H.R. 847: H.R. 847 - James Zadroga 9/11 Health and Compensation Act of 2010

H.R. 847

H.R. 847 - James Zadroga 9/11 Health and Compensation Act of 2010

Sponsor
Rep. Carolyn B. Maloney

Date
July 27, 2010 (111th Congress, 2nd Session)

Staff Contact
Communications

Floor Situation

H.R. 847 is expected to be considered on the floor on July 27, 2010, under suspension of the rules, which requires two-thirds votes to pass.  Rep. Maloney (D-NY) introduced H.R. 847 on February 4, 2009, and it was referred to the Committee on Energy and Commerce and the Committee on Judiciary. On July 29, 2009, the Committee on Judiciary reported the bill 22-9.  On May 25, 2010, the Energy and Commerce Committee reported H.R 847 by a 33-12 vote.

Bill Summary

Title I

 

Title I of H.R. 847 eliminates the current Medical Monitoring and Treatment Program (MMTP) and creates a permanent and mandatory World Trade Center Health Program (WTC program) within the National Institute for Occupational Safety and Health (NIOSH). The WTC program will provide: (1) medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers who responded to the World Trade Center terrorist attacks on September 11, 2001, and (2) initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers who were directly impacted and adversely affected by such attacks.

 

The federal government would provide funding on a mandatory basis over the next 10 years for 90 percent of the costs of operating the new program. The remaining 10 percent of the costs of the program would be the responsibility of New York City—up to a program life cap of $511 million.  The federal government’s contribution would be capped at the lower of 90 percent of the costs or a specified amount each fiscal year beginning in FY2011 and ending in FY2020. Over this 10-year period, federal outlays for all aspects of the new program—education and outreach, initial evaluation, monitoring, treatment, data collection, and research—could not exceed $4.59 billion. No federal funds would be available for the program after FY2020.

 

In addition, Title I authorizes the WTC program administrator to: (1) implement a quality assurance program, (2) establish the WTC Health Program Scientific/Technical Advisory Committee, (3) establish the WTC Responders Steering Committee and the WTC Community Program Steering Committee, (4) provide for education and outreach on services under the WTC program, (5) collect data related to WTC-related health conditions, (6) conduct research on physical and mental health conditions that may be related to the September 11 terrorist attacks, (7) extend and expand arrangements with the New York City Department of Health and Mental Hygiene to provide for the World Trade Center Health Registry, and (8) modify payment amounts to providers to improve quality and efficient delivery of services.  To ensure accountability, the bill directs the Inspector General of HHS to review the program’s expenditures to detect fraudulent or duplicate billing, payment for inappropriate services, or unreasonable administrative costs.

 

H.R. 847 prohibits the disbursement of any federal funds for the program unless New York City has entered into an enforceable contract with the WTC Program Administrator in which it agrees to pay its share of program costs on a timely basis.  Payment may not be made for treatment services unless they are medically necessary as determined under regulations issued by the WTC Program Administrator. In addition, treatment services must be consistent with protocols developed by the Data Centers and approved by the Administrator. Monitoring services must also be consistent with protocols approved by the Administrator in order to qualify for payment.

 

H.R. 847 aims to strengthen the federal government’s commitment to uniform data collection through Data Centers designated by the Program Administrator, epidemiological surveillance through the WTC Registry, and ongoing research into health conditions that may be related to exposures to the toxic dust at the World Trade Center site.

 

In addition, Title I of H.R. 847 would establish formal eligibility requirements based on a person’s activities after September 11, 2001, and current health conditions. Health benefits would be provided by a national network of providers, and the program would be administered by the Department of Health and Human Services (HHS).

 

Title II

 

Title II of H.R. 847 amends the Air Transportation Safety and System Stabilization Act: (1) to reopen the September 11 Victim Compensation Fund of 2001 to provide monetary compensation to eligible individuals as a result of debris removal and (2) to extend the deadline for making a claim for compensation.

 

H.R. 847 would establish broader eligibility rules for compensation than those established for the VCF under the Air Transportation Safety and System Stabilization Act.  Under H.R. 847, total payments would be capped at $8.4 billion through 2032. Changes in eligibility include:  (1) time present at site, (2) expansion of geographic definition related to the location of the attacks, (3) an extended claims filing timeline of two years.

Background

Title I

 

In the wake of the September 11, 2001, terrorist attack on New York City, Congress passed appropriations to provide health screening and treatment services to persons involved in rescue, recovery, and cleanup operations around the site of the World Trade Center. This program, now known as the World Trade Center (WTC) Medical Monitoring and Treatment Program (MMTP), is not authorized in statute.  Since its inception in FY2002, the MMTP has received approximately $475 million in federal funds, and more than 57,000 responders and community members have met initial eligibility requirements for the program.

 

The programs are administered by the National Institute for Occupational Safety and Health (NIOSH), an agency of the Centers for Disease Control and Prevention (CDC) within the Department of Health and Human Services (HHS). NIOSH supports six clinical centers and two data coordination centers as well as the WTC Health Registry. A total of $71 million is appropriated in FY2010 to support these activities. The President’s budget requests $150 million in FY2011. Since FY2003, a total of $326 million has been obligated for these purposes.  There are three WTC Responder programs.

