42 U.S. Code § 300mm - Establishment of World Trade Center Health Program
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(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
(b) Components of program
The WTC Program includes the following components:
(1) Medical monitoring for responders
Medical monitoring under section 300mm–21 of this title, including clinical examinations and long-term health monitoring and analysis for enrolled WTC responders who were likely to have been exposed to airborne toxins that were released, or to other hazards, as a result of the September 11, 2001, terrorist attacks.
(2) Initial health evaluation for survivors
An initial health evaluation under section 300mm–31 of this title, including an evaluation to determine eligibility for followup monitoring and treatment.
(3) Followup monitoring and treatment for WTC-related health conditions for responders and survivors
Provision under sections 300mm–22, 300mm–32, and 300mm–33 of this title of followup monitoring and treatment and payment, subject to the provisions of subsection (d), for all medically necessary health and mental health care expenses of an individual with respect to a WTC-related health condition (including necessary prescription drugs).
Establishment under section 300mm–2 of this title of an education and outreach program to potentially eligible individuals concerning the benefits under this subchapter.
(5) Clinical data collection and analysis
(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
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 section 1320a–7b (f) of this title) and is a health plan (as defined in section 1320a–7c (c) of this title) for purposes of applying sections 1320a–7 through 1320a–7e of this title.
(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—
(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
(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 section 300mm–41 of this title.
(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
(E) Scientific reports
(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
(B) Other WTC responders
The benefits provided for enrolled WTC responders not described in subparagraph (A).
(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 section 300mm–21 (a)(4) of this title has reached 80 percent of such limit.
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 section 300mm–1 of this title, regarding the implementation and improvement of programs under this subchapter.