WAYNE CLARK for SHERIFF
Broward County Safe & Strong

Throughout Florida and our local communities, first responders continue to face daily challenges resulting from the Novel Coronavirus pandemic (hereinafter “COVID-19”).  Some have been exposed and contracted the virus during their public safety and life-saving efforts. Sadly, some of our frontline heroes have been lost and leave behind families and survivors.  These heroic actions must not go unsupported.

To care for these heroes, my team drafted a preliminary bill to extend and improve protections and services to first responders directly impacted by the COVID-19 pandemic exposures.  We have submitted the draft language to Florida legislators entitled:

Florida First Responder Health and COVID-19 Relief Act of 2020

which is modeled after previously approved legislation following the September 11 terrorist attacks and are coordinating with sponsors to push this early legislation.

The draft of the bill can be viewed at below.  Please join our support for the Relief Act by signing our online petition at COVID-19 Bill and contact your elected representatives directly to show your support for our everyday heroes.

 

***************************APRIL 19, 2020*******************************

Florida First Responder Health and COVID-19 Relief Act of 2020

To extend and improve protections and services to first responders directly impacted by the Novel Coronavirus (hereinafter “COVID-19”) pandemic exposures and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Florida First Responder Health and COVID-19 Relief Act of 2020.

(b)

Table of Contents

The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—Pandemic and Health Recovery Program

Sec. 101. First Responders Health Program.

TITLE XXXIII—First Responders Health Program

Subtitle A—Establishment of Program; Advisory Committee

Sec. 3301. Establishment of FIRST RESPONDERS Health Program.

Sec. 3302. FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee; FIRST RESPONDERS Health Program Steering Committees.

Sec. 3303. Education and outreach.

Sec. 3304. Uniform data collection and analysis.

Sec. 3305. Clinical Centers of Excellence and Data Centers.

Sec. 3306. Definitions.

Subtitle B—Program of Monitoring, Initial Health Evaluations, and Treatment

PART 1—FIRST RESPONDERS

Sec. 3311. Identification of FIRST RESPONDERS and provision of FIRST RESPONDERS-related monitoring services.

Sec. 3312. Treatment of enrolled FIRST RESPONDERS for FIRST RESPONDERS-related health conditions.

Sec. 3313. National arrangement for benefits for eligible first responders.

PART 2—FIRST RESPONDERS Survivors

Sec. 3321. Identification and initial health evaluation of screening-eligible and certified-eligible FIRST RESPONDERS survivors.

Sec. 3322. Follow-up monitoring and treatment of certified-eligible FIRST RESPONDERS survivors for FIRST RESPONDERS-related health conditions.

Sec. 3323. Follow-up monitoring and treatment of other first responders with FIRST RESPONDERS-related health conditions.

PART 3—Payor provisions

Sec. 3331. Payment of claims.

Sec. 3332. Administrative arrangement authority.

Subtitle C—Research into Conditions

Sec. 3341. Research regarding certain health conditions related to COVID-19 pandemic.

Sec. 3342. First Responders Health Registry.

Subtitle D—Funding

Sec. 3351. First Responders Health Program Fund.

 

I

First Responders Health Program

101.

First Responders Health Program

The Public Health Service Act is amended by adding at the end the following new title:

XXXIII

First Responders Health Program

A

Establishment of Program; Advisory Committee

3301.

Establishment of First Responders Health Program

(a)

In general

There is hereby established within the State of Florida Department of Emergency Management, a program to be known as the First Responders Health Program, which shall be administered by the FIRST RESPONDERS Program Administrator, to provide beginning on May 1, 2020—

(1)

medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers (including those who are State employees) who responded to areas declared by  the federal government as COVID-19 pandemic disaster areas; and

(2)

initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers in declared disaster areas who were directly impacted and adversely affected by pandemic and occupational exposure.

(b)

Components of Program

The FIRST RESPONDERS Program includes the following components:

(1)

Medical monitoring for responders

Medical monitoring under section 3311, including clinical examinations and long-term health monitoring and analysis for enrolled FIRST RESPONDERS who were likely to have been exposed to COVID-19 airborne toxins and viral infections that were released, or to other hazards, as a result of the a declared pandemic

(2)

Initial health evaluation for survivors

An initial health evaluation under section 3321, including an evaluation to determine eligibility for follow-up monitoring and treatment.

(3)

Follow-up monitoring and treatment for FIRST RESPONDERS-related health conditions for responders and survivors

Provision under sections 3312, 3322, and 3323 of follow-up 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 FIRST RESPONDERS-related health condition (including necessary prescription drugs).

(4)

Outreach

Establishment under section 3303 of an education and outreach program to potentially eligible first responders concerning the benefits under this title.

(5)

Clinical data collection and analysis

Collection and analysis under section 3304 of health and mental health data relating to first responders receiving monitoring or treatment benefits in a uniform manner in collaboration with the collection of epidemiological data under section 3342.

(6)

Research on health conditions

Establishment under subtitle C of a research program on health conditions resulting from a declared pandemic.

(c)

No cost sharing

Monitoring and treatment benefits and initial health evaluation benefits are provided under subtitle B without any deductibles, copayments, or other cost sharing to an enrolled FIRST RESPONDERS responder or certified-eligible FIRST RESPONDERS survivor. Initial health evaluation benefits are provided under subtitle B without any deductibles, copayments, or other cost sharing to a screening-eligible FIRST RESPONDERS survivor.

(d)

Preventing fraud and unreasonable administrative costs

(1)

Fraud

The Inspector General of the State of Florida shall develop and implement a program to review the FIRST RESPONDERS Program’s health care expenditures to detect fraudulent or duplicate billing and payment for inappropriate services.

(2)

Unreasonable administrative costs

The Inspector General of the State of Florida shall develop and implement a program to review the FIRST RESPONDERS Program for unreasonable administrative costs, including with respect to infrastructure, administration, and claims processing.

(e)

Quality assurance

The FIRST RESPONDERS 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—

(1)

adherence to monitoring and treatment protocols;

(2)

appropriate diagnostic and treatment referrals for participants;

(3)

prompt communication of test results to participants; and

(4)

such other elements as the Administrator specifies in consultation with the Clinical Centers of Excellence.

(f)

Annual program report

(1)

In general

Not later than 6 months after the end of each fiscal year in which the FIRST RESPONDERS Program is in operation, the FIRST RESPONDERS Program Administrator shall submit an annual report to the State Legislature on the operations of this title 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 first responders

Information for each clinical program described in paragraph (3)—

(i)

on the number of first responders who applied for certification under subtitle B and the number of such first responders who were so certified;

(ii)

of the first responders who were certified, on the number who received monitoring under the program and the number of such first responders who received medical treatment under the program;

(iii)

with respect to first responders so certified who received such treatment, on the FIRST RESPONDERS-related health conditions for which they were treated; and

(iv)

on the projected number of first responders who will be certified under subtitle B in the succeeding fiscal year and the succeeding 10-year period.

(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 FIRST RESPONDERS-related health conditions that have been paid for or reimbursed by workers’ compensation, by public or private health plans, or by local government health programs.

(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 first responders; and

(ii)

a list of the Clinical Centers of Excellence and other providers that are participating in the program.

(E)

Scientific reports

A summary of the findings of any new scientific reports or studies on the health effects associated with exposure described in section 3306(1), including the findings of research conducted under section 3341(a).

(F)

Advisory committee recommendations

A list of recommendations by the FIRST RESPONDERS Scientific/Technical Advisory Committee on additional FIRST RESPONDERS Program eligibility criteria and on additional FIRST RESPONDERS-related health conditions and the action of the FIRST RESPONDERS Program Administrator concerning each such recommendation.

(3)

Separate clinical programs described

In paragraph (2), each of the following shall be treated as a separate clinical program of the FIRST RESPONDERS Program:

(A)

Firefighters and related personnel

The benefits provided for enrolled FIRST RESPONDERS described in section 3311(a)(2)(A).

(B)

Other FIRST RESPONDERS

The benefits provided for enrolled FIRST RESPONDERS not described in subparagraph (A).

(C)

FIRST RESPONDERS survivors

The benefits provided for screening-eligible FIRST RESPONDERS survivors and certified-eligible FIRST RESPONDERS survivors in section 3321(a).

(g)

Notification to State Legislature upon reaching 80 percent of eligibility numerical limits

The Secretary shall promptly notify the State Legislature of each of the following:

(1)

When the number of enrollments of FIRST RESPONDERS subject to the limit established under section 3311(a)(4) has reached 80 percent of such limit.

(2)

When the number of certifications for certified-eligible FIRST RESPONDERS survivors subject to the limit established under section 3321(a)(3) has reached 80 percent of such limit.

(h)

Consultation

The FIRST RESPONDERS Program Administrator shall engage in ongoing outreach and consultation with relevant stakeholders, including the FIRST RESPONDERS Health Program Steering Committees and the Advisory Committee under section 3302, regarding the implementation and improvement of programs under this title.

3302.

FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee; FIRST RESPONDERS Health Program Steering Committees

(a)

Advisory Committee

(1)

Establishment

The FIRST RESPONDERS Program Administrator shall establish an advisory committee to be known as the FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee (in this subsection referred to as the Advisory Committee) to review scientific and medical evidence and to make recommendations to the Administrator on additional FIRST RESPONDERS Program eligibility criteria and on additional FIRST RESPONDERS-related health conditions.

(2)

Composition

The FIRST RESPONDERS Program Administrator shall appoint the members of the Advisory Committee and shall include at least—

(A)

4 occupational physicians, at least 2 of whom have experience treating FIRST RESPONDERS rescue and recovery workers;

(B)

1 physician with expertise in pulmonary medicine;

(C)

2 environmental medicine or environmental health specialists;

(D)

2 representatives of FIRST RESPONDERS;

(E)

2 representatives of certified-eligible FIRST RESPONDERS survivors;

(F)

an industrial hygienist;

(G)

a toxicologist;

(H)

an epidemiologist; and

(I)

a mental health professional.

(3)

Meetings

The Advisory Committee shall meet at such frequency as may be required to carry out its duties.

(4)

Reports

The FIRST RESPONDERS Program Administrator shall provide for publication of recommendations of the Advisory Committee on the public Web site established for the FIRST RESPONDERS Program.

(5)

Duration

Notwithstanding any other provision of law, the Advisory Committee shall continue in operation during the period in which the FIRST RESPONDERS Program is in operation.

(6)

Application of State Advisory Committee Acts

Except as otherwise specifically provided, the Advisory Committee shall be subject to any State Advisory Committee Act.

(b)

FIRST RESPONDERS Health Program Steering Committees

(1)

Consultation

The FIRST RESPONDERS Program Administrator shall consult with 2 steering committees (each in this section referred to as a Steering Committee) that are established as follows:

(A)

FIRST RESPONDERS steering committee

One Steering Committee, to be known as the FIRST RESPONDERS Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of monitoring and treatment programs for the enrolled FIRST RESPONDERS under part 1 of subtitle B.

(B)

FIRST RESPONDERS survivors steering committee

One Steering Committee, to be known as the FIRST RESPONDERS Survivors Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of initial health evaluations, monitoring, and treatment programs for screening-eligible and certified-eligible FIRST RESPONDERS survivors under part 2 of subtitle B.

(2)

Membership

(A)

FIRST RESPONDERS steering committee

(i)

Representation

The FIRST RESPONDERS Steering Committee shall include—

(I)

representatives of the Centers of Excellence providing services to FIRST RESPONDERS;

(II)

representatives of labor organizations representing firefighters, police, other civil service employees, and recovery and cleanup workers who responded to the declared pandemic; and

(III)

3 representatives of each affected State, as appointed by the Governor

(ii)

Initial membership

The FIRST RESPONDERS Steering Committee shall initially be composed of members of the FIRST RESPONDERS Monitoring and Treatment Program Steering Committee (as in existence on the day before the date of the enactment of this title).

(B)

FIRST RESPONDERS survivors steering committee

(i)

Representation

The FIRST RESPONDERS Survivors Steering Committee shall include representatives of—

(I)

the Centers of Excellence providing services to screening-eligible and certified-eligible FIRST RESPONDERS survivors;

(II)

the population of residents, students, and area and other workers affected by any declared pandemic;

(III)

screening-eligible and certified-eligible survivors receiving initial health evaluations, monitoring, or treatment under part 2 of subtitle B and organizations advocating on their behalf; and

(IV)

State of Florida.

(ii)

Initial membership

The FIRST RESPONDERS Survivors Steering Committee shall initially be composed of members of the FIRST RESPONDERS Environmental Health Center Survivor Advisory Committee (as in existence on the day before the date of the enactment of this title).

(C)

Additional appointments

Each Steering Committee may recommend, if approved by a majority of voting members of the Committee, additional members to the Committee.

(D)

Vacancies

A vacancy in a Steering Committee shall be filled by an individual recommended by the Steering Committee.

3303.

Education and outreach

The FIRST RESPONDERS Program Administrator shall institute a program that provides education and outreach on the existence and availability of services under the FIRST RESPONDERS Program. The outreach and education program—

(1)

shall include—

(A)

the establishment of a public Web site with information about the FIRST RESPONDERS Program;

(B)

meetings with potentially eligible populations;

(C)

development and dissemination of outreach materials informing people about the program; and

(D)

the establishment of phone information services; and

(2)

shall be conducted in a manner intended—

(A)

to reach all affected populations; and

(B)

to include materials for culturally and linguistically diverse populations.

3304.

Uniform data collection and analysis

(a)

In general

The FIRST RESPONDERS Program Administrator shall provide for the uniform collection of data, including claims data (and analysis of data and regular reports to the Administrator) on the prevalence of FIRST RESPONDERS-related health conditions and the identification of new FIRST RESPONDERS-related health conditions. Such data shall be collected for all first responders provided monitoring or treatment benefits under subtitle B and regardless of their place of residence or Clinical Center of Excellence through which the benefits are provided. The FIRST RESPONDERS Program Administrator shall provide, through the Data Centers or otherwise, for the integration of such data into the monitoring and treatment program activities under this title.

(b)

Coordinating through Centers of Excellence

Each Clinical Center of Excellence shall collect data described in subsection (a) and report such data to the corresponding Data Center for analysis by such Data Center.

(c)

Collaboration with FIRST RESPONDERS health registry

The FIRST RESPONDERS Program Administrator shall provide for collaboration between the Data Centers and the First Responders Health Registry described in section 3342.

(d)

Privacy

The data collection and analysis under this section shall be conducted and maintained in a manner that protects the confidentiality of individually identifiable health information consistent with applicable statutes and regulations, including, as applicable, HIPAA privacy and security law (as defined in section 3009(a)(2)) and section 552a of title 5, United States Code.

3305.

Clinical Centers of Excellence and Data Centers

(a)

In general

(1)

Contracts with clinical centers of excellence

The FIRST RESPONDERS Program Administrator shall, subject to subsection (b)(1)(B), enter into contracts with Clinical Centers of Excellence (as defined in subsection (b)(1)(A))—

(A)

for the provision of monitoring and treatment benefits and initial health evaluation benefits under subtitle B;

(B)

for the provision of outreach activities to first responders eligible for such monitoring and treatment benefits, for initial health evaluation benefits, and for follow-up to first responders who are enrolled in the monitoring program;

(C)

for the provision of counseling for benefits under subtitle B, with respect to FIRST RESPONDERS-related health conditions, for first responders eligible for such benefits;

(D)

for the provision of counseling for benefits for FIRST RESPONDERS-related health conditions that may be available under workers’ compensation or other benefit programs for work-related injuries or illnesses, health insurance, disability insurance, or other insurance plans or through public or private social service agencies and assisting eligible first responders in applying for such benefits;

(E)

for the provision of translational and interpretive services for program participants who are not English language proficient; and

(F)

for the collection and reporting of data, including claims data, in accordance with section 3304.

(2)

Contracts with data centers

(A)

In general

The FIRST RESPONDERS Program Administrator shall enter into contracts with one or more Data Centers (as defined in subsection (b)(2))—

(i)

for receiving, analyzing, and reporting to the FIRST RESPONDERS Program Administrator on data, in accordance with section 3304, that have been collected and reported to such Data Centers by the corresponding Clinical Centers of Excellence under subsection (b)(1)(B)(iii);

(ii)

for the development of monitoring, initial health evaluation, and treatment protocols, with respect to FIRST RESPONDERS-related health conditions;

(iii)

for coordinating the outreach activities conducted under paragraph (1)(B) by each corresponding Clinical Center of Excellence;

(iv)

for establishing criteria for the credentialing of medical providers participating in the nationwide network under section 3313;

(v)

for coordinating and administering the activities of the FIRST RESPONDERS Health Program Steering Committees established under section 3002(b); and

(vi)

for meeting periodically with the corresponding Clinical Centers of Excellence to obtain input on the analysis and reporting of data collected under clause (i) and on the development of monitoring, initial health evaluation, and treatment protocols under clause (ii).

(B)

Medical provider selection

The medical providers under subparagraph (A)(iv) shall be selected by the FIRST RESPONDERS Program Administrator on the basis of their experience treating or diagnosing the health conditions included in the list of FIRST RESPONDERS-related health conditions.

(C)

Clinical discussions

In carrying out subparagraph (A)(ii), a Data Center shall engage in clinical discussions across the FIRST RESPONDERS Program to guide treatment approaches for first responders with a FIRST RESPONDERS-related health condition.

(D)

Transparency of data

A contract entered into under this subsection with a Data Center shall require the Data Center to make any data collected and reported to such Center under subsection (b)(1)(B)(iii) available to health researchers and others as provided in the CDC/ATSDR Policy on Releasing and Sharing Data.

(3)

Authority for contracts to be class specific

A contract entered into under this subsection with a Clinical Center of Excellence or a Data Center may be with respect to one or more class of enrolled FIRST RESPONDERS, screening-eligible FIRST RESPONDERS survivors, or certified-eligible FIRST RESPONDERS survivors.

(4)

Use of cooperative agreements

Any contract under this title between the FIRST RESPONDERS Program Administrator and a Data Center or a Clinical Center of Excellence may be in the form of a cooperative agreement.

