WTCHealthProgramOverview9-11PartnerUse.pptx

World Trade Center Health Program Overview

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Pentagon photo courtesy of FEMA. Shanksville photo by vlashton, courtesy of Flickr.

What is the World Trade Center (WTC) Health Program?

The WTC Heath Program is a limited federal health program that provides no-cost medical monitoring and treatment for eligible responders and survivors with certain health conditions that have been certified as related to their 9/11 exposures.

Program benefits include:

Doctors Visits Surgeries Hospital Stays Prescription Drugs

WTC Health Program

The WTC Health Program continues the monitoring and treatment programs in the NYC area prior to the passage of the James Zadroga 9/11 Health and Compensation Act of 2010. This includes the Medical Monitoring and Treatment Program (MMTP), the WTC Environmental Health Center (EHC) Community Program, and FDNY

NPN matches members outside of the New York metropolitan area with medical providers near where they live.

Medical monitoring is a really important program benefit:

-a person may come in with a cough and our doctors can catch that it may be 9/11-related illness early on and get you in for treatment of that condition.

WTC Health Program Key Facts

Limited federal health program that provides no-cost medical monitoring and treatment for eligible 9/11 responders and survivors.

Established by the James Zadroga 9/11 Health and Compensation Act of 2010. Reauthorized in 2015 to run until 2090.

NIOSH Director is WTC Health Program Administrator per the Zadroga Act.

Currently has over 125,000 members. Members in all 50 states.

WTC Health Program

The WTC Health Program is a federal program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services.

$15+ million per year for research projects (Zadroga req.)

$7+ million (add’l.) per year for WTC Health Registry (Zadroga req.)

Approx. 1,000 publications since 2001

WTC Health Program Key Facts cont.

Provides medical treatment at no out-of-pocket cost for certified WTC-related health conditions only. Program is not insurance.

Care for certified conditions is provided through 8 Clinical Centers of Excellence (CCEs) in New York metropolitan area or through the Nationwide Provider Network (NPN) nationally.

Funds health research into physical and mental health conditions related to 9/11 exposures.

WTC Health Program

The WTC Health Program is a federal program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) within the U.S. Department of Health and Human Services.

$15+ million per year for research projects (Zadroga req.)

$7+ million (add’l.) per year for WTC Health Registry (Zadroga req.)

Approx. 1,000 publications since 2001

WTC Health Program Purpose

WTC Responders: Medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers (including Federal employees) who responded to the September 11, 2001, terrorist attacks in New York City, at the Pentagon, and near Shanksville, Pennsylvania.

WTC Survivors: Initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers in New York City who were directly impacted and adversely affected by such attacks.

Care in the WTC Health Program CCEs and the NPN provide Program benefits to members, including:

Initial health evaluation and annual monitoring exams Cancer screening (certain cancers only) Certification requests Treatment of WTC-related and medically-associated conditions WTC Health Program benefits also include:

Case management Care coordination Benefits counseling (social services, public insurance programs etc.)

Administrative member services CCEs are central clinics while the NPN is an extensive network of providers across the country made available through a central administrator.

NIOSH oversees the administrative aspects of the Program while the clinics handle care delivery.

WTC Health Program

Program administration (policies, enrollments, certifications, claims, etc)

CCEs/NPN WTC-related care and monitoring

Were You There?

Who are WTC Health Program members?

WTC Responders:

Rescue, recovery, and cleanup workers/volunteers who responded to the September 11, 2001, terrorist attacks site in New York City, at the Pentagon, and in Shanksville, PA.

Also includes those that supported cleanup efforts at related sites, such as Staten Island Landfill.

Responder benefits: Medical monitoring and treatment WTC Survivors:

Residents, other building occupants, and area workers in the New York City Disaster Area who were directly impacted and adversely affected by the events of 9/11.

Survivor benefits: Initial health evaluation and, if condition certified, medical monitoring and treatment.

Survivors from Pentagon/Shanksville not eligible.

Map by CDC/ATSDR/GRASP/NIOSH

One important difference between the Responder and Survivor Programs is that the Survivor Program requires Coordination of Benefits. Coordination of Benefits is the process where your WTC Health Program provider or pharmacy must bill your primary insurance first, including any public insurance such as Medicare or Medicaid, and then bill the Program the remaining amount. This leaves no out-of-pocket cost to you. Coordination of Benefits is required to pay medical and pharmacy claims for WTC-certified Survivors.

Enrolled Survivors receive initial health evaluations. If the initial health evaluation does not result in any certifications and the Survivor later feels a new health problem may be WTC-related, he or she can pay out of pocket or use primary health insurance for an additional health evaluation by a Program doctor. WTC-certified survivors receive annual monitoring exams.

