacks, based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of WTC-related health conditions, is substantially likely to be a significant factor in aggravating, contributing to, or causing the condition, as determined under paragraph (2); and
(B) is included in the applicable list of WTC-related health conditions or—
(i) with respect to a WTC responder, is provided certification of coverage under subsection (b)(2)(B)(iii); or
(ii) with respect to a screening-eligible WTC survivor or certified-eligible WTC survivor, is provided certification of coverage under subsection (b)(2)(B)(iii), as applied under section 300mm–32(a) of this title.
In the case of a WTC responder described in section 300mm–21(a)(2)(A)(ii) of this title (relating to a surviving immediate family member of a firefighter), such term does not include an illness or health condition described in subparagraph (A)(i).
(2) DeterminationThe determination under paragraph (1) or subsection (b) of whether the September 11, 2001, terrorist attacks were substantially likely to be a significant factor in aggravating, contributing to, or causing an individual’s illness or health condition shall be made based on an assessment of the following:
(A) The individual’s exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the terrorist attacks. Such exposure shall be—
(i) evaluated and characterized through the use of a standardized, population-appropriate questionnaire approved by the Director of the National Institute for Occupational Safety and Health; and
(ii) assessed and documented by a medical professional with experience in treating or diagnosing health conditions included on the list of WTC-related health conditions.
(B) The type of symptoms and temporal sequence of symptoms. Such symptoms shall be—
(i) assessed through the use of a standardized, population-appropriate medical questionnaire approved by the Director of the National Institute for Occupational Safety and Health and a medical examination; and
(ii) diagnosed and documented by a medical professional described in subparagraph (A)(ii).
(3) List of health conditions for WTC respondersThe list of health conditions for WTC responders consists of the following:
(A) Aerodigestive disorders
(i) Interstitial lung diseases.
(ii) Chronic respiratory disorder—fumes/vapors.
(iii) Asthma.
(iv) Reactive airways dysfunction syndrome (RADS).
(v) WTC-exacerbated chronic obstructive pulmonary disease (COPD).
(vi) Chronic cough syndrome.
(vii) Upper airway hyperreactivity.
(viii) Chronic rhinosinusitis.
(ix) Chronic nasopharyngitis.
(x) Chronic laryngitis.
(xi) Gastroesophageal reflux disorder (GERD).
(xii) Sleep apnea exacerbated by or related to a condition described in a previous clause.
(B) Mental health conditions
(i) Posttraumatic stress disorder (PTSD).
(ii) Major depressive disorder.
(iii) Panic disorder.
(iv) Generalized anxiety disorder.
(v) Anxiety disorder (not otherwise specified).
(vi) Depression (not otherwise specified).
(vii) Acute stress disorder.
(viii) Dysthymic disorder.
(ix) Adjustment disorder.
(x) Substance abuse.
(C) Musculoskeletal disorders for certain WTC responders
(D) Additional conditions
(4) Musculoskeletal disorders
(A) In generalFor purposes of this subchapter, in the case of a WTC responder who received any treatment for a WTC-related musculoskeletal disorder on or before September 11, 2003, the list of health conditions in paragraph (3) shall include:
(i) Low back pain.
(ii) Carpal tunnel syndrome (CTS).
(iii) Other musculoskeletal disorders.
(B) Definition
(5) Cancer
(A) In general
(B) Proposed regulations and rulemaking
(C) Final regulations
(D) Determinations not to add cancer or certain types of cancer
(6) Addition of health conditions to list for WTC responders
(A) In general
(B) Administrator’s options after receipt of petitionIn the case that the WTC Program Administrator receives a written petition by an interested party to add a health condition to the list of health conditions in paragraph (3), not later than 90 days after the date of receipt of such petition the Administrator shall—
(i) request a recommendation of the Advisory Committee;
(ii) publish a proposed rule in the Federal Register to add such health condition, in accordance with subparagraph (D);
(iii) publish in the Federal Register the Administrator’s determination not to publish such a proposed rule and the basis for such determination; or
(iv) publish in the Federal Register a determination that insufficient evidence exists to take action under clauses (i) through (iii).
(C) Action by Advisory Committee
(D) PublicationThe WTC Program Administrator shall, with respect to any proposed rule under this paragraph—
(i) publish such proposed rule in accordance with section 553 of title 5; and
(ii) provide interested parties a period of 30 days after such publication to submit written comments on the proposed rule.
The WTC Program Administrator may extend the period described in clause (ii) upon a finding of good cause. In the case of such an extension, the Administrator shall publish such extension in the Federal Register.