(5)

Review on feasibility of consolidating Data Centers

Not later than July 1, 2020, the Chief Financial Officer for the State of Florida shall submit to the State Legislature a report on the feasibility of consolidating Data Centers into a single Data Center.

(b)

Centers of excellence

(1)

Clinical Centers of Excellence

(A)

Definition

For purposes of this title, the term Clinical Center of Excellence means a Center that demonstrates to the satisfaction of the Administrator that the Center—

(i)

uses an integrated, centralized health care provider approach to create a comprehensive suite of health services under this title that are accessible to enrolled FIRST RESPONDERS, screening-eligible FIRST RESPONDERS survivors, or certified-eligible FIRST RESPONDERS survivors;

(ii)

has experience in caring for FIRST RESPONDERS responders and screening-eligible FIRST RESPONDERS survivors or includes health care providers who have been trained pursuant to section 3313(c);

(iii)

employs health care provider staff with expertise that includes, at a minimum, occupational medicine, environmental medicine, trauma-related psychiatry and psychology, and social services counseling; and

(iv)

meets such other requirements as specified by the Administrator.

(B)

Contract requirements

The FIRST RESPONDERS Program Administrator shall not enter into a contract with a Clinical Center of Excellence under subsection (a)(1) unless the Center agrees to do each of the following:

(i)

Establish a formal mechanism for consulting with and receiving input from representatives of eligible populations receiving monitoring and treatment benefits under subtitle B from such Center.

(ii)

Coordinate monitoring and treatment benefits under subtitle B with routine medical care provided for the treatment of conditions other than FIRST RESPONDERS-related health conditions.

(iii)

Collect and report to the corresponding Data Center data, including claims data, in accordance with section 3304(b).

(iv)

Have in place safeguards against fraud that are satisfactory to the Administrator, in consultation with the Inspector General of the State of Florida.

(v)

Treat or refer for treatment all first responders who are enrolled FIRST RESPONDERS or certified-eligible FIRST RESPONDERS survivors with respect to such Center who present themselves for treatment of a FIRST RESPONDERS-related health condition.

(vi)

Have in place safeguards, consistent with section 3304(c), to ensure the confidentiality of an individual’s individually identifiable health information, including requiring that such information not be disclosed to the individual’s employer without the authorization of the individual.

(vii)

Use amounts paid under subsection (c)(1) only for costs incurred in carrying out the activities described in subsection (a), other than those described in subsection (a)(1)(A).

(viii)

Utilize health care providers with occupational and environmental medicine expertise to conduct physical and mental health assessments, in accordance with protocols developed under subsection (a)(2)(A)(ii).

(ix)

Communicate with FIRST RESPONDERS and screening-eligible and certified-eligible FIRST RESPONDERS survivors in appropriate languages and conduct outreach activities with relevant stakeholder worker or community associations.

(x)

Meet all the other applicable requirements of this title, including regulations implementing such requirements.

(C)

Transition rule to ensure continuity of care

The FIRST RESPONDERS Program Administrator shall to the maximum extent feasible ensure continuity of care in any period of transition from monitoring and treatment of an enrolled FIRST RESPONDERS responder or certified-eligible FIRST RESPONDERS survivor by a provider to a Clinical Center of Excellence or a health care provider participating in the nationwide network under section 3313.

(2)

Data Centers

For purposes of this title, the term Data Center means a Center that the FIRST RESPONDERS Program Administrator determines has the capacity to carry out the responsibilities for a Data Center under subsection (a)(2).

(3)

Corresponding centers

For purposes of this title, a Clinical Center of Excellence and a Data Center shall be treated as corresponding to the extent that such Clinical Center and Data Center serve the same population group.

(c)

Payment for infrastructure costs

(1)

In general

The FIRST RESPONDERS Program Administrator shall reimburse a Clinical Center of Excellence for the fixed infrastructure costs of such Center in carrying out the activities described in subtitle B at a rate negotiated by the Administrator and such Centers. Such negotiated rate shall be fair and appropriate and take into account the number of enrolled FIRST RESPONDERS receiving services from such Center under this title.

(2)

Fixed infrastructure costs

For purposes of paragraph (1), the term fixed infrastructure costs means, with respect to a Clinical Center of Excellence, the costs incurred by such Center that are not otherwise reimbursable by the FIRST RESPONDERS Program Administrator under section 3312(c) for patient evaluation, monitoring, or treatment but which are needed to operate the FIRST RESPONDERS program such as the costs involved in outreach to participants or recruiting participants, data collection and analysis, social services for counseling patients on other available assistance outside the FIRST RESPONDERS program, and the development of treatment protocols. Such term does not include costs for new construction or other capital costs.

(d)

CFO analysis

Not later than July 1, 2020, the Chief Financial Officer shall submit to the Florida Legislature an analysis on whether Clinical Centers of Excellence with which the FIRST RESPONDERS Program Administrator enters into a contract under this section have financial systems that will allow for the timely submission of claims data for purposes of section 3304 and subsections (a)(1)(F) and (b)(1)(B)(iii).

3306.

Definitions

In this title:

(1)

The term aggravating means, with respect to a health condition, a health condition that existed on March 1, 2020, and that, as a result of COVID-19 exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the a declared pandemic, requires medical treatment that is (or will be) in addition to, more frequent than, or of longer duration than the medical treatment that would have been required for such condition in the absence of such exposure.

(2)

The term certified-eligible FIRST RESPONDERS survivor has the meaning given such term in section 3321(a)(2).

(3)

The terms Clinical Center of Excellence and Data Center have the meanings given such terms in section 3305.

(4)

The term enrolled FIRST RESPONDERS responder means a FIRST RESPONDERS responder enrolled under section 3311(a)(3).

(5)

The term initial health evaluation includes, with respect to an individual, a medical and exposure history, a physical examination, and additional medical testing as needed to evaluate whether the individual has a FIRST RESPONDERS-related health condition and is eligible for treatment under the FIRST RESPONDERS Program.

(6)

The term list of FIRST RESPONDERS-related health conditions means—

(A)

for FIRST RESPONDERS, the health conditions listed in section 3312(a)(3); and

(B)

for screening-eligible and certified-eligible FIRST RESPONDERS survivors, the health conditions listed in section 3322(b).

(7)

The term declared disaster area means the area within the designated area declared by the State of Florida, federal government and/or the Federal Emergency Management Agency that is—

(A)

the area of each declared disaster area; and

(B)

any geographic region that is wholly or partially contained within a 1.5-mile radius of the former First Responders site.

(8)

The term Federal Declaration Disaster Area means an area, specified by the FIRST RESPONDERS Program Administrator, within which FIRST RESPONDERS and eligible FIRST RESPONDERS screening-eligible survivors who reside in such area are reasonably able to access monitoring and treatment benefits and initial health evaluation benefits under this title through a Clinical Center of Excellence described in subparagraphs (A), (B), or (C) of section 3305(b)(1).

(9)

The term screening-eligible FIRST RESPONDERS survivor has the meaning given such term in section 3321(a)(1).

(10)

Any reference to State or Federal Declaration of Pandemic shall be deemed a reference to the period on such date subsequent to the declaration of a disaster emergency, as applicable, on such date.

(11)

The term Pandemic means any viral emergency as declared by the state or federal government in areas declared as disaster areas and includes the aftermath of such declarations.

(12)

The term FIRST RESPONDERS Health Program Steering Committee means such a Steering Committee established under section 3302(b).

(13)

The term FIRST RESPONDERS Program means the FIRST RESPONDER Program established under section 3301(a).

(14)(A)

The term FIRST RESPONDERS Program Administrator means—

(i)

subject to subparagraph (B), with respect to paragraphs (3) and (4) of section 3311(a) (relating to enrollment of FIRST RESPONDERS responders), section 3312(c) and the corresponding provisions of section 3322 (relating to payment for initial health evaluation, monitoring, and treatment, paragraphs (1)(C), (2)(B), and (3) of section 3321(a) (relating to determination or certification of screening-eligible or certified-eligible FIRST RESPONDERS responders), and part 3 of subtitle B (relating to payor provisions), an official in the Department of Emergency Management to be designated by the Governor; and

(ii)

with respect to any other provision of this title, the Director of the Institute for Occupational Safety and Health, or a designee of such Director.

(15)

The term FIRST RESPONDERS-related health condition is defined in section 3312(a).

(16)

The term FIRST RESPONDERS responder is defined in section 3311(a).

(17)

The term FIRST RESPONDERS Scientific/Technical Advisory Committee means such Committee established under section 3302(a).

B

Program of Monitoring, Initial Health Evaluations, and Treatment

1

FIRST RESPONDERS

3311.

Identification of FIRST RESPONDERS and provision of FIRST RESPONDERS-related monitoring services

(a)

FIRST RESPONDERS defined

(1)

In general

For purposes of this title, the term FIRST RESPONDERS means any of the following first responders, subject to paragraph (4):

(A)

Currently identified responder

An individual who has been identified as eligible for monitoring under the arrangements as in effect on the date of the enactment of this title by the Department of Emergency Management and—

(i)

Any hospital safety-net consortium that coordinates the monitoring and treatment for enrolled FIRST RESPONDERS other than with respect to those covered under the arrangement with the local provider; or

(ii)

the designated local FIRST RESPONDER agency.

(B)

Responder who meets current eligibility criteria

An individual who meets the current eligibility criteria described in paragraph (2).

(C)

Responder who meets modified eligibility criteria

An individual who—

(i)

performed rescue, recovery, demolition, debris cleanup, or other related services in declared disaster areas in response to declared pandemic, regardless of whether such services were performed by a municipal, county, State or Federal employee or member of the National Guard or otherwise; and

(ii)

meets such eligibility criteria relating to exposure to COVID-19 airborne toxins, other hazards, or adverse conditions resulting from any declare pandemic as the FIRST RESPONDERS Program Administrator, after consultation with the FIRST RESPONDERS Scientific/Technical Advisory Committee, determines appropriate.

The FIRST RESPONDERS Program Administrator shall not modify such eligibility criteria on or after the date that the number of enrollments of FIRST 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 FIRST RESPONDERS survivors under section 3321(a)(2)(B) has reached 80 percent of the limit described in section 3321(a)(3).(2)

Current eligibility criteria

The 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 personnel

The individual—

(i)

was a member of the Fire Department of a municipal, county, state, or Indian land, or (whether fire or emergency personnel, active or retired) who participated at least one day in the rescue, response and recovery effort at any of the former First Responders declared disaster areas for any time during the period beginning on the date 10 (ten) days prior to the date of federal declaration for the following 6 (six) months thereafter.

(ii)(I)

is a surviving immediate family member of an individual who was a member of the Fire Department (whether fire or emergency personnel, active or retired) and was killed or exposed at in the designated time frame; and

(II)

received any treatment for a FIRST RESPONDERS-related health condition described in section 3312(a)(1)(A)(ii) (relating to mental health conditions) on or before August, 1, 2020.

(B)

Law enforcement officers and FIRST RESPONDERS rescue, recovery, and cleanup workers

The individual—

(i)

worked or volunteered onsite in rescue, recovery, debris cleanup, or related support services in declared disaster areas for at least 4 hours during the period beginning March 1, 2020, and ending on August 1, 2020, for at least 24 hours during the period beginning on March 1, 2020, and ending on August 1, 2020;

(ii)(I)

was a member of a designated FIRST RESPONDER agency who participated onsite in rescue, recovery, debris cleanup, or related services of the declared disaster area between March 1, 2020 and ending on August 1, 2020;

(II)

participated onsite in rescue, recovery, response, debris cleanup, or related services to declared disaster areas for at least one day during the period beginning on March 1, 2020, and ending on August 1, 2020;

(III)

participated onsite in rescue, recovery, debris cleanup, or related services to declared disaster areas for at least 24 hours during the period beginning on March 1, 2020 and ending on August 1, 2020; or

(IV)

participated onsite in rescue, recovery, debris cleanup, or related services to declared disaster areas for at least 80 hours during the period beginning on March 1, 2020, and ending on August 1, 2020;

(iii)

was an employee of the Office of the Chief Medical Examiner of any municipal, county or state agency involved in the examination and handling of human remains from the First Responders efforts, or other morgue worker who performed similar pandemic-related efforts for such Office staff, during the period beginning on March 1, 2020, and ending on August 1, 2020;

(iv)

was a worker in a local Port Authority for at least 24 hours during the period beginning on March 1, 2020, and ending on August 1, 2020; or

(v)

was a vehicle-maintenance worker who was exposed to medical-related debris from the hospitals for First Responders while retrieving, driving, cleaning, repairing, and maintaining vehicles contaminated by airborne toxins during a duration and period described in subparagraph (A).

(C)

Responders to the declared COVID-19 pandemic

The 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 directly related to any declared pandemic during the period beginning March 1, 2020, and ending on the date on which the cleanup of the site was concluded, as determined by the FIRST RESPONDERS Program Administrator; or

(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 directly related to a federal declared pandemic from March 1, 2020, and ending on the date on which the cleanup of the site was concluded, as determined by the FIRST RESPONDERS Program Administrator; and

(ii)

is determined by the FIRST RESPONDERS Program Administrator to be at an increased risk of developing a FIRST RESPONDERS-related health condition as a result of exposure to airborne toxins, other hazards, or adverse conditions resulting from the pandemic and meets such eligibility criteria related to such exposures, as the FIRST RESPONDERS Program Administrator determines are appropriate, after consultation with the FIRST RESPONDERS Scientific/Technical Advisory Committee.

(3)

Enrollment process

(A)

In general

The FIRST RESPONDERS Program Administrator shall establish a process for enrolling FIRST RESPONDERS the FIRST RESPONDERS Program. Under such process—

(i)

FIRST 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 first responders who are determined to be FIRST 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 FIRST 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

In accordance with subparagraph (A)(i), the FIRST RESPONDERS Program Administrator shall enroll an individual described in paragraph (1)(A) in the FIRST RESPONDERS Program not later than July 1, 2011.

(ii)

Other responders

In accordance with subparagraph (A)(ii) and consistent with paragraph (4), the FIRST RESPONDERS Program Administrator shall enroll any other individual who is determined to be a FIRST RESPONDERS responder in the FIRST RESPONDERS Program at the time of such determination.

(4)

Numerical limitation on eligible FIRST RESPONDERS

(A)

In general

The total number of first responders not described in paragraph (1)(A) or (2)(A)(ii) who may be enrolled under paragraph (3)(A)(ii) shall not exceed 25,000 at any time, of which no more than 25,000 may be first responders enrolled based on modified eligibility criteria established under paragraph (1)(C).

(B)

Process

In implementing subparagraph (A), the FIRST RESPONDERS 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 section 3351, that will ensure sufficient funds will be available to provide treatment and monitoring benefits under this title, with respect to all first responders who are enrolled through the end of fiscal year 2020; and

(ii)

provide priority (subject to paragraph (3)(A)(i)) in such enrollments in the order in which first responders apply for enrollment under paragraph (3).

(5)

Disqualification of first responders on terrorist watch list

No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify eligible FIRST RESPONDERS. Before enrolling any individual as a FIRST RESPONDERS responder in the FIRST RESPONDERS Program under paragraph (3), the Administrator, in consultation with the Secretary of Homeland Security, shall determine whether the individual is on such list.

(b)

Monitoring Benefits

(1)

In general

In the case of an enrolled FIRST RESPONDERS responder (other than one described in subsection (a)(2)(A)(ii)), the FIRST RESPONDERS Program shall provide for monitoring benefits that include monitoring consistent with protocols approved by the FIRST RESPONDERS Program Administrator and including clinical examinations and long-term health monitoring and analysis. In the case of an enrolled FIRST RESPONDERS responder who is an active member of the local Fire or Police Department, the responder shall receive such benefits as part of the individual’s periodic company medical exams.

(2)

Provision of monitoring benefits

The monitoring benefits under paragraph (1) shall be provided through the Clinical Center of Excellence for the type of individual involved or, in the case of an individual, under an arrangement under section 3313.

3312.

Treatment of enrolled FIRST RESPONDERS for FIRST RESPONDERS-related health conditions

(a)

FIRST RESPONDERS-Related Health Condition Defined

(1)

In general

For purposes of this title, the term FIRST RESPONDERS-related health condition means a condition that—

(A)(i)

is an illness or health condition for which exposure to COVID-19 airborne toxins or viruses, any other hazard, or any other adverse condition resulting from pandemic based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of FIRST RESPONDERS-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 exposure, based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of FIRST RESPONDERS-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 FIRST RESPONDERS-related health conditions or—

(i)

with respect to a FIRST RESPONDERS responder, is provided certification of coverage under subsection (b)(2)(B)(iii); or

(ii)

with respect to a screening-eligible FIRST RESPONDERS survivor or certified-eligible FIRST RESPONDERS survivor, is provided certification of coverage under subsection (b)(2)(B)(iii), as applied under section 3322(a).

In the case of a FIRST RESPONDERS responder described in section 3311(a)(2)(A)(ii) (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)

Determination

The determination under paragraph (1) or subsection (b) of whether the COVID-19 pandemic is 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 COVID-19 airborne toxins or viruses, any other hazard, or any other adverse condition resulting from the pandemic. Such exposure shall be—

(i)

evaluated and characterized through the use of a standardized, population-appropriate questionnaire approved by the Department of Emergency Management and

(ii)

assessed and documented by a medical professional with experience in treating or diagnosing health conditions included on the list of FIRST RESPONDERS-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 Department of Emergency Management and a medical examination; and

(ii)

diagnosed and documented by a medical professional described in subparagraph (A)(ii).

(3)

List of health conditions for FIRST RESPONDERS

The list of health conditions for FIRST 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)

FIRST RESPONDERS-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)

Post-Traumatic 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 FIRST RESPONDERS

In the case of a FIRST RESPONDERS responder described in paragraph (4), a condition described in such paragraph.

(D)

Additional conditions

Any cancer (or type of cancer) or other condition added, pursuant to paragraph (5) or (6), to the list under this paragraph.