 

As of March 31, 2010, a total of 52,700 individuals were enrolled in the WTC Responders programs (about 4,500 of these were enrolled in the national program). During the previous year, 24,100 of these enrolled responders received monitoring exams, and 13,300 received treatment through five clinical centers of excellence.  These clinical centers are supported by two data and coordination centers.  

 

The Responder programs have been funded by the federal government since FY2003.  In FY2009, $104 million was obligated for the program. Federal funding for the WTC Community Program began in September 2008. The program is operated by the New York City Health and Hospitals Corporation through three locations.  About 4,600 individuals were enrolled in the WTC Community Program as of March 31, 2010. Of these, 1,200 received monitoring exams and 2,600 received treatment during the previous year. In FY2009, $10 million was obligated for the Community Program.  In addition to providing initial screening, monitoring, and treatment services, the WTC Health Programs have supported research on the health effects of exposure to the toxic dust cloud by rescue workers and others at the World Trade Center site. This developing science is used to inform the treatment of enrollees in the Responder and Community programs and is posted on the NIOSH website.  In addition, the New York City Department of Health and Mental Hygiene established the WTC Health Registry, which includes individuals at risk for possible near and long term physical and mental health effects from the attacks. Before it closed to new registrants in 2004, the WTC Health Registry had enrolled more than 70,000 residents, workers, students, and responders.  NIOSH funding helps to support the Registry. 

 

Title II

 

The Victim Compensation Fund (VCF), which terminated in 2004, provided compensation to any individual (or relatives of a deceased individual) who was physically injured or killed as a result of the terrorist attacks. The VCF was established by the Air Transportation Safety and System Stabilization Act (Public Law 107-42) as an administrative alternative to litigation. That act created a Special Master, who determined the compensation levels based on specified eligibility criteria and subsequent regulations.  Through 2004, the VCF made 2,880 death and 2,680 injury awards, which totaled more than $7 billion (about $6 billion was for death awards).  Public Law 107-42 did not cap the number or amount of awards that could be issued by the Special Master.

Cost

CBO estimates that enacting H.R. 847 would increase direct spending by $10.5 billion over the 2011-2020 period. About $4.2 billion of that amount would result from spending for health care benefits provided under title I. The remaining $6.3 billion would be spent on compensation payments provided under title II.

Additional Information

Member Concerns

 

Some Members may be concerned about several issues:

 

  1. H.R. 847 creates a new entitlement program. 
  2. NIOSH does not have expertise in administering a health care payment program.  The current program is a block-grant program, and under H.R. 847, NIOSH will negotiate contracts and approve treatment protocols.
  3. H.R. 847 sets a cap on enrollment, and since the Secretary of HHS is not required to verify citizenship, illegal aliens may get treated ahead of American responders.
  4. H.R. 848 increases Medicare reimbursement rates for New York City hospitals to 140 percent of Medicare reimbursement rates while ObamaCare cuts $150 billion in payments to hospitals around the country. 
  5. H.R. 847 does not reward hospitals and providers for improving health care.  They will be reimbursed based on each service they perform, which will encourage overutilization and increase health care spending.
  6. Currently, several programs receive federal funding for medical monitoring and treatment programs. Those programs include:  Fire Department of New York WTC Medical Monitoring Program, New York/New Jersey WTC Consortium, WTC Health Registry, WTC Federal Responder Screening Program,  Project COPE, and POPPA (Police Organization Providing Peer Assistance) program

 

In addition, this is a funding history of September 11, health programs:

 

  • Fiscal Year 2002:
    • Congress directed $12 million in supplemental appropriations to the CDC to develop a baseline medical screening program for WTC responders. 
    • Fiscal Year 2003:
      • Congress provided $90 million to continue baseline screenings and to provide long-term medical monitoring of program participants. 
    • Fiscal Year 2006:
      • Congress provided $75 million for ongoing registry, screening, and monitoring activities, and stipulated for the first time that funds could also be used for treatment. 
    • Fiscal Year 2007:
      • In May 2007, Congress provided an additional $50 million in supplemental funding for FY2007, to remain available until expended. 
    • Fiscal Year 2008:
      • Congress provided a total appropriation of approximately $108.1 million, providing in the law that funds shall be used "... to provide screening and treatment for first response emergency services personnel, residents, students, and others.... "
    • Fiscal Year 2009:
      • The FY2009 Omnibus Appropriations bill included $70M “to provide screening and treatment for first response emergency services personnel, residents, students, and others related to the September 11, 2001 terrorist attacks on the World Trade Center:..."
      • The accompanying Explanatory Statement for the FY09 Omnibus included the following language: "For the World Trade Center (WTC) Medical Monitoring and Treatment program, the fiscal year 2009 program level is $182M. Approximately $112M in carryover balances from prior year appropriated funds are available in fiscal year 2009. Combined with the $70M included in this bill, the total amount available for the WTC program is sufficient to continue to expand the program in the New York City area and around the country for first response emergency personnel, residents, students, and others whose health has been impacted from exposure to toxins in or around the WTC site."
    • Fiscal Year 2010:
      • The FY2010 Omnibus Appropriations bill included “$70.723M “shall be available until expended to provide screening and treatment for first response emergency services personnel, residents, students, and others related to the September 11, 2001 terrorist attacks on the World Trade Center.”