(E) Interested party defined
(F) Independent peer reviews
(G) Additional advisory committee recommendations
(i) Program policies(I) Existing policies(II) Subsequent policies
(ii) Identification of individuals conducting independent peer reviews
(b) Coverage of treatment for WTC-related health conditions
(1) Determination for enrolled WTC responders based on a WTC-related health condition
(A) In generalIf a physician at a Clinical Center of Excellence that is providing monitoring benefits under section 300mm–21 of this title for an enrolled WTC responder makes a determination that the responder has a WTC-related health condition that is in the list in subsection (a)(3) and that exposure to airborne toxins, other hazards, or adverse conditions resulting from the September 1, 2001, terrorist attacks is substantially likely to be a significant factor in aggravating, contributing to, or causing the condition—
(i) the physician shall promptly transmit such determination to the WTC Program Administrator and provide the Administrator with the medical facts supporting such determination; and
(ii) on and after the date of such transmittal and subject to subparagraph (B), the WTC Program shall provide for payment under subsection (c) for medically necessary treatment for such condition.
(B) Review; certification; appeals
(i) Review
(ii) Certification
(iii) Appeal process
(2) Determination based on medically associated WTC-related health conditions
(A) In generalIf a physician at a Clinical Center of Excellence determines pursuant to subsection (a) that the enrolled WTC responder has a health condition described in subsection (a)(1)(A) that is not in the list in subsection (a)(3) but which is medically associated with a WTC-related health condition—
(i) the physician shall promptly transmit such determination to the WTC Program Administrator and provide the Administrator with the facts supporting such determination; and
(ii) the Administrator shall make a determination under subparagraph (B) with respect to such physician’s determination.
(B) Procedures for review, certification, and appealThe WTC Program Administrator shall, by rule, establish procedures for the review and certification of physician determinations under subparagraph (A). Such rule shall provide for—
(i) the timely review of such a determination by a physician panel with appropriate expertise for the condition and recommendations to the WTC Program Administrator;
(ii) not later than 60 days after the date of the transmittal under subparagraph (A)(i), a determination by the WTC Program Administrator on whether or not the condition involved is described in subsection (a)(1)(A) and is medically associated with a WTC-related health condition;
(iii) certification in accordance with paragraph (1)(B)(ii) of coverage of such condition if determined to be described in subsection (a)(1)(A) and medically associated with a WTC-related health condition; and
(iv) a process for appeals of determinations relating to such conditions.
(C) Inclusion in list of health conditions
(D) Conditions already declined for inclusion in list
(3) Requirement of medical necessity
(A) In general
(B) Regulations relating to medical necessity
(4) Scope of treatment covered
(A) In general
(B) Pharmaceutical coverage
(C) Transportation expenses for nationwide network
(5) Provision of treatment pending certification
(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 generalSubject to clause (ii):(I) Subject to subparagraphs (B) and (C), the WTC Program Administrator shall reimburse costs for medically necessary treatment under this subchapter for WTC-related health conditions according to the payment rates that would apply to the provision of such treatment and services by the facility under the Federal Employees Compensation Act.(II) For treatment not covered under subclause (i) or subparagraph (B), the WTC Program Administrator shall establish by regulation a reimbursement rate for such treatment.
(ii) Exception
(B) Pharmaceuticals
(i) In general
(ii) Competitive biddingUnder such program the Administrator shall—(I) select one or more appropriate vendors through a Federal competitive bid process; and(II) select the lowest bidder (or bidders) meeting the requirements for providing pharmaceutical benefits for participants in the WTC Program.
(iii) Treatment of FDNY participants
(iv) Pharmaceuticals
(C) Improving quality and efficiency through modification of payment amounts and methodologies
(2) Monitoring and initial health evaluation
(3) Determination of medical necessity
(A) Review of medical necessity and protocols
(B) Withholding of payment for medically unnecessary treatment
(d) Medical treatment protocols
(1) Development
(2) Approval
(July 1, 1944, ch. 373, title XXXIII, § 3312, as added Pub. L. 111–347, title I, § 101, Jan. 2, 2011, 124 Stat. 3639; amended Pub. L. 114–113, div. O, title III, § 302(e), Dec. 18, 2015, 129 Stat. 2999.)
§ 300mm–23. National arrangement for benefits for eligible individuals outside New York
(a) In general
(b) Network requirements
Any health care provider participating in the network under subsection (a) shall—
(1) meet criteria for credentialing established by the Data Centers;
(2) follow the monitoring, initial health evaluation, and treatment protocols developed under section 300mm–4(a)(2)(A)(ii) of this title;
(3) collect and report data in accordance with section 300mm–3 of this title; and
(4) meet such fraud, quality assurance, and other requirements as the WTC Program Administrator establishes, including sections 1320a–7 through 1320a–7e of this title, as applied by section 300mm(d) of this title.
(c) Training and technical assistance
(d) Provision of services through the VA
(1) In general
(2) National program
(July 1, 1944, ch. 373, title XXXIII, § 3313, as added Pub. L. 111–347, title I, § 101, Jan. 2, 2011, 124 Stat. 3647.)