(4)

Cancer

(A)

In general

The FIRST RESPONDERS Program Administrator shall periodically conduct a review of all available scientific and medical evidence, including findings and recommendations of Clinical Centers of Excellence, published in peer-reviewed journals to determine if, based on such evidence, cancer or a certain type of cancer should be added to the applicable list of FIRST RESPONDERS-related health conditions. The FIRST RESPONDERS Program Administrator shall conduct the first review under this subparagraph not later than 180 days after the date of the enactment of this title.

(B)

Proposed regulations and rulemaking

Based on the periodic reviews under subparagraph (A), if the FIRST RESPONDERS Program Administrator determines that cancer or a certain type of cancer should be added to such list of FIRST RESPONDERS-related health conditions, the FIRST RESPONDERS Program Administrator shall propose regulations, through rulemaking, to add cancer or the certain type of cancer to such list.

(C)

Final regulations

Based on all the available evidence in the rulemaking record, the FIRST RESPONDERS Program Administrator shall make a final determination of whether cancer or a certain type of cancer should be added to such list of FIRST RESPONDERS-related health conditions.

(D)

Determinations not to add cancer or certain types of cancer

In the case that the FIRST RESPONDERS Program Administrator determines under subparagraph (B) or (C) that cancer or a certain type of cancer should not be added to such list of FIRST RESPONDERS-related health conditions, the FIRST RESPONDERS Program Administrator shall publish an explanation for such determination in the  State Register. Any such determination to not make such an addition shall not preclude the addition of cancer or the certain type of cancer to such list at a later date.

(5)

Addition of health conditions to list for FIRST RESPONDERS

(A)

In general

Whenever the FIRST RESPONDERS Program Administrator determines that a proposed rule should be promulgated to add a health condition to the list of health conditions in paragraph (3), the Administrator may request a recommendation of the Advisory Committee or may publish such a proposed rule in the Federal Register in accordance with subparagraph (D).

(B)

Administrator’s options after receipt of petition

In the case that the FIRST RESPONDERS 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 60 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 State 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

In the case that the Administrator requests a recommendation of the Advisory Committee under this paragraph, with respect to adding a health condition to the list in paragraph (3), the Advisory Committee shall submit to the Administrator such recommendation not later than 60 days after the date of such request or by such date (not to exceed 180 days after such date of request) as specified by the Administrator.

(D)

Publication

The FIRST RESPONDERS 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, United States Code; and

(ii)

provide interested parties a period of 30 days after such publication to submit written comments on the proposed rule.

The FIRST RESPONDERS 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.

 

(E)

Interested Party defined

For purposes of this paragraph, the term interested party includes a representative of any organization representing FIRST RESPONDERS, a nationally recognized medical association, a Clinical or Data Center, a State or political subdivision, or any other interested person.

(b)

Coverage of Treatment for FIRST RESPONDERS-Related Health Conditions

(1)

Determination for enrolled FIRST RESPONDERS based on a FIRST RESPONDERS-related health condition

(A)

In general

If a physician at a Clinical Center of Excellence that is providing monitoring benefits under section 3311 for an enrolled FIRST RESPONDERS responder makes a determination that the responder has a FIRST RESPONDERS-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 COVID-19 pandemic 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 FIRST RESPONDERS 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 FIRST RESPONDERS Program shall provide for payment under subsection (c) for medically necessary treatment for such condition.

(B)

Review; certification; appeals

(i)

Review

A state employee designated by the FIRST RESPONDERS Program Administrator shall review determinations made under subparagraph (A).

(ii)

Certification

The Administrator shall provide a certification of such condition based upon reviews conducted under clause (i). Such a certification shall be provided unless the Administrator determines that the responder’s condition is not a FIRST RESPONDERS-related health condition in the list in subsection (a)(3) or that exposure to airborne toxins, other hazards, or adverse conditions resulting from the pandemic is not substantially likely to be a significant factor in aggravating, contributing to, or causing the condition.

(iii)

Appeal process

The Administrator shall establish, by rule, a process for the appeal of determinations under clause (ii).

(2)

Determination based on medically associated FIRST RESPONDERS-related health conditions

(A)

In general

If a physician at a Clinical Center of Excellence determines pursuant to subsection (a) that the enrolled FIRST RESPONDERS 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 FIRST RESPONDERS-related health condition—

(i)

the physician shall promptly transmit such determination to the FIRST RESPONDERS 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 appeal

The FIRST RESPONDERS 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 FIRST RESPONDERS Program Administrator;

(ii)

not later than 60 days after the date of the transmittal under subparagraph (A)(i), a determination by the FIRST RESPONDERS Program Administrator on whether or not the condition involved is described in subsection (a)(1)(A) and is medically associated with a FIRST RESPONDERS-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 FIRST RESPONDERS-related health condition; and

(iv)

a process for appeals of determinations relating to such conditions.

(C)

Inclusion in list of health conditions

If the FIRST RESPONDERS Program Administrator provides certification under subparagraph (B)(iii) for coverage of a condition, the Administrator may, pursuant to subsection (a)(6), add the condition to the list in subsection (a)(3).

(D)

Conditions already declined for inclusion in list

If the FIRST RESPONDERS Program Administrator publishes a determination under subsection (a)(6)(B) not to include a condition in the list in subsection (a)(3), the FIRST RESPONDERS Program Administrator shall not provide certification under subparagraph (B)(iii) for coverage of the condition. In the case of an individual who is certified under subparagraph (B)(iii) with respect to such condition before the date of the publication of such determination the previous sentence shall not apply.

(3)

Requirement of medical necessity

(A)

In general

In providing treatment for a FIRST RESPONDERS-related health condition, a physician or other provider shall provide treatment that is medically necessary and in accordance with medical treatment protocols established under subsection (d).

(B)

Regulations relating to medical necessity

For the purpose of this title, the FIRST RESPONDERS Program Administrator shall issue regulations specifying a standard for determining medical necessity with respect to health care services and prescription pharmaceuticals, a process for determining whether treatment furnished and pharmaceuticals prescribed under this title meet such standard (including any prior authorization requirement), and a process for appeal of a determination under subsection (c)(3).

(4)

Scope of treatment covered

(A)

In general

The scope of treatment covered under this subsection includes services of physicians and other health care providers, diagnostic and laboratory tests, prescription drugs, inpatient and outpatient hospital services, and other medically necessary treatment.

(B)

Pharmaceutical coverage

With respect to ensuring coverage of medically necessary outpatient prescription drugs, such drugs shall be provided, under arrangements made by the FIRST RESPONDERS Program Administrator, directly through participating Clinical Centers of Excellence or through one or more outside vendors.

(C)

Transportation expenses for nationwide network

The FIRST RESPONDERS Program Administrator may provide for necessary and reasonable transportation and expenses incident to the securing of medically necessary treatment through the nationwide network under section 3313 involving travel of more than 250 miles and for which payment is made under this section in the same manner in which first responders may be furnished necessary and reasonable transportation and expenses incident to services involving travel of more than 250 miles under existing regulations.

(5)

Provision of treatment pending certification

With respect to an enrolled FIRST RESPONDERS responder for whom a determination is made by an examining physician under paragraph (1) or (2), but for whom the FIRST RESPONDERS Program Administrator has not yet determined whether to certify the determination, the FIRST RESPONDERS Program Administrator may establish by rule a process through which the Administrator may approve the provision of medical treatment under this subsection (and payment under subsection (c)) with respect to such responder and such responder’s FIRST RESPONDERS-related health condition (under such terms and conditions as the Administrator may provide) until the Administrator makes a decision on whether to certify the determination.

(c)

Payment for Initial health evaluation, monitoring, and treatment of FIRST RESPONDERS-Related Health Conditions

(1)

Medical treatment

(A)

Use of payment rates

(i)

In general

Subject to clause (ii):

(I)

Subject to subparagraphs (B) and (C), the FIRST RESPONDERS Program Administrator shall reimburse costs for medically necessary treatment under this title for FIRST RESPONDERS-related health conditions according to the payment rates that would apply to the provision of such treatment and services by the facility under Employees Compensation Acts.

(II)

For treatment not covered under subclause (i) or subparagraph (B), the FIRST RESPONDERS Program Administrator shall establish by regulation a reimbursement rate for such treatment.

(ii)

Exception

In no case shall payments for products or services under clause (i) be made at a rate higher than the Office of Worker's Compensation Programs in the Department Labor would pay for such products or services rendered at the time such products or services were provided.

(B)

Pharmaceuticals

(i)

In general

The FIRST RESPONDERS Program Administrator shall establish a program for paying for the medically necessary outpatient prescription pharmaceuticals prescribed under this title for FIRST RESPONDERS-related health conditions through one or more contracts with outside vendors.

(ii)

Competitive bidding

Under 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 FIRST RESPONDERS Program.

(iii)

Treatment of participants

Under such program the Administrator may enter into an agreement with a separate vendor to provide pharmaceutical benefits to enrolled FIRST RESPONDERS for whom the Clinical Center of Excellence is described in section 3305 if such an arrangement is deemed necessary and beneficial to the program by the FIRST RESPONDERS Program Administrator.

(iv)

Pharmaceuticals

Not later than July 1, 2020, the Chief Financial Officer shall submit to the State Legislature a report on whether existing Federal or State pharmaceutical purchasing programs can provide pharmaceutical benefits more efficiently and effectively than through the FIRST RESPONDERS program.

(C)

Improving quality and efficiency through modification of payment amounts and methodologies

The FIRST RESPONDERS Program Administrator may modify the amounts and methodologies for making payments for initial health evaluations, monitoring, or treatment, if, taking into account utilization and quality data furnished by the Clinical Centers of Excellence under section 3305(b)(1)(B)(iii), the Administrator determines that a bundling, capitation, pay for performance, or other payment methodology would better ensure high quality and efficient delivery of initial health evaluations, monitoring, or treatment to an enrolled FIRST RESPONDERS responder, screening-eligible FIRST RESPONDERS survivor, or certified-eligible FIRST RESPONDERS survivor.

(2)

Monitoring and initial health evaluation

The FIRST RESPONDERS Program Administrator shall reimburse the costs of monitoring and the costs of an initial health evaluation provided under this title at a rate set by the Administrator by regulation.

(3)

Determination of medical necessity

(A)

Review of medical necessity and protocols

As part of the process for reimbursement or payment under this subsection, the FIRST RESPONDERS Program Administrator shall provide for the review of claims for reimbursement or payment for the provision of medical treatment to determine if such treatment is medically necessary and in accordance with medical treatment protocols established under subsection (d).

(B)

Withholding of payment for medically unnecessary treatment

The Administrator shall withhold such reimbursement or payment for treatment that the Administrator determines is not medically necessary or is not in accordance with such medical treatment protocols.

(d)

Medical Treatment Protocols

(1)

Development

The Data Centers shall develop medical treatment protocols for the treatment of enrolled FIRST RESPONDERS and certified-eligible FIRST RESPONDERS survivors for health conditions included in the applicable list of FIRST RESPONDERS-related health conditions.

(2)

Approval

The medical treatment protocols developed under paragraph (1) shall be subject to approval by the FIRST RESPONDERS Program Administrator.

3313.

National arrangement for benefits for eligible first responders outside the state

(a)

In general

In order to ensure reasonable access to benefits under this subtitle for first responders who are enrolled FIRST RESPONDERS, screening-eligible FIRST RESPONDERS survivors, or certified-eligible FIRST RESPONDERS survivors and who reside the State, as defined in section 2(f), the FIRST RESPONDERS Program Administrator shall establish a nationwide network of health care providers to provide monitoring and treatment benefits and initial health evaluations near such first responders’ areas of residence. Nothing in this subsection shall be construed as preventing such first responders from being provided such monitoring and treatment benefits or initial health evaluation through any Clinical Center of Excellence.

(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 3305(a)(2)(A)(ii);

(3)

collect and report data in accordance with section 3304; and

(4)

meet such fraud, quality assurance, and other requirements as the FIRST RESPONDERS Program Administrator establishes, including sections 1128 through 1128E of the Social Security Act, as applied by section 3301(d).

(c)

Training and technical assistance

The FIRST RESPONDERS Program Administer may provide, including through contract, for the provision of training and technical assistance to health care providers participating in the network under subsection (a).

(d)

Provision of services through the VA

(1)

In general

The FIRST RESPONDERS Program Administrator may enter into an agreement with the Secretary of Veterans Affairs for the Secretary to provide services under this section through facilities of the Department of Veterans Affairs.

(2)

State program

Not later than July 1, 2020, the Chief Financial Officer shall submit to the State Legislature a report on whether the Department of Veterans Affairs can provide monitoring and treatment services to first responders under this section more efficiently and effectively than through the nationwide network to be established under subsection (a).

2

FIRST RESPONDERS Survivors

3321.

Identification and initial health evaluation of screening-eligible and certified-eligible FIRST RESPONDERS survivors

(a)

Identification of screening-Eligible FIRST RESPONDERS survivors and certified-Eligible FIRST RESPONDERS survivors

(1)

Screening-eligible FIRST RESPONDERS survivors

(A)

Definition

In this title, the term screening-eligible FIRST RESPONDERS survivor means, subject to subparagraph (C) and paragraph (3), an individual who is described in any of the following clauses:

(i)

Currently identified survivor

An individual, including a FIRST RESPONDERS responder, who has been identified as eligible for medical treatment and monitoring by the FIRST RESPONDERS Environmental Health Center as of the date of enactment of this title.

(ii)

Survivor who meets current eligibility criteria

An individual who is not a FIRST RESPONDERS responder, for purposes of the initial health evaluation under subsection (b), claims symptoms of a FIRST RESPONDERS-related health condition and meets any of the current eligibility criteria described in subparagraph (B).

(iii)

Survivor who meets modified eligibility criteria

An individual who is not a FIRST RESPONDERS responder, for purposes of the initial health evaluation under subsection (b), claims symptoms of a FIRST RESPONDERS-related health condition and meets such eligibility criteria relating to exposure to airborne toxins, other hazards, or adverse conditions resulting from a disaster declaration of the COVID-19 pandemic as the FIRST RESPONDERS Administrator determines, after consultation with the Data Centers described in section 3305 and the FIRST RESPONDERS Scientific/Technical Advisory Committee and FIRST RESPONDERS Health Program Steering Committees under section 3302.

The Administrator shall not modify such criteria under clause (iii) on or after the date that the number of certifications for certified-eligible FIRST RESPONDERS survivors under paragraph (2)(B) has reached 80 percent of the limit described in paragraph (3) or on or after the date that the number of enrollments of FIRST RESPONDERS has reached 80 percent of the limit described in section 3311(a)(4).(B)

Current eligibility criteria

The eligibility criteria described in this subparagraph for an individual are that the individual is described in any of the following clauses:

(i)

A FIRST RESPONDER who was present in a declared disaster area between March 1, 2020 and August 1, 2020.

(ii)

A FIRST RESPONDER who worked, resided, or attended school, childcare, or adult daycare in the designated disaster area for—

(I)

at least 4 days during the 4-month period beginning on March 1, 2020, and ending on August 1, 2020; or

(II)

at least 30 days during the period beginning on March 1, and ending on August 1, 2020.

(iii)

Any person who worked as a cleanup worker or performed maintenance work in the designated disaster area during the 4-month period described in subparagraph (B)(i) and had extensive exposure to FIRST RESPONDERS as a result of such work.

(iv)

Any FIRST RESPONDER who was deemed eligible to receive a grant from any banking institution, who possessed a lease for a residence or purchased a residence in any declared disaster area, and who resided in such residence during the period beginning on March 1, 2020, and ending on August 1, 2020.

(v)

A person whose place of employment—

(I)

at any time during the period beginning on March 1, 2020, and ending on August 1, 2020, was in the declared disaster area; and

(II)

was deemed eligible to receive a grant or other government incentive program designed to revitalize the Florida economy after the COVID-19 pandemic.

(C)

Application and determination process for screening eligibility

(i)

In general

The FIRST RESPONDERS Program Administrator in consultation with the Data Centers shall establish a process for first responders, other than first responders described in subparagraph (A)(i), to be determined to be screening-eligible FIRST RESPONDERS survivors. Under such process—

(I)

there shall be no fee charged to the applicant for making an application for such determination;

(II)

the Administrator shall make a determination on such an application not later than 60 days after the date of filing the application;

(III)

the Administrator shall make such a determination relating to an applicant’s compliance with this title and shall not determine that an individual is not so eligible or deny written documentation under clause (ii) to such individual unless the Administrator determines that—

(aa)

based on the application submitted, the individual does not meet the eligibility criteria; or

(bb)

the numerical limitation on certifications of certified-eligible FIRST RESPONDERS survivors set forth in paragraph (3) has been met; and

(IV)

an individual who is determined not to be a screening-eligible FIRST RESPONDERS survivor shall have an opportunity to appeal such determination in a manner established under such process.

(ii)

Written documentation of screening-eligibility

(I)

In general

In the case of an individual who is described in subparagraph (A)(i) or who is determined under clause (i) (consistent with paragraph (3)) to be a screening-eligible FIRST RESPONDERS survivor, the FIRST RESPONDERS Program Administrator shall provide an appropriate written documentation of such fact.

(II)

Timing

(aa)

Currently identified survivors

In the case of an individual who is described in subparagraph (A)(i), the FIRST RESPONDERS Program Administrator shall provide the written documentation under subclause (I) not later than July 1, 2020.

(bb)

Other members

In the case of another individual who is determined under clause (i) and consistent with paragraph (3) to be a screening-eligible FIRST RESPONDERS survivor, the FIRST RESPONDERS Program Administrator shall provide the written documentation under subclause (I) at the time of such determination.

(2)

Certified-eligible FIRST RESPONDERS survivors

(A)

Definition

The term certified-eligible FIRST RESPONDERS survivor means, subject to paragraph (3), a screening-eligible FIRST RESPONDERS survivor who the FIRST RESPONDERS Program Administrator certifies under subparagraph (B) to be eligible for follow-up monitoring and treatment under this part.

(B)

Certification of eligibility for monitoring and treatment

(i)

In general

The FIRST RESPONDERS Program Administrator shall establish a certification process under which the Administrator shall provide appropriate certification to screening-eligible FIRST RESPONDERS survivors who, pursuant to the initial health evaluation under subsection (b), are determined to be eligible for follow-up monitoring and treatment under this part.