WTC-Related Condition Categories

Cancers Airway and Digestive Disorders Mental Health Conditions

Musculoskeletal Disorders* See a full list of covered conditions at www.cdc.gov/wtc/conditions.html *Responders only

Acute Traumatic Injuries

WTC Health Program

Authority to add to List through rulemaking Cancers (2012) Acute Traumatic Injuries (2016) New-onset COPD (2016) Uterine Cancer (2023) As of January 18, 2023, all types of uterine cancer, including endometrial cancer, have been added to the List of WTC-Related Health Conditions (List).

The addition of uterine cancer to the List means that uterine cancer is now eligible for certification by the WTC Health Program. Program members with certified uterine cancer can receive treatment covered by the Program at no out-of-pocket cost on and after January 18, 2023.

The WTC Health Program covers specific physical and mental health conditions associated with 9/11 exposures.

WTC-related conditions include:

Certain cancers;

Respiratory diseases like asthma and chronic cough;

Digestive disorders, such as acid reflux Musculoskeletal disorders Mental health conditions like post-traumatic stress disorder; and Acute traumatic injury

We get a lot of questions about why we don’t cover certain conditions.

The truth is that we can only cover what the law allows.

There are always ways that we can try to cover new conditions. There is a petition process for conditions that you or your doctor feel are related to your exposure. But in order for the condition to be added, there must be enough scientific evidence to prove the relationship between that condition and exposure to 9/11 toxins.

The program also funds a research program that looks into these relationships so there is always a chance we may start covering additional conditions in the future.

For a Member to receive treatment for a qualified condition, it must be certified by the Program as a WTC-related condition or medically associated health condition The WTC Health Program pays for medically necessary treatment of certified conditions if the treatment is provided by a WTC Health Program affiliated provider or pharmacy Members can access services without having to pay any co-payments, deductibles, or other out-of-pocket expenses for medically necessary treatment of certified WTC-related health conditions.

Survivors must use their primary insurance for treatment benefits and follow the Coordination of Benefits process. Visit Coordination of Benefits to learn more

Addition of Health Conditions to List

Additions to the List of WTC-Related Health Conditions may be initiated in two ways:

At the Administrator’s discretion; or Via an interested party submitting a written petition to the Administrator requesting the addition of a condition to the List

Both require rulemaking Final Rule to add uterine cancer (January 2023).

The James Zadroga 9/11 Health and Compensation Act of 2010, as amended, and the WTC Health Program’s regulations establish procedures for adding conditions to the List based on extensive scientific review and research through a process known as rulemaking.

To learn more about the rulemaking process, visit the Program’s Policies page.

Uterine Cancer Update:

As of January 18, 2023, all types of uterine cancer, including endometrial cancer, have been added to the List of WTC-Related Health Conditions (List).

The addition of uterine cancer to the List means that uterine cancer is now eligible for certification by the WTC Health Program. Program members with certified uterine cancer can receive treatment covered by the Program at no out-of-pocket cost on and after January 18, 2023.

Members who think they may have symptoms of uterine cancer should contact their Clinical Center of Excellence (CCE) or the Nationwide Provider Network (NPN). Program doctors will review uterine cancer symptoms and refer members for further evaluation should it be medically necessary.

WTC Health Program members who have already been diagnosed with uterine cancer(s) should contact their CCE or the NPN to see if their cancer qualifies for certification and to learn more about treatment through the Program.

As a reminder, Survivor members must follow all coordination of benefits requirements including having primary health insurance to receive any treatment, including treatment for uterine cancer, in the WTC Health Program. Learn more about coordination of benefits at www.cdc.gov/wtc/cob.html.

September 11th Federal and State Programs

There are also NYC-level programs such New York City Employees Retirement System VCF uses WTC Health Program certifications to validate WTC-related conditions for awards

There is some confusion about the various federal programs and the benefits they provide. Reference chart to emphasize differences in criterial and benefits provided.

