42 U.S.C. § 300mm — Establishment of World Trade Center Health Program

(a) In general: This section creates the World Trade Center (WTC) Health Program inside the Department of Health and Human Services. The WTC Program Administrator runs it. Starting July 1, 2011, the program must give (1) medical monitoring and treatment to eligible emergency responders and recovery and cleanup workers (including federal employees) who responded to the September 11, 2001 terrorist attacks; and (2) an initial health evaluation, plus monitoring and treatment, to New York City residents, other building occupants, and area workers who were directly hurt by the attacks. (b) Components of program: The WTC Program has six parts: (1) medical monitoring for responders under section 300mm–21, including clinical exams and long-term health tracking for responders likely exposed to airborne toxins or other hazards from 9/11; (2) an initial health evaluation for survivors under section 300mm–31, to decide if they qualify for followup care; (3) followup monitoring and treatment under sections 300mm–22, 300mm–32, and 300mm–33, paying for all medically necessary health and mental health costs (including needed prescription drugs) for a WTC-related health condition, subject to subsection (d); (4) an outreach and education program under section 300mm–2 to tell potentially eligible people about their benefits; (5) uniform collection and analysis of health and mental health data under section 300mm–3, coordinated with the epidemiological data collected under section 300mm–52; and (6) a research program on health conditions from 9/11, set up under part C. (c) No cost sharing: An enrolled WTC responder or a certified-eligible WTC survivor gets monitoring, treatment, and initial health evaluation benefits with no deductibles, copayments, or other cost sharing. A screening-eligible WTC survivor gets the initial health evaluation the same way, with no cost sharing. (d) Preventing fraud and unreasonable administrative costs: (1) The Department of Health and Human Services' Inspector General must build and run a program to catch fraudulent or duplicate billing and payment for inappropriate services. For this purpose, the WTC Program counts as a "Federal health care program" and a "health plan" under the fraud and abuse laws in sections 1320a–7 through 1320a–7e. (2) The Inspector General must also review the WTC Program for unreasonable administrative costs, including costs of infrastructure, administration, and claims processing. (e) Quality assurance: The Administrator, working with the Clinical Centers of Excellence, must build and run a quality assurance program covering the care those Centers (and other participating providers) deliver. It must include (1) sticking to monitoring and treatment protocols; (2) making the right diagnostic and treatment referrals; (3) promptly telling participants their test results; and (4) any other elements the Administrator sets after talking with the Centers of Excellence. (f) Annual program report: (1) Within 6 months after each fiscal year the WTC Program operates, the Administrator must send Congress a report on that year's operations and on the program's whole history. (2) Each report must include at least: (A) for each of the three clinical programs described in paragraph (3) — how many people applied for certification and how many were certified, how many certified people got monitoring versus treatment, what conditions were treated, and projected certifications for next year and the next 10 years; (B) monitoring, evaluation, and treatment cost data and projections for each clinical program, plus an estimate of WTC-related treatment costs already paid by workers' compensation, other health plans, or New York City; (C) the cost of running the program, including program support, data collection and analysis, and research; (D) how well the program performed administratively, including how quickly it evaluated and treated people, and a list of participating Centers of Excellence and other providers; (E) a summary of new scientific findings on health effects tied to the exposures described in section 300mm–5(1), including findings from research under section 300mm–51; and (F) a list of the Advisory Committee's recommendations on eligibility and health conditions, and what the Administrator did about each one. (3) For purposes of paragraph (2), three groups are each treated as a separate clinical program: (A) firefighters and related personnel described in section 300mm–21(a)(2)(A); (B) other enrolled WTC responders; and (C) WTC survivors under section 300mm–31(a). (g) Notification to Congress upon reaching 80 percent of eligibility numerical limits: The Secretary must promptly tell Congress (1) when responder enrollments reach 80 percent of the limit in section 300mm–21(a)(4); and (2) when certified-eligible survivor certifications reach 80 percent of the limit in section 300mm–31(a)(3). (h) Consultation: The Administrator must keep doing outreach to and consulting with relevant stakeholders, including the WTC Health Program Steering Committees and the Advisory Committee under section 300mm–1, about running and improving the program. (i) GAO studies: (1) Within 18 months of December 18, 2015, the Comptroller General must report to two congressional committees on how well the WTC Program is doing at: (A) the quality assurance program under subsection (e); (B) certifying WTC-related health conditions for responders and survivors; and (C) ensuring proper payments — including checking who is eligible for workers' compensation or other health coverage, figuring out what that coverage owes, and recommending ways to coordinate benefits without burdening enrolled individuals. (2) Starting 6 years and 6 months after December 18, 2015, and every 5 years after that through fiscal year 2042, the Comptroller General must (A) consult those same two committees on what to assess; and (B) prepare and submit a report assessing the WTC Program for that period. (j) Regulations: The Administrator may issue any regulations needed to run this program. (k) Termination: The WTC Program ends on October 1, 2090.