(ii)

Timing

(I)

Currently identified survivors

In the case of an individual who is described in paragraph (1)(A)(i), the FIRST RESPONDERS Program Administrator shall provide the certification under clause (i) not later than July 1, 2020.

(II)

Other members

In the case of another individual who is determined under clause (i) to be eligible for follow-up monitoring and treatment, the FIRST RESPONDERS Program Administrator shall provide the certification under such clause at the time of such determination.

(3)

Numerical limitation on certified-eligible FIRST RESPONDERS survivors

(A)

In general

The total number of first responders not described in paragraph (1)(A)(i) who may be certified as certified-eligible FIRST RESPONDERS survivors under paragraph (2)(B) shall not exceed 25,000 at any time.

(B)

Process

In implementing subparagraph (A), the FIRST RESPONDERS Program Administrator shall—

(i)

limit the number of certifications provided under paragraph (2)(B)—

(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 made available under section 3351, that will ensure sufficient funds will be available to provide treatment and monitoring benefits under this title, with respect to all first responders receiving such certifications through the end of fiscal year 2020; and

(ii)

provide priority in such certifications in the order in which first responders apply for a determination under paragraph (2)(B).

(4)

Disqualification of first responders on terrorist watch list

No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify as a screening-eligible FIRST RESPONDERS survivor or a certified-eligible FIRST RESPONDERS survivor. Before determining any individual to be a screening-eligible FIRST RESPONDERS survivor under paragraph (1) or certifying any individual as a certified eligible FIRST RESPONDERS survivor under paragraph (2), the Administrator, in consultation with the Secretary of Homeland Security, shall determine whether the individual is on such list.

(b)

Initial health evaluation to determine eligibility for follow-up monitoring or treatment

(1)

In general

In the case of a screening-eligible FIRST RESPONDERS survivor, the FIRST RESPONDERS Program shall provide for an initial health evaluation to determine if the survivor has a FIRST RESPONDERS-related health condition and is eligible for follow-up monitoring and treatment benefits under the FIRST RESPONDERS Program. Initial health evaluation protocols under section 3305(a)(2)(A)(ii) shall be subject to approval by the FIRST RESPONDERS Program Administrator.

(2)

Initial health evaluation providers

The initial health evaluation described in paragraph (1) shall be provided through a Clinical Center of Excellence with respect to the individual involved.

(3)

Limitation on initial health evaluation benefits

Benefits for an initial health evaluation under this part for a screening-eligible FIRST RESPONDERS survivor shall consist only of a single medical initial health evaluation consistent with initial health evaluation protocols described in paragraph (1). Nothing in this paragraph shall be construed as preventing such an individual from seeking additional medical initial health evaluations at the expense of the individual.

3322.

Follow-up monitoring and treatment of certified-eligible FIRST RESPONDERS survivors for FIRST RESPONDERS-related health conditions

(a)

In general

Subject to subsection (b), the provisions of sections 3311 and 3312 shall apply to follow-up monitoring and treatment of FIRST RESPONDERS-related health conditions for certified-eligible FIRST RESPONDERS survivors in the same manner as such provisions apply to the monitoring and treatment of FIRST RESPONDERS-related health conditions for enrolled FIRST RESPONDERS.

(b)

List of FIRST RESPONDERS-Related health conditions for survivors

The list of health conditions for screening-eligible FIRST RESPONDERS survivors and certified-eligible FIRST RESPONDERS survivors consists of the following:

(1)

Aerodigestive disorders

(A)

Interstitial lung diseases.

(B)

Chronic respiratory disorder—fumes/vapors.

(C)

Asthma.

(D)

Reactive airways dysfunction syndrome (RADS).

(E)

FIRST RESPONDERS-exacerbated chronic obstructive pulmonary disease (COPD).

(F)

Chronic cough syndrome.

(G)

Upper airway hyperreactivity.

(H)

Chronic rhinosinusitis.

(I)

Chronic nasopharyngitis.

(J)

Chronic laryngitis.

(K)

Gastroesophageal reflux disorder (GERD).

(L)

Sleep apnea exacerbated by or related to a condition described in a previous clause.

(2)

Mental health conditions

(A)

Post-Traumatic stress disorder (PTSD).

(B)

Major depressive disorder.

(C)

Panic disorder.

(D)

Generalized anxiety disorder.

(E)

Anxiety disorder (not otherwise specified).

(F)

Depression (not otherwise specified).

(G)

Acute stress disorder.

(H)

Dysthymic disorder.

(I)

Adjustment disorder.

(J)

Substance abuse.

(3)

Additional conditions

Any cancer (or type of cancer) or other condition added to the list in section 3312(a)(3) pursuant to paragraph (5) or (6) of section 3312(a), as such provisions are applied under subsection (a) with respect to certified-eligible FIRST RESPONDERS survivors.

3323.

Follow-up monitoring and treatment of other first responders with FIRST RESPONDERS-related health conditions

(a)

In General

Subject to subsection (c), the provisions of section 3322 shall apply to the follow-up monitoring and treatment of FIRST RESPONDERS-related health conditions in the case of first responders described in subsection (b) in the same manner as such provisions apply to the follow-up monitoring and treatment of FIRST RESPONDERS-related health conditions for certified-eligible FIRST RESPONDERS survivors.

(b)

First responders described

An individual described in this subsection is an individual who, regardless of location of residence—

(1)

is not an enrolled FIRST RESPONDERS responder or a certified-eligible FIRST RESPONDERS survivor; and

(2)

is diagnosed at a Clinical Center of Excellence with a FIRST RESPONDERS-related health condition for certified-eligible FIRST RESPONDERS survivors.

(c)

Limitation

(1)

In general

The FIRST RESPONDERS Program Administrator shall limit benefits for any fiscal year under subsection (a) in a manner so that payments under this section for such fiscal year do not exceed the amount specified in paragraph (2) for such fiscal year.

(2)

Limitation

The amount specified in this paragraph for—

(A)

the last calendar quarter of fiscal year 2020 is $5,000,000;

(B)

fiscal year 2021 is $20,000,000; or

(C)

a succeeding fiscal year is the amount specified in this paragraph for the previous fiscal year increased by the annual percentage increase in the medical care component of the consumer price index for all urban consumers.

3

Payor provisions

3331.

Payment of claims

(a)

In general

Except as provided in subsections (b) and (c), the cost of monitoring and treatment benefits and initial health evaluation benefits provided under parts 1 and 2 of this subtitle shall be paid for by the FIRST RESPONDERS Program from the First Responders Health Program Fund.

(b)

Workers’ compensation payment

(1)

In general

Subject to paragraph (2), payment for treatment under parts 1 and 2 of this subtitle of a FIRST RESPONDERS-related health condition of an individual that is work-related shall be reduced or recouped to the extent that the FIRST RESPONDERS Program Administrator determines that payment has been made, or can reasonably be expected to be made, under a workers’ compensation law or plan of the United States, a State, or a locality, or other work-related injury or illness benefit plan of the employer of such individual, for such treatment. The provisions of clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) of section 1862(b) of the Social Security Act and paragraphs (3) and (4) of such section shall apply to the recoupment under this subsection of a payment to the FIRST RESPONDERS Program (with respect to a workers’ compensation law or plan, or other work-related injury or illness plan of the employer involved, and such individual) in the same manner as such provisions apply to the reimbursement of a payment under section 1862(b)(2) of such Act to the Secretary (with respect to such a law or plan and an individual entitled to benefits under title XVIII of such Act) except that any reference in such paragraph (4) to payment rates under title XVIII of the Social Security Act shall be deemed a reference to payment rates under this title.

(2)

Exception

Paragraph (1) shall not apply for any quarter, with respect to any workers’ compensation law or plan, including line of duty compensation, to which any local government or agency is obligated to make payments, if, in accordance with terms specified under the contract under subsection (d)(1)(A),

(3)

Rules of construction

Nothing in this title shall be construed to affect, modify, or relieve any obligations under a worker’s compensation law or plan, other work-related injury or illness benefit plan of an employer, or any health insurance plan.

(c)

Health insurance coverage

(1)

In general

In the case of an individual who has a FIRST RESPONDERS-related health condition that is not work-related and has health coverage for such condition through any public or private health plan (including health benefits under title XVIII, XIX, or XXI of the Social Security Act) the provisions of section 1862(b) of the Social Security Act shall apply to such a health plan and such individual in the same manner as they apply to group health plan and an individual entitled to benefits under title XVIII of such Act pursuant to section 226(a) of such Act. Any costs for items and services covered under such plan that are not reimbursed by such health plan, due to the application of deductibles, copayments, coinsurance, other cost sharing, or otherwise, are reimbursable under this title to the extent that they are covered under the FIRST RESPONDERS Program. The program under this title shall not be treated as a legally liable party for purposes of applying section 1902(a)(25) of the Social Security Act.

(2)

Recovery by individual providers

Nothing in paragraph (1) shall be construed as requiring an entity providing monitoring and treatment under this title to seek reimbursement under a health plan with which the entity has no contract for reimbursement.

(3)

Maintenance of required minimum essential coverage

No payment may be made for monitoring and treatment under this title for an individual for a month (beginning with July 2020) if with respect to such month the individual—

(A)

is an applicable individual (as defined in subsection (d) of section 5000A of Internal Revenue Code of 1986) 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 Florida in program costs

(1)

Contract requirement

(A)

In general

No funds may be disbursed from the First Responders Health Program Fund under section 3351 unless the State of Florida has entered into a contract with the FIRST RESPONDERS Program Administrator under which the State of Florida agrees, in a form and manner specified by the Administrator, to pay the full contribution described in subparagraph (B) in accordance with this subsection on a timely basis, plus any interest owed pursuant to subparagraph (E)(i). Such contract shall specify the terms under which the State of Florida shall be considered to have made the full payment required for a quarter for purposes of subsection (b)(2).

(B)

Full contribution amount

Under such contract, with respect to the last calendar quarter of fiscal year 2020 and each calendar quarter in fiscal years 2021 the full contribution amount under this subparagraph shall be equal to 10 percent of the expenditures in carrying out this title for the respective quarter and with respect to calendar quarters in fiscal year 2019, such full contribution amount shall be equal to 1/9 of the expenditures in carrying out this title for the respective quarter.

(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 the date of the enactment of this title.

(iii)

An amount paid to satisfy a judgment or as part of a settlement related to injuries or illnesses arising out of the COVID-19 pandemic.

(D)

Timing of contribution

The payment obligation under such contract for a calendar quarter in a fiscal year shall be paid not later than the last day of the second succeeding calendar quarter.

(E)

Compliance

(i)

Interest for late payment

If the State of Florida fails to pay to the FIRST RESPONDERS Program Administrator pursuant to such contract the amount required for any calendar quarter by the day specified in subparagraph (D), interest shall accrue on the amount not so paid at the rate (determined by the Administrator) based on the average yield to maturity, plus 1 percentage point, on outstanding bonds issued by with a remaining maturity of at least 1 year.

(ii)

Recovery of amounts owed

The amounts owed to the FIRST RESPONDERS Program Administrator under such contract shall be recoverable by the United States in an action in the same manner as payments made under title XVIII of the Social Security Act may be recoverable in an action brought under section 1862(b)(2)(B)(iii) of such Act.

(F)

Deposit in Fund

The FIRST RESPONDERS Program Administer shall deposit amounts paid under such contract into the First Responders Health Program Fund under section 3351.

(2)

Payment of State of Florida share of monitoring and treatment costs

With respect to each calendar quarter for which a contribution is required by State of Florida under the contract under paragraph (1), the FIRST RESPONDERS Program Administrator shall—

(A)

provide State of Florida 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 State of Florida; and

(C)

certify periodically, for purposes of this subsection, whether or not State of Florida has paid the amount so billed.

Such amount shall initially be estimated by the FIRST RESPONDERS Program Administrator and shall be subject to adjustment and reconciliation based upon actual expenditures in carrying out this title.(3)

Rule of construction

Nothing in this subsection shall be construed as authorizing the FIRST RESPONDERS Administrator, with respect to a fiscal year, to reduce the numerical limitation under section 3311(a)(4) or 3321(a)(3) for such fiscal year if State of Florida fails to comply with paragraph (1) for a calendar quarter in such fiscal year.

(e)

Work-Related described

For the purposes of this section, a FIRST RESPONDERS-related health condition shall be treated as a condition that is work-related if—

(1)

the condition is diagnosed in an enrolled FIRST RESPONDERS, or in an individual who qualifies as a certified-eligible FIRST RESPONDERS survivor on the basis of being a rescue, recovery, or cleanup worker during the COVID-19 pandemic; 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 State, or other work-related injury or illness benefit plan of the employer of such individual.

3332.

Administrative arrangement authority

The FIRST RESPONDERS 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 3312, 3313, 3322, and 3323.

C

Research into Conditions

3341.

Research regarding certain health conditions related to the COVID-19 pandemic

(a)

In General

With respect to first responders, including enrolled FIRST RESPONDERS and certified-eligible FIRST RESPONDERS survivors, receiving monitoring or treatment under subtitle B, the FIRST RESPONDERS Program Administrator shall conduct or support—

(1)

research on physical and mental health conditions that may be related to the COVID-19 pandemic;

(2)

research on diagnosing FIRST RESPONDERS-related health conditions of such first responders, in the case of conditions for which there has been diagnostic uncertainty; and

(3)

research on treating FIRST RESPONDERS-related health conditions of such first responders, in the case of conditions for which there has been treatment uncertainty.

The Administrator may provide such support through continuation and expansion of research that was initiated before the date of the enactment of this title and through the First Responders Health Registry (referred to in section 3342), through a Clinical Center of Excellence, or through a Data Center.(b)

Types of research

The research under subsection (a)(1) shall include epidemiologic and other research studies on FIRST RESPONDERS-related health conditions or emerging conditions—

(1)

among enrolled FIRST RESPONDERS and certified-eligible FIRST RESPONDERS survivors under treatment; and

(2)

in sampled populations outside the disaster area, along with control populations, to identify potential for long-term adverse health effects in less exposed populations.

(c)

Consultation

The FIRST RESPONDERS Program Administrator shall carry out this section in consultation with the FIRST RESPONDERS Scientific/Technical Advisory Committee.

(d)

Application of Privacy and Human Subject Protections

The privacy and human subject protections applicable to research conducted under this section shall not be less than such protections applicable to research conducted or funded by the Florida Department of Health and Human Services.

3342.

First Responders Health Registry

For the purpose of ensuring ongoing data collection relating to victims of the COVID-19 pandemic, the FIRST RESPONDERS Program Administrator shall ensure that a registry of such victims is maintained that is at least as comprehensive as the First Responders Health Registry maintained under the arrangements in effect as of April 20, 2020, with the Florida Department of Health and Human Services.

D

Funding

3351.

First Responders Health Program Fund

(a)

Establishment of Fund

(1)

In general

There is established a fund to be known as the First Responders Health Program Fund (referred to in this section as the Fund).

(2)

Funding

Out of any money in the Treasury not otherwise appropriated, there shall be deposited into the Fund for each of fiscal years 2020 through 2021,

(A)

the state share, consisting of an amount equal to the lesser of—

(i)

90 percent of the expenditures in carrying out this title for the respective fiscal year (initially based on estimates, subject to subsequent reconciliation based on actual expenditures);

(II)

subject to paragraph (4), an additional amount for fiscal year 2019 from unexpended amounts for previous fiscal years; plus

(B)

the State of Florida share, consisting of the amount contributed under the contract under section 3331(d).

(3)

Contract requirement

(A)

In general

No funds may be disbursed from the Fund unless State of Florida has entered into a contract with the FIRST RESPONDERS Program Administrator under section 3331(d)(1).

(B)

Breach of contract

In the case of a failure to pay the amount so required under the contract—

(i)

the amount is recoverable under subparagraph (E)(ii) of such section;

(ii)

such failure shall not affect the disbursement of amounts from the Fund; and

(iii)

The state share described in paragraph (2)(A) shall not be increased by the amount so unpaid.

(4)

Aggregate limitation on funding beginning with fiscal year 2021

Beginning with fiscal year 2021, in no case shall the share of state funds deposited into the Fund under paragraph (2) for such fiscal year and previous fiscal years and quarters exceed the sum of the amounts specified in paragraph (2)(A)(ii)(I).

(b)

Mandatory funds for monitoring, initial health evaluations, treatment, and claims processing

(1)

In general

The amounts deposited into the Fund under subsection (a)(2) shall be available, without further appropriation, consistent with paragraph (2) and subsection (c), to carry out subtitle B and sections 3302(a), 3303, 3304, 3305(a)(2), 3305(c), 3341, and 3342.

(2)

Limitation on mandatory funding

This title does not establish any state obligation for payment of amounts in excess of the amounts available from the Fund for such purpose.

(3)

Limitation on authorization for further appropriations

This title does not establish any authorization for appropriation of amounts in excess of the amounts available from the Fund under paragraph (1).

(c)

Limits on Spending for Certain Purposes

Of the amounts made available under subsection (b)(1), not more than each of the following amounts may be available for each of the following purposes:

(1)

Surviving immediate family members of firefighters

For the purposes of carrying out subtitle B with respect to FIRST RESPONDERS described in section 3311(a)(2)(A)(ii)—

(A)

for the last calendar quarter of fiscal year 2020, $100,000;

(B)

for fiscal year 2021, $250,000;

(2)

FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee

For the purpose of carrying out section 3302(a)—

(A)

for the last calendar quarter of fiscal year 2020, $25,000;

(B)

for fiscal year 2021, $100,000;

(3)

Education and outreach

For the purpose of carrying out section 3303—

(A)

for the last calendar quarter of fiscal year 2020, $100,000;

(B)

for fiscal year 2021, $250,000;

(4)

Uniform data collection

For the purpose of carrying out section 3304 and for reimbursing Data Centers (as defined in section 3305(b)(2)) for the costs incurred by such Centers in carrying out activities under contracts entered into under section 3305(a)(2)—

(A)

for the last calendar quarter of fiscal year 2020, $2,500,000;

(B)

for fiscal year 2021, $5,000,000;

(5)

Research regarding certain health conditions

For the purpose of carrying out section 3341—

(A)

for the last calendar quarter of fiscal year 2020, $3,750,000;

(B)

for fiscal year 2021, $7,000,000;

(6)

First Responders Health Registry

For the purpose of carrying out section 3342—

(A)

for the last calendar quarter of fiscal year 2020, $1,750,000;

(B)

for fiscal year 2021, $3,000,000;

AN ACT

To extend and improve protections and services to first responders directly impacted by the Novel Coronavirus (hereinafter “COVID-19”) pandemic exposures and for other purposes.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Florida First Responder Health and COVID-19 Relief Act of 2020.

