Collapse to view only § 300mm-41. Payment of claims
§ 300mm–41. Payment of claims
(a) In general
(b) Workers’ compensation payment
(1) In general
(2) Exception
(3) Rules of construction
(c) Health insurance coverage
(1) In general
(2) Recovery by individual providers
(3) Maintenance of required minimum essential coverage
No payment may be made for monitoring and treatment 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) for whom the exemption under subsection (e) of such section does not apply; and
(B) is not covered under minimum essential coverage, as required under subsection (a) of such section.
(d) Required contribution by New York City in program costs
(1) Contract requirement
(A) In general
(B) Full contribution amount
(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.
(D) Timing of contribution
(E) Compliance
(i) Interest for late payment
(ii) Recovery of amounts owed
(F) Deposit in fund
(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 under the contract under paragraph (1), the WTC Program Administrator shall—
(A) provide New York City 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; and
(C) certify periodically, for purposes of this subsection, whether or not New York City has paid the amount so billed.
Such amount shall initially be estimated by the WTC Program Administrator 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 Supplemental Fund under section 300mm–62 of this title or the World Trade Center Health Program Fund for Certain WTC Responders at the Pentagon and Shanksville, Pennsylvania under section 300mm–64 of this title).
(3) Rule of construction
(e) Work-related described
For the purposes of this section, a WTC-related health condition shall be treated as a condition that is work-related if—
(1) the condition is diagnosed in an enrolled WTC responder, or in an individual who qualifies as a certified-eligible WTC survivor 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 under a workers’ compensation law or plan of the United States or a State, or other work-related injury or illness benefit plan of the employer of such individual.
(July 1, 1944, ch. 373, title XXXIII, § 3331, as added Pub. L. 111–347, title I, § 101, Jan. 2, 2011, 124 Stat. 3653; amended Pub. L. 114–113, div. O, title III, § 302(g), Dec. 18, 2015, 129 Stat. 3000; Pub. L. 117–328, div. FF, title VII, § 7701(b)(3), Dec. 29, 2022, 136 Stat. 5965; Pub. L. 118–31, div. A, title XVIII, § 1851(c)(3), Dec. 22, 2023, 137 Stat. 708.)
§ 300mm–42. Administrative arrangement authority
The WTC Program Administrator may enter into arrangements with other government agencies, insurance companies, or other third-party administrators to provide for timely and accurate processing of claims under sections 300mm–22, 300mm–23, 300mm–32, and 300mm–33 of this title.
(July 1, 1944, ch. 373, title XXXIII, § 3332, as added Pub. L. 111–347, title I, § 101, Jan. 2, 2011, 124 Stat. 3656.)