Page:United States Statutes at Large Volume 124.djvu/3671

 124 STAT. 3645 PUBLIC LAW 111–347—JAN. 2, 2011 ‘‘(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 serv- ices, 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 WTC Program Administrator, directly through participating Clinical Centers of Excel- lence or through one or more outside vendors. ‘‘(C) TRANSPORTATION EXPENSES FOR NATIONWIDE NET- WORK.—The WTC 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 individuals may be furnished necessary and reasonable transportation and expenses incident to services involving travel of more than 250 miles under regulations implementing section 3629(c) of the Energy Employees Occupational Illness Compensation Program Act of 2000 (title XXXVI of Public Law 106–398; 42 U.S.C. 7384t(c)). ‘‘(5) PROVISION OF TREATMENT PENDING CERTIFICATION.— With respect to an enrolled WTC responder for whom a deter- mination is made by an examining physician under paragraph (1) or (2), but for whom the WTC Program Administrator has not yet determined whether to certify the determination, the WTC 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 WTC-related health condition (under such terms and conditions as the Administrator may provide) until the Administrator makes a decision on whether to certify the deter- mination. ‘‘(c) PAYMENT FOR INITIAL HEALTH EVALUATION, MONITORING, AND TREATMENT OF WTC-RELATED HEALTH CONDITIONS.— ‘‘(1) MEDICAL TREATMENT.— ‘‘(A) USE OF FECA PAYMENT RATES.— ‘‘(i) IN GENERAL.—Subject to clause (ii): ‘‘(I) Subject to subparagraphs (B) and (C), the WTC Program Administrator shall reimburse costs for medically necessary treatment under this title for WTC-related health conditions according to the payment rates that would apply to the provision of such treatment and services by the facility under the Federal Employees Compensation Act. ‘‘(II) For treatment not covered under sub- clause (i) or subparagraph (B), the WTC 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 Regulations.