(b)

Table of Contents

The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

TITLE I—Pandemic and Health Recovery Program

Sec. 101. First Responders Health Program.

TITLE XXXIII—First Responders Health Program

Subtitle A—Establishment of Program; Advisory Committee

Sec. 3301. Establishment of FIRST RESPONDERS Health Program.

Sec. 3302. FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee; FIRST RESPONDERS Health Program Steering Committees.

Sec. 3303. Education and outreach.

Sec. 3304. Uniform data collection and analysis.

Sec. 3305. Clinical Centers of Excellence and Data Centers.

Sec. 3306. Definitions.

Subtitle B—Program of Monitoring, Initial Health Evaluations, and Treatment

PART 1—FIRST RESPONDERS

Sec. 3311. Identification of FIRST RESPONDERS and provision of FIRST RESPONDERS-related monitoring services.

Sec. 3312. Treatment of enrolled FIRST RESPONDERS for FIRST RESPONDERS-related health conditions.

Sec. 3313. National arrangement for benefits for eligible first responders.

PART 2—FIRST RESPONDERS Survivors

Sec. 3321. Identification and initial health evaluation of screening-eligible and certified-eligible FIRST RESPONDERS survivors.

Sec. 3322. Follow-up monitoring and treatment of certified-eligible FIRST RESPONDERS survivors for FIRST RESPONDERS-related health conditions.

Sec. 3323. Follow-up monitoring and treatment of other first responders with FIRST RESPONDERS-related health conditions.

PART 3—Payor provisions

Sec. 3331. Payment of claims.

Sec. 3332. Administrative arrangement authority.

Subtitle C—Research into Conditions

Sec. 3341. Research regarding certain health conditions related to COVID-19 pandemic.

Sec. 3342. First Responders Health Registry.

Subtitle D—Funding

Sec. 3351. First Responders Health Program Fund.

 

I

First Responders Health Program

101.

First Responders Health Program

The Public Health Service Act is amended by adding at the end the following new title:

XXXIII

First Responders Health Program

A

Establishment of Program; Advisory Committee

3301.

Establishment of First Responders Health Program

(a)

In general

There is hereby established within the State of Florida Department of Emergency Management, a program to be known as the First Responders Health Program, which shall be administered by the FIRST RESPONDERS Program Administrator, to provide beginning on May 1, 2020—

(1)

medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers (including those who are State employees) who responded to areas declared by  the federal government as COVID-19 pandemic disaster areas; and

(2)

initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers in declared disaster areas who were directly impacted and adversely affected by pandemic and occupational exposure.

(b)

Components of Program

The FIRST RESPONDERS Program includes the following components:

(1)

Medical monitoring for responders

Medical monitoring under section 3311, including clinical examinations and long-term health monitoring and analysis for enrolled FIRST RESPONDERS who were likely to have been exposed to COVID-19 airborne toxins and viral infections that were released, or to other hazards, as a result of the a declared pandemic

(2)

Initial health evaluation for survivors

An initial health evaluation under section 3321, including an evaluation to determine eligibility for follow-up monitoring and treatment.

(3)

Follow-up monitoring and treatment for FIRST RESPONDERS-related health conditions for responders and survivors

Provision under sections 3312, 3322, and 3323 of follow-up 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 FIRST RESPONDERS-related health condition (including necessary prescription drugs).

(4)

Outreach

Establishment under section 3303 of an education and outreach program to potentially eligible first responders concerning the benefits under this title.

(5)

Clinical data collection and analysis

Collection and analysis under section 3304 of health and mental health data relating to first responders receiving monitoring or treatment benefits in a uniform manner in collaboration with the collection of epidemiological data under section 3342.

(6)

Research on health conditions

Establishment under subtitle C of a research program on health conditions resulting from a declared pandemic.

(c)

No cost sharing

Monitoring and treatment benefits and initial health evaluation benefits are provided under subtitle B without any deductibles, copayments, or other cost sharing to an enrolled FIRST RESPONDERS responder or certified-eligible FIRST RESPONDERS survivor. Initial health evaluation benefits are provided under subtitle B without any deductibles, copayments, or other cost sharing to a screening-eligible FIRST RESPONDERS survivor.

(d)

Preventing fraud and unreasonable administrative costs

(1)

Fraud

The Inspector General of the State of Florida shall develop and implement a program to review the FIRST RESPONDERS Program’s health care expenditures to detect fraudulent or duplicate billing and payment for inappropriate services.

(2)

Unreasonable administrative costs

The Inspector General of the State of Florida shall develop and implement a program to review the FIRST RESPONDERS Program for unreasonable administrative costs, including with respect to infrastructure, administration, and claims processing.

(e)

Quality assurance

The FIRST RESPONDERS 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—

(1)

adherence to monitoring and treatment protocols;

(2)

appropriate diagnostic and treatment referrals for participants;

(3)

prompt communication of test results to participants; and

(4)

such other elements as the Administrator specifies in consultation with the Clinical Centers of Excellence.

(f)

Annual program report

(1)

In general

Not later than 6 months after the end of each fiscal year in which the FIRST RESPONDERS Program is in operation, the FIRST RESPONDERS Program Administrator shall submit an annual report to the State Legislature on the operations of this title 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 first responders

Information for each clinical program described in paragraph (3)—

(i)

on the number of first responders who applied for certification under subtitle B and the number of such first responders who were so certified;

(ii)

of the first responders who were certified, on the number who received monitoring under the program and the number of such first responders who received medical treatment under the program;

(iii)

with respect to first responders so certified who received such treatment, on the FIRST RESPONDERS-related health conditions for which they were treated; and

(iv)

on the projected number of first responders who will be certified under subtitle B in the succeeding fiscal year and the succeeding 10-year period.

(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 FIRST RESPONDERS-related health conditions that have been paid for or reimbursed by workers’ compensation, by public or private health plans, or by local government health programs.

(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 first responders; and

(ii)

a list of the Clinical Centers of Excellence and other providers that are participating in the program.

(E)

Scientific reports

A summary of the findings of any new scientific reports or studies on the health effects associated with exposure described in section 3306(1), including the findings of research conducted under section 3341(a).

(F)

Advisory committee recommendations

A list of recommendations by the FIRST RESPONDERS Scientific/Technical Advisory Committee on additional FIRST RESPONDERS Program eligibility criteria and on additional FIRST RESPONDERS-related health conditions and the action of the FIRST RESPONDERS Program Administrator concerning each such recommendation.

(3)

Separate clinical programs described

In paragraph (2), each of the following shall be treated as a separate clinical program of the FIRST RESPONDERS Program:

(A)

Firefighters and related personnel

The benefits provided for enrolled FIRST RESPONDERS described in section 3311(a)(2)(A).

(B)

Other FIRST RESPONDERS

The benefits provided for enrolled FIRST RESPONDERS not described in subparagraph (A).

(C)

FIRST RESPONDERS survivors

The benefits provided for screening-eligible FIRST RESPONDERS survivors and certified-eligible FIRST RESPONDERS survivors in section 3321(a).

(g)

Notification to State Legislature upon reaching 80 percent of eligibility numerical limits

The Secretary shall promptly notify the State Legislature of each of the following:

(1)

When the number of enrollments of FIRST RESPONDERS subject to the limit established under section 3311(a)(4) has reached 80 percent of such limit.

(2)

When the number of certifications for certified-eligible FIRST RESPONDERS survivors subject to the limit established under section 3321(a)(3) has reached 80 percent of such limit.

(h)

Consultation

The FIRST RESPONDERS Program Administrator shall engage in ongoing outreach and consultation with relevant stakeholders, including the FIRST RESPONDERS Health Program Steering Committees and the Advisory Committee under section 3302, regarding the implementation and improvement of programs under this title.

3302.

FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee; FIRST RESPONDERS Health Program Steering Committees

(a)

Advisory Committee

(1)

Establishment

The FIRST RESPONDERS Program Administrator shall establish an advisory committee to be known as the FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee (in this subsection referred to as the Advisory Committee) to review scientific and medical evidence and to make recommendations to the Administrator on additional FIRST RESPONDERS Program eligibility criteria and on additional FIRST RESPONDERS-related health conditions.

(2)

Composition

The FIRST RESPONDERS Program Administrator shall appoint the members of the Advisory Committee and shall include at least—

(A)

4 occupational physicians, at least 2 of whom have experience treating FIRST RESPONDERS rescue and recovery workers;

(B)

1 physician with expertise in pulmonary medicine;

(C)

2 environmental medicine or environmental health specialists;

(D)

2 representatives of FIRST RESPONDERS;

(E)

2 representatives of certified-eligible FIRST RESPONDERS survivors;

(F)

an industrial hygienist;

(G)

a toxicologist;

(H)

an epidemiologist; and

(I)

a mental health professional.

(3)

Meetings

The Advisory Committee shall meet at such frequency as may be required to carry out its duties.

(4)

Reports

The FIRST RESPONDERS Program Administrator shall provide for publication of recommendations of the Advisory Committee on the public Web site established for the FIRST RESPONDERS Program.

(5)

Duration

Notwithstanding any other provision of law, the Advisory Committee shall continue in operation during the period in which the FIRST RESPONDERS Program is in operation.

(6)

Application of State Advisory Committee Acts

Except as otherwise specifically provided, the Advisory Committee shall be subject to any State Advisory Committee Act.

(b)

FIRST RESPONDERS Health Program Steering Committees

(1)

Consultation

The FIRST RESPONDERS Program Administrator shall consult with 2 steering committees (each in this section referred to as a Steering Committee) that are established as follows:

(A)

FIRST RESPONDERS steering committee

One Steering Committee, to be known as the FIRST RESPONDERS Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of monitoring and treatment programs for the enrolled FIRST RESPONDERS under part 1 of subtitle B.

(B)

FIRST RESPONDERS survivors steering committee

One Steering Committee, to be known as the FIRST RESPONDERS Survivors Steering Committee, for the purpose of receiving input from affected stakeholders and facilitating the coordination of initial health evaluations, monitoring, and treatment programs for screening-eligible and certified-eligible FIRST RESPONDERS survivors under part 2 of subtitle B.

(2)

Membership

(A)

FIRST RESPONDERS steering committee

(i)

Representation

The FIRST RESPONDERS Steering Committee shall include—

(I)

representatives of the Centers of Excellence providing services to FIRST RESPONDERS;

(II)

representatives of labor organizations representing firefighters, police, other civil service employees, and recovery and cleanup workers who responded to the declared pandemic; and

(III)

3 representatives of each affected State, as appointed by the Governor

(ii)

Initial membership

The FIRST RESPONDERS Steering Committee shall initially be composed of members of the FIRST RESPONDERS Monitoring and Treatment Program Steering Committee (as in existence on the day before the date of the enactment of this title).

(B)

FIRST RESPONDERS survivors steering committee

(i)

Representation

The FIRST RESPONDERS Survivors Steering Committee shall include representatives of—

(I)

the Centers of Excellence providing services to screening-eligible and certified-eligible FIRST RESPONDERS survivors;

(II)

the population of residents, students, and area and other workers affected by any declared pandemic;

(III)

screening-eligible and certified-eligible survivors receiving initial health evaluations, monitoring, or treatment under part 2 of subtitle B and organizations advocating on their behalf; and

(IV)

State of Florida.

(ii)

Initial membership

The FIRST RESPONDERS Survivors Steering Committee shall initially be composed of members of the FIRST RESPONDERS Environmental Health Center Survivor Advisory Committee (as in existence on the day before the date of the enactment of this title).

(C)

Additional appointments

Each Steering Committee may recommend, if approved by a majority of voting members of the Committee, additional members to the Committee.

(D)

Vacancies

A vacancy in a Steering Committee shall be filled by an individual recommended by the Steering Committee.

3303.

Education and outreach

The FIRST RESPONDERS Program Administrator shall institute a program that provides education and outreach on the existence and availability of services under the FIRST RESPONDERS Program. The outreach and education program—

(1)

shall include—

(A)

the establishment of a public Web site with information about the FIRST RESPONDERS Program;

(B)

meetings with potentially eligible populations;

(C)

development and dissemination of outreach materials informing people about the program; and

(D)

the establishment of phone information services; and

(2)

shall be conducted in a manner intended—

(A)

to reach all affected populations; and

(B)

to include materials for culturally and linguistically diverse populations.

3304.

Uniform data collection and analysis

(a)

In general

The FIRST RESPONDERS Program Administrator shall provide for the uniform collection of data, including claims data (and analysis of data and regular reports to the Administrator) on the prevalence of FIRST RESPONDERS-related health conditions and the identification of new FIRST RESPONDERS-related health conditions. Such data shall be collected for all first responders provided monitoring or treatment benefits under subtitle B and regardless of their place of residence or Clinical Center of Excellence through which the benefits are provided. The FIRST RESPONDERS Program Administrator shall provide, through the Data Centers or otherwise, for the integration of such data into the monitoring and treatment program activities under this title.

(b)

Coordinating through Centers of Excellence

Each Clinical Center of Excellence shall collect data described in subsection (a) and report such data to the corresponding Data Center for analysis by such Data Center.

(c)

Collaboration with FIRST RESPONDERS health registry

The FIRST RESPONDERS Program Administrator shall provide for collaboration between the Data Centers and the First Responders Health Registry described in section 3342.

(d)

Privacy

The data collection and analysis under this section shall be conducted and maintained in a manner that protects the confidentiality of individually identifiable health information consistent with applicable statutes and regulations, including, as applicable, HIPAA privacy and security law (as defined in section 3009(a)(2)) and section 552a of title 5, United States Code.

3305.

Clinical Centers of Excellence and Data Centers

(a)

In general

(1)

Contracts with clinical centers of excellence

The FIRST RESPONDERS Program Administrator shall, subject to subsection (b)(1)(B), enter into contracts with Clinical Centers of Excellence (as defined in subsection (b)(1)(A))—

(A)

for the provision of monitoring and treatment benefits and initial health evaluation benefits under subtitle B;

(B)

for the provision of outreach activities to first responders eligible for such monitoring and treatment benefits, for initial health evaluation benefits, and for follow-up to first responders who are enrolled in the monitoring program;

(C)

for the provision of counseling for benefits under subtitle B, with respect to FIRST RESPONDERS-related health conditions, for first responders eligible for such benefits;

(D)

for the provision of counseling for benefits for FIRST RESPONDERS-related health conditions that may be available under workers’ compensation or other benefit programs for work-related injuries or illnesses, health insurance, disability insurance, or other insurance plans or through public or private social service agencies and assisting eligible first responders in applying for such benefits;

(E)

for the provision of translational and interpretive services for program participants who are not English language proficient; and

(F)

for the collection and reporting of data, including claims data, in accordance with section 3304.

(2)

Contracts with data centers

(A)

In general

The FIRST RESPONDERS Program Administrator shall enter into contracts with one or more Data Centers (as defined in subsection (b)(2))—

(i)

for receiving, analyzing, and reporting to the FIRST RESPONDERS Program Administrator on data, in accordance with section 3304, that have been collected and reported to such Data Centers by the corresponding Clinical Centers of Excellence under subsection (b)(1)(B)(iii);

(ii)

for the development of monitoring, initial health evaluation, and treatment protocols, with respect to FIRST RESPONDERS-related health conditions;

(iii)

for coordinating the outreach activities conducted under paragraph (1)(B) by each corresponding Clinical Center of Excellence;

(iv)

for establishing criteria for the credentialing of medical providers participating in the nationwide network under section 3313;

(v)

for coordinating and administering the activities of the FIRST RESPONDERS Health Program Steering Committees established under section 3002(b); and

(vi)

for meeting periodically with the corresponding Clinical Centers of Excellence to obtain input on the analysis and reporting of data collected under clause (i) and on the development of monitoring, initial health evaluation, and treatment protocols under clause (ii).

(B)

Medical provider selection

The medical providers under subparagraph (A)(iv) shall be selected by the FIRST RESPONDERS Program Administrator on the basis of their experience treating or diagnosing the health conditions included in the list of FIRST RESPONDERS-related health conditions.

(C)

Clinical discussions

In carrying out subparagraph (A)(ii), a Data Center shall engage in clinical discussions across the FIRST RESPONDERS Program to guide treatment approaches for first responders with a FIRST RESPONDERS-related health condition.

(D)

Transparency of data

A contract entered into under this subsection with a Data Center shall require the Data Center to make any data collected and reported to such Center under subsection (b)(1)(B)(iii) available to health researchers and others as provided in the CDC/ATSDR Policy on Releasing and Sharing Data.

(3)

Authority for contracts to be class specific

A contract entered into under this subsection with a Clinical Center of Excellence or a Data Center may be with respect to one or more class of enrolled FIRST RESPONDERS, screening-eligible FIRST RESPONDERS survivors, or certified-eligible FIRST RESPONDERS survivors.

(4)

Use of cooperative agreements

Any contract under this title between the FIRST RESPONDERS Program Administrator and a Data Center or a Clinical Center of Excellence may be in the form of a cooperative agreement.

(5)

Review on feasibility of consolidating Data Centers

Not later than July 1, 2020, the Chief Financial Officer for the State of Florida shall submit to the State Legislature a report on the feasibility of consolidating Data Centers into a single Data Center.

(b)

Centers of excellence

(1)

Clinical Centers of Excellence

(A)

Definition

For purposes of this title, the term Clinical Center of Excellence means a Center that demonstrates to the satisfaction of the Administrator that the Center—

(i)

uses an integrated, centralized health care provider approach to create a comprehensive suite of health services under this title that are accessible to enrolled FIRST RESPONDERS, screening-eligible FIRST RESPONDERS survivors, or certified-eligible FIRST RESPONDERS survivors;

(ii)

has experience in caring for FIRST RESPONDERS responders and screening-eligible FIRST RESPONDERS survivors or includes health care providers who have been trained pursuant to section 3313(c);

(iii)

employs health care provider staff with expertise that includes, at a minimum, occupational medicine, environmental medicine, trauma-related psychiatry and psychology, and social services counseling; and

(iv)

meets such other requirements as specified by the Administrator.