Eligibility Overview–General Responders WTC or related sites (9/11/2001 to 7/31/2002) Lower Manhattan (South of Canal Street) Ground Zero Staten Island Landfill Certain Barge Loading Piers PATH Tunnel NYC Chief Medical Examiner’s Office* Examples of General Responders include:

Fire, police, and other law enforcement officers (active or retired) Emergency medical care workers/volunteers Federal responders Recovery or cleanup workers/volunteers Transit, building, construction, and communication workers/volunteers who assisted in rescue, recovery, or cleanup efforts *must have handled human remains or dust covered body bags

Eligibility Overview – General Responders (continued)

Pentagon (9/11/2001 to 11/19/2001) Examples include:

Federal responders (e.g., FBI agents) Fire, police, and other law enforcement officers (active or retired) Recovery or cleanup workers/volunteers

Shanksville (9/11/2001 to 10/3/2001) Examples include:

Federal responders (e.g., FBI agents) Fire, police, and other law enforcement officers (active or retired) Recovery or cleanup workers/volunteers

Eligibility Overview–Survivors

New York City Disaster Area South of Houston Street and area of Brooklyn within a 1.5 mile radius of the WTC Examples include:

Present in the dust or dust cloud on 9/11 Lived, worked, or went to school, childcare or adult daycare Exposure period 9/11/2001 to 7/31/2002 Specific exceptions through 5/31/2003

How to Apply Visit www.cdc.gov/wtc/apply.html to learn more

WTC Health Program

Select appropriate application New York City site Responder versus survivor based on activity Pentagon or Shanksville sites Responder only (Zadroga Act) Submit necessary supporting documentation Must demonstrate:

Location (be as specific as possible);

Dates and hours in exposure area; and Activity Can be demonstrated through more than one document, if necessary Examples:

Copies of pay stubs, rental leases, school transcript, letter from employer or union

Step 1: See If You Are Eligible

Eligibility for the WTC Health Program is based on what you did during and/or after 9/11, where you were, and how long you were there.

Step 2: Review What Documentation You’ll Need

You will need to provide documents that show you were present and/or worked at Ground Zero or related sites. These are needed to verify your eligibility when applying.

Each eligible group has different eligibility requirements that must be reflected in your supporting documentation. Your supporting documentation must show your involvement in an appropriate activity, at a covered location, during specific time periods, and meet minimum hours requirements.

More than one document may be required.

Step 3: Apply

The next step is to complete the application. You can apply online or by mail. The paper application is also available in Español, Polskie, and 中文.

Resources Program Website:

www.cdc.gov/wtc Member Materials – Annual Member Newsletter, Member Handbook, Fact Sheets (materials available in English, Spanish, Polish, and Chinese) Social Media (Facebook and Twitter) Outreach Materials - Enrollment application supporting materials, outreach products (flyers, packets, etc.)

Outreach and Education Contractors Health Effects of 9/11 Online Exhibition

9/11 Health Research:

www.cdc.gov/wtc/research.html

Resources Mention recently launched research webpages, publication search feature Research Trends and Findings Aerodigestive disorders are largest research category (56%) Higher prevalence among responders than in the general population Highest in those with greatest exposure

Persistent increased risk of PTSD among the affected population

Evidence of modestly increased cancer risk for all cancers combined, thyroid cancer, and prostate cancer; with intermittent indications of other excess cancers (bladder, malignant melanoma, multiple myeloma, leukemia, and non-Hodkin’s lymphoma) Potentially Vulnerable Populations Research is needed to better identify at-risk populations, characterize burden, assess health equity, and inform care.

Groups of interest include minorities, pregnant women, women of reproductive age, the elderly, and persons exposed as minors.

New Conditions As members age, surveillance and research activities may uncover new health conditions.

Topics of current interest include autoimmune diseases, cardiovascular disease, and issues associated with cognitive impairment.

Future Research Directions Identify effective approaches to improve the healthcare and wellbeing of at-risk populations.

Identify knowledge gaps, especially in areas of causal determinates, disease progression, and emerging health conditions.

Identify prevention and mitigation strategies intended to reduce adverse health effects in populations affected by future disasters.

Sign up for WTC Health Program eNews!

New eNews service features the latest Program news and updates

Scan the QR Code or sign up at:

www.cdc.gov/wtc/enews.html

How to Reach Us [Put in vendor contact information here]

For petitions to add a WTC-related condition to the List of Covered Conditions. Learn More...

For concerns or complaints about the Program. You can instead use our online feedback form.

Feedback form available at: www.oasis.cdc.gov/feedback

WTC Health Program https://oasis.cdc.gov/feedback

For petitions to add a WTC-related condition to the List of Covered Conditions. Learn More...

For concerns or complaints about the Program. You can instead use our online feedback form.

For More Information

You do not need to call your CCE or the NPN before receiving emergency medical care. However, in all emergencies, you must notify your CCE or the NPN within 24 hours. This allows the Program to coordinate your ongoing care and ensure you receive proper authorization.

When seeking emergency care, please note that the Program only covers emergency care services that are related to your certified WTC-related health condition(s).

Thank You!

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