(B)

Contract requirements

The FIRST RESPONDERS Program Administrator shall not enter into a contract with a Clinical Center of Excellence under subsection (a)(1) unless the Center agrees to do each of the following:

(i)

Establish a formal mechanism for consulting with and receiving input from representatives of eligible populations receiving monitoring and treatment benefits under subtitle B from such Center.

(ii)

Coordinate monitoring and treatment benefits under subtitle B with routine medical care provided for the treatment of conditions other than FIRST RESPONDERS-related health conditions.

(iii)

Collect and report to the corresponding Data Center data, including claims data, in accordance with section 3304(b).

(iv)

Have in place safeguards against fraud that are satisfactory to the Administrator, in consultation with the Inspector General of the State of Florida.

(v)

Treat or refer for treatment all first responders who are enrolled FIRST RESPONDERS or certified-eligible FIRST RESPONDERS survivors with respect to such Center who present themselves for treatment of a FIRST RESPONDERS-related health condition.

(vi)

Have in place safeguards, consistent with section 3304(c), to ensure the confidentiality of an individual’s individually identifiable health information, including requiring that such information not be disclosed to the individual’s employer without the authorization of the individual.

(vii)

Use amounts paid under subsection (c)(1) only for costs incurred in carrying out the activities described in subsection (a), other than those described in subsection (a)(1)(A).

(viii)

Utilize health care providers with occupational and environmental medicine expertise to conduct physical and mental health assessments, in accordance with protocols developed under subsection (a)(2)(A)(ii).

(ix)

Communicate with FIRST RESPONDERS and screening-eligible and certified-eligible FIRST RESPONDERS survivors in appropriate languages and conduct outreach activities with relevant stakeholder worker or community associations.

(x)

Meet all the other applicable requirements of this title, including regulations implementing such requirements.

(C)

Transition rule to ensure continuity of care

The FIRST RESPONDERS Program Administrator shall to the maximum extent feasible ensure continuity of care in any period of transition from monitoring and treatment of an enrolled FIRST RESPONDERS responder or certified-eligible FIRST RESPONDERS survivor by a provider to a Clinical Center of Excellence or a health care provider participating in the nationwide network under section 3313.

(2)

Data Centers

For purposes of this title, the term Data Center means a Center that the FIRST RESPONDERS Program Administrator determines has the capacity to carry out the responsibilities for a Data Center under subsection (a)(2).

(3)

Corresponding centers

For purposes of this title, a Clinical Center of Excellence and a Data Center shall be treated as corresponding to the extent that such Clinical Center and Data Center serve the same population group.

(c)

Payment for infrastructure costs

(1)

In general

The FIRST RESPONDERS Program Administrator shall reimburse a Clinical Center of Excellence for the fixed infrastructure costs of such Center in carrying out the activities described in subtitle B at a rate negotiated by the Administrator and such Centers. Such negotiated rate shall be fair and appropriate and take into account the number of enrolled FIRST RESPONDERS receiving services from such Center under this title.

(2)

Fixed infrastructure costs

For purposes of paragraph (1), the term fixed infrastructure costs means, with respect to a Clinical Center of Excellence, the costs incurred by such Center that are not otherwise reimbursable by the FIRST RESPONDERS Program Administrator under section 3312(c) for patient evaluation, monitoring, or treatment but which are needed to operate the FIRST RESPONDERS program such as the costs involved in outreach to participants or recruiting participants, data collection and analysis, social services for counseling patients on other available assistance outside the FIRST RESPONDERS program, and the development of treatment protocols. Such term does not include costs for new construction or other capital costs.

(d)

CFO analysis

Not later than July 1, 2020, the Chief Financial Officer shall submit to the Florida Legislature an analysis on whether Clinical Centers of Excellence with which the FIRST RESPONDERS Program Administrator enters into a contract under this section have financial systems that will allow for the timely submission of claims data for purposes of section 3304 and subsections (a)(1)(F) and (b)(1)(B)(iii).

3306.

Definitions

In this title:

(1)

The term aggravating means, with respect to a health condition, a health condition that existed on March 1, 2020, and that, as a result of COVID-19 exposure to airborne toxins, any other hazard, or any other adverse condition resulting from the a declared pandemic, requires medical treatment that is (or will be) in addition to, more frequent than, or of longer duration than the medical treatment that would have been required for such condition in the absence of such exposure.

(2)

The term certified-eligible FIRST RESPONDERS survivor has the meaning given such term in section 3321(a)(2).

(3)

The terms Clinical Center of Excellence and Data Center have the meanings given such terms in section 3305.

(4)

The term enrolled FIRST RESPONDERS responder means a FIRST RESPONDERS responder enrolled under section 3311(a)(3).

(5)

The term initial health evaluation includes, with respect to an individual, a medical and exposure history, a physical examination, and additional medical testing as needed to evaluate whether the individual has a FIRST RESPONDERS-related health condition and is eligible for treatment under the FIRST RESPONDERS Program.

(6)

The term list of FIRST RESPONDERS-related health conditions means—

(A)

for FIRST RESPONDERS, the health conditions listed in section 3312(a)(3); and

(B)

for screening-eligible and certified-eligible FIRST RESPONDERS survivors, the health conditions listed in section 3322(b).

(7)

The term declared disaster area means the area within the designated area declared by the State of Florida, federal government and/or the Federal Emergency Management Agency that is—

(A)

the area of each declared disaster area; and

(B)

any geographic region that is wholly or partially contained within a 1.5-mile radius of the former First Responders site.

(8)

The term Federal Declaration Disaster Area means an area, specified by the FIRST RESPONDERS Program Administrator, within which FIRST RESPONDERS and eligible FIRST RESPONDERS screening-eligible survivors who reside in such area are reasonably able to access monitoring and treatment benefits and initial health evaluation benefits under this title through a Clinical Center of Excellence described in subparagraphs (A), (B), or (C) of section 3305(b)(1).

(9)

The term screening-eligible FIRST RESPONDERS survivor has the meaning given such term in section 3321(a)(1).

(10)

Any reference to State or Federal Declaration of Pandemic shall be deemed a reference to the period on such date subsequent to the declaration of a disaster emergency, as applicable, on such date.

(11)

The term Pandemic means any viral emergency as declared by the state or federal government in areas declared as disaster areas and includes the aftermath of such declarations.

(12)

The term FIRST RESPONDERS Health Program Steering Committee means such a Steering Committee established under section 3302(b).

(13)

The term FIRST RESPONDERS Program means the FIRST RESPONDER Program established under section 3301(a).

(14)(A)

The term FIRST RESPONDERS Program Administrator means—

(i)

subject to subparagraph (B), with respect to paragraphs (3) and (4) of section 3311(a) (relating to enrollment of FIRST RESPONDERS responders), section 3312(c) and the corresponding provisions of section 3322 (relating to payment for initial health evaluation, monitoring, and treatment, paragraphs (1)(C), (2)(B), and (3) of section 3321(a) (relating to determination or certification of screening-eligible or certified-eligible FIRST RESPONDERS responders), and part 3 of subtitle B (relating to payor provisions), an official in the Department of Emergency Management to be designated by the Governor; and

(ii)

with respect to any other provision of this title, the Director of the Institute for Occupational Safety and Health, or a designee of such Director.

(15)

The term FIRST RESPONDERS-related health condition is defined in section 3312(a).

(16)

The term FIRST RESPONDERS responder is defined in section 3311(a).

(17)

The term FIRST RESPONDERS Scientific/Technical Advisory Committee means such Committee established under section 3302(a).

B

Program of Monitoring, Initial Health Evaluations, and Treatment

1

FIRST RESPONDERS

3311.

Identification of FIRST RESPONDERS and provision of FIRST RESPONDERS-related monitoring services

(a)

FIRST RESPONDERS defined

(1)

In general

For purposes of this title, the term FIRST RESPONDERS means any of the following first responders, subject to paragraph (4):

(A)

Currently identified responder

An individual who has been identified as eligible for monitoring under the arrangements as in effect on the date of the enactment of this title by the Department of Emergency Management and—

(i)

Any hospital safety-net consortium that coordinates the monitoring and treatment for enrolled FIRST RESPONDERS other than with respect to those covered under the arrangement with the local provider; or

(ii)

the designated local FIRST RESPONDER agency.

(B)

Responder who meets current eligibility criteria

An individual who meets the current eligibility criteria described in paragraph (2).

(C)

Responder who meets modified eligibility criteria

An individual who—

(i)

performed rescue, recovery, demolition, debris cleanup, or other related services in declared disaster areas in response to declared pandemic, regardless of whether such services were performed by a municipal, county, State or Federal employee or member of the National Guard or otherwise; and

(ii)

meets such eligibility criteria relating to exposure to COVID-19 airborne toxins, other hazards, or adverse conditions resulting from any declare pandemic as the FIRST RESPONDERS Program Administrator, after consultation with the FIRST RESPONDERS Scientific/Technical Advisory Committee, determines appropriate.

The FIRST RESPONDERS Program Administrator shall not modify such eligibility criteria on or after the date that the number of enrollments of FIRST 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 FIRST RESPONDERS survivors under section 3321(a)(2)(B) has reached 80 percent of the limit described in section 3321(a)(3).(2)

Current eligibility criteria

The 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 personnel

The individual—

(i)

was a member of the Fire Department of a municipal, county, state, or Indian land, or (whether fire or emergency personnel, active or retired) who participated at least one day in the rescue, response and recovery effort at any of the former First Responders declared disaster areas for any time during the period beginning on the date 10 (ten) days prior to the date of federal declaration for the following 6 (six) months thereafter.

(ii)(I)

is a surviving immediate family member of an individual who was a member of the Fire Department (whether fire or emergency personnel, active or retired) and was killed or exposed at in the designated time frame; and

(II)

received any treatment for a FIRST RESPONDERS-related health condition described in section 3312(a)(1)(A)(ii) (relating to mental health conditions) on or before August, 1, 2020.

(B)

Law enforcement officers and FIRST RESPONDERS rescue, recovery, and cleanup workers

The individual—

(i)

worked or volunteered onsite in rescue, recovery, debris cleanup, or related support services in declared disaster areas for at least 4 hours during the period beginning March 1, 2020, and ending on August 1, 2020, for at least 24 hours during the period beginning on March 1, 2020, and ending on August 1, 2020;

(ii)(I)

was a member of a designated FIRST RESPONDER agency who participated onsite in rescue, recovery, debris cleanup, or related services of the declared disaster area between March 1, 2020 and ending on August 1, 2020;

(II)

participated onsite in rescue, recovery, response, debris cleanup, or related services to declared disaster areas for at least one day during the period beginning on March 1, 2020, and ending on August 1, 2020;

(III)

participated onsite in rescue, recovery, debris cleanup, or related services to declared disaster areas for at least 24 hours during the period beginning on March 1, 2020 and ending on August 1, 2020; or

(IV)

participated onsite in rescue, recovery, debris cleanup, or related services to declared disaster areas for at least 80 hours during the period beginning on March 1, 2020, and ending on August 1, 2020;

(iii)

was an employee of the Office of the Chief Medical Examiner of any municipal, county or state agency involved in the examination and handling of human remains from the First Responders efforts, or other morgue worker who performed similar pandemic-related efforts for such Office staff, during the period beginning on March 1, 2020, and ending on August 1, 2020;

(iv)

was a worker in a local Port Authority for at least 24 hours during the period beginning on March 1, 2020, and ending on August 1, 2020; or

(v)

was a vehicle-maintenance worker who was exposed to medical-related debris from the hospitals for First Responders while retrieving, driving, cleaning, repairing, and maintaining vehicles contaminated by airborne toxins during a duration and period described in subparagraph (A).

(C)

Responders to the declared COVID-19 pandemic

The 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 directly related to any declared pandemic during the period beginning March 1, 2020, and ending on the date on which the cleanup of the site was concluded, as determined by the FIRST RESPONDERS Program Administrator; or

(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 directly related to a federal declared pandemic from March 1, 2020, and ending on the date on which the cleanup of the site was concluded, as determined by the FIRST RESPONDERS Program Administrator; and

(ii)

is determined by the FIRST RESPONDERS Program Administrator to be at an increased risk of developing a FIRST RESPONDERS-related health condition as a result of exposure to airborne toxins, other hazards, or adverse conditions resulting from the pandemic and meets such eligibility criteria related to such exposures, as the FIRST RESPONDERS Program Administrator determines are appropriate, after consultation with the FIRST RESPONDERS Scientific/Technical Advisory Committee.

(3)

Enrollment process

(A)

In general

The FIRST RESPONDERS Program Administrator shall establish a process for enrolling FIRST RESPONDERS the FIRST RESPONDERS Program. Under such process—

(i)

FIRST 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 first responders who are determined to be FIRST 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 FIRST 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

In accordance with subparagraph (A)(i), the FIRST RESPONDERS Program Administrator shall enroll an individual described in paragraph (1)(A) in the FIRST RESPONDERS Program not later than July 1, 2011.

(ii)

Other responders

In accordance with subparagraph (A)(ii) and consistent with paragraph (4), the FIRST RESPONDERS Program Administrator shall enroll any other individual who is determined to be a FIRST RESPONDERS responder in the FIRST RESPONDERS Program at the time of such determination.

(4)

Numerical limitation on eligible FIRST RESPONDERS

(A)

In general

The total number of first responders not described in paragraph (1)(A) or (2)(A)(ii) who may be enrolled under paragraph (3)(A)(ii) shall not exceed 25,000 at any time, of which no more than 25,000 may be first responders enrolled based on modified eligibility criteria established under paragraph (1)(C).

(B)

Process

In implementing subparagraph (A), the FIRST RESPONDERS 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 section 3351, that will ensure sufficient funds will be available to provide treatment and monitoring benefits under this title, with respect to all first responders who are enrolled through the end of fiscal year 2020; and

(ii)

provide priority (subject to paragraph (3)(A)(i)) in such enrollments in the order in which first responders apply for enrollment under paragraph (3).

(5)

Disqualification of first responders on terrorist watch list

No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify eligible FIRST RESPONDERS. Before enrolling any individual as a FIRST RESPONDERS responder in the FIRST RESPONDERS Program under paragraph (3), the Administrator, in consultation with the Secretary of Homeland Security, shall determine whether the individual is on such list.

(b)

Monitoring Benefits

(1)

In general

In the case of an enrolled FIRST RESPONDERS responder (other than one described in subsection (a)(2)(A)(ii)), the FIRST RESPONDERS Program shall provide for monitoring benefits that include monitoring consistent with protocols approved by the FIRST RESPONDERS Program Administrator and including clinical examinations and long-term health monitoring and analysis. In the case of an enrolled FIRST RESPONDERS responder who is an active member of the local Fire or Police Department, the responder shall receive such benefits as part of the individual’s periodic company medical exams.

(2)

Provision of monitoring benefits

The monitoring benefits under paragraph (1) shall be provided through the Clinical Center of Excellence for the type of individual involved or, in the case of an individual, under an arrangement under section 3313.

3312.

Treatment of enrolled FIRST RESPONDERS for FIRST RESPONDERS-related health conditions

(a)

FIRST RESPONDERS-Related Health Condition Defined

(1)

In general

For purposes of this title, the term FIRST RESPONDERS-related health condition means a condition that—

(A)(i)

is an illness or health condition for which exposure to COVID-19 airborne toxins or viruses, any other hazard, or any other adverse condition resulting from pandemic based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of FIRST RESPONDERS-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 exposure, based on an examination by a medical professional with experience in treating or diagnosing the health conditions included in the applicable list of FIRST RESPONDERS-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 FIRST RESPONDERS-related health conditions or—

(i)

with respect to a FIRST RESPONDERS responder, is provided certification of coverage under subsection (b)(2)(B)(iii); or

(ii)

with respect to a screening-eligible FIRST RESPONDERS survivor or certified-eligible FIRST RESPONDERS survivor, is provided certification of coverage under subsection (b)(2)(B)(iii), as applied under section 3322(a).

In the case of a FIRST RESPONDERS responder described in section 3311(a)(2)(A)(ii) (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)

Determination

The determination under paragraph (1) or subsection (b) of whether the COVID-19 pandemic is 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 COVID-19 airborne toxins or viruses, any other hazard, or any other adverse condition resulting from the pandemic. Such exposure shall be—

(i)

evaluated and characterized through the use of a standardized, population-appropriate questionnaire approved by the Department of Emergency Management and

(ii)

assessed and documented by a medical professional with experience in treating or diagnosing health conditions included on the list of FIRST RESPONDERS-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 Department of Emergency Management and a medical examination; and

(ii)

diagnosed and documented by a medical professional described in subparagraph (A)(ii).

(3)

List of health conditions for FIRST RESPONDERS

The list of health conditions for FIRST 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)

FIRST RESPONDERS-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)

Post-Traumatic 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 FIRST RESPONDERS

In the case of a FIRST RESPONDERS responder described in paragraph (4), a condition described in such paragraph.

(D)

Additional conditions

Any cancer (or type of cancer) or other condition added, pursuant to paragraph (5) or (6), to the list under this paragraph.

(4)

Cancer

(A)

In general

The FIRST RESPONDERS Program Administrator shall periodically conduct a review of all available scientific and medical evidence, including findings and recommendations of Clinical Centers of Excellence, published in peer-reviewed journals to determine if, based on such evidence, cancer or a certain type of cancer should be added to the applicable list of FIRST RESPONDERS-related health conditions. The FIRST RESPONDERS Program Administrator shall conduct the first review under this subparagraph not later than 180 days after the date of the enactment of this title.

(B)

Proposed regulations and rulemaking

Based on the periodic reviews under subparagraph (A), if the FIRST RESPONDERS Program Administrator determines that cancer or a certain type of cancer should be added to such list of FIRST RESPONDERS-related health conditions, the FIRST RESPONDERS Program Administrator shall propose regulations, through rulemaking, to add cancer or the certain type of cancer to such list.

(C)

Final regulations

Based on all the available evidence in the rulemaking record, the FIRST RESPONDERS Program Administrator shall make a final determination of whether cancer or a certain type of cancer should be added to such list of FIRST RESPONDERS-related health conditions.

(D)

Determinations not to add cancer or certain types of cancer

In the case that the FIRST RESPONDERS Program Administrator determines under subparagraph (B) or (C) that cancer or a certain type of cancer should not be added to such list of FIRST RESPONDERS-related health conditions, the FIRST RESPONDERS Program Administrator shall publish an explanation for such determination in the  State Register. Any such determination to not make such an addition shall not preclude the addition of cancer or the certain type of cancer to such list at a later date.

(5)

Addition of health conditions to list for FIRST RESPONDERS

(A)

In general

Whenever the FIRST RESPONDERS Program Administrator determines that a proposed rule should be promulgated to add a health condition to the list of health conditions in paragraph (3), the Administrator may request a recommendation of the Advisory Committee or may publish such a proposed rule in the Federal Register in accordance with subparagraph (D).

(B)

Administrator’s options after receipt of petition

In the case that the FIRST RESPONDERS 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 60 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 State 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

In the case that the Administrator requests a recommendation of the Advisory Committee under this paragraph, with respect to adding a health condition to the list in paragraph (3), the Advisory Committee shall submit to the Administrator such recommendation not later than 60 days after the date of such request or by such date (not to exceed 180 days after such date of request) as specified by the Administrator.

(D)

Publication

The FIRST RESPONDERS 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, United States Code; and

(ii)

provide interested parties a period of 30 days after such publication to submit written comments on the proposed rule.

The FIRST RESPONDERS 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.

 

(E)

Interested Party defined

For purposes of this paragraph, the term interested party includes a representative of any organization representing FIRST RESPONDERS, a nationally recognized medical association, a Clinical or Data Center, a State or political subdivision, or any other interested person.

(b)

Coverage of Treatment for FIRST RESPONDERS-Related Health Conditions

(1)

Determination for enrolled FIRST RESPONDERS based on a FIRST RESPONDERS-related health condition

(A)

In general

If a physician at a Clinical Center of Excellence that is providing monitoring benefits under section 3311 for an enrolled FIRST RESPONDERS responder makes a determination that the responder has a FIRST RESPONDERS-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 COVID-19 pandemic 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 FIRST RESPONDERS 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 FIRST RESPONDERS Program shall provide for payment under subsection (c) for medically necessary treatment for such condition.

(B)

Review; certification; appeals

(i)

Review

A state employee designated by the FIRST RESPONDERS Program Administrator shall review determinations made under subparagraph (A).

(ii)

Certification

The Administrator shall provide a certification of such condition based upon reviews conducted under clause (i). Such a certification shall be provided unless the Administrator determines that the responder’s condition is not a FIRST RESPONDERS-related health condition in the list in subsection (a)(3) or that exposure to airborne toxins, other hazards, or adverse conditions resulting from the pandemic is not substantially likely to be a significant factor in aggravating, contributing to, or causing the condition.

(iii)

Appeal process

The Administrator shall establish, by rule, a process for the appeal of determinations under clause (ii).

(2)

Determination based on medically associated FIRST RESPONDERS-related health conditions

(A)

In general

If a physician at a Clinical Center of Excellence determines pursuant to subsection (a) that the enrolled FIRST RESPONDERS 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 FIRST RESPONDERS-related health condition—

(i)

the physician shall promptly transmit such determination to the FIRST RESPONDERS 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 appeal

The FIRST RESPONDERS 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 FIRST RESPONDERS Program Administrator;

(ii)

not later than 60 days after the date of the transmittal under subparagraph (A)(i), a determination by the FIRST RESPONDERS Program Administrator on whether or not the condition involved is described in subsection (a)(1)(A) and is medically associated with a FIRST RESPONDERS-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 FIRST RESPONDERS-related health condition; and

(iv)

a process for appeals of determinations relating to such conditions.

(C)

Inclusion in list of health conditions

If the FIRST RESPONDERS Program Administrator provides certification under subparagraph (B)(iii) for coverage of a condition, the Administrator may, pursuant to subsection (a)(6), add the condition to the list in subsection (a)(3).

(D)

Conditions already declined for inclusion in list

If the FIRST RESPONDERS Program Administrator publishes a determination under subsection (a)(6)(B) not to include a condition in the list in subsection (a)(3), the FIRST RESPONDERS Program Administrator shall not provide certification under subparagraph (B)(iii) for coverage of the condition. In the case of an individual who is certified under subparagraph (B)(iii) with respect to such condition before the date of the publication of such determination the previous sentence shall not apply.

(3)

Requirement of medical necessity

(A)

In general

In providing treatment for a FIRST RESPONDERS-related health condition, a physician or other provider shall provide treatment that is medically necessary and in accordance with medical treatment protocols established under subsection (d).

(B)

Regulations relating to medical necessity

For the purpose of this title, the FIRST RESPONDERS Program Administrator shall issue regulations specifying a standard for determining medical necessity with respect to health care services and prescription pharmaceuticals, a process for determining whether treatment furnished and pharmaceuticals prescribed under this title meet such standard (including any prior authorization requirement), and a process for appeal of a determination under subsection (c)(3).

(4)

Scope of treatment covered

(A)

In general

The scope of treatment covered under this subsection includes services of physicians and other health care providers, diagnostic and laboratory tests, prescription drugs, inpatient and outpatient hospital services, and other medically necessary treatment.

(B)

Pharmaceutical coverage

With respect to ensuring coverage of medically necessary outpatient prescription drugs, such drugs shall be provided, under arrangements made by the FIRST RESPONDERS Program Administrator, directly through participating Clinical Centers of Excellence or through one or more outside vendors.

(C)

Transportation expenses for nationwide network

The FIRST RESPONDERS Program Administrator may provide for necessary and reasonable transportation and expenses incident to the securing of medically necessary treatment through the nationwide network under section 3313 involving travel of more than 250 miles and for which payment is made under this section in the same manner in which first responders may be furnished necessary and reasonable transportation and expenses incident to services involving travel of more than 250 miles under existing regulations.

(5)

Provision of treatment pending certification

With respect to an enrolled FIRST RESPONDERS responder for whom a determination is made by an examining physician under paragraph (1) or (2), but for whom the FIRST RESPONDERS Program Administrator has not yet determined whether to certify the determination, the FIRST RESPONDERS Program Administrator may establish by rule a process through which the Administrator may approve the provision of medical treatment under this subsection (and payment under subsection (c)) with respect to such responder and such responder’s FIRST RESPONDERS-related health condition (under such terms and conditions as the Administrator may provide) until the Administrator makes a decision on whether to certify the determination.

(c)

Payment for Initial health evaluation, monitoring, and treatment of FIRST RESPONDERS-Related Health Conditions

(1)

Medical treatment

(A)

Use of payment rates

(i)

In general

Subject to clause (ii):

(I)

Subject to subparagraphs (B) and (C), the FIRST RESPONDERS Program Administrator shall reimburse costs for medically necessary treatment under this title for FIRST RESPONDERS-related health conditions according to the payment rates that would apply to the provision of such treatment and services by the facility under Employees Compensation Acts.

(II)

For treatment not covered under subclause (i) or subparagraph (B), the FIRST RESPONDERS Program Administrator shall establish by regulation a reimbursement rate for such treatment.

(ii)

Exception

In no case shall payments for products or services under clause (i) be made at a rate higher than the Office of Worker's Compensation Programs in the Department Labor would pay for such products or services rendered at the time such products or services were provided.

(B)

Pharmaceuticals

(i)

In general

The FIRST RESPONDERS Program Administrator shall establish a program for paying for the medically necessary outpatient prescription pharmaceuticals prescribed under this title for FIRST RESPONDERS-related health conditions through one or more contracts with outside vendors.

(ii)

Competitive bidding

Under 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 FIRST RESPONDERS Program.

(iii)

Treatment of participants

Under such program the Administrator may enter into an agreement with a separate vendor to provide pharmaceutical benefits to enrolled FIRST RESPONDERS for whom the Clinical Center of Excellence is described in section 3305 if such an arrangement is deemed necessary and beneficial to the program by the FIRST RESPONDERS Program Administrator.

(iv)

Pharmaceuticals

Not later than July 1, 2020, the Chief Financial Officer shall submit to the State Legislature a report on whether existing Federal or State pharmaceutical purchasing programs can provide pharmaceutical benefits more efficiently and effectively than through the FIRST RESPONDERS program.

(C)

Improving quality and efficiency through modification of payment amounts and methodologies

The FIRST RESPONDERS Program Administrator may modify the amounts and methodologies for making payments for initial health evaluations, monitoring, or treatment, if, taking into account utilization and quality data furnished by the Clinical Centers of Excellence under section 3305(b)(1)(B)(iii), the Administrator determines that a bundling, capitation, pay for performance, or other payment methodology would better ensure high quality and efficient delivery of initial health evaluations, monitoring, or treatment to an enrolled FIRST RESPONDERS responder, screening-eligible FIRST RESPONDERS survivor, or certified-eligible FIRST RESPONDERS survivor.

(2)

Monitoring and initial health evaluation

The FIRST RESPONDERS Program Administrator shall reimburse the costs of monitoring and the costs of an initial health evaluation provided under this title at a rate set by the Administrator by regulation.

(3)

Determination of medical necessity

(A)

Review of medical necessity and protocols

As part of the process for reimbursement or payment under this subsection, the FIRST RESPONDERS Program Administrator shall provide for the review of claims for reimbursement or payment for the provision of medical treatment to determine if such treatment is medically necessary and in accordance with medical treatment protocols established under subsection (d).

(B)

Withholding of payment for medically unnecessary treatment

The Administrator shall withhold such reimbursement or payment for treatment that the Administrator determines is not medically necessary or is not in accordance with such medical treatment protocols.

(d)

Medical Treatment Protocols

(1)

Development

The Data Centers shall develop medical treatment protocols for the treatment of enrolled FIRST RESPONDERS and certified-eligible FIRST RESPONDERS survivors for health conditions included in the applicable list of FIRST RESPONDERS-related health conditions.

(2)

Approval

The medical treatment protocols developed under paragraph (1) shall be subject to approval by the FIRST RESPONDERS Program Administrator.

3313.

National arrangement for benefits for eligible first responders outside the state

(a)

In general

In order to ensure reasonable access to benefits under this subtitle for first responders who are enrolled FIRST RESPONDERS, screening-eligible FIRST RESPONDERS survivors, or certified-eligible FIRST RESPONDERS survivors and who reside the State, as defined in section 2(f), the FIRST RESPONDERS Program Administrator shall establish a nationwide network of health care providers to provide monitoring and treatment benefits and initial health evaluations near such first responders’ areas of residence. Nothing in this subsection shall be construed as preventing such first responders from being provided such monitoring and treatment benefits or initial health evaluation through any Clinical Center of Excellence.

(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 3305(a)(2)(A)(ii);

(3)

collect and report data in accordance with section 3304; and

(4)

meet such fraud, quality assurance, and other requirements as the FIRST RESPONDERS Program Administrator establishes, including sections 1128 through 1128E of the Social Security Act, as applied by section 3301(d).

(c)

Training and technical assistance

The FIRST RESPONDERS Program Administer may provide, including through contract, for the provision of training and technical assistance to health care providers participating in the network under subsection (a).

(d)

Provision of services through the VA

(1)

In general

The FIRST RESPONDERS Program Administrator may enter into an agreement with the Secretary of Veterans Affairs for the Secretary to provide services under this section through facilities of the Department of Veterans Affairs.

(2)

State program

Not later than July 1, 2020, the Chief Financial Officer shall submit to the State Legislature a report on whether the Department of Veterans Affairs can provide monitoring and treatment services to first responders under this section more efficiently and effectively than through the nationwide network to be established under subsection (a).

2

FIRST RESPONDERS Survivors

3321.

Identification and initial health evaluation of screening-eligible and certified-eligible FIRST RESPONDERS survivors

(a)

Identification of screening-Eligible FIRST RESPONDERS survivors and certified-Eligible FIRST RESPONDERS survivors

(1)

Screening-eligible FIRST RESPONDERS survivors

(A)

Definition

In this title, the term screening-eligible FIRST RESPONDERS survivor means, subject to subparagraph (C) and paragraph (3), an individual who is described in any of the following clauses:

(i)

Currently identified survivor

An individual, including a FIRST RESPONDERS responder, who has been identified as eligible for medical treatment and monitoring by the FIRST RESPONDERS Environmental Health Center as of the date of enactment of this title.

(ii)

Survivor who meets current eligibility criteria

An individual who is not a FIRST RESPONDERS responder, for purposes of the initial health evaluation under subsection (b), claims symptoms of a FIRST RESPONDERS-related health condition and meets any of the current eligibility criteria described in subparagraph (B).

(iii)

Survivor who meets modified eligibility criteria

An individual who is not a FIRST RESPONDERS responder, for purposes of the initial health evaluation under subsection (b), claims symptoms of a FIRST RESPONDERS-related health condition and meets such eligibility criteria relating to exposure to airborne toxins, other hazards, or adverse conditions resulting from a disaster declaration of the COVID-19 pandemic as the FIRST RESPONDERS Administrator determines, after consultation with the Data Centers described in section 3305 and the FIRST RESPONDERS Scientific/Technical Advisory Committee and FIRST RESPONDERS Health Program Steering Committees under section 3302.

The Administrator shall not modify such criteria under clause (iii) on or after the date that the number of certifications for certified-eligible FIRST RESPONDERS survivors under paragraph (2)(B) has reached 80 percent of the limit described in paragraph (3) or on or after the date that the number of enrollments of FIRST RESPONDERS has reached 80 percent of the limit described in section 3311(a)(4).(B)

Current eligibility criteria

The eligibility criteria described in this subparagraph for an individual are that the individual is described in any of the following clauses:

(i)

A FIRST RESPONDER who was present in a declared disaster area between March 1, 2020 and August 1, 2020.

(ii)

A FIRST RESPONDER who worked, resided, or attended school, childcare, or adult daycare in the designated disaster area for—

(I)

at least 4 days during the 4-month period beginning on March 1, 2020, and ending on August 1, 2020; or

(II)

at least 30 days during the period beginning on March 1, and ending on August 1, 2020.

(iii)

Any person who worked as a cleanup worker or performed maintenance work in the designated disaster area during the 4-month period described in subparagraph (B)(i) and had extensive exposure to FIRST RESPONDERS as a result of such work.

(iv)

Any FIRST RESPONDER who was deemed eligible to receive a grant from any banking institution, who possessed a lease for a residence or purchased a residence in any declared disaster area, and who resided in such residence during the period beginning on March 1, 2020, and ending on August 1, 2020.

(v)

A person whose place of employment—

(I)

at any time during the period beginning on March 1, 2020, and ending on August 1, 2020, was in the declared disaster area; and

(II)

was deemed eligible to receive a grant or other government incentive program designed to revitalize the Florida economy after the COVID-19 pandemic.

(C)

Application and determination process for screening eligibility

(i)

In general

The FIRST RESPONDERS Program Administrator in consultation with the Data Centers shall establish a process for first responders, other than first responders described in subparagraph (A)(i), to be determined to be screening-eligible FIRST RESPONDERS survivors. Under such process—

(I)

there shall be no fee charged to the applicant for making an application for such determination;

(II)

the Administrator shall make a determination on such an application not later than 60 days after the date of filing the application;

(III)

the Administrator shall make such a determination relating to an applicant’s compliance with this title and shall not determine that an individual is not so eligible or deny written documentation under clause (ii) to such individual unless the Administrator determines that—

(aa)

based on the application submitted, the individual does not meet the eligibility criteria; or

(bb)

the numerical limitation on certifications of certified-eligible FIRST RESPONDERS survivors set forth in paragraph (3) has been met; and

(IV)

an individual who is determined not to be a screening-eligible FIRST RESPONDERS survivor shall have an opportunity to appeal such determination in a manner established under such process.

(ii)

Written documentation of screening-eligibility

(I)

In general

In the case of an individual who is described in subparagraph (A)(i) or who is determined under clause (i) (consistent with paragraph (3)) to be a screening-eligible FIRST RESPONDERS survivor, the FIRST RESPONDERS Program Administrator shall provide an appropriate written documentation of such fact.

(II)

Timing

(aa)

Currently identified survivors

In the case of an individual who is described in subparagraph (A)(i), the FIRST RESPONDERS Program Administrator shall provide the written documentation under subclause (I) not later than July 1, 2020.

(bb)

Other members

In the case of another individual who is determined under clause (i) and consistent with paragraph (3) to be a screening-eligible FIRST RESPONDERS survivor, the FIRST RESPONDERS Program Administrator shall provide the written documentation under subclause (I) at the time of such determination.

(2)

Certified-eligible FIRST RESPONDERS survivors

(A)

Definition

The term certified-eligible FIRST RESPONDERS survivor means, subject to paragraph (3), a screening-eligible FIRST RESPONDERS survivor who the FIRST RESPONDERS Program Administrator certifies under subparagraph (B) to be eligible for follow-up monitoring and treatment under this part.

(B)

Certification of eligibility for monitoring and treatment

(i)

In general

The FIRST RESPONDERS Program Administrator shall establish a certification process under which the Administrator shall provide appropriate certification to screening-eligible FIRST RESPONDERS survivors who, pursuant to the initial health evaluation under subsection (b), are determined to be eligible for follow-up monitoring and treatment under this part.

(ii)

Timing

(I)

Currently identified survivors

In the case of an individual who is described in paragraph (1)(A)(i), the FIRST RESPONDERS Program Administrator shall provide the certification under clause (i) not later than July 1, 2020.

(II)

Other members

In the case of another individual who is determined under clause (i) to be eligible for follow-up monitoring and treatment, the FIRST RESPONDERS Program Administrator shall provide the certification under such clause at the time of such determination.

(3)

Numerical limitation on certified-eligible FIRST RESPONDERS survivors

(A)

In general

The total number of first responders not described in paragraph (1)(A)(i) who may be certified as certified-eligible FIRST RESPONDERS survivors under paragraph (2)(B) shall not exceed 25,000 at any time.

(B)

Process

In implementing subparagraph (A), the FIRST RESPONDERS Program Administrator shall—

(i)

limit the number of certifications provided under paragraph (2)(B)—

(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 made available under section 3351, that will ensure sufficient funds will be available to provide treatment and monitoring benefits under this title, with respect to all first responders receiving such certifications through the end of fiscal year 2020; and

(ii)

provide priority in such certifications in the order in which first responders apply for a determination under paragraph (2)(B).

(4)

Disqualification of first responders on terrorist watch list

No individual who is on the terrorist watch list maintained by the Department of Homeland Security shall qualify as a screening-eligible FIRST RESPONDERS survivor or a certified-eligible FIRST RESPONDERS survivor. Before determining any individual to be a screening-eligible FIRST RESPONDERS survivor under paragraph (1) or certifying any individual as a certified eligible FIRST RESPONDERS survivor under paragraph (2), the Administrator, in consultation with the Secretary of Homeland Security, shall determine whether the individual is on such list.

(b)

Initial health evaluation to determine eligibility for follow-up monitoring or treatment

(1)

In general

In the case of a screening-eligible FIRST RESPONDERS survivor, the FIRST RESPONDERS Program shall provide for an initial health evaluation to determine if the survivor has a FIRST RESPONDERS-related health condition and is eligible for follow-up monitoring and treatment benefits under the FIRST RESPONDERS Program. Initial health evaluation protocols under section 3305(a)(2)(A)(ii) shall be subject to approval by the FIRST RESPONDERS Program Administrator.

(2)

Initial health evaluation providers

The initial health evaluation described in paragraph (1) shall be provided through a Clinical Center of Excellence with respect to the individual involved.

(3)

Limitation on initial health evaluation benefits

Benefits for an initial health evaluation under this part for a screening-eligible FIRST RESPONDERS survivor shall consist only of a single medical initial health evaluation consistent with initial health evaluation protocols described in paragraph (1). Nothing in this paragraph shall be construed as preventing such an individual from seeking additional medical initial health evaluations at the expense of the individual.

3322.

Follow-up monitoring and treatment of certified-eligible FIRST RESPONDERS survivors for FIRST RESPONDERS-related health conditions

(a)

In general

Subject to subsection (b), the provisions of sections 3311 and 3312 shall apply to follow-up monitoring and treatment of FIRST RESPONDERS-related health conditions for certified-eligible FIRST RESPONDERS survivors in the same manner as such provisions apply to the monitoring and treatment of FIRST RESPONDERS-related health conditions for enrolled FIRST RESPONDERS.

(b)

List of FIRST RESPONDERS-Related health conditions for survivors

The list of health conditions for screening-eligible FIRST RESPONDERS survivors and certified-eligible FIRST RESPONDERS survivors consists of the following:

(1)

Aerodigestive disorders

(A)

Interstitial lung diseases.

(B)

Chronic respiratory disorder—fumes/vapors.

(C)

Asthma.

(D)

Reactive airways dysfunction syndrome (RADS).

(E)

FIRST RESPONDERS-exacerbated chronic obstructive pulmonary disease (COPD).

(F)

Chronic cough syndrome.

(G)

Upper airway hyperreactivity.

(H)

Chronic rhinosinusitis.

(I)

Chronic nasopharyngitis.

(J)

Chronic laryngitis.

(K)

Gastroesophageal reflux disorder (GERD).

(L)

Sleep apnea exacerbated by or related to a condition described in a previous clause.

(2)

Mental health conditions

(A)

Post-Traumatic stress disorder (PTSD).

(B)

Major depressive disorder.

(C)

Panic disorder.

(D)

Generalized anxiety disorder.

(E)

Anxiety disorder (not otherwise specified).

(F)

Depression (not otherwise specified).

(G)

Acute stress disorder.

(H)

Dysthymic disorder.

(I)

Adjustment disorder.

(J)

Substance abuse.

(3)

Additional conditions

Any cancer (or type of cancer) or other condition added to the list in section 3312(a)(3) pursuant to paragraph (5) or (6) of section 3312(a), as such provisions are applied under subsection (a) with respect to certified-eligible FIRST RESPONDERS survivors.

3323.

Follow-up monitoring and treatment of other first responders with FIRST RESPONDERS-related health conditions

(a)

In General

Subject to subsection (c), the provisions of section 3322 shall apply to the follow-up monitoring and treatment of FIRST RESPONDERS-related health conditions in the case of first responders described in subsection (b) in the same manner as such provisions apply to the follow-up monitoring and treatment of FIRST RESPONDERS-related health conditions for certified-eligible FIRST RESPONDERS survivors.

(b)

First responders described

An individual described in this subsection is an individual who, regardless of location of residence—

(1)

is not an enrolled FIRST RESPONDERS responder or a certified-eligible FIRST RESPONDERS survivor; and

(2)

is diagnosed at a Clinical Center of Excellence with a FIRST RESPONDERS-related health condition for certified-eligible FIRST RESPONDERS survivors.

(c)

Limitation

(1)

In general

The FIRST RESPONDERS Program Administrator shall limit benefits for any fiscal year under subsection (a) in a manner so that payments under this section for such fiscal year do not exceed the amount specified in paragraph (2) for such fiscal year.

(2)

Limitation

The amount specified in this paragraph for—

(A)

the last calendar quarter of fiscal year 2020 is $5,000,000;

(B)

fiscal year 2021 is $20,000,000; or

(C)

a succeeding fiscal year is the amount specified in this paragraph for the previous fiscal year increased by the annual percentage increase in the medical care component of the consumer price index for all urban consumers.

3

Payor provisions

3331.

Payment of claims

(a)

In general

Except as provided in subsections (b) and (c), the cost of monitoring and treatment benefits and initial health evaluation benefits provided under parts 1 and 2 of this subtitle shall be paid for by the FIRST RESPONDERS Program from the First Responders Health Program Fund.

(b)

Workers’ compensation payment

(1)

In general

Subject to paragraph (2), payment for treatment under parts 1 and 2 of this subtitle of a FIRST RESPONDERS-related health condition of an individual that is work-related shall be reduced or recouped to the extent that the FIRST RESPONDERS Program Administrator determines that payment has been made, or can reasonably be expected to be made, under a workers’ compensation law or plan of the United States, a State, or a locality, or other work-related injury or illness benefit plan of the employer of such individual, for such treatment. The provisions of clauses (iii), (iv), (v), and (vi) of paragraph (2)(B) of section 1862(b) of the Social Security Act and paragraphs (3) and (4) of such section shall apply to the recoupment under this subsection of a payment to the FIRST RESPONDERS Program (with respect to a workers’ compensation law or plan, or other work-related injury or illness plan of the employer involved, and such individual) in the same manner as such provisions apply to the reimbursement of a payment under section 1862(b)(2) of such Act to the Secretary (with respect to such a law or plan and an individual entitled to benefits under title XVIII of such Act) except that any reference in such paragraph (4) to payment rates under title XVIII of the Social Security Act shall be deemed a reference to payment rates under this title.

(2)

Exception

Paragraph (1) shall not apply for any quarter, with respect to any workers’ compensation law or plan, including line of duty compensation, to which any local government or agency is obligated to make payments, if, in accordance with terms specified under the contract under subsection (d)(1)(A),

(3)

Rules of construction

Nothing in this title shall be construed to affect, modify, or relieve any obligations under a worker’s compensation law or plan, other work-related injury or illness benefit plan of an employer, or any health insurance plan.

(c)

Health insurance coverage

(1)

In general

In the case of an individual who has a FIRST RESPONDERS-related health condition that is not work-related and has health coverage for such condition through any public or private health plan (including health benefits under title XVIII, XIX, or XXI of the Social Security Act) the provisions of section 1862(b) of the Social Security Act shall apply to such a health plan and such individual in the same manner as they apply to group health plan and an individual entitled to benefits under title XVIII of such Act pursuant to section 226(a) of such Act. Any costs for items and services covered under such plan that are not reimbursed by such health plan, due to the application of deductibles, copayments, coinsurance, other cost sharing, or otherwise, are reimbursable under this title to the extent that they are covered under the FIRST RESPONDERS Program. The program under this title shall not be treated as a legally liable party for purposes of applying section 1902(a)(25) of the Social Security Act.

(2)

Recovery by individual providers

Nothing in paragraph (1) shall be construed as requiring an entity providing monitoring and treatment under this title to seek reimbursement under a health plan with which the entity has no contract for reimbursement.

(3)

Maintenance of required minimum essential coverage

No payment may be made for monitoring and treatment under this title for an individual for a month (beginning with July 2020) if with respect to such month the individual—

(A)

is an applicable individual (as defined in subsection (d) of section 5000A of Internal Revenue Code of 1986) 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 Florida in program costs

(1)

Contract requirement

(A)

In general

No funds may be disbursed from the First Responders Health Program Fund under section 3351 unless the State of Florida has entered into a contract with the FIRST RESPONDERS Program Administrator under which the State of Florida agrees, in a form and manner specified by the Administrator, to pay the full contribution described in subparagraph (B) in accordance with this subsection on a timely basis, plus any interest owed pursuant to subparagraph (E)(i). Such contract shall specify the terms under which the State of Florida shall be considered to have made the full payment required for a quarter for purposes of subsection (b)(2).

(B)

Full contribution amount

Under such contract, with respect to the last calendar quarter of fiscal year 2020 and each calendar quarter in fiscal years 2021 the full contribution amount under this subparagraph shall be equal to 10 percent of the expenditures in carrying out this title for the respective quarter and with respect to calendar quarters in fiscal year 2019, such full contribution amount shall be equal to 1/9 of the expenditures in carrying out this title for the respective quarter.

(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 the date of the enactment of this title.

(iii)

An amount paid to satisfy a judgment or as part of a settlement related to injuries or illnesses arising out of the COVID-19 pandemic.

(D)

Timing of contribution

The payment obligation under such contract for a calendar quarter in a fiscal year shall be paid not later than the last day of the second succeeding calendar quarter.

(E)

Compliance

(i)

Interest for late payment

If the State of Florida fails to pay to the FIRST RESPONDERS Program Administrator pursuant to such contract the amount required for any calendar quarter by the day specified in subparagraph (D), interest shall accrue on the amount not so paid at the rate (determined by the Administrator) based on the average yield to maturity, plus 1 percentage point, on outstanding bonds issued by with a remaining maturity of at least 1 year.

(ii)

Recovery of amounts owed

The amounts owed to the FIRST RESPONDERS Program Administrator under such contract shall be recoverable by the United States in an action in the same manner as payments made under title XVIII of the Social Security Act may be recoverable in an action brought under section 1862(b)(2)(B)(iii) of such Act.

(F)

Deposit in Fund

The FIRST RESPONDERS Program Administer shall deposit amounts paid under such contract into the First Responders Health Program Fund under section 3351.

(2)

Payment of State of Florida share of monitoring and treatment costs

With respect to each calendar quarter for which a contribution is required by State of Florida under the contract under paragraph (1), the FIRST RESPONDERS Program Administrator shall—

(A)

provide State of Florida 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 State of Florida; and

(C)

certify periodically, for purposes of this subsection, whether or not State of Florida has paid the amount so billed.

Such amount shall initially be estimated by the FIRST RESPONDERS Program Administrator and shall be subject to adjustment and reconciliation based upon actual expenditures in carrying out this title.(3)

Rule of construction

Nothing in this subsection shall be construed as authorizing the FIRST RESPONDERS Administrator, with respect to a fiscal year, to reduce the numerical limitation under section 3311(a)(4) or 3321(a)(3) for such fiscal year if State of Florida fails to comply with paragraph (1) for a calendar quarter in such fiscal year.

(e)

Work-Related described

For the purposes of this section, a FIRST RESPONDERS-related health condition shall be treated as a condition that is work-related if—

(1)

the condition is diagnosed in an enrolled FIRST RESPONDERS, or in an individual who qualifies as a certified-eligible FIRST RESPONDERS survivor on the basis of being a rescue, recovery, or cleanup worker during the COVID-19 pandemic; 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 State, or other work-related injury or illness benefit plan of the employer of such individual.

3332.

Administrative arrangement authority

The FIRST RESPONDERS 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 3312, 3313, 3322, and 3323.

C

Research into Conditions

3341.

Research regarding certain health conditions related to the COVID-19 pandemic

(a)

In General

With respect to first responders, including enrolled FIRST RESPONDERS and certified-eligible FIRST RESPONDERS survivors, receiving monitoring or treatment under subtitle B, the FIRST RESPONDERS Program Administrator shall conduct or support—

(1)

research on physical and mental health conditions that may be related to the COVID-19 pandemic;

(2)

research on diagnosing FIRST RESPONDERS-related health conditions of such first responders, in the case of conditions for which there has been diagnostic uncertainty; and

(3)

research on treating FIRST RESPONDERS-related health conditions of such first responders, in the case of conditions for which there has been treatment uncertainty.

The Administrator may provide such support through continuation and expansion of research that was initiated before the date of the enactment of this title and through the First Responders Health Registry (referred to in section 3342), through a Clinical Center of Excellence, or through a Data Center.(b)

Types of research

The research under subsection (a)(1) shall include epidemiologic and other research studies on FIRST RESPONDERS-related health conditions or emerging conditions—

(1)

among enrolled FIRST RESPONDERS and certified-eligible FIRST RESPONDERS survivors under treatment; and

(2)

in sampled populations outside the disaster area, along with control populations, to identify potential for long-term adverse health effects in less exposed populations.

(c)

Consultation

The FIRST RESPONDERS Program Administrator shall carry out this section in consultation with the FIRST RESPONDERS Scientific/Technical Advisory Committee.

(d)

Application of Privacy and Human Subject Protections

The privacy and human subject protections applicable to research conducted under this section shall not be less than such protections applicable to research conducted or funded by the Florida Department of Health and Human Services.

3342.

First Responders Health Registry

For the purpose of ensuring ongoing data collection relating to victims of the COVID-19 pandemic, the FIRST RESPONDERS Program Administrator shall ensure that a registry of such victims is maintained that is at least as comprehensive as the First Responders Health Registry maintained under the arrangements in effect as of April 20, 2020, with the Florida Department of Health and Human Services.

D

Funding

3351.

First Responders Health Program Fund

(a)

Establishment of Fund

(1)

In general

There is established a fund to be known as the First Responders Health Program Fund (referred to in this section as the Fund).

(2)

Funding

Out of any money in the Treasury not otherwise appropriated, there shall be deposited into the Fund for each of fiscal years 2020 through 2021,

(A)

the state share, consisting of an amount equal to the lesser of—

(i)

90 percent of the expenditures in carrying out this title for the respective fiscal year (initially based on estimates, subject to subsequent reconciliation based on actual expenditures);

(II)

subject to paragraph (4), an additional amount for fiscal year 2019 from unexpended amounts for previous fiscal years; plus

(B)

the State of Florida share, consisting of the amount contributed under the contract under section 3331(d).

(3)

Contract requirement

(A)

In general

No funds may be disbursed from the Fund unless State of Florida has entered into a contract with the FIRST RESPONDERS Program Administrator under section 3331(d)(1).

(B)

Breach of contract

In the case of a failure to pay the amount so required under the contract—

(i)

the amount is recoverable under subparagraph (E)(ii) of such section;

(ii)

such failure shall not affect the disbursement of amounts from the Fund; and

(iii)

The state share described in paragraph (2)(A) shall not be increased by the amount so unpaid.

(4)

Aggregate limitation on funding beginning with fiscal year 2021

Beginning with fiscal year 2021, in no case shall the share of state funds deposited into the Fund under paragraph (2) for such fiscal year and previous fiscal years and quarters exceed the sum of the amounts specified in paragraph (2)(A)(ii)(I).

(b)

Mandatory funds for monitoring, initial health evaluations, treatment, and claims processing

(1)

In general

The amounts deposited into the Fund under subsection (a)(2) shall be available, without further appropriation, consistent with paragraph (2) and subsection (c), to carry out subtitle B and sections 3302(a), 3303, 3304, 3305(a)(2), 3305(c), 3341, and 3342.

(2)

Limitation on mandatory funding

This title does not establish any state obligation for payment of amounts in excess of the amounts available from the Fund for such purpose.

(3)

Limitation on authorization for further appropriations

This title does not establish any authorization for appropriation of amounts in excess of the amounts available from the Fund under paragraph (1).

(c)

Limits on Spending for Certain Purposes

Of the amounts made available under subsection (b)(1), not more than each of the following amounts may be available for each of the following purposes:

(1)

Surviving immediate family members of firefighters

For the purposes of carrying out subtitle B with respect to FIRST RESPONDERS described in section 3311(a)(2)(A)(ii)—

(A)

for the last calendar quarter of fiscal year 2020, $100,000;

(B)

for fiscal year 2021, $250,000;

(2)

FIRST RESPONDERS Health Program Scientific/Technical Advisory Committee

For the purpose of carrying out section 3302(a)—

(A)

for the last calendar quarter of fiscal year 2020, $25,000;

(B)

for fiscal year 2021, $100,000;

(3)

Education and outreach

For the purpose of carrying out section 3303—

(A)

for the last calendar quarter of fiscal year 2020, $100,000;

(B)

for fiscal year 2021, $250,000;

(4)

Uniform data collection

For the purpose of carrying out section 3304 and for reimbursing Data Centers (as defined in section 3305(b)(2)) for the costs incurred by such Centers in carrying out activities under contracts entered into under section 3305(a)(2)—

(A)

for the last calendar quarter of fiscal year 2020, $2,500,000;

(B)

for fiscal year 2021, $5,000,000;

(5)

Research regarding certain health conditions

For the purpose of carrying out section 3341—

(A)

for the last calendar quarter of fiscal year 2020, $3,750,000;

(B)

for fiscal year 2021, $7,000,000;

(6)

First Responders Health Registry

For the purpose of carrying out section 3342—

(A)

for the last calendar quarter of fiscal year 2020, $1,750,000;

(B)

for fiscal year 2021, $3